Abstract
Purpose: To develop mathematical formulae to aid the selection of antibiotics most appropriate in the empirical treatment of infections.Methods: Formulae quantifying the characteristics of antibiotics with regard to their cost and activity against associated bacterial isolates of given infections were derived from probability laws. Data from records of culture sensitivity test results were compiled and analysed to ascertain bacterial pathogen associations with infections and their sensitivities to prescribed antibiotics. Applicability of derived formulae was demonstrated in the rational selection of antibiotics most appropriate in the empirical treatment of urinary tract infections (UTIs) in selected hospitals in Lesotho.Results: Escherichia. coli, followed by Klebsiella spp, Proteus spp, non-haemolytic Streptococci, Streptococcus pyogenes and then, Pseudomonas spp were identified as the most common uropathogens at the hospitals studied. Two mathematical formulae were derived and used in quantifying activity and cost characteristics of prescribed antibiotics. Cefotaxime, followed by ciprofloxacin - were considered most appropriate for use in treating UTIs empirically among inpatients of the hospitals.Conclusion: Quantifying and using procedurally antibacterial activities and cost characteristics of antibiotics provides a suitable means of making antibiotic choices in the empirical treatment of infections.Keywords: Antibiotics, Derived formulae, Rational selection, Empiric treatment, Urinary tract infection, Lesotho.
Highlights
Empiric antibiotic treatment of infections, though commonly done in medical practice, presents formidable challenges to prescribers [1,]
In the derivations of the formulae we considered in principle that: infections at a given anatomic body site can be caused by any one, some or all of the bacterial pathogens commonly associated with infections at the site; the chances of a given pathogen being the cause of an infection are equal to the pathogen’s incidence of isolation from specimens taken from the site of the given infection; and that the chances of a prescribed antibiotic terminating the growth and the process of infection of a given pathogen are equivalent to the chances of the pathogen being sensitive to the antibiotic
Bacterial isolates commonly isolated from urine specimens which are considered most common causative agents of urinary tract infections (UTIs) among inpatients of study site hospitals were found, and in order of their frequencies of isolation, to be Escherichia coli, Klebsiella spp, Proteus spp, Non-haemolytic streptococci, Streptococcus pyogenes and Pseudomonas spp
Summary
Empiric antibiotic treatment of infections, though commonly done in medical practice, presents formidable challenges to prescribers [1,]. Making antibiotic choices for empiric treatments of infections, can be complex and difficult It requires logical reasoning in which prescribers’ use of their knowledge of relevant therapeutic and cost properties of all antibiotics legible for prescribing becomes important [1,3]. To be seen as appropriately prescribed, antibiotics need to be selected on comparative basis to enable the selection of an agent or agents that is/are most cost-effective in treating an infection in question. Considerations in such instances need to be given essentially to factors contributing to the clinical efficacy as well as the safety of the selected agent(s). Knowledge about the antibiotic’s spectrum of activity, its adverse effect profiles, pharmacokinetic disposition and dosage likewise are important factors to be considered in the choice of therapy [4]
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