Antibiotics In Korea Research Articles

Clinical Characteristics of Nocardiosis: a Multicenter Retrospective Study in Korea.

Nocardiosis is a rare, but potentially life-threatening condition. It is difficult to diagnose, and bacterial culture identification can be time consuming. We investigated the characteristics of nocardiosis and the suitability of the treatment approach in Korea. This retrospective study was conducted at 5 medical institutions between 2011 and 2021. We reviewed the medical records of patients with microbiologically confirmed nocardiosis. Appropriate antibiotic selection was defined as follows: (1) selecting antibiotics according to the species, (2) if the species of Nocardia was unknown, trimethoprim-sulfamethoxazole-based therapy or linezolid-based therapy was administered, and (3) selection of antibiotics using the antibiotic susceptibility test. The appropriate treatment periods for antibiotics were defined as treatment maintained from 3 to 12 months, depending on involvement of the organs. Descriptive analysis and Fisher exact test were used. Statistical significance was set at P-values of <0.05. Thirty patients were enrolled. Of these patients, 18 (60.0%) were male. The median age was 70.5 years. Among the diagnosed patients, 12 (40.0%) had an immunocompromised status. Eight (30.0%) patients received optimal treatment for the appropriate treatment period. Appropriate dosing duration was observed in 3 of the 12 (25.0%) immunocompromised patients. There was no significant difference between the presence or absence of immunosuppression and the adequacy of treatment for nocardiosis (P = 1.000). Skin and soft tissue (14 patients) were most frequently involved in this study. Nocardia species (spp.) were isolated from culture at a median of 6.0 days. There were 7 cases with N. farcinica (23.3%). We found that 60.0% of the patients with nocardiosis did not have an immunocompromised status. Further, 26.7% of the total patients received adequate treatment for nocardiosis. The reasons for suboptimal management of nocardiosis in Korea are presumed to be diagnostic difficulties, lack of awareness about nocardiosis, and difficulties in selecting antibiotics for Nocardia spp. among clinicians. The lack of antibiotic susceptibility tests for Nocardia spp. could be the source of these problems. Nocardiosis should be suspected in cases of recurrent infections with skin and soft tissue, musculoskeletal, or respiratory system involvement with or without an immunocompromised status. Clinical microbiological support is required for the diagnosis and selection of antibiotics in Korea. High clinical index of suspicion and clinical microbiological support are required for the accurate diagnosis of nocardiosis in Korea.

Current Status and Prospect of Qualitative Assessment of Antibiotics Prescriptions.

Identifying inappropriately prescribed antibiotics for infectious diseases by monitoring the quality of antibiotics use is essential for effective implementation of antibiotic stewardship. Qualitative assessment of the use of antibiotics has been conducted in some countries, including Korea, since the 2000s. The qualitative assessment generally involves an assessment of each component of the antibiotics prescription process, based on specific criteria. However, there is no standardized assessment method or cycle, and infectious diseases or antibiotics included in the assessments vary from country-to-country. According to the results reported in the United States, Europe, Australia, and Korea so far, approximately 20 - 55% of all antibiotics prescriptions are inappropriate. In this review, we describe the current progress in the quality assessment of the use of antibiotics on a global scale. Further, we highlight the future directions to improve antibiotic stewardship activities and the quality assessment of the use of antibiotics in Korea.

Core Elements for Successful Implementation of Antimicrobial Stewardship Programs.

Antimicrobial resistance has emerged as a serious global public health threat. One of the countermeasures to increased antibiotic-resistant bacterial infections is the use of an integrative intervention strategy for the selection and administration of appropriate antibiotics and for the monitoring of antibiotic use, collectively known as “Antimicrobial Stewardship Programs” (ASPs). However, since the medical environment and policies vary by country and medical facilities, ASPs also need to be applied to each facility and condition accordingly. The United States Centers for Disease Control and Prevention announced the core elements for hospital ASPs, which outlines the specific structural and procedural components required to implement ASPs in 2014. As multidrug-resistant bacterial infections and use of broad-spectrum antibiotics in Korea are on the rise, ASPs must be urgently applied to medical facilities for appropriate management of antibiotic use. However, there is an ongoing limitation to the immediate adoption and application of ASPs in Korean medical facilities due to the lack of medical workforce and related financial resources. To address this issue, efforts of medical professionals and government are required, and core elements that match the characteristics and circumstances of Korean medical facilities must be urgently developed.

Do we need topical antibiotics for simple excision or the dressing after a skin wound?

We often use topical antibiotics for simple excisions or the skin after minor wounds. This is a long-standing practice to minimize scarring by preventing wound or surgical site infection to promote wound healing. Is this old practice the right way for today? Is there a scientific basis for it and can it persist? These questions are related to the increase in antibiotic-resistant bacteria in Korea. Currently, the guidelines for the use of oral antibiotics have been established and are being applied relatively well-controlled to prevent overuse and misuse, while discussions for evaluating the adequacy of the prophylactic use of topical antibiotics or establishing correct guidelines are lacking. Based on related research data, American Academy of Dermatology has been continuously campaigning against the abuse of prophylactic antibiotics by the public and doctors, following the increase in the abuse of topical antibiotics since 2013. Therefore, we discuss the necessity of using topical antibiotics for the prophylaxis based on literature evidence. Now is the time to make efforts to prevent the increase of antibiotic-resistant bacteria through the correct use and by reducing the prescription of topical antibiotics in Korea.

Application of tylosin antibiotics to olive flounder (Paralichthys olivaceus) infected with Streptococcus parauberis

BackgroundOlive flounder, Paralichthys olivaceus, is an economically important aquaculture species in Korea. Olive flounders have been heavily damaged by streptococcal infections every year and are treated with antibiotics. However, antibiotic abuse is causing the emergence of resistant strains, and to overcome this, research has shown that new antibiotics must be applied. Tylosin is a relatively safe antibiotic and has good activity against Gram-positive bacteria and mycoplasma. We studied the therapeutic effects and side effects of tylosin on Streptococcus parauberis-infected olive flounder.MethodsAfter artificial infection of olive flounder with S. parauberis SPOF18J3, an appropriate dose of tylosin was confirmed by intramuscular injection (I.M.) at 2.5, 5, 10, and 15 mg/kg, and oral administration at 10 and 20 mg/kg. After I.M. and oral administration dosing of tylosin, side effects were confirmed by serological analysis, histopathological analysis, and median lethal dose (LD50) analysis at both an appropriate concentration and a high concentration. Statistical analysis was performed using one-way analysis of variance (ANOVA) and Tukey’s test (p < 0.05).ResultsThe appropriate I.M. and oral administration concentration of tylosin administered to olive flounder infected with S. parauberis SPOF18J3 was found to be 10 mg/kg. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were showed not significantly different between the control group and the experimental groups. The histopathologic results showed mild inflammatory responses in muscle and tubular vacuolization and tubular atrophy appeared, but there were no significant differences between the groups. The LD50 was confirmed to be 461 mg/kg.ConclusionIn this study, an effective treatment method was provided by verifying the treatment effects and side effects of tylosin in olive flounder infected with S. parauberis, which can be applied directly to aquaculture sites. In addition, these results may be used as a reference for evaluation required upon request to obtain approval for tylosin antibiotics as fishery antibiotics in Korea. After approval, it is possible that a fishery disease manager will be able to prescribe and sell the antibiotic tylosin.

Primary and secondary antibiotic resistance of Helicobacter pylori in Korea from 2003 to 2018.

Antimicrobial resistance of Helicobacter pylori (Hpylori) affects the efficacy of eradication therapy. The aim of this study was to estimate the prevalence of primary and secondary resistance of Hpylori isolates to antibiotics in Korea. The present study was performed from 2003 to 2018. Primary resistance was evaluated in 591 patients without any history of eradication and secondary resistance in 149 patients from whom Helicobacter pylori was cultured after failure of eradication. A minimal inhibitory concentration test was performed for amoxicillin, clarithromycin, metronidazole, tetracycline, levofloxacin, and rifabutin using the agar dilution method. An increase in the primary resistance rate was found in clarithromycin (P<.001), metronidazole (P<.001), and both levofloxacin (P<.001) during the study period. The primary resistance rates of amoxicillin and tetracycline were low and stable during the study period. The secondary resistance rate significantly increased in metronidazole and levofloxacin (P=.022 and .039, respectively). The primary and secondary resistance rates of clarithromycin, metronidazole, and levofloxacin for Helicobacter pylori in Korea were high and increased over time. However, the primary and secondary resistance rates of amoxicillin and tetracycline were low and stable over time. These results will help in selecting effective eradication regimens of Hpylori in Korea in the future.

Trends in the use of antibiotics among Korean children.

Inappropriate antibiotic use is the most important factor causing increased bacterial resistance to antibiotics, thus affecting patient outcomes. Multidrug-resistant bacteria have become a serious public health threat, causing significant morbidity and mortality worldwide. In Korea, the burden of antibioticresistant bacteria has become an important public health issue. There is increasing evidence of overuse and misuse of antibiotics in Korea, as observed in cohorts with large sample sizes. Antibiotic use among children should receive particular attention because of the frequency of community-associated infections among this population and the elevated risk of transmission. Recent studies from Korea have demonstrated that the use of broad-spectrum antibiotics, either for inpatient or outpatient treatment, has increased among many age groups, especially children. In this review, we aim to describe the patterns of antibiotic prescription and evaluate recent trends in antibiotic use among children. Coordinated efforts toward communication and education in order to address misunderstandings regarding antibiotic use, involving interprofessional antimicrobial stewardship programs, are required in the near future.

Occurrence of sulfonamide class of antibiotics resistance in Korean paddy soils under long-term fertilization practices

Bacteria and genes that can resist antibiotics are emerging as environmental pollutants, and they need to be dealt with. While a few reports have been published, on veterinary antibiotic resistant bacteria and genes, none has been done on the soils in Korea, where the use of sulfonamides in veterinary antibiotics is prevalent. This is the first study to investigate the prevalence and distribution of sulfonamide (sulfamethoxazole, sulfamethazine, and sulfathiazole)-resistant bacteria and genes in both natural and long-term fertilized (inorganic fertilizer and pig and cattle manure composts) soils in Korea. Three long-term (47 years) fertilized (NPK, pig or cattle manure composts) paddy field soils along with an unfertilized, natural wetland soil of a mountain site collected from South Korea were examined in this study. Antibiotic resistance rates of bacteria in the collected samples were calculated for different concentrations of the sulfonamide class of antibiotics. The antibiotic-resistant bacteria were identified using the matrix-assisted laser desorption/ionization—time of flight or MALDI-TOF identification method at genus and species levels. Soil DNA was extracted, and PCR coupled with gel electrophoresis was done in order to detect sulfonamide resistant genes. Results showed that amendment of antibiotics containing animal manures, particularly from pig farms, may be a prime root cause for the spread and abundance of antibiotic resistance in Korean agricultural soils (cumulative resistance rate of 40 to 95% in the order sulfathiazole > sulfamethazine > sulfamethoxazole). Of the 2444 antibiotic-resistant isolates identified, about 80–95% belonged to Bacillus followed by Arthrobacter and Pseudomonas. Of the 56–58 distinct bacterial species detected in the long-term manure-amended Korean paddy soils, the known endospore-forming B. megatherium was predominant and it is suggested that they contribute to the observed high antibiotic resistance. Further, the sulfonamide-resistant genes [sul(I) and sul(II)] were prevalent in both natural and fertilized soils, confirming the widespread prevalence of the sulfonamide-resistant community in Korean soils. This study demonstrates that applying livestock manure compost to agricultural fields does have a large impact on the occurrence of sulfonamide-resistant bacteria and genes, particularly the ability to increase their prevalence in the environment. This outcome highlights the necessity to regulate the usage of veterinary antibiotics in Korea.

급성상기도감염 환자의 항생제 처방에 영향을 주는 요인

Background: Initial treatment of acute upper respiratory infection (AURI) should not include antibiotics because most AURIs are caused by virus. However, the prescription rate of antibiotics in Korea is higher than in any other countries. Inappropriate use of antibiotics in Korea accelerated the emergence of antibiotics resistance and increased the social and economic burden. The objective of this study was to investigate the factors related to antibiotics use for the AURI among children-adolescents and adults. Methods: This study analyzed the Health Insurance Review and Assessment Service-National Patient Sample data which was nationally representative sampling stratified by sex and age. Results: The influencing factors of antibiotics use for AURI are gender, age, types of medical security, primary disease, existence of concomitant disease, treatment seasons, first visit or revisit, indicated specialty, types of medical institution, and location of medical institution. Conclusion: The results showed health policy makers are required to place more efforts to resolve inappropriate antibiotics use. Especially they need to establish a health policy to reduce the gap between areas and specialties and recommend standardized clinical guidelines according to the subgroup code of AURI and the age group of patients.

Diagnosis and Treatment of &amp;lt;i&amp;gt;Helicobacter Pylori&amp;lt;/i&amp;gt; Infection: Korean and Overseas Guidelines

The Korean College of Helicobacter and Upper Gastrointestinal Research proposed revised guidelines for the diagnosis and treatment of Helicobacter pylori infection in 2013. These new guidelines were developed using an adaptation process, and addressed the revised recommendations especially in the changes of indication and treatment of H. pylori infection in Korea. They included 19 statements: 11 on the indications for tests and treatment, four for the diagnosis, and four for the treatment. A critical difference between the new and previous guidelines was that the proposed treatment regimen was more detailed, in consideration of the increasing resistance to antibiotics in Korea. Although clarithromycin-containing triple therapy was proposed as the first-line treatment option, per the previous guidelines, a bismuth-based quadruple regimen was also proposed as an effective alternative. In the case of treatment failure following bismuth quadruple therapy, second-line treatment should be based on two or more antibiotics that had not been used previously. Several overseas guidelines - from America, Europe, Canada, Japan, and the Asia-Pacific region - have been published concerning H. pylori infection, they indicate regional differences in epidemiology, antibiotic susceptibility, and national health insurance systems. This review compares the guidelines for H. pylori infection among these regions. (Korean J Med 2015,89:157-168)

The diagnosis and management of otitis media in children

Otitis media is one of the most common bacterial infectious diseases in children and the most common indication for the prescription of antibiotics in Korea. Otitis media, including acute otitis media (AOM) and otitis media with effusion (OME), is also one of the most common reasons for an illness-related visit to a primary care clinician. The first step in management decisions regarding otitis media must focus on accurate diagnosis to distinguish normal from AOM or OME. In 2010, the Korean Otologic Society published the first version of a set of evidence-based clinical practice guidelines for pediatric otitis media. In 2014, revised clinical practice guidelines were published for otitis media that applied to children under 15 years of age. The guidelines addressed the diagnosis and management of otitis media as well as pain management, choice of antibiotics, and methods for prevention. These guidelines recognized that many episodes of otitis media will resolve on their own without antimicrobial therapy; therefore, one of the recommendations for the initial treatment of otitis media in specified situations is watchful waiting without antibacterial therapy. This study introduces excerpts of the guidelines for the diagnosis and management of otitis media in children. We then briefly discuss the current knowledge about AOM and OME and address the new AOM and OME guidelines point by point. It is important to remember that the actual management of patients with otitis media should depend on the physician’s clinical judgment, the symptoms of the individual child, other underlying medical conditions, ready access to adequate follow-up care, and other features.

Molecular genetics of Mycobacterium tuberculosis resistant to aminoglycosides and cyclic peptide capreomycin antibiotics in Korea

Aminoglycosides are key drugs for the treatment of multidrug-resistant tuberculosis. A total of 97 extensively drug-resistant (XDR) and 29 pan-susceptible Mycobacterium tuberculosis isolates from Korean tuberculosis patients were analyzed to characterize mutations within the rrs, rpsL, gidB, eis and tlyA genes. Thirty (56.6%) of the 53 streptomycin (STR)-resistant strains had a rpsL mutation and eight strains (15.1%) had a rrs (514 or 908 site) mutation, whereas 11 (20.8%) of the 53 STR-resistant strains had a gidB mutation without rpsL or either rrs mutation. Most of the gidB mutations conferred low-level STR resistance, and 22 of these mutations were novel. Mutation at position 1401 in rrs lead to resistance to kanamycin (80/95=84.2%; KAN), amikacin (80/87=92.0%; AMK), and capreomycin (74/86=86.0%; CAP). In this study, 13.7% (13/95) of KAN-resistant strains showed eis mutations, including 4 kinds of novel mutations. Isolates with eis structural gene mutations were cross-resistant to STR, KAN, CAP, and AMK. Here, 5.8% (5/86) of the CAP-resistant strains harbored a tlyA mutation that included 3 different novel point mutations. Detection of the A1401G mutation appeared to be 100% specific for the detection of resistance to KAN and AMK. These data establish the presence of phenotypic XDR strains using molecular profiling and are helpful to understanding of aminoglycoside resistance at the molecular level.

Comparison of Antimicrobial Resistance in Escherichia coli Strains Isolated From Healthy Poultry and Swine Farm Workers Using Antibiotics in Korea

ObjectivesThe aim of this study is to compare the antibiotic resistance of Escherichia coli isolates from faecal samples of workers who often use antibiotics. MethodsA total of 163E coli strains isolated from faecal samples of livestock workers (poultry and swine farm workers) and restaurant workers in the same regions as a control group were analyzed by agar disc diffusion to determine their susceptibility patterns to 16 antimicrobial agents. ResultsMost of the tested isolates showed high antimicrobial resistance to ampicillin and tetracycline. The isolates showed higher resistance to cephalothin than other antibiotics among the cephems. Among the aminoglycosides, the resistance to gentamicin and tobramycin occurred at higher frequencies compared with resistance to amikacin and netilmicin. Our data indicated that faecal E coli isolates of livestock workers showed higher antibiotic resistances than nonlivestock workers (restaurant workers), especially cephalothin, gentamicin, and tobramycin (p < 0.05). Moreover, the rates of the livestock workers in the association of multidrug resistance were also higher than the rates of the restaurant workers. ConclusionThis study implies that usage of antibiotics may contribute to the prevalence of antibiotic resistance in commensal E coli strains of humans.

Resistance of Helicobacter pylori strains to antibiotics in Korea with a focus on fluoroquinolone resistance

New regimens, including those with new fluoroquinolones, have been developed to overcome the antibiotic resistance of Helicobacter pylori. We aimed to assess the antibiotic resistance rates, as well as the molecular mechanisms of fluoroquinolone resistance, of the clinical isolates obtained in Korea. The minimal inhibitory concentration (MIC) values of ciprofloxacin, amoxicillin, clarithromycin, metronidazole and tetracycline were determined by the agar dilution method for 185 treatment-naïve Helicobacter pylori isolates. The resistant strains were evaluated for the presence of point mutations in the quinolone resistance-determining region (QRDR) of the gyrA and gyrB genes by direct nucleotide sequencing. Twenty-nine (29/185, 15.7%) of the strains were found to be resistant to ciprofloxacin. The resistance rates to amoxicillin, clarithromycin, metronidazole and tetracycline were 2.2% (four of 185), 10.8% (20 of 185), 30.3% (56 of 185) and 0.5% (one of 185), respectively. The most common mutations in the H. pylori gyrA gene were found at codons corresponding to Asp87 (16/29, 55.2%) and Asn91 (10/29, 34.5%). Primary H. pylori resistance to ciprofloxacin occurred at a high frequency. The fluoroquinolone resistance is most likely mediated through amino acid point mutation in the gyrA gene at Asn87 and Asp91.

The Current Practice of Skin Testing for Antibiotics in Korean Hospitals

Background/AimsAntibiotic skin testing is a useful procedure for identifying patients with IgE-mediated hypersensitivity to antibiotics. The procedures, however, have not been standardized, and the testing is performed with diverse protocols in Korean hospitals wards. Thus, we examined the current practice of antibiotic skin testing in Korea.MethodsWe sent questionnaires to 12 allergists working in secondary or tertiary referral hospitals and collected them by e-mail or fax. The questionnaire included items such as the types and concentrations of the tested antibiotics, the methods of antibiotic skin testing, and the interpretation of the results.ResultsAll hospitals responded to the questionnaire. The antibiotic skin testing protocols were variable, inconsistent, and differed with regard to the type and concentrations of antibiotics, the volume injected, and the interpretation of the results. Moreover, the protocols differed from the commonly recommended procedures in the medical literature.ConclusionsStandardized guidelines for antibiotic skin testing are needed for the safe and effective use of antibiotics in Korea.

Comparison of the Causes and Clinical Features of Drug Rash With Eosinophilia and Systemic Symptoms and Stevens-Johnson Syndrome

PurposeDrug rash with eosinophilia and systemic symptoms (DRESS) and the Stevens-Johnson syndrome (SJS) are both severe drug reactions. Their pathogenesis and clinical features differ. This study compared the causes and clinical features of SJS and DRESS.MethodsWe enrolled 31 patients who were diagnosed with DRESS (number=11) and SJS (number=20). We retrospectively compared the clinical and laboratory data of patients with the two disorders.ResultsIn both syndromes, the most common prodromal symptoms were itching, fever, and malaise. The liver was commonly involved in DRESS. The mucosal membrane of the oral cavity and eyes was often affected in SJS. The most common causative agents in both diseases were antibiotics (DRESS 4/11 (37%), SJS 8/20 (40%)), followed by anticonvulsants (DRESS 3/11 (27%), SJS 7/20 (35%)). In addition, dapsone, allopurinol, clopidogrel, sulfasalazine and non-steroidal anti-inflammatory drugs (NSAIDs) were sporadic causes.ConclusionsThe most common causes of DRESS and SJS were antibiotics, followed by anticonvulsants, NSAIDs and sulfonamides. The increase in the use of antibiotics in Korea might explain this finding.

Anaphylaxis After Epidermal Contact with Cefotiam Hydrochloride

RATIONALE: Contact urticaria is characterized by local immediate or delayed urticarial reaction, with swelling and redness at sites of epidermal contact with certain agents. The symptoms may involve generalized immediate hypersensitivity reactions including anaphylaxis, and such cases are called contact urticaria syndrome. Cefotiam is one of popular cephem antibiotics in Korea and Japan. Recently we experienced a case of nurse with cefotiam-induced contact urticaria syndrome.