Antibiotics For Viral Infections Research Articles

Bacterial and Fungal Superinfections in COVID-19 Patients Hospitalized in an Intensive Care Unit from Timișoara, Romania.

Critically ill patients hospitalized in the intensive care unit (ICU) have an increased infection risk. The aim of this study was to determine the bacterial and fungal superinfections rate in Coronavirus disease 2019 (COVID-19) patients stationed in the ICU, identify risk factors associated with their development and to determine whether superinfection plays a role in patients' outcome in this population. In this retrospective, non-interventional, single centre, cohort study, medical records of 302 consecutive patients with SARS-COV-2 pneumonia admitted into the COVID-19 ICU of the largest university hospital from Western Romania between October 2020 and May 2021, were reviewed, of whom 236 patients met the inclusion criteria. One hundred and nineteen patients developed a superinfection ≥48 h after being admitted to the hospital. Superinfection rate in the ICU was 50.42%. Coagulase-negative Staphylococci (CoNS) and Enterococcus spp. were predominantly isolated from blood cultures, while Acinetobacter baumannii, Staphylococcus aureus and Candida spp. from tracheobronchial aspirates. Significant independent risk factors regarding bacterial/fungal superinfection in COVID-19 patients were obtained for the following variables: number of days of central venous catheter (HR = 1.13 [1.07-1.20], p < 0.001) and prior administration of corticosteroids (HR = 2.80 [1.33-5.93], p = 0.007). Four independent predictive risk factors were associated with unfavorable outcome: age (HR = 1.07 [95% CI 1.03-1.12], p = 0.001); Carmeli Score (HR = 6.09 [1.18-31.50], p = 0.031); body mass index (HR = 1.11 [1.02-1.21], p = 0.011) and the presence of a central venous catheter (HR = 6.49 [1.93-21.89], p = 0.003). The superinfection rate in COVID-19 patients was high in this study group. Exogenous risk factors were associated with superinfection more than endogenous factors. Only a small percentage of uninfected COVID-19 patients were not prescribed antibiotics during their hospitalization, raising serious concerns regarding the judicious prescribing of antibiotics in viral infections.

What interventions do general practitioners recommend avoiding? A nationwide survey from Switzerland.

To address low-value interventions in healthcare, &ldquo;Choosing Wisely&rdquo; campaigns provide recommendations of interventions to avoid (RIAs). These are usually developed by expert panels rather than general practitioners (GPs). The aim of our study was to develop RIAs for ambulatory general medicine based on the suggestions of GPs, with their involvement from the very beginning. This was a nationwide online Delphi survey among Swiss Society of General Internal Medicine members. In round one, each participant suggested two interventions perceived as particularly inappropriate. In round two, the 16 most frequent RIAs were rated by importance on a 0&ndash;100 scale and compared with &ldquo;Choosing Wisely&rdquo; lists. We calculated descriptive statistics for suggestions and importance ratings, and used regression models to search for associations with GP characteristics. Response rates were 7.4% (538/7318) for round one and 18.2% (1357/7468) for round two. GPs provided 1074 suggestions. Out of the 16 most frequent RIAs, 13 corresponded to existing &ldquo;Choosing Wisely&rdquo; lists. The RIAs rated most important were: antibiotics in viral infections, unnecessarily duplicated tests and imaging in unspecific low back pain (means 88.5&ndash;91.7, standard deviations 18.6&ndash;19.9). None of the GPs&rsquo; characteristics were associated with any of the five highest rated RIAs except for working in a hospital setting. Most RIA suggestions from GPs were concordant with previously published recommendations of interventions to avoid, independently of GPs knowledge of these and reflecting their high clinical relevance. In addition, our study revealed some more relevant topics and may help to develop future &ldquo;Choosing Wisely&rdquo; recommendations, with the final goal to reduce low-value care.

A Study on Drug Utilization of Antibiotics in Respiratory Tract Infections among Geriartrics

Back ground: Respiratory Tract Infections (RTIs) often pose a major threat for geriatric patients (&gt;60 years) who are at higher risk of developing complications. The first line treatments for RTIs are antibiotics which help in reducing the infection. As there is increasing incidence of antimicrobial resistance it is necessary to conduct drug utilization of antibiotics which helps in better understanding about errors and risks involved in prescriptions.&#x0D; Objectives: The objective of the study is to access the prescribing pattern, appropriate use of antibiotics and inappropriateness of antibiotics in viral infections.&#x0D; Methodology: The present study is a prospective observational study. The study included 110 patients which included the evaluation of the patients medical records of antibiotics, sputum culture reports and physician records.&#x0D; Results: Out of 110 geriartric RTI patients, female (59.09%) were more predominantly affected over males (40.90%). Among the RTIs diagnosed pneumonia (40%) was higher followed by LRTI (28.18%). The common signs and symptoms found were breathlessness (34.54%) with major comorbidity of diabetes milletus (47.31%). Piperacillin + tazobactam (40.90%) was the mostly prescribed antibiotic for both gram positive (Streptococci) and gram negative (E. coli) bacteria which was given through I.V. (90%). Total drug interactions and medication errors were 13.03% and 3.32% respectively.&#x0D; Conclusion: The present study gives an overview of antibiotics use and complications involved in geriatric population diagnosed with RTIs. Appropriate antibiotic usage according to Hospital Antibiotic Policy was observed in the study site with lower number of medication errors and drug interactions.&#x0D; Key words: Respiratory Tract Infections, drug utilization, antibiotics, geriatrics.

The Knowledge on antibiotics and antimicrobial resistance among Polish medical students

Abstract Background Antimicrobial resistance (AMR) is one of the biggest threats to public health worldwide, compromising ability to treat infections. Medical students as a future doctors will have an important role to play in preventing the spread of antibiotic resistance. The aim of this study was to analyse the knowledge and attitudes of Polish medical students towards antibiotics and AMR. Methods A questionnaire containing 24 questions, on medical students’ knowledge, attitudes and perceptions of antibiotic prescribing and antibiotic resistance was developed. The survey was conducted in May-June 2018 among medical students of Medical University of Warsaw at various years of their studies. Results The study group consisted of 291 students (70% women, 30% men). Forty six of the students had used antibiotics within the previous 12 months. The prevailing reasons for taking an antibiotic were: pharyngitis (25%), bronchitis (12,8%), sore throat (12%), cough (8.3%), pneumonia (7.9%), urinary tract infection (7.6%), cold (6.6%). Ninety-two percent of the respondents considered AMR to be a significant problem, and 7.9% stated it will become in the future. Four percent of respondents believed that antibiotics are effective in treating common cold. The majority of students (83.5%) expressed the opinion that doctors often prescribe an antibiotic without need. Most respondents think that too frequent prescription and low awareness of the consequences of their overuse have an impact on the rise and spread of antibiotic resistant bacteria. The vast majority of respondents (80%) declared that university studies enabled the gaining of a wider knowledge about the use of antibiotics. The vast majority of respondents (92.4%) indicated a willingness to extend their knowledge on antibiotic use. Conclusions Medical students are aware that AMR is a growing problem resulting in diminishing treatment options. The results of the study should be taken into future education programs. Key messages Medical students have a good understanding of the health risk of AMR but consider antibiotics for viral infections. More training on rationale antibiotic use included in the curriculum is warranted.

Knowledge and Expectations on Antibiotic Use among Older Adults in Malaysia: A Cross-Sectional Survey.

Antibiotics are commonly prescribed among older adults, and inappropriate use of antibiotics has been noted. However, there is limited information about their knowledge and expectations for antibiotics. This study aimed to assess older adults’ knowledge of antibiotic use and resistance, their expectations for antibiotics and the relationship between knowledge, expectation and inappropriate practices related to antibiotic use. A cross-sectional survey involving respondents aged 60 years and above was conducted, using a validated questionnaire. A lack of knowledge about the role of antibiotics was observed, whereby more than half of the respondents incorrectly believed that antibiotics can treat viral infections (53.5%) and colds and coughs (53.7%). Also, 67.9% of respondents incorrectly believed that antibiotic resistance occurs when the body becomes resistant to antibiotics. Almost half of the respondents would expect antibiotics for symptoms of self-limiting viral infections. Respondents who answered correctly for the role of antibiotics in viral infections were more likely not to expect antibiotics for cold, flu and cough (p < 0.001). Respondents who answered correctly regarding the need to adhere to antibiotics were more likely to have completed their antibiotic course (p < 0.001). Future educational initiatives should provide key information on the role of antibiotics and the importance of complying with antibiotics in this population.

Knowledge, attitude and practices of general practitioners about use of antiviral drugs in viral infections other than HIV

Background: Antiviral drugs for viral infections other than HIV are effective only for hepatitis, herpes and influenza. It has been observed that general practitioners (GPs) treat viral infections with antibiotics. The use of antibiotics in viral infections is not rational. Hence, authors conducted this study to assess the Knowledge, Attitude and Practices of General Practitioners (GPs) about treatment of viral infections other than HIV.Methods: It was a descriptive, observational, cross- sectional study among 100 GPs in Southern Pune. A pretested questionnaire was used to assess their knowledge, attitude and practices about treatment of viral infections other than HIV. Prior informed written consent was taken from the GPs who were grouped under MBBS, BHMS and BAMS categories according to their qualifications. Correct answers among these groups were analysed using chi-square test, Spearman’s coefficient test and ANOVA.Results: The percentages of correct answers in the groups were comparable.56% GPs have poor knowledge of Influenza treatment.30-36% do not treat Herpes genitalis and zoster with antiviral drugs. Authors found that 44%, 30% and 28% of total GPs don’t have proper knowledge, attitude and practice respectively about common viral infections other than HIV and antiviral drugs.Conclusions: GPs are significantly unaware about rational use of antiviral drugs. They have poor knowledge about management of influenza.

India, Pfizer tackling antimicrobial resistance

The Indian Council of Medical Research and the pharmaceutical giant Pfizer are establishing a center in New Delhi to combat the growing threat of antimicrobial resistance. India has among the highest rates of antibiotic consumption and antimicrobial resistance in the world. Reasons for those rates include over-the-counter pharmacy sales and a market flooded with unregulated drugs. One recent study of Indian antibiotic sales data and regulatory records from 2007 to 2012 found that 64% of one class of antibiotic formulations had no record of regulatory approval (Br. J. Clin. Pharmacol. 2018, DOI: 10.1111/bcp.13503). People taking antibiotics for viral infections or antibiotics that don’t work for the microorganism causing the problem “just helps to select out resistant bacteria that then spread around,” says Patricia McGettigan of Queen Mary University of London, the lead author of the study. Pfizer has provided an initial grant of about $1.09 million for the new center,

Biochemical Challenges in Combating Antimicrobial Resistance

Antimicrobial resistance (AMR) is an emerging global health crisis concerning the ability of a microorganism to withstand the inhibiting or killing action of an antimicrobial. AMR develops as a result of inappropriate use of antibiotics (taking antibiotics for viral infections like cold or flu) or not finishing antibiotics that are prescribed. It threatens the effective treatment of an ever-increasing range of infections caused by bacteria, fungi, parasites amd viruses. The World Health Organization (WHO) selected antimicrobial resistance as the theme for World Health Day 2011, chanting “combat drug resistance – no action today, no cure tomorrow”. They also produced in 2014, a global report on AMR surveillance that resistance to common bacteria has reached alarming levels in many parts of the world [1]. A previous study revealed that Aeromonas species are common inhabitants of aquatic ecosystems. These Aeromonas spp. strains showed to be potential reservoirs of antibiotic resistance genes [2]. The rising AMR of Pseudomonas aeruginosa isolated from clinical specimens in India became a great concern to public health officials [3]. High AMR was indicated among antimicrobials widely used in veterinary and human medicine with several Salmonella isolates exhibiting multidrug resistance, signaling serious implications in the treatment of salmonellosis in both public and animal health [4]. According to a Center for Disease Control and Prevention report, over twenty thousand Americans died from serious infections caused by AMR bacteria each year [5]. These superbugs include Clostridium difficile infection, methicillin-resistant Staphylococcus aureus, vancomycinresistant Enterococci and carbapenem-producing Enterobacteriaceae. Enterococci can acquire new resistance to antimicrobial agents by mutation or acquisition of extrachromosomal DNA, as plasmids or transposons. Due to the various genetic transfer mechanisms they may elicit, Enterococci may become important reservoirs for the spread of antibiotic resistance genes [6]. E. faecium vanA is the predominant resistance gene among vancomycin-resistant Enterococci bloodstream infections of the urinary tract [7].

Addressing Requests by Patients for Nonbeneficial Interventions

PATIENTS FREQUENTLY EXPRESS STRONG PREFERENCES FOR medical tests or treatments of their own choosing, even when physicians believe that those interventions are not beneficial. Physicians grant such requests for various reasons. One compelling reason is to avoid confrontation: patient-physician relationships flourish in an atmosphere of trust and goodwill, and physicians rightly worry that disagreement will threaten those relationships. Moreover, explaining why an intervention is not beneficial takes time. For patients with the common cold, granting requests for antibiotics is far less time-consuming than discussing viral microbiology and harms of antibiotic overuse. Although patients’ preferences are key factors in clinical decision making, a patient’s preference for a diagnostic or therapeutic intervention is not decisive unless a modicum of potential benefit, viewed from a conventional medical perspective, is present. When diagnostic or therapeutic choices are consistent with such a modicum of benefit, patients’ preferences should drive decisions. In contrast, physicians should not provide interventions that do not meet this criterion. Patients are increasinglywilling tochallengephysicians’ intellectual authority. Patients request interventions based on media publicity about new research findings, sometimes before physicians learn about them. Internet sources of clinical information empower patients to make medical judgments independent of consultations with physicians. Directto-consumer advertising prompts patients to diagnose themselveswithconditions tied toadvertiseddrugs. Inone respect, physiciansshouldwelcomethesechanges: clinical encounters involving informedpatientsbecomegratifyingwhenbothparties collaborate to advance patients’ best interests. However, patients who misinterpret self-acquired medical information may request unnecessary or even harmful interventions. Physicians may respond to requests for nonbeneficial interventions not only through individualized clinical reasoning but also by applying practice guidelines. When guidelines recommend against a requested intervention, physicians can appeal to them as external sources of authority and depersonalize potential conflict with the patient. However, guidelines also can be problematic: those who create guidelines may have conflicts of interest, guidelines from different sources may conflict, and applicable guidelines are unavailable for many clinical problems. Patient Autonomy and Professional Integrity Patient autonomy is often invoked to support patients’ requests for specific interventions. According to this perspective, patients’ preferences are always decisive because medical decisions reflect value judgments, and patients are always better suited to choose interventions consistent with their personal values than are physicians. However, this rationale is flawed. Distorting biases may influence a patient’s clinical judgment, and autonomous patients sometimes make decisions that confer no benefit or put their health at risk. Using patient autonomy to justify acquiescence to patients’ requests for nonbeneficial services violates professional integrity. Professional integrityrequiresphysicianstoadheretostandards of intellectual and moral excellence. Physicians achieve intellectual excellence by submitting clinical judgment to disciplined, evidence-based reasoning. Physicians achieve moral excellence by protecting patients’ health-related interests as a primaryconcern,keepingself-interests systematically secondary. Commitment to professional integrity requires that physicianschallenge requests fornonbeneficial interventions.For example, patients may derive subjective value from taking antibiotics for viral infections; however, such value is not decisive intheabsenceofbenefit fromthemedicalperspective.Over time,allowingpatients’demandsforunnecessary interventions to trumpcarefulclinical reasoningresults inanondeliberative, rote practice style that undermines clinical excellence. Patient autonomy is not an unqualified right to choose. A broader view of autonomy includes the ability to understand and apply relevant information in making clinical judgments. Correspondingly, the physician’s obligation is to promote coherent deliberation and not simply to dispense whatever the patient wants. The interpersonal nature of patient-physician encounters is better captured by the idea of respect for autonomy than by an abstract principle of autonomy. This idea underscores the physician’s obligation to consider seriously patients’ values and preferences while protecting their health-related interests.

Knowledge and beliefs about antibiotics among people in Yogyakarta City Indonesia: a cross sectional population-based survey

BackgroundMisconceptions about antibiotic use among community members potentially lead to inappropriate use of antibiotics in the community. This population-based study was aimed at examining common knowledge and beliefs about antibiotic use of people in an urban area of Indonesia.MethodsThe population of the study was adults (over 18 years old) in Yogyakarta City. A cluster random sampling technique was applied (N = 640). Data were collected using a pre-tested questionnaire and analyzed using descriptive statistics and correlation.ResultsA total of 625 respondents was approached and 559 respondents completed the questionnaire (90% response rate). Out of 559 respondents, 283 (51%) are familiar with antibiotics. Out of 283 respondents who are familiar with antibiotics, more than half have appropriate knowledge regarding antibiotic resistance (85%), allergic reactions (70%), and their effectiveness for bacterial infections (76%). Half these respondents know that antibiotics ought not to be used immediately for fever (50%). More than half have incorrect knowledge regarding antibiotics for viral infections (71%). More than half believe that antibiotics can prevent illnesses from becoming worse (74%). Fewer than half believe that antibiotics have no side effects (24%), that antibiotics can cure any disease (40%), and that antibiotic powders poured onto the skin can quickly cure injuries (37%). Those who are uncertain with these beliefs ranged from 25% to 40%. Generally, these respondents have moderate knowledge; where the median is 3 with a range of 0 to 5 (out of a potential maximum of 5). Median of scores of beliefs is 13 (4 to 19; potential range: 4 to 20). The results of correlation analysis show that those with appropriate knowledge regarding antibiotics would also quite likely have more appropriate beliefs regarding antibiotics. The correlation is highest for those who are male, young participants, with higher education levels, and have a higher income level.ConclusionsMisconceptions regarding antibiotic use exist among people in this study. Therefore, improving appropriate knowledge regarding antibiotic use is required.

The use of pure and impure placebo interventions in primary care - a qualitative approach.

BackgroundPlacebos play an important role in clinical trials and several surveys have shown that they are also common in daily practice. Previous research focused primarily on the frequency of placebo use in outpatient care. Our aim was to explore physicians' views on the use of placebos in daily practice, whereby distinction was made between pure placebos (substances with no pharmacological effect, e.g. sugar pills) and impure placebos (substances with pharmacological effect but not on the condition being treated, e.g. antibiotics in viral infections or vitamins).MethodsWe performed semi-structured interviews with a sample of twelve primary care physicians (PCPs). The interview addressed individual definitions of a placebo, attitudes towards placebos and the participants' reasons for prescribing them. The interviews were transcribed and analysed using qualitative content analysis.ResultsThe definition of a placebo given by the majority of the PCPs in our study was one which actually only describes pure placebos. This definition, combined with the fact that most impure placebos were not regarded as placebos at all, means that most of the participating PCPs were not aware of the extent to which placebos are used in daily practice. The PCPs stated that they use placebos (both pure and impure) mainly in the case of non-severe diseases for which there was often no satisfactory somatic explanation. According to the PCPs, cases like this are often treated by complementary and alternative therapies and these, too, are associated with placebo effects. However, all PCPs felt that the ethical aspects of such treatment were unclear and they were unsure as to how to communicate the use of placebos to their patients. Most of them would appreciate ethical guidelines on how to deal with this issue.ConclusionsMany PCPs seem to be unaware that some of the drugs they prescribe are classified as impure placebos. Perceptions of effectiveness and doubts about the legal and ethical aspects of the use of placebos by PCPs may discourage their application. Dissemination of guidelines and consensus papers may be one approach, but it has to be acknowledged that the topic itself is in conflict with the PCPs' perception of themselves as professional and reliable physicians.

Frequency and circumstances of placebo use in clinical practice - a systematic review of empirical studies

BackgroundThe use of placebo interventions outside clinical trials is ethically, professionally and legally controversial. Little is known about the frequency and circumstances of placebo use in clinical practice. Our aim was to summarize the available empirical studies addressing these issues.MethodsWe searched PubMed and EMBASE from inception to July 2009 in order to identify cross-sectional surveys, qualitative or longitudinal studies among health care professionals, students or patients which investigated at least one of the following issues - frequency of placebo use or attitudes to, or motivations for, the use of placebo interventions. At least two reviewers extracted information on the study methods, participants and findings. Descriptive summaries were prepared in an iterative process by at least two reviewers per study.ResultsTwenty-two studies from 12 different countries met the inclusion criteria. Most studies had relevant shortcomings. The proportion of respondents reporting that they had applied 'pure' placebos (for example, saline injection) during their professional life varied between 17% and 80% among physicians and between 51% and 100% among nurses, but it seems that the actual frequency of such use seems to be rare. The use of 'impure' or 'active' placebos (for example, antibiotics for viral infections) is likely to be much more frequent. However, it is impossible to make a reliable estimation because there is no agreement of what an impure placebo might be. Studies using qualitative methods or asking participants to judge case examples suggest that motivations and attitudes towards placebo use are complex and health care providers are often faced with a dilemma.ConclusionsAlthough the available evidence is incomplete and confusing at times there can be little doubt that the prevalence of placebo use outside of clinical trials is not negligible and that views and attitudes on placebos use differ considerably among individuals, both health care professionals and patients. Further research is needed to clarify these issues.

The use of placebo interventions in medical practice--a national questionnaire survey of Danish clinicians.

The authors sent a questionnaire to 772 randomly selected Danish clinicians and asked them about their use of placebo interventions. Sixty-five percent responded. Among the general practitioners, 86% (95% confidence interval 81-91) reported to have used placebo interventions at least once, and 48% (41-55) to have used placebo interventions more than ten times, within the last year. Hospital-based doctors and private specialists reported to have used placebo interventions less frequently (p < .001). The most important reason for the use of placebo interventions was to avoid a confrontation with the patient. Typical placebos were antibiotics for viral infections. Approximately 30% (28-36) of the clinicians believed in an effect of placebo interventions on objective outcomes, and 46% (42-50) found clinical placebo interventions generally ethically acceptable.