Benefit Of Antibiotic Therapy Research Articles

Effect of antibiotic therapy in the postoperative period of third molar surgeries: a split-mouth, randomized and controlled study

Purpose: The objective of this randomized clinical trial was to evaluate the postoperative period of 32 third molars, semi-included or included, in a split mouth, of patients from the São Paulo State University. Material and Methods: The teeth were divided into two groups, in the test group drug treatment with Amoxicillin 500 mg, Dexamethasone 4 mg and Dipyrone 500 mg and in the control group patients received treatment with Dexamethasone 4 mg and Dipyrone 500 mg. The parameters used were edema, trismus and pain, measured before and after the operation, where the benefits of antibiotic therapy were evaluated. To compare the data, an analog pain scale was used, the method of Ustün, and the millimeter ruler, being submitted to Student's T test. Results: Both test and control groups had similar values, with no statistically significant difference in the incidence of postoperative complications, as well as in the presence of edema, pain and more pronounced trismus between the groups analyzed in the study. Conclusions: In view of the statistical results obtained, it was not possible to state that the use of antibiotic therapy was beneficial when related to edema, trismus and pain.

Antibiotic Therapy and Gastrointestinal Graft-Versus-Host Disease in the Allogeneic Stem Cell Transplantation Population.

Purpose:Hematopoietic stem cell transplantation patients undergo rigorous courses of myeloablative chemotherapy that increase vulnerability for infections. Complications can arise in the form of graft-vs.-host disease (GvHD) manifesting in various organs, including the skin, lung, liver, and gastrointestinal (GI) tract. Antibiotic therapy is generally begun in order to prevent further complications from infection but may increase the risk for acute GI GvHD. Studies that investigated antibiotic therapy and the subsequent occurrence of GI GvHD in allogeneic stem cell transplantation (aSCT) patients were reviewed.Methods:PubMed, Scopus, and CINAHL databases were utilized. Articles published between January 1, 2009, and December 15, 2019, were included in this review. A total of 1,142 articles were retrieved. Duplicates, reviews, letters to the editors, irrelevant interventions/outcomes, and non-English articles were excluded. Inclusion criteria included individuals who were undergoing an aSCT and received antibiotic therapy. A total of seven articles were included for this review after applying the inclusion and exclusion criteria.Results:The use of broad-spectrum antibiotics increased the risk of developing GI GvHD. Stool analysis when available showed a decrease in the diversity of the gut microbiome, which in turn led to the increase in acute GvHD.Implications:The increased risk of GvHD may have implications for the standard of care therapy, which includes treatment, for infections during SCTs. Providers will need to weigh the risk vs. benefit of antibiotic therapy and exercise judicious selection of antibiotics prior to engraftment.

Предварительные результаты проспективного сравнительного неинтервенционного исследования по лечению бессимптомной бактериурии у беременных

Introduction. Over the past three decades, the views on the diagnosis and treatment of asymptomatic bacteriuria in pregnant women have not undergone any changes. However, the majority of randomized clinical trials concerning the treatment of pathients with this nosology are of low methodological quality and date back to the 60-80s. Since then, diagnostic and treatment protocols have changed dramatically, so the quality of the evidence base is low. In a recent Scandinavian study of higher methodological quality, there was no clear benefit of antibiotic therapy in pregnant women with asymptomatic bacteriuria. Material and methods. This publication is devoted to the interim results of a study that analyzed the efficacy and safety of herbal medicinal product Canephron® N in the treatment of asymptomatic bacteriuria in 29 pregnant women aged 22 to 34 years at a gestation period of 14-28 weeks. When included in the study, as well as on days 14, 30 and 60, the following laboratory control was performed: general urine analysis, urine bacteriological examination, clinical analysis of vaginal smears, analysis of vaginal microbiota by quantitative PCR Results. In the group of our patients, the distributions by age and gestational age differed from normal, the mean values are presented by the median and were 29 years and 14 weeks, respectively. Already had children – 13 (44.8%) women. In total, 35 microorganisms were isolated in a diagnostically significant titer. Most of the representatives of the Enterococcaceae family were traditionally 57.1%. At the time of inclusion, the median pyuria was 2.5 μl and exceeded the reference values only in 10.3% of patients. Clinical examination of vaginal smears revealed no inflammatory changes. However, an assessment of the vaginal microbiota showed the presence of dysbiosis due to an increase in the amount of obligate-anaerobic microflora in 58.6% and vaginal candidiasis in 10.3% of pregnant women. After 2 months, the 28 pregnant women remaining in the study had no episodes of symptomatic urinary infection. During the herbal drug therapy, there was a decrease in diagnostically significant bacteriuria and signs of the inflammatory process in all patients. The frequency of vaginal dysbiosis was recorded in 10.7% of pregnant women (р>0,05). Conclusion. Thus, our preliminary results shows that the use of Canephron N in pregnant women with asymptomatic bacteriuria (ABU) may be an effective alternative approach comparing the use of antibiotics. The treatment with Canephron N promotes the normalization of the urinary tract microflora and save the intactness of the saprophytic flora, in contrast to antibacterial drugs, and this is especially important in the paradigm of the antibiotics stewardship and the fight against growing antibiotic resistance. Comparative results of the use of antibacterial agents and Canephron N will be analyzed in the next publication, on the basis of which final conclusions will be drawn about the advisability of using herbal medicines to control bacteriuria in pregnant women Conclusion. We have obtained encouraging results from the use of Canephron-N® in patients with asymptomatic bacteriuria in pregnant. To obtain an evidence base of a recommendatory level, it is advisable to increase the number of observations.

Antimicrobial therapy in neonatal intensive care unit.

Severe infections represent the main cause of neonatal mortality accounting for more than one million neonatal deaths worldwide every year. Antibiotics are the most commonly prescribed medications in neonatal intensive care units (NICUs) and in industrialized countries about 1% of neonates are exposed to antibiotic therapy. Sepsis has often nonspecific signs and symptoms and empiric antimicrobial therapy is promptly initiated in high risk of sepsis or symptomatic infants. However continued use of empiric broad-spectrum antibiotic treatment in the setting of negative cultures especially in preterm infants may not be harmless.The benefits of antibiotic therapy when indicated are clearly enormous, but the continued use of antibiotics without any microbiological justification is dangerous and only leads to adverse events. The purpose of this review is to highlight the inappropriate use of antibiotics in the NICUs, to exam the impact of antibiotic treatment in preterm infants with negative cultures and to summarize existing knowledge regarding the appropriate choice of antimicrobial agents and optimal duration of therapy in neonates with suspected or culture-proven sepsis in order to prevent serious consequences.

Neonatal infections due to multi-resistant strains: Epidemiology, current treatment, emerging therapeutic approaches and prevention

Severe infections represent the main cause of neonatal mortality accounting for more than one million neonatal deaths worldwide every year. Antibiotics are the most commonly prescribed medications in neonatal intensive care units. The benefits of antibiotic therapy when indicated are clearly enormous, but the continued and widespread use of antibiotics has generated over the years a strong selective pressure on microorganisms, favoring the emergence of resistant strains. Health agencies worldwide are galvanizing attention toward antibiotic resistance in gram-positive and gram-negative bacteria. Infections in neonatal units due to multidrug and extensively multidrug resistant bacteria are rising and are already seriously challenging antibiotic treatment options. While there is a growing choice of agents against multi-resistant gram-positive bacteria, new options for multi-resistant gram-negative bacteria in the clinical practice have decreased significantly in the last 20years making the treatment of infections caused by multidrug-resistant pathogens challenging mostly in neonates. Treatment options are currently limited and will be some years before any new treatment for neonates become available for clinical use, if ever.The aim of the review is to highlight the current knowledge on antibiotic resistance in the neonatal population, the possible therapeutic choices, and the prevention strategies to adopt in order to reduce the emergency and spread of resistant strains.

Antibiotics for leptospirosis.

Leptospirosis has a wide-ranging clinical and public health impact. Leptospira are globally distributed. Case attack rates are as high as 1:4 to 2:5 persons in exposed populations. In some settings mortality has exceeded 10% of infected people. The benefit of antibiotic therapy in the disease has been unclear. We sought to characterise the risks and benefits associated with use of antibiotic therapy in the management of leptospirosis. We searched the The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded regardless of study language. This was augmented by a manual search. The last date of search was November, 2011. To be included in assessment of benefits, trials had to specifically assess the use of antibiotics in a randomised clinical trial. A broad range of study types were incorporated to seek potential harms. Included trials were systematically abstracted, as were excluded studies for the purposes of assessing harms. Analyses were conducted in accordance with The Cochrane Handbook and practices of The Cochrane Hepato-Biliary Group. Seven randomised trials were included. Four trials with 403 patients compared an antibiotic with placebo or no intervention. Three trials compared at least one antibiotic regimen with another antibiotic regimen. The trials all had high risk of bias. The trials varied in the severity of leptospirosis among trial patients. The ability to group data for meta-analysis was limited. While all four trials that compared antibiotics with placebo reported mortality and used parenteral penicillin, there were no deaths in two of them. Since odds ratio calculations cannot employ zero-event trials, only two trials contributed to this estimate. The number of deaths were 16/200 (8.0%) in the antibiotic arm versus 11/203 (5.4%) in the placebo arm giving a fixed-effect OR 1.56 (95% CI 0.70 to 3.46). The random-effects OR is 1.16 (95% CI 0.23 to 5.95). The heterogeneity among these four trials for the mortality outcome was moderate (I(2)= 50%). Only one trial (253 patients) reported days of hospitalisation.It compared parenteral penicillin to placebo without significant effect of therapy (8.9 versus 8.8 days; mean difference (MD) 0.10 days, 95% CI -0.83 to 1.03). The difference in days of clinical illness was reported in two of these trials (71 patients). While parenteral penicillin therapy conferred 4.7 to 5.6 days of clinical illness in contrast to 7.7 to 11.6 days in the placebo arm, the size of the estimate of effect increased but statistical significance was lost under the random-effect model (fixed-effect: MD -2.13 days, 95% CI -2.46 to -1.80; random-effects: MD -4.04, 95% CI -8.66 to 0.58). I(2) for this outcome was high (81%). When duration of fever alone was assessed between antibiotics and placebo in a single trial (79 patients), no significant difference existed (6.9 versus 6.6 days; MD 0.30, 95% CI -1.26 to 1.86). Two trials with 332 patients in relatively severe and possibly late leptospirosis, resulted in trends towards increased dialysis when penicillin was used rather than placebo, but the estimate of effect was small and did not reach statistical significance (42/163 (25.8%) versus 31/169 (18.4%); OR 1.54, 95% CI 0.91 to 2.60). When one antibiotic was assessed against another antibiotic, there were no statistically significant results. For mortality in particular, these comparisons included cephalosporin versus penicillin (2 trials, 6/176 (3.4%) versus 9/175 (5.2%); fixed-effect: OR 0.65, 95% CI 0.23 to 1.87, I(2)= 16%), doxycycline versus penicillin (1 trial, 2/81 (2.5%) versus 4/89 (4.5); OR 0.54, 95% CI 0.10 to 3.02), cephalosporin versus doxycycline (1 trial, 1/88 (1.1%) versus 2/81 (2.5%); OR 0.45, 95% CI 0.04 to 5.10). There were no adverse events of therapy which reached statistical significance. Insufficient evidence is available to advocate for or against the use of antibiotics in the therapy for leptospirosis. Among survivors who were hospitalised for leptospirosis, use of antibiotics for leptospirosis may have decreased the duration of clinical illness by two to four days, though this result was not statistically significant. When electing to treat with an antibiotic, selection of penicillin, doxycycline, or cephalosporin does not seem to impact mortality nor duration of fever. The benefit of antibiotic therapy in the treatment of leptospirosis remains unclear, particularly for severe disease. Further clinical research is needed to include broader panels of therapy tested against placebo.

Benefit of antibiotic therapy on pouchitis after ileal pouch anal anastomosis: A systematic review and meta-analysis of clinical trials

Abstract The aim of the study was to evaluate and collect current evidence on the effect of antibiotics in pretreatment of pouchitis after restorative ileal pouch anal anastomosis (IPAA). Pubmed, Embase, Web of Science, Scopus, and Cochrane Library databases were searched between 1966 and July 2008; and relevant clinical trials extracted, reviewed, and validated according to the study protocol. The outcome of interest was clinical improvement after treatment. Nine randomized, placebo-controlled clinical trials were found relevant and studied but 3 of them with 70 patients were entered into meta-analysis. Pooling of the results from these trials yielded an odds ratio of 15.96 with a 95% CI of 4.20–60.70, indicating a significant OR (p<0.0001) in treatment group in comparison to the placebo group. In conclusion, the meta-analysis confirms benefit of antibiotics in management of pouchitis after IPAA operation.

Antibiotic-related acute effects within the intestinal microcirculation in experimental sepsis

Although the benefit of antibiotic therapy in infectious inflammatory diseases remains unquestioned [1], little is known about the effects of these antibiotics on the inflamed microcirculation independent of their antimicrobial property. The aim of this study was to evaluate acute effects related to antibiotics administration upon the intestinal microcirculation, which plays a crucial role in the pathogenesis of sepsis and subsequent multiorgan failure [2,3].

Bacterial flora in irritable bowel syndrome: role in pathophysiology, implications for management

Irritable bowel syndrome (IBS) may, in part at least, result from a dysfunctional interaction between the indigenous flora and the intestinal mucosa which, in turn, leads to immune activation in the colonic mucosa. Some propose a role for bacterial overgrowth as a common causative factor in the pathogenesis of symptoms in IBS; other evidence points to more subtle qualitative changes in the colonic flora; both hypotheses remain to be confirmed but the likelihood that bacterial overgrowth will prove to be a major factor in IBS now seems remote. Nevertheless, short-term therapy with either antibiotics or probiotics does seem to reduce symptoms among IBS patients. It seems most likely that the benefits of antibiotic therapy are mediated through subtle and, perhaps, localized, quantitative and/or qualitative changes in the colonic flora. How probiotics exert their effects remain to be defined but an anti-inflammatory effect seems likely. While this approach to the management of IBS is in its infancy, it is evident that manipulation of the flora, whether through the administration of antibiotics or probiotics, deserves further attention in IBS.

Therapeutic use of cephazolin to prevent complications of spine surgery

Discitis, caused by pyogenic organisms, is a potential complication of any procedure which involves entering the intervertebral disc during open or percutaneous procedures. While there are wide variations in the severity of symptoms, the characteristic feature of discitis is the development of increasingly severe back pain, which is not relieved by rest, or narcotic analgesics. While there is a tendency to spontaneous resolution over time, a self-limiting course does not always eventuate. Serious complications resulting from spread of the infective process can lead to vertebral osteomyelitis or to the formation of an epidural abscess with further risk of neural compression. Clinical and experimental evidence now supports the prophylactic use of a suitable antibiotic, but some uncertainties exist about the benefits of antibiotic therapy in treating established discitis. While cephazolin is a widely favoured choice of antibiotic, the timing of its administration to prevent or treat discitis has been complicated by the lack of suitable methods for detecting and measuring the concentration of cephazolin in the plasma and disc in experimental and clinical conditions. This paper describes a high-performance liquid chromatography technique for detecting the antibiotic cephazolin. The results conclude cephazolin can be detected in the plasma and disc after administering an intravenous bolus dose. However, concentration of cephazolin in the outer disc was 12 times greater than that of the inner disc.

Patients’ Expectations about the Benefit of Antibiotic Treatment: Lessons from a Randomised Controlled Trial

Background: Patient expectations may be an importantcomponent of a placebo effect, and yet few studies assesshow patients’ pre-existing expectations affect subsequenthealth outcomes. Objectives: To estimate the associationbetween patients’ expectations and time tocure in patients with clinically diagnosed acute bacterialrhinosinusitis. Methods: In a randomised controlled trial,expectations about the benefit of an antibiotic therapywere measured prior to treatment with either an antibioticor placebo. Results: Of the patients asked for consent,64% refused mostly because they either wanted or didnot want to receive antibiotics. Over 25% of the patientswho gave consent were ambivalent about the benefit ofantibiotic therapy. Predictably there was no evidence ofan association between expectations and time to cure inthose that gave consent. Conclusions: Selection bias occursif patients with strong expectations refuse to participatein a trial and if the success of the intervention dependsin part on a patient’s expectations. Methods thatadjust for selection bias are recommended for trialswhere placebo effects are either of interest or could bean important component of an intervention.

Effects of Antibiotic Therapy on Outcomes of Patients With Coronary Artery Disease

Although Chlamydia pneumoniae infection has been associated with the initiation and progression of atherosclerosis, results of clinical trials investigating antichlamydial antibiotics as adjuncts to standard therapy in patients with coronary artery disease (CAD) have been inconsistent. To conduct a meta-analysis of clinical trials of antichlamydial antibiotic therapy in patients with CAD. The MEDLINE and Cochrane Central Register of Controlled Trials databases were searched from 1966 to April 2005 for English-language trials of antibiotic therapy in patients with CAD. Bibliographies of retrieved articles were searched for further studies. Presentations at major scientific meetings (2003-2004) were also reviewed. Search terms included antibacterial agents, myocardial infarction, unstable angina, and coronary arteriosclerosis. Eligible studies were prospective, randomized, placebo-controlled trials of antichlamydial antibiotic therapy in patients with CAD that reported all-cause mortality, myocardial infarction, or unstable angina. Of the 110 potentially relevant articles identified, 11 reports enrolling 19,217 patients were included. Included studies were reviewed to determine the number of patients randomized, mean duration of follow-up, and end points. End points of interest included all-cause mortality, myocardial infarction (MI), and a combined end point of MI and unstable angina. Event rates were combined using a random-effects model. Antibiotic therapy had no impact on all-cause mortality among treated vs untreated patients (4.7% vs 4.6%; odds ratio [OR], 1.02; 95% confidence interval [CI], 0.89-1.16; P = .83), on the rates of MI (5.0% vs 5.4%; OR, 0.92; 95% CI, 0.81-1.04; P = .19), or on the combined end point of MI and unstable angina (9.2% vs 9.6%; OR, 0.91; 95% CI, 0.76-1.07; P = .25). Evidence available to date does not demonstrate an overall benefit of antibiotic therapy in reducing mortality or cardiovascular events in patients with CAD.

Antibiotic therapy in preterm premature rupture of membranes.

Good quality evidence supports the use of antibiotic therapy in women with preterm PROM for whom expectant management is planned. The best evidence supports the choice of an extended-spectrum agent or combination administered intravenously for 2 days followed by an extended spectrum or combination of oral agents for several more days. Despite the effectiveness of antimicrobial therapy in this setting, the potential risks of systemic antibiotic administration, such as allergic reactions, overgrowth of commensal organisms, and emergence of resistant pathogens, much always be kept in mind. Nevertheless, in the majority of cases, assuming the patient is a good candidate for expectant management, the benefits of antibiotic therapy outweigh the risks.

Antibiotic treatment in preterm labor and intact membranes: A randomized, double‐blinded, placebo‐controlled trial

Although an association between microbial invasion of amniotic cavity and preterm birth has been extensively demonstrated, there is conflicting evidence regarding the benefits of antibiotic therapy in patients with preterm labor and intact membranes. We attempted to assess the efficacy of amoxicillin and erythromycin on pregnancy outcome in those patients. A randomized, double-blinded, placebo-controlled trial was designed and implemented. A total of 196 patients with singleton pregnancies and preterm labor with intact membranes (22–36 weeks) were randomly allocated to receive either antibiotics or placebo, plus adjunctive parenteral tocolysis, and 173 patients (antibiotics group n = 83 vs. placebo group n = 90) completed the treatment. The overall prevalence of microbial invasion of the amniotic cavity was 5.2% (9/173). No significant difference between both groups was found in maternal outcomes, including duration of randomization-to-delivery interval, frequency of preterm delivery, and frequency of clinical chorioamnionitis and endometritis. Rate of cesarean section was significantly higher in the placebo group (28% vs. 12%). Regarding neonatal outcome, no significant difference was detected between both groups in neonatal death, respiratory distress syndrome, proven sepsis, and birthweight. Suspected sepsis was significantly more frequent in the placebo group (6/90 vs. 0/78). The results of this trial indicate that amoxicillin and erythromycin do not prolong pregnancy in patients with preterm labor and intact membranes. A significant reduction in the rate of cesarean section was observed in patients receiving antibiotics. A significant reduction in the rate of neonatal suspected sepsis was also demonstrated. J. Matern.-Fetal Med. 7:105–110, 1998. © 1998 Wiley-Liss, Inc.

Antibiotic treatment in preterm labor and intact membranes: A randomized, double-blinded, placebo-controlled trial

Although an association between microbial invasion of amniotic cavity and preterm birth has been extensively demonstrated, there is conflicting evidence regarding the benefits of antibiotic therapy in patients with preterm labor and intact membranes. We attempted to assess the efficacy of amoxicillin and erythromycin on pregnancy outcome in those patients. A randomized, double-blinded, placebo-controlled trial was designed and implemented. A total of 196 patients with singleton pregnancies and preterm labor with intact membranes (22–36 weeks) were randomly allocated to receive either antibiotics or placebo, plus adjunctive parenteral tocolysis, and 173 patients (antibiotics group n = 83 vs. placebo group n = 90) completed the treatment. The overall prevalence of microbial invasion of the amniotic cavity was 5.2% (9/173). No significant difference between both groups was found in maternal outcomes, including duration of randomization-to-delivery interval, frequency of preterm delivery, and frequency of clinical chorioamnionitis and endometritis. Rate of cesarean section was significantly higher in the placebo group (28% vs. 12%). Regarding neonatal outcome, no significant difference was detected between both groups in neonatal death, respiratory distress syndrome, proven sepsis, and birthweight. Suspected sepsis was significantly more frequent in the placebo group (6/90 vs. 0/78). The results of this trial indicate that amoxicillin and erythromycin do not prolong pregnancy in patients with preterm labor and intact membranes. A significant reduction in the rate of cesarean section was observed in patients receiving antibiotics. A significant reduction in the rate of neonatal suspected sepsis was also demonstrated.

Cholelithiasis and Cholecystitis: With a Study of 513 Patients Operated Upon at Bellevue Hospital

Disease of the gall bladder and biliary tract affects large numbers of people and a voluminous literature exists on all phases of this problem; however, fundamental factors of disease and methods of treatment merit continued study and evaluation. After a review of 513 consecutive records of patients with proved cholecystic disease, on the Second Surgical Division at Bellevue, it has seemed worthwhile to make certain comparisons between acute and chronic cholecystitis and to determine our results in patients operated upon both with­ out and with the benefit of antibiotic therapy and in the light of improved preoperative preparation and postoperative care. Unselected cases, 229 before 1935 and 284 from 1935 to 1949, have been studied. In 1935 the sulfonamide drugs became available and since then a large number of antimicrobial agents have been added to our armamentarium. Dur­ ing this period also advancing knowledge of fluid and electrolyte replacement and maintenance has improved preoperative preparation; anesthesia and an­ esthetic agents have grown better; liberal use of blood transfusions and early ambulation have made operations less hazardous and the postoperative re­ covery shorter and easier to bear. Gall stones have been found at all ages; even in the foetus. 1 The incidence of stones becomes significant in the third decade and according to Lieber 2