Cost-effective Antibiotic Research Articles

ANALYSIS OF COST EFFECTIVENESS OF ANTIBIOTIC USE IN TYPHOD FEVER PATIENTS AT KARTINI RANGKASBITUNG HOSPITAL IN 2022

The high prevalence rate of typhoid fever is one of the health problems in Indonesia. Antibiotic therapy is the only therapy that can be used to treat the main cause of typhoid fever. Antibiotics are a type of drug therapy that requires a lot of budgets to procure. This study aims to find out the most cost-effective type of antibiotic for treating typhoid fever. This research was conducted at Kartini Rangkasbitung Hospital using observational research methods with a cross-sectional approach. The data used uses secondary data conducted retrospectively. This research uses medical record data and cost data. This study was divided into three groups, namely ciprofloxacin tablets, intravenous ceftriaxone, levofloxacin tablets and intravenous levofloxacin. Based on the calculation results, the ACER value of ceftriaxone is IDR 2,955,250, the ACER value of IV levofloxacin is IDR 2,727,306, and the ACER value of levofloxacin tablets is IDR 3,047,337. The ICER value from the comparison between levofloxacin tablets and ceftriaxone is IDR 43,250. The most cost-effective antibiotic is the antibiotic levofloxacin in intravenous form.

Cost-Effectiveness Analysis Of Ceftriaxone-Gentamicin And Ampicillin-Gentamicin In Pediatric Pneumonia At Hospital X Madiun

Pneumonia is an infectious disease caused by bacteria characterized by fever, chills, coughing up phlegm, and breathing difficulty. Generally pneumonia is caused by an infection of Streptococcus pneumoniae bacteria. Antibiotics is a therapy used in pediatric pneumonia patients at hospitals X. in Madiun. This study aims to determine a more cost-effective antibiotics therapy combination between ceftriaxone-Gentamicin and Ampicillin-Gentamicin in pediatric pneumonia patients at Hospital X in Madiun in 2019-2021. This study used a cross sectional design and data collection was carried out retrospectively. There were 39 patients as samples who were pediatric patients aged ≤ 12 years who were adjusted to the inclusion criteria. The datawere identified using decision trees and analyzed cost-effectiveness with ACER and ICER calculations. The ACER value of Ceftriaxone-Gentamicin antibiotic therapy is IDR 6,047,334.23, which is lower than Ampicillin-Gentamicin therapy whch is of IDR 9,730,746.21, thus showing that Seftriaxone-Gentamicin is more cost-effective than Ampicillin-Gentamicin. The ICER calculation has negative result of Idr 500,953.74 so it shows that the Ceftriaxone-Gentamicin combination antibiotic is more cost-effective.

A RETROSPECTIVE REVIEW OF THE BACTERIOLOGY OF HAND SEPSIS AT A TERTIARY HOSPITAL IN GAUTENG

The aim of this investigation is to firstly quantify the burden of disease, and secondly qualify the organisms being cultured during debridement to establish their sensitivities to available antibiotics. This study will also look at the concomitant burden of Human Immunodeficiency Virus (HIV) and Diabetes Mellitus (DM) in cases of hand sepsis, to establish whether these two disease processes require special consideration and treatment tailoring.The method employed to collect the data will be retrospective collection of patient information, using random sampling. Included patients will be adult patients who undergo debridement and have a sample registered on the National Health Laboratory System (NHLS). The daily intake sheet will be used to collect patients details and these details will then be used to collect results of intra-operative specimens using the NHLS. These patient details will also be used to check patients’ HIV results and HBA1c (Glycated Haemoglobin A1c) results.Majority of the specimens revealed Methicillin Sensitive Staphylococcus Aureus (MSSA), with a reassuringly low rate of Methicillin Resistant Staphylococcus Aureus (MRSA) when compared to international data. The yield of patients tested for HIV or DM was lower than expected, despite this being the standard of care.The projected impact of this study will be assessment of the current burden of disease and then clarification of our current management strategy, in order to assess if it would be possible to change to a more cost-effective antibiotic with a narrower spectrum of bacteria coverage. The potential exists to not only implement cost saving measures, but also promote antibiotic stewardship by decreasing the practice of empiric broad-spectrum antibiotic use.

Dalbavancin and moleculight in the COVID-19 pandemic

The COVID-19 Pandemic, which began in March 2020, and its associated surges, had an immense impact on our medical staff and their ability to perform their daily duties. The COVID-19 Pandemic necessitated hospital modifications, including the expansion of the Emergency Department, ICU, and Isolation units. The overwhelmed staff and overburdened ER and ICU required adjustments to deal with the Inpatient impasse. For example, temporary patient care rooms needed to be set up for the overflow of patients. The tsunami of the Pandemic almost overwhelmed our hospital. With the challenges presented to our hospital during the Pandemic, we needed a fresh perspective to our multi-disciplinary approach. Thus, we fathomed that the use and cost-effectiveness of both Dalbavancin, a long-acting lipoglycopeptide antibiotic combined with the diagnostic Moleculight Imaging Device would be a sound decision. We hypothesized that with the use of this cost-effective antibiotic in conjunction with the use of the Moleculight Imaging Device, with its fluorescent imaging, we could detect the presence of bacteria and assist our wound treatment and decision-making. A shift in patients from the Emergency Room/Inpatient Department to the Outpatient Department/Wound Care Center was made possible with the use of these two novel products.

COST-EFFECTIVENESS ANALYSIS OF ANTIBIOTIC USAGE IN DIABETIC FOOT ULCUS PATIENTS IN DOKTER SOEKARDJO TASIKMALAYA HOSPITAL

Objective: Diabetic foot ulcers is sores on the skin surface until it penetrates the skin layer caused by infection, which is require high costs for treatment. This puts a considerable burden on the patient's family, health agencies and society in general. The purpose of this study was to describe the direct medical costs and cost-effective antibiotics for diabetic foot ulcer patients at Dokter Soekardjo Tasikmalaya Hospital. Methods: The research method is retrospectively with a purposive sampling technique. The research subjects included 24 hospitalized diabetic foot ulcer patients who received antibiotic treatment ceftriaxone with metronidazole or meropenem with metronidazole. The effectiveness of therapy was determined by the Length of Stay (LOS). Direct medical costs were obtained from medical costs, treatment costs, laboratory costs, and radiology costs. Results: The average direct medical cost for the combination of ceftriaxone and metronidazole antibiotics was Rp. 4 668 062 and for the combination of meropenem antibiotics with metronidazole was Rp. 9 093 830. The effectiveness of the antibiotic ceftriaxone with metronidazole was 47%. Conclusion: The cost-effective antibiotic was ceftriaxone with metronidazole which has the lowest ACER value Rp. 9 932 046 and the ICER value is Rp. 22 128 840.

Differences in clinical and cost-effectiveness between cefmetazole and flomoxef for the prevention of surgical site infection in elective colorectal surgery: A single-center, retrospective cohort study

IntroductionSurgical site infection (SSI) is associated with increased morbidity and mortality rates, postoperative length of stay (pLOS), and medical costs. In colorectal surgery, cefmetazole (CMZ) and flomoxef (FMOX) are predominantly used in Japan, and they have almost the same spectrum of antibiotic activity against SSI pathogens, and an approximately four-fold cost difference (CMZ: ∼4$, FMOX: ∼16$). However, the difference between these antibiotics in SSI prophylaxis in colorectal surgery remains poorly understood. MethodsWe performed a single-center retrospective cohort study to investigate the prophylactic effects of these antibiotics, pLOS, and hospitalization costs. Patients who underwent elective colorectal surgery between April 2016 and March 2020 were considered for this study. ResultsOf the 634 patients, 316 (49.8%) were eligible. The SSI rates in the CMZ and FMOX groups were 14.7% and 12.5%, respectively. The incidence of organ/space SSI was approximately two-fold lower in the CMZ group than in the FMOX group (4.4% vs. 9.4%). Multivariable regression analysis revealed that CMZ was not significantly related to SSI, with an adjusted odds ratio of 1.21 (95% confidence interval [CI]: 0.52–2.82) and did not induce a significant difference in pLOS (difference ratio: 0.951 [95% CI: 0.868–1.041]). Hospitalization costs were reduced in the CMZ group (difference ratio, 0.951 [95% CI: 0.907–0.998], p = 0.042). The sensitivity analysis also showed results similar to the above findings. ConclusionOur study showed that CMZ could be a cost-effective antibiotic with similar efficacy for SSI prophylaxis in colorectal surgery, compared with FMOX.

In vitro evaluation of antioxidant and antimicrobial activities of the root of Rheum tanguticum

Rheum tanguticum, belonging to the family Polygonaceae, is one of the most important Traditional Chinese Medicines (TCM) which have been used for centuries. The roots, stems, and rhizomes have been reported to contain active pharmacological components that are of biological importance. The rhizomes and roots of Rheum species have been one of the most important and abundant ingredients used in TCM and have been used in the prevention of many diseases since prehistory. It has been reported to possess various pharmacological activities such as anticancer, antifungal, antiviral, antibacterial, purgative, hepatoprotective, anti-inflammatory, anti-platelet aggregation, anticoagulant, etc. An In vitro antioxidant activity of the DPPH Radical Scavenging Activity of ethanol, methanol, ethyl acetate, and water extracts of the root of R. tanguticum was found to be concentration-dependent and had an IC50 of 17.327 µg/mL, 18.848 µg/mL 19.769 µg/mL, and 49.639 µg/mL respectively as compared to the standard, L-ascorbic acid of 7.4 µg/mL. The crude extract was highest in methanol (42.25%), followed by ethanol (30.59%), water (25.55%), and ethyl acetate (10.40%) extracts. The antimicrobial activity of the root of R. tanguticum of ethanol, methanol, ethyl acetate, and water extracts was determined using the paper disc and agar well diffusion methods and exhibited a range of activity against Staphylococcus aureus, Pseudomonas aeruginosa, Pseudomonas solanacarum, and Xanthomonas oryzae as compared to the positive control, neomycin. The high phenolic content, antioxidant and antimicrobial activities exhibited by the root of R. tanguticum is an indication of the widely used of the plant as one of the main ingredients in TCM and could be used as a prototype in developing natural cost-effective antibiotics against a wide range of pathogenic microorganisms and oxidative-related diseases.

Biochemical Profile and Antibacterial Examination of Freshwater Crab Scylla Serrata (FORSKAL, 1775)

Natural products from the aquatic organisms provide unlimited opportunities for the production of new drugs. To verify this fact in the present study ‘the biochemical profile and antimicrobial activity of different samples of the estuarine crab, Sylla serrata’ was investigated. Biochemical study of the body parts of the crab gains substantial attention for their specificity in connection to the food values of the crab and for the evaluation of their physiological needs at different periods of life. The total protein was estimated by Lowry's method and the amount of protein was highest in the soft muscle sample (20.27mg/ml). The total sugar was estimated by the Phenol-Sulphuric acid method and it was highest in the leg sample (209.8mg/ml). The lipids of the samples were estimated by Folchs method. Lipid was highest in the shell sample (28.35mg/ml). Thin Layer chromatography was done for characterization of protein. Antibiotics are used against bacterial infections. The natural products gained importance to screen antibiotics. For this reason the antibacterial activity of the samples were tested against grampositive and gramnegative pathogenic bacterial strains. The bacterial strains like Klebsiella pneumoniae, Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli and Enterobacter aerogenes were used as the test strains. In the present study, the ethanol extract of crab sample I showed maximum zone of inhibition (13 mm) in P. aeruginosa. The sample I showed moderate zone of inhibition (11 mm) in K.pneumoniae. The sample II showed the minimum zone of inhibition (7 mm) in P. aeruginosa. It indicated that the shell of crabs would be a good source of antimicrobial agents and would replace the existing inadequate and cost effective antibiotics. The microbial associates of crustaceans have proven to be a rich source of bioactivity with antimicrobial and cytotoxic effects. So the organism used in the present study will be the promising source to the biotechnological and pharmaceutical applications.

Emergence of antimicrobial resistance and magnitude of Unani medicine- scope and challenges.

Emergence of antimicrobial resistance, with practically all newly developed and even more potent antibiotics like carbapenem and colistin, has become a matter of great public health concern. A number of common diseases of public health importance are becoming harder and sometimes impossible to treat due to increased resistance of pathogens. These alarming threats seek prime attention of scientific community to develop newer antibiotics with long-lasting efficacy, least side effects, and low economic burden. Unani classical texts have enormous citations on different infectious diseases. Many single drugs and compound formulations are in vogue since ages for the treatment of infectious diseases. Use of Afaviya (spices), Mufarrehat (exhilarants), Tiryaqi Advia (drugs with antidote properties) and Sirka (vinegar) is highly advocated in treating various infectious diseases. Though, enormous research activities have been undertaken worldwide to explore and develop newer antibiotics from natural resources, indicating massive magnitude of natural products in treating various infectious diseases, however, the higher plants, still largely seems to be unexplored. Moreover, elaborated and well controlled clinical studies are still lacking to authenticate their clinical significance. Hence, a rigorous, well-designed & well-structured research is highly paramount to ascertain the provision of newer, relatively safe and cost effective natural antibiotics.

Natural outer membrane permeabilizers boost antibiotic action against irradiated resistant bacteria

BackgroundThis study sought to develop new strategies for reverting the resistance of pathogenic Gram-negative bacilli by a combination of conventional antibiotics, potent permeabilizers and natural beta lactamase inhibitors enhancing the activity of various antibiotics.MethodsThe antibiotic susceptibility in the presence of natural non-antibacterial tested concentrations of phytochemicals (permeabilizers and natural beta lactamase inhibitors) was performed by disk diffusion and susceptibility assays. Thymol and gallic acid were the most potent permeabilizers and facilitated the passage of the antibiotics through the outer membrane, as evidenced by their ability to cause LPS release, sensitize bacteria to SDS and Triton X-100.ResultsThe combination of permeabilizers and natural beta lactamase inhibitors (quercetin and epigallocatechin gallate) with antibiotics induced greater susceptibility of resistant isolates compared to antibiotic treatment with beta lactamase inhibitors alone. Pronounced effects were detected with 24.4 Gy in vitro gamma irradiation on permeability barrier, beta lactamase activity, and outer membrane protein profiles of the tested isolates.ConclusionsThe synergistic effects of the studied natural phytochemicals and antibiotics leads to new clinical choices via outer membrane destabilization (permeabilizers) and/or inactivation of the beta lactamase enzyme, which enables the use of older, more cost-effective antibiotics against resistant strains.

Pharmacoeconomic analysis of antibiotic therapy in surgical site infections .

Surgical site infections (SSIs) are considered to be one of the most common complications in operative treatment due to increased microbiological resistance. Having knowledge of the flora that most frequently cause SSIs in a given population allows for the implementation of effective empirical antibiotic therapies. Such an approach leads to a decrease in both time and costs associated with SSI treatment. The aim of this paper is to assess the most common pathogens causing SSIs in orthopedic and general surgery and to conduct a cost-minimization analysis. A total of 908 isolates from 547 patients with an SSI in general surgery and 463 swabs from 267 patients with an SSI at the department of orthopedics were obtained. All patients were treated at St. John of God Hospital in Katowice from 2011 to 2016. The incidence rate of SSIs was 4.25% in general surgery and 2.66% in orthopedics. The most commonly isolated strains in general surgery were E. coli (24.3%), K. pneumoniae (12.5%), and P. mirabilis (4.76%). Gram-positive cocci dominated the isolates in orthopedics, with S. epidermidis and S. aureus accounting for 19.8% and 13.6%, respectively. The most cost-effective antibiotics for general surgery are currently the cephalosporins cefotaxime or ceftriaxone, either alone or in combination with amikacin, while in orthopedics the most cost-effective were trimethoprim/sulfamethoxazole. Empirical antibiotic therapy should be based on the current epidemiological situation of infections from both a medical and pharmacoeconomic point of view.

Antimicrobial Potentials of Vernonia amygdalina and Honey on Vancomycin-Resistant Staphylococcus aureus from Clinical and Environmental Sources

Background and Objective: Vancomycin has been a cost effective and frontline antibiotic in the treatment of methicillin resistant Staphylococcus aureus for many years. However, some vancomycin-resistant Staphylococcus aureus (VRSA) have been recently reported. This study therefore aimed to determine the antimicrobial effects of Vernonia amygdalina and honey on VRSA from environmental and clinical sources. Materials and Methods: Vernonia amygdalina plant was sourced from farmland within Ekiti State University vicinity while honey samples, Blessed honey and Sunshine honey, were purchased from stores in Ado-Ekiti and Ondo State respectively. Ethanolic and aqueous extracts of V. amygdalina parts were prepared using standard method. The extracts were screened for the presence of some secondary metabolites using standard procedures. Honey brands were also analyzed physicochemically for these parameters: appearance, colour, pH and moisture content, according to standard methods. The antimicrobial activities of extracts of V. amygdalina and different samples of honey against the VRSA were performed using the Kirby Bauer’s method. Data from the study were statistically analyzed using descriptive, Pearson’s correlation and regression. Results: Phytochemical screening of V. amygdalina extracts revealed the presence of alkaloids, flavonoids, tan-nins, saponins and phenols at varied concentrations. Comparatively, the ethanolic extracts of the plant parts had higher concentration of these me-tabolites than their aqueous extracts. Differences were observed in the physicochemical parameters of both honey samples. Also, the antimicrobial activities of the plant extracts and honey brands demonstrated effective inhibition against most of the VRSA, though, in a concentration dependent manner. Conclusion: Findings from this study suggest that the leaves, barks and roots of this plant as well as honey could be very useful in the therapy against VRSA.

Cost effective analysis of tab. nitrofurantoin vs. inj. ceftriaxone as an empirical therapy in patients of urinary tract infection at a tertiary health care centre

Background: Urinary tract infections (UTI) are commonly seen in adults, Urinary tract infection and asymptomatic bacteriuria in adults are a significant health care burden. In a developing country it is necessary to minimize the cost of therapy while giving maximum health benefits to the patient. Appropriate antimicrobial selection is clearly important, as treatment failures will increase the cost of care and result in additional morbidity for patients. Empirical treatment of urinary tract infection is common at tertiary health care center, authors conducted a pharmacoeconomic study to evaluate cost effectiveness of the empirical treatment.Methods: Patients with similar symptoms suffering from UTI were divided into 5 groups with 10 patients in each group. Each group was subdivided into two subgroups with subgroup A having five patients receiving tab nitrofurantoin and subgroup B having 5 patients receiving inj ceftriaxone. Out of the total cost of therapy, percentage of cost attributed to tab nitrofurantoin was compared with inj ceftriaxone. Most cost-effective antibiotic was analysed. Average number of admission days for groups of UTI patients receiving tab nitrofurantoin and inj ceftriaxone were calculated and compared. Group of UTI patients receiving antibiotic with least number of admission days was calculated.Results: Percentage of cost attributed to Nitrofurantoin therapy out of total cost in urinary tract infection patient was less than percentage of cost attributed to inj Ceftriaxone in all five groups of patients and was found to be statistically significant (p <0.05). However, there was no statistically significant difference in average number of admission (IPD) days between groups of patients receiving tab nitrofurantoin and inj ceftriaxone (p>0.05).Conclusions: In current study authors found tab nitrofurantoin to be more cost effective than inj ceftriaxone as an empirical therapy in UTI patients.

Prevalence of Pseudomonas aeruginosa in cholesteatoma patients in tertiary care hospital in North India

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Chronic suppurative otitis media (CSOM) is middle ear infection that lasts for more than three months and is accompanied by a perforation of tympanic membrane. Cholesteatoma is a well know complication of CSOM. Prevalence of CSOM varies between racial and socioeconomic groups. The aim of present study was to determine the principal bacteria in ear discharge in patients with cholesteatoma. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">This was a prospective study conducted in department of ENT in tertiary care hospital and medical college in north India from March 2017 to May 2017.Total 80 patients attended ENT OPD with complain of ear discharge and deafness during the study period, but only 47 patients were clinically diagnosed unsafe type of CSOM or cholesteatoma. Ear swabs were collected and send for microbiology laboratory for bacteriological process. </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Out of 80 patients, 47(58.75%) were clinically diagnosed cholesteatoma and of 29(61.70%) were male and 18(38.29%) were female. Most commonly affected age group was between 10 to 20 year (40.42%) followed by 21 to 30 (21.27%). More than 60 Year was less affected by cholesteatoma. Most common isolated organism was <em>Pseudomonas aeruginosa</em> (66.66%) followed by <em>Klebsiella pneumonia</em> (19.44%) and we used <em>Piperacillin tazobactum</em> and amikacin, and ciprofloxacin in all cases in perioperative period and noticed good response and modified radical mastoidectomy was done in all patients. </span></p><p class="abstract"><strong>Conclusions:</strong> <em><span lang="EN-IN">P. aeruginosa</span></em><span lang="EN-IN"> was found to be the most common isolate in CSOM with cholesteatoma case and piperacillin-tazobactum, amikacin, and ciprofloxacin was found to be cost effective antibiotics.</span></p>

Acute epididymorchitis: a study of the predisposing factors and immediate management outcome in adult men in Irrua, Nigeria

Acute epididymorchitis: a study of the predisposing factors and immediate management outcome in adult men in Irrua, Nigeria Eshiobo Irekpita,1 Friday Ogbetere,1 Emmanuel Esezobor1 1Urology Division, Department of Surgery, 2Department of Surgery, Plastic Surgery Division, Irrua Specialist Teaching Hospital, Irrua, NigeriaAim: To assess the immediate (14 days) outcome of management and to determine the predisposing factors (PF) to acute epididymorchitis in this rural community.Materials and methods: This is a retrospective study. All men who were diagnosed as having acute epididymorchitis within the study period of 5 years were included. Those with epididymorchitis secondary to testicular tumors were excluded. Information related to age, HIV infection and other PF, organisms isolated, duration of hospital stay, antibiotic treatment, adjunct treatment, and duration of symptoms before presentation were documented. Immediate outcome was graded as good if symptoms and signs resolved within 2 weeks of treatment or poor if this took more than 2 weeks. Findings were analyzed using simple statistical methods and statistical package for the social sciences (SPSS-17).Results: A total of 58 men met the selection criteria and were included in the study. The risk factors included two (3.4%) prostatitis, 36 (62.1%) bladder outlet obstruction, three (5.2%) trauma/instrumentation, and ten (17.2%) multiple sexual partners. No risk factor was documented in seven (12.1%). One (1.7%) of the men, who also had bladder outlet obstruction , was HIV positive. When age was cross tabulated with risk factors, there was a significant correlation (P=0.000) but it had no significant effect on immediate management outcome (P=0.442). Immediate outcome was considered good in 40 (69%) and poor in 18 (31%). Independent factors that affected outcome included the duration of symptoms before presentation (P=0.000), presenting symptoms (P=0.000), and the need for adjunct treatment (P=0.018). Ciprofloxacin was the antibiotic used in 57 (98.28%), while cefuroxime was used in one (1.7%). These drugs had no statistically significant correlation with outcome.Conclusion: Many patients with epididymorchitis have PF that need to be treated to avoid its recurrence and complications. It would then mean that the diagnosis “acute epididymorchitis” is incomplete without including the PF. In this study, ciprofloxacin was not uniformly effective (69%) using the aforementioned criteria, indicating the need for prospective studies to identify cost-effective antibiotics. Keywords: risk factors, adjunct treatment, ciprofloxacin, treatment outcome

Drug utilization study in medical emergency unit of a tertiary care hospital in north India.

Objective. To generate data on the drug utilization pattern and cost of drug treatment and to determine the rationality of prescriptions. Methods. A retrospective cross-sectional drug utilization study was conducted in the medical emergency unit of our hospital. Patient case records were reviewed to extract data on the pattern of drug use. Cost of drug treatment for the emergency visit was calculated by referring to the cost mentioned in Monthly Index of Medical Specialties and the rationality of prescriptions was evaluated using WHO core indicators of drug utilization. Results. 1100 case records were reviewed. Majority of patients received proton pump inhibitors followed by multivitamins. The median cost per prescription was 119.23$ (7.32$–7663.46$). Majority (49.9%) of drug cost was driven by antibiotics alone. An average of 4.9 drugs was prescribed per prescription. There were 14.89% encounters with antibiotics. 75.17% of the drugs were given as injectables and only 29.27% of the drugs were prescribed as generics. Conclusion. There is need to rationalize the drug therapy in terms of increasing prescribing of drugs by generic name and to avoid overuse of PPIs and multivitamins in emergency unit. Also the hospital pharmacy should be encouraged to procure more cost effective alternative antibiotics in future.

Utility of penicillin allergy testing in patients presenting with a history of penicillin allergy

BackgroundCurrent statistics show that approximately 10% of patients claim to be allergic to penicillin yet only 10% of these have demonstrable allergy. The most appropriate and cost-effective antibiotics are sometimes withheld on the basis of patient history of drug allergy.ObjectiveInvestigation of IgE hypersensitivity and delayed hypersensitivity in patients with a history of penicillin allergy to a teaching hospital allergy clinic.MethodsPatients underwent skin prick and intradermal testing (IDT) with major and minor penicillin determinants. Those with negative skin tests were administered a three-day oral challenge. Demographic and clinical details about the reactions were noted.ResultsOne hundred twenty eight patients underwent testing, of these, one hundred and ten had self-reported histories of penicillin allergy and eighteen were referred because of other antibiotic allergies. Seventeen patients with self-reported penicillin allergy had either positive skin tests or oral challenge results, corresponding to 15% of patients having proven allergy. None reacted on skin prick testing, four reacted to IDT, thirteen reacted to oral challenge (five immediate and eight delayed). Analysis of clinical histories showed that patients with a well-defined history of allergy and a history of anaphylaxis were more likely to have a positive test compared to patients with vague histories. Skin testing proved to be less sensitive than oral challenge.ConclusionA minority of patients presenting with a history of penicillin allergy have evidence of immune-mediated hypersensitivity (17/110, 15%) in this study. Of these, eight out of seventeen (47%) had delayed reactions, demonstrating the usefulness and discriminating power of objective testing, which must include three-day oral challenge. Discriminating factors for immune-mediated allergy from patient history were a clear description of the original reaction and a history of anaphylaxis. Negative allergy testing enables the use of penicillin as first-line treatment when necessary and this can significantly reduce costs of antibiotics.

Antibiotic sensitivity pattern and cost-effectiveness analysis of antibiotic therapy in an Indian tertiary care teaching hospital

Objective:The purpose of this study is to analyze the antibiotic sensitivity pattern of microorganisms, to study the antibiotic usage pattern, and to conduct a cost-effectiveness analysis (CEA) for the antibiotics prescribed in a tertiary care teaching hospital in south India.Methods:This prospective study was carried out in the General Medicine and Pulmonology departments of the hospital for a period of 6 months. The study was carried out in three phases: A prospective analysis to check the sensitivity pattern of microorganisms to various antibiotics, data extraction and determining the cost of antibiotics and finally evaluation of the sensitivity pattern of microorganisms and the antibiotic usage. A total of 796 documented records were analyzed.Findings:It was found that Escherichia coli was the major organism identified in 36.4% of the isolated specimens, followed by Klebsiella sp. (18.9%), Streptococcus pneumoniae (15.8%), Staphylococcus aureus (12.4%), and Pseudomonas (9.3%). The sensitivity pattern data of the prospective study revealed that E. coli was highly sensitive to Amikacin (99.3%), Klebsiella to Amikacin (93.8%), Pseudomonas to Meropenem (97.6%), and S. pneumoniae to Ofloxacin (93.8%). In the prescribing pattern study, it was found that the most common disease (21.2%) was found to be lower respiratory tract infection in 51 patients. Cephalosporins (73%), in particular Ceftriaxone (63.5%) was highly prescribed, followed by fluoroquinolones (53.9%). In the CEA, it was revealed that Ceftriaxone was the cost-effective antibiotic with a cost-effectiveness ratio (CER) of 78.27 compared to Levofloxacin, which had a CER of 95.13.Conclusion:Continuous surveillance of susceptibility testing is necessary for cost-effective customization of empiric antibiotic therapy. Furthermore, reliable statistics on antibiotic resistance and policies should be made available.

Intracameral antibiotics for the prevention of endophthalmitis in cataract surgery

Aim: To determine if there is enough evidence to support the use of intracameral antibiotics for the prevention of endophthalmitis post cataract surgery. Method: A systemic review of English language articles was conducted by performing a broad search using Medline/ProQuest, Science Direct, the Cochrane Library and Embase. The search was restricted to articles published between January 2005 and October 2010. The terms endophthalmitis and intracameral antibiotics were used to initiate the search but the term cataract was used for further exclusion. The population base incorporated adult patients undergoing cataract surgery. Limitations include one author as a reviewer of the titles resulting from the literature searches. A team review would give a more robust methodological quality. Results: Of the 493 results that were identified in the literature search 451 citations were excluded after screening titles and abstracts. Forty two publications were included for this review and were identified as being relevant after scrutiny. Publications showing retrospective data far exceeded the number of prospective case controlled studies negatively affecting the number of high quality articles reviewed. A randomized controlled study released by the European Society of Cataract and Refractive Surgeons (ESCRS) published results in 2006 showing a near _fivefold decrease in the rates of post-operative endophthalmitis with the use of intracameral cefuroxime. This study was discontinued due to ethical considerations. The study observed a clear benefit from the use of intracameral cefuroxime. Moxifloxacin has not been truly evaluated and has a potential for bacterial resistance. Topical antibiotics are unreliable relying on patient compliance and requiring frequent administration. From this review an effective solution for endophthalmitis prevention remains unclear. Conclusion: Intracameral cefuroxime administered at the time of surgery seems to work well for reducing the incidence of post-operative endophthalmitis as it is a broad spectrum and cost-effective antibiotic. The major barrier to its clinical use is the lack of a commercial preparation which increases the threat of dilution errors, which is known to be toxic to human endothelial cells.

Components of the Rv0081-Rv0088 locus, which encodes a predicted formate hydrogenlyase complex, are coregulated by Rv0081, MprA, and DosR in Mycobacterium tuberculosis.

Mycobacterium tuberculosis, the etiological agent of tuberculosis, remains a significant cause of morbidity and mortality throughout the world despite a vaccine and cost-effective antibiotics. The success of this organism can be attributed, in part, to its ability to adapt to potentially harmful stress within the host and establish, maintain, and reactivate from long-term persistent infection within granulomatous structures. The DosRS-DosT/DevRS-Rv2027c, and MprAB two-component signal transduction systems have previously been implicated in aspects of persistent infection by M. tuberculosis and are known to be responsive to conditions likely to be found within the granuloma. Here, we describe initial characterization of a locus (Rv0081-Rv0088) encoding components of a predicted formate hydrogenylase enzyme complex that is directly regulated by DosR/DevR and MprA, and the product of the first gene in this operon, Rv0081. In particular, we demonstrate that Rv0081 negatively regulates its own expression and that of downstream genes by binding an inverted repeat element in its upstream region. In contrast, DosR/DevR and MprA positively regulate Rv0081 expression by binding to recognition sequences that either partially or completely overlap that recognized by Rv0081, respectively. Expression of Rv0081 initiates from two promoter elements; one promoter located downstream of the DosR/DevR binding site but overlapping the sequence recognized by both Rv0081 and MprA and another promoter downstream of the DosR/DevR, Rv0081, and MprA binding sites. Interestingly, Rv0081 represses Rv0081 and downstream determinants following activation of DosRS-DosT/DevRS-Rv2027c by nitric oxide, suggesting that expression of this locus is complex and subject to multiple levels of regulation. Based on this and other published information, a model is proposed detailing Rv0081-Rv0088 expression by these transcription factors within particular growth environments.