Evaluation Of Antibiotic Therapy Research Articles

Expectations of the pediatric intensive care unit team for the clinical pharmacist performance

Objective: We aimed to know the expectations of a pediatric intensive care unit staff for the activities to be undertaken by the clinical pharmacist, in order to plan her work along with the multidisciplinary team. Study design: A cross-sectional study, involving the multidisciplinary team of the pediatric intensive care unit of a tertiary-care university hospital. Method: A self-completion questionnaire containing questions regarding expectations of the pediatric intensive care unit staff for the role of the clinical pharmacist in the multidisciplinary team was applied to the team members, using a Likert-type scale response. Results: The nursing assistants/technicians and physiotherapists showed higher expectation for issues related to administration of medications; for nurses, the expectation for the clinical pharmacist performance focused on issues related to prescription drugs, such as evaluation of antibiotic therapy, while physicians considered most important information on drug therapy, as notification of allergies related to drugs, information on period of validity of medicines and evaluation of drug administration by gastric or enteral tubes. Conclusions: Team expectations varied according to the needs and routine of each professional category. The results of this study have contributed to implementation of the clinical pharmacy service in a Brazilian pediatric intensive care unit

An Evaluation of Antibiotic Therapy in Pediatric Dentistry Outpatients

An Evaluation of Antibiotic Therapy in Pediatric Dentistry Outpatients

Évaluation prospective des associations antibiotiques d’un centre hospitalier général

Introduction We previously reported a 30% rate of inadequate antibiotic therapy in a general hospital with optimal organization. This data led to implement a systematic weekly infectious diseases consultation. We report an evaluation of antibiotic combinations. Patients and methods The infectious diseases consultation was scheduled half-a-day per week. Antibiotic combinations were collected by the pharmacist via computerized prescriptions. Discussion with the managing physician was systematic in order to evaluate the adequacy of the treatment both in terms of diagnosis and therapy. Results For 9 months, 381 patients were prescribed 486 antibiotic combinations, among which 116 were evaluated. The infectious diseases specialist suggested a similar diagnosis in 71 antibiotic treatments (61%), the diagnosis appeared doubtful in 36 cases (31%), and a true diagnostic discordance was noted in nine cases. The discussion between specialist and managing physician suggested that the antibiotic combination was justified in 35%, of limited usefulness in 22%, and inadequate in 43% of the cases. There was a significant correlation between the result of the discussion and the accuracy of the antibiotic combination ( p < 0.001). Respiratory infections were the main reason for inadequate or limited usefulness of antibiotic combinations (30/49, 61%). Conclusion Computerized prescriptions allow the evaluation of antibiotic therapy even when the infectious diseases specialist intervention is short. The discussion with the managing physician on diagnosis and treatment appears to play a central role for a better use of antibiotherapy.

Evaluation of antibiotic therapy following valve replacement for native valve endocarditis

We retrospectively evaluated 105 patients at the Mayo Clinic between 1970 and 2006 with native valve endocarditis who underwent acute valve surgery. The objective was to determine if outcomes differed based on whether they had received an antibiotic regimen recommended for native valve endocarditis or one for prosthetic valve endocarditis. Fifty-two patients had streptococcal and 53 had staphylococcal infections. Patients with each type of infection were divided into two groups: the first received postoperative monotherapy (with a beta-lactam or vancomycin), and the second received combination therapy (with an aminoglycoside for streptococcal infection, and gentamicin and/or rifampin for staphylococcal infection). The duration and types of antibiotics given pre- and postoperatively, valve cultures results, antibiotic-related adverse events, relapses, and mortality rates within 6 months of surgery were analyzed. Cure rates were similar regardless of the regimen administered. With the small number of patients in each group, a multicenter study with a larger cohort of patients is needed to better define optimal postoperative treatment regimens in this population.

Experimental infection of dogs with Borrelia burgdorferi sensu stricto using Ixodes scapularis ticks artificially infected by capillary feeding.

Specific pathogen-free dogs were experimentally infected with Borrelia burgdorferi sensu stricto using nymphal or adult female Ixodes scapularis ticks artificially infected with spirochetes by capillary feeding. The ticks were capillary fed B. burgdorferi isolate 610, previously isolated from a dog with Lyme disease and grown in BSK medium. This isolate induced clinical signs in the dogs similar to those for dogs infested with ticks naturally infected with B. burgdorferi. Adult ticks were more efficient than nymphs in transmitting spirochetes to the dogs. One of five dogs infested with nymphal ticks capillary fed B. burgdorferi was skin biopsy culture and serologically positive, and demonstrated lameness. In contrast, all five dogs infested with adult female ticks that had been capillary fed with B. burgdorferi were culture and serologically positive, with one dog developing lameness. The immunoblot profiles of dogs challenged with female ticks infected by capillary feeding (8 weeks post challenge) were similar to immunoblots (4 weeks post challenge) from dogs challenged with naturally infected females collected in the field. These studies demonstrated that B. burgdorferi cultured in BSK medium can be capillary fed to either nymphal or adult female ticks under laboratory controlled conditions for the purpose of transmitting the spirochete to dogs during the tick's blood meal. This tick infection system would be useful for a controlled and defined challenge of vaccinated and non-vaccinated dogs for proper evaluation of vaccine efficacy, which is difficult to achieve using field-collected ticks. Furthermore, this system may also be useful for investigation of the pathogenesis of Lyme disease, evaluation of the pathogenicity of new isolates of B. burgdorferi, or evaluation of antibiotic therapy.

Evaluation of antibiotic therapy in a rabbit model of Shiga toxin-producing E.coli (STEC) infection: No evidence for adverse effects

Evaluation of antibiotic therapy in a rabbit model of Shiga toxin-producing E.coli (STEC) infection: No evidence for adverse effects

Diversity of Streptococcus agalactiae and Staphylococcus aureus ribotypes recovered from New York dairy herds

Abstract Objectives To develop a reference database for characterization of bovine Staphylococcus aureus and Streptococcus agalactiae strains by automated ribotyping and to use it to assess the discriminatory power of this typing procedure and the geographic distribution of Sta aureus and Str agalactiae strains in New York state dairy herds. Sample Population 22 commercial dairy herds. Procedure Isolates of Sta aureus and Str agalactiae from bovine milk were identified by standard bacteriologic procedures, then typed by automated ribotyping. Antimicrobial susceptibility of isolates was tested in vitro. Two indicators made from the data were percentage of farms with multiple ribotypes and percentage of single ribotypes found in several geographic regions. Standard bacteriologic diagnosis, automated ribotyping, and determination of antibiograms (Kirby-Bauer method) also were done. Results Of 50 Sta aureus and 44 Str agalactiae isolates from composite milk samples of 12 and 10 herds, respectively, 18 and 14 ribotypes, respectively, were identified. The discriminatory power of automated ribotyping was approximately 0.96 (Hunter-Gaston's formula). A higher percentage of herds with Sta aureus had multiple ribotypes. The most common Sta aureus ribotypes tended to have broader geographic distribution. Some Sta aureus ribotypes were significantly associated with antibiotic resistance profiles. Conclusions Automated ribotyping appears to characterize bovine strains of bacteria associated with intramammary infections with a high discriminatory index. Potential applications include identification of strains that appear to have broad geographic distribution suggesting interfarm transfer, discrimination between recurrent versus new intramammary infections (ie, for control of Str agalactiae and Sta aureus), and evaluation of antibiotic therapy. (Am J Vet Res 1997;58:482–487)

The economic evaluation of antibiotic therapy: relevance to urinary tract infection.

Economic analyses of health care interventions can be performed with various levels of sophistication but all aid in decision-making processes which determine funding priorities. Pharmacoeconomics is the application of health economic techniques to the evaluation of drug therapy. In this article the pharmacoeconomic principles underlying the rational choice of an antibiotic for the treatment of urinary tract infections are discussed. Examples of pharmacoeconomic, adverse reaction and non-compliance studies are quoted to illustrate these principles. Efficacy and freedom from adverse effects are the principal determinants of favourable cost-effectiveness ratios, rather than antibiotic costs alone. Doctors should bear this in mind when choosing drugs to treat urinary tract infection.

An evaluation of antibiotic therapy on Pasteurella haemolytica present in the nasopharynx of healthy calves

Twenty clinically healthy calves, carrying Pasteurella haemolytica biotype A serotype 2 ( P. haemolytica A2) in their upper respiratory tracts, were used in an attempt to evaluate the potential usefulness of routine treatment of calves with either oxytetracycline or ampicillin as a means of eliminating such infections. Use of a long-acting oxytetracycline, at recommended dose rate, reduced the isolation rate of P. haemolytica A2 from nasopharyngeal swabs by ∼ 30% during the first week post-treatment. Subsequent use of conventional (short-acting) preparation of oxytetracycline at twice the dose recommended by the manufacturer, in the same calves, reduced the isolation rate of this organism by only ∼ 20% during the first week post-treatment. In another group of calves given ampicillin, the antibiotic also did not eliminate P. haemolytica A2 from the calves. The usefulness of routine treatment of calves using antibacterial agents as a means of preventing pneumonic pasteurellosis has been discussed on the basis of the present findings and field observations.

Evaluation of Antibiotic Therapy Following Penetrating Abdominal Trauma

Postoperative infection accounts for significant morbidity and mortality following penetrating abdominal trauma. During a 2 1/2-year period, December 1980 through June 1983, 257 patients sustaining penetrating abdominal injury were initially treated at Parkland Memorial Hospital in Dallas. Following the patient's written consent, they were prospectively randomized to receive, prior to surgery, intravenous clindamycin 600 mg every 6 hours and tobramycin 1.2 mg/kg every 6 hours (CT), or cefamandole 1 gm every 4 hours (M), or cefoxitin 1 gm every 4 hours (C). The antibiotics were continued for 48 hours. Major organ injuries in the three groups were comparable. The overall infection rate was significantly less in the cefoxitin group (13%), compared to cefamandole at 29%, and was comparable to the combination of clindamycin/tobramycin at 20%. The most significant difference followed colon injury. There were 96 patients who sustained colon injuries and the infection rate was CT 33%, M 62%, and C 19% (p = 0.002). If nonoperative wound infections were excluded from the colon group and only severe infections were evaluated, the infection rate was CT 18%, M 38%, and C 13% (p = 0.021). The infection rate was higher in the shock patients and tended to increase as age increased. Enterococcus, Escherichia coli, and Klebsiella pneumoniae were the most frequent aerobes isolated along with anaerobes. Five of six Bacteroides isolates from major infections occurred in the cefamandole group; two of which were in bacteremic patients. The hospital stay corresponded with infection rates, being 11.4 days (CT), 13.1 days (M), and 9.4 days (C). The results of this study indicate that cefoxitin is comparable to the combination of clindamycin/tobramycin and superior to cefamandole when used before surgery in patients sustaining penetrating abdominal trauma. The study suggests that antibiotic coverage should be against aerobes and anaerobes. Routine administration of an aminoglycoside is unnecessary.

Leptospira grippotyphosa.

Case Reports1 December 1954LEPTOSPIRA GRIPPOTYPHOSAEDWIN E. GOLDBERG, M.D., HAROLD B. SHRIFTER, M.D., MURRAY FRANKLIN, M.D., F.A.C.P.EDWIN E. GOLDBERG, M.D.Search for more papers by this author, HAROLD B. SHRIFTER, M.D.Search for more papers by this author, MURRAY FRANKLIN, M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-41-6-1245 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptLeptospiral diseases have been for many years considered uncommon in the United States and have therefore not received their due attention in medical colleges or in clinical medicine. However, an increasing awareness of the importance of leptospirosis in human and animal disease is attested to by the numerous reports on this subject appearing in the literature in recent years. These reports have dealt primarily with leptospiral diseases in which the etiologic agents were the Leptospira icterohaemorrhagiae1, 5 and, to a lesser extent, Lept. canicola,6, 9Lept. pomona,10, 13 and outbreaks of Lept. autumnalis in troops.14, 15To our knowledge there...Bibliography1. YagerGochenour RHWS: Current problems in the field of leptospirosis, Am. J. Pub. Health 43: 411, 1953. CrossrefGoogle Scholar2. AshePratt-ThomasKumpe WFHRCW: Weil's disease: complete review of American literature and abstract of world literature; 7 case reports, Medicine 20: 145, 1941. CrossrefGoogle Scholar3. JeghersHoughtonFoley HJJDJA: Weil's disease: report of case with postmortem observations and review of recent literature, Arch. Path. 20: 447, 1935. Google Scholar4. Bertucci EA: Leptospirosis, Am. J. M. Sc. 209: 86, 1945. CrossrefGoogle Scholar5. Jeghers HJ: The leptospirosis in the United States, Bull. New England M. Center 15: 61, 1953. MedlineGoogle Scholar6. 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Author, Article, and Disclosure InformationAffiliations: Chicago, Illinois*Received for publication March 12, 1954.From the Department of Medicine, Cook County Hospital, the Departments of Clinical Science and Medicine, University of Illinois College of Medicine, and the Hektoen Institute for Medical Research, Chicago, Illinois. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 December 1954Volume 41, Issue 6Page: 1245-1249KeywordsHospital medicineLeptospiraLeptospirosis ePublished: 1 December 2008 Issue Published: 1 December 1954 PDF downloadLoading ...