Inadequate Use Of Antibiotics Research Articles

Self-Medication with Antibiotics among People Dwelling in Rural Areas of Sindh.

Self-medication with antibiotics is becoming increasingly common due to multiple factors. The public who are using these antibiotics generally do not have full information regarding their proper use, especially the dosages and possible side-effects. Hence, unregulated use of such medicines may cause dangerous adverse effects in the patients. The study was aimed to evaluate the prevalence and practice of self-medication with antibiotics among people dwelling in the rural areas of province Sindh. A cross-sectional survey was performed at Outpatient Department of Civil Hospital Karachi, from January to March 2015. Four hundred rural dwellers who lived in the outskirts of Karachi city area of province Sindh were recruited for the study in the aforementioned time period through non-probability convenience sampling. The investigation reported a prevalence of 81.25% among rural dwellers of Sindh with regards to self-medication of antibiotics. The most common reason behind self-medication were economic reasons (88.0%). Amoxicillin (52.0%) was found to be the most self-prescribed antibiotic. Majority of the participants (74.7%) didn't know about the phenomena of antibiotic resistance associated with inadequate use of antibiotics and only 25 subjects identified correctly that the situation would lead to increase resistance. The self-medication rates with antibiotic are higher in rural areas of Sindh. There is an urgent need for the government to enforce stricter laws on pharmacies dispensing medications, especially antibiotics, without prescriptions. Lastly, provision of cost effective treatment from public sector can significantly reduce self-medication with antibiotics among rural dwellers of Sindh.

Assessment of Antibiotics Misuse among People in Erbil City

Background: Antibiotics are only useful for treating bacterial infections. Inadequate use of antibiotics includes overuse, inappropriate type, dose, duration and/or frequency of administration had been a major problem. Antibiotic use has been identified as a major contributor to the development and spread of antibiotic resistance. Objectives: Assessment self-medication and inappropriate of antibiotics were used among people in Erbil city. To find out the associations between the antibiotic use and knowledge related antibiotic consumption. Methodology: The study was used a cross-sectional study, which conducted on 500 randomly, selected adult residents in Erbil by using a face-to-face questionnaire. Results: About half of the study samples (52.40%) did not know that antibiotics has adverse effect on humans body, 37.80% were agree to used antibiotic for headache treatment, 65.80% of them did not know that antibiotics kill normal flora, and 57.20% were did not know that bacteria become resistant to antibiotics. In addition, 46.00% were used antibiotics on advice of someone other than a physician or pharmacist, 46.20% of peoples were some time used antibiotics against colds and flu, 52.40% of peoples were some time used antibiotics as injection, and 57.20% of peoples were some time used antibiotic as one capsule when needed. Conclusion: Self-medication and inappropriate use of antibiotics were problems among people in the community. Recommendation: Strict precautions should be taken about antibiotics use and sale without prescriptions.

Seroprevalence of hepatitis E virus differs significantly among first and second generation migrant groups in Amsterdam, the Netherlands

s / Journal of Clinical Virology 70 (2015) S1–S126 S9 Methods: Pediatric inpatients (0–5 year) were identified between January 1st, 2013 and December 31st, 2014 for whom a respiratory TAC analysis was ordered within 24hours of admission. Patients with respiratory symptoms, were selected by All Patient Refined Diagnosis Related Group (APR-DRG). The TAC panel (implemented January, 2013) included testing for following 34 respiratory pathogens: influenza A virus (H1, H3, H7), influenza B virus, RSV A, RSV B, parainfluenza virus 1 to 4, adenovirus, rhinovirus, enterovirus, hMPV, coronavirus (229E, HKU1, OC43, NL63, MERS), bocavirus, cytomegalovirus, parechovirus, mumps virus, measles virus, Mycoplasma pneumoniae, Chlamydophila pneumoniae, Chlamydophila psittaci, Bordetella pertussis, Bordetella parapertussis, Bordetella holmesii/bronchiseptica, Coxiella burnetii, Legionella pneumophila, Pneumocystis jiroveccii, and Aspergillus species. Results: During the study period, 875 pediatric patients were admitted among who 298 (34.1%) were diagnosed with respiratory pathology and received antibiotic therapy (180 in 2013, 118 in 2014). In 2013, 192 tests of different respiratory episodes were performed. Based on the results of this novel test, clinicians only prescribed antibiotics for 63 episodes (32.8%) reflecting a possible reduction of antibiotic use for 129 patients. One year after implementation, 164 tests of different infectious episodes were conducted, reflecting a possible slight overconsumption linked to the introduction period. However, only 69 results (42%) led to antibiotic use. 95 (58%) results did not evoke antibiotics prescription. Conclusion: A change in clinical management based on TAC results was observed. Awareness of potential viral pathogens causing LRTI’s resulted in reduction of antibiotic use. Implementation of respiratory TAC had following potential benefits: early, highly sensitive and specific adequate broad pathogen diagnosis, improved management of the individual child, reduced selection of resistant bacteria, considering coinfections, treatment adaptation options, transmission prevention opportunity, expanding view on respiratory epidemiology, reduced need for further laboratory evaluation, and possibly reducing the overall costs of care. In conclusion, the use of respiratory TAC guides clinical decision making and reduces inadequate antibiotic use for viral infections. http://dx.doi.org/10.1016/j.jcv.2015.07.028

Clinical Characteristics of Invasive Methicillin-Resistant Staphylococcus aureus at General Hospital in the Central Region of Japan from July 2014 to June 2015

Methicillin-resistant Staphylococcus aureus is crucial pathogen caused severe invasive infection disease. This study was conducted to find out the prevalence and antimicrobial susceptibility pat- tern of invasive Methicillin-resistant Staphylococcus aureus isolates at general hospital in the cen- tral region of Japan from July 2014 to June 2015. Methicillin-resistant Staphylococcus aureus was identified by standard laboratory procedure. Antimicrobial susceptibility testing was performed by micro dilution assay according to CLSI recommendation. Invasive Methicillin-resistant Staphy- lococcus aureus disease was defined as isolation of bacteria from a normally sterile body site. One hundred seventy-one methicillin-resistant Staphylococcus aureus were isolated among which 95 (55.6%) were from inpatient and 76 (44.4%) were from outpatient. The age incidence of (0 - 1) years, (1 - 10) years, (11 - 40) years, (41 - 60) years and >60 years age groups were 18 (10.5%), 41 (24.0%), 15 (8.8%), 5 (2.9%), and 92 (53.8%) respectively. There was significant difference of age distribution between invasive and noninvasive disease in 0 - 1 years group and 11 - 40 years age group. Positive samples were received mostly from the pediatrics (56/32.7%), respiratory medi- cine (25/14.6%) and general medicine (25/14.6%). We also found the significant differences of department between invasive and noninvasive disease in pediatrics, dermatology, and surgery. Arbekacin, teicoplanin, and vancomycin were the most active antibiotics with 100% susceptible rates in our study. Our study revealed that erythromycin and gentamicin were more antimicrobial effective in invasive disease than in noninvasive disease significantly. Methicillin-resistant Sta- phylococcus aureus infection spreads worldwide easily and inadequate use of antibiotics contri- butes to uptake of their new antimicrobial resistance. Continuous antimicrobial surveys are need for guiding policy on the adequate use of antibiotics to reduce the morbidity and mortality. * Corresponding author.

An epidemiologic survey of pediatric sepsis in regional hospitals in China.

To determine the prevalence, treatment, and outcomes of sepsis at regional hospitals in Huai'an, Jiangsu, China. Prospective data registry using a descriptive clinical epidemiologic approach through a collaborative network. Pediatric departments in 11 regional city and county referral hospitals serving 843,000 children (exclusive of neonates). All admissions (n = 27,836) of patients from 28 days to 15 years old from September 1, 2010, to August 31, 2011. None. A total of 1,530 patients met the 2005 international consensus definition of sepsis, corresponding to an estimated incidence of 181/100,000 children, with 80% under 5 years old, and in 10% (153), severe sepsis or septic shock developed. The overall case fatality rate for sepsis was 3.5% (53/1,530) or 34.6% (53/153) in those in whom severe sepsis or septic shock developed. Treatment varied widely and in many instances did not conform to international guidelines as reflected by inadequate use of antibiotics, corticosteroids, vasoactive agents, and inotropes. We first report the prevalence and outcome of pediatric sepsis based on a regional hospital network in China. The diverse treatment approaches and practice at low-level clinics suggest the need for clinical implementation of internationally recognized strategy to improve the care standard in resource-limited regional hospitals.

Assessment of patient adherence to anti-infective treatment after returning home

ObjectiveThe lack of patient adherence to medical treatment has become a major concern for healthcare professionals. The World Health Organization estimated patient adherence to treatment at 50% only. The inadequate use of antibiotics can cause bacterial resistance the progression of which reduces therapeutic alternatives. The objective of this pilot study was to assess the patient's adherence to anti-infective agents prescribed for acute infection, after returning home. MethodThirty-seven patients hospitalized in the Infectious and Tropical Diseases unit were included. Their adherence to anti-infective drugs was assessed indirectly through data collected by calling the pharmacy and the patient in the week following discontinuation of anti-infective treatment. ResultsSixteen patients were identified as non-adherent (43.2%). A single patient could have several behaviors: extension of treatment (50%), dose modification (6.3%), voluntary omission (12.5%), and involuntary (6.3%). One patient (6.3%) did not take his anti-infective treatment. There was no major cause of non-adherence; every patient had his own reasons. The comparison of several criteria between adherent and non-adherent patients did not reveal any predictive risk factors. ConclusionOur study results revealed for the first time that 50% of patients were adherent to anti-infective agents, after returning home. They confirm the need to implement preventive actions such as a discharge pharmaceutical consultation.

Efectividad de un programa para mejorar el uso de antibióticos en niños internados en un hospital pediátrico de tercer nivel de atención en Argentina

Inadequate antibiotic use is associated with an increased emergence of resistant microorganisms, higher morbidity and mortality rates, and an impact on public health. To assess the effectiveness of a program aimed at improving the use of antimicrobials in patients hospitalized at Hospital Garrahan. Prospective, longitudinal, before and after study with no control group. From November 1st, 2010 to June 30th, 2011. Patients receiving parenteral antibiotics were included. Newborn infants, burned patients and those receiving prophylactic antibiotics were excluded. The periods before and after implementing discussion and monitoring workshops for antibiotic prescription and distributing treatment guidelines were compared. An univariate analysis and a multiple logistic regression study were performed (STATA 8.0). In the pre-intervention period,376 patients were included; of them, 35.6% had received inadequate treatment. The multiple regression analysis showed that the endpoints for inadequate antibiotic use were acute lower respiratory tract infection (OR: 3.80; 95% CI: 1.35-3.26; p=0.04), fever without a source in hospitalized patients (OR: 5.55; 95% CI: 2.43-12.6; p < 0.01), and febrile neutropenia (OR: 0.29; 95% CI: 0.10-0.7; p < 0.01). In the post-intervention period, 357 patients were included; 21.5% had received inadequate treatment. A reduction in inadequate antibiotic prescription was observed compared to the pre-intervention period (p < 0.01). The multiple regression analysis showed that endpoints for inadequate use were skin and soft tissue infections (OR: 0.33; 95% CI: 0.13-0.93; p = 0.035), and febrile neutropenia (OR: 0.48; 95% CI: 0.220.94; p= 0.04). The program was effective and allowed to improve antibiotic prescription practices in hospitalized children.

Antibacterial Activity and Mode of Action of Ferulic and Gallic Acids Against Pathogenic Bacteria

The increased resistance of pathogenic microorganisms is frequently attributed to the extreme and inadequate use of antibiotics and transmission of resistance within and between individuals. To counter the emergence of resistant microorganisms, considerable resources have been invested in the search for new antimicrobials. Plants synthesize a diverse array of secondary metabolites (phytochemicals) known to be involved in defense mechanisms, and in the last few years it is recognized that some of these molecules have health beneficial effects, including antimicrobial properties. In this study, the mechanism of action of gallic (GA) and ferulic (FA) acids, a hydroxybenzoic acid and a hydroxycinnamic acid, was assessed on Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, and Listeria monocytogenes. The targets of antimicrobial action were studied using different bacterial physiological indices: minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC), membrane permeabilization, intracellular potassium release, physicochemical surface properties, and surface charge. It was found that FA and GA had antimicrobial activity against the bacteria tested with MIC of 500 μg/mL for P. aeruginosa, 1500 μg/mL for E. coli, 1750 μg/mL for S. aureus, and 2000 μg/mL for L. monocytogenes with GA; 100 μg/mL for E. coli and P. aeruginosa, 1100 μg/mL and 1250 μg/mL for S. aureus and L. monocytogenes, respectively, with FA. The MBC for E. coli was 2500 μg/mL (FA) and 5000 (GA), for S. aureus was 5000 μg/mL (FA) and 5250 μg/mL (GA), for L. monocytogenes was 5300 μg/mL (FA) and 5500 μg/mL (GA), and 500 μg/mL for P. aeruginosa, with both phytochemicals. GA and FA led to irreversible changes in membrane properties (charge, intra and extracellular permeability, and physicochemical properties) through hydrophobicity changes, decrease of negative surface charge, and occurrence of local rupture or pore formation in the cell membranes with consequent leakage of essential intracellular constituents. The overall study emphasizes the potential of plant-derived molecules as a green and sustainable source of new broad spectrum antimicrobial products.

Recent therapeutic developments for acne

Current therapeutic concepts of acne vulgaris have to consider that acne is now understood as a primary inflammatory and chronic disease aggravated by genetic, microbial and environmental factors. Recent developments still focus on topical fixed combinations of substances with complementary effects in order to optimize efficacy without promoting bacterial resistance, which is a major concern resulting from inadequate use of antibiotics. New innovative therapeutic targets of acne pathophysiology are rare. Easy, convenient application and patient education are the basis to ensure patient adherence, which has been identified as a vital factor of therapeutic success of this chronic disease. The implementation of the European evidence-based S3 guidelines represents a major advancement in supporting therapeutic decisions based on literature review instead of expert opinion alone and traded therapy concepts.

Variation in antibiotic prescriptions: is area deprivation an explanation? Analysis of 1.2 million children in Germany

Inadequate use of antibiotics can lead to problems such as resistance. Overuse is especially a problem for children, since they are more affected by acute (often virus-caused) infections. While the problem has been addressed internationally over the past several years, regional variations in prescriptions are striking. Therefore, the present study aims to analyze regional variations in antibiotic prescription on a district level in Germany and tries to identify reasons for those variations through adding possible influencing factors to the analysis on individual and district levels. We analyzed 1.2 million children insured in a German health insurance fund. Antibiotic prescriptions were quantified in 2010 and reasons for prescriptions were analyzed in multilevel regressions based on the district of residence, regional deprivation, and age and sex of the child. Thirty-six percent of all children aged 0-17 years received an antibiotic prescription in 2010. In the south, prevalences are generally lower, and also to the very north. The highest prevalences are found in the close-to-border districts in the west, as well as in a band throughout the middle of Germany, in rather low population density areas. Regional variation in the prevalence range from 19 to 53 % between districts. Regional deprivation can explain part of this variation. Including area deprivation measures helped identify an influence of especially regional income and occupational deprivation on antibiotic prescriptions for children. Regional analysis such as this can help identify specific regions and groups of persons to address information programs on the risks of preventable antibiotic consumption and alternative treatment methods.

Infektionsdiagnostik in der Pneumologie

Lower respiratory tract infections rank among the leading causes of morbidity and mortality worldwide. In clinical practice, especially in the care of severely ill patients, discrimination between tracheobronchial colonisation with potentially pathogenic microorganisms and infection is a common diagnostic challenge. While prompt antibiotic treatment is needed in critically ill patients with pneumonia, an inadequate use of antibiotics is the major cause for the emergence of drug-resistant microorganisms. The first part of this review provided a detailed overview of the currently available methods for the diagnosis of pulmonary infectious diseases. In the present second part of the manuscript, we focus upon methods and criteria for the differentiation between lower respiratory tract bacterial colonisation and lower respiratory tract infections, highlighting important pathogens.

Diverse mutations in the ftsI gene in ampicillin-resistant Haemophilus influenzae isolates from pediatric patients with acute otitis media

To clarify molecular changes in beta-lactamase-nonproducing, ampicillin-resistant (BLNAR) Haemophilus influenzae, which is increasing in pediatric patients with acute otitis media (AOM) in Japan, we identified amino acid (aa) substitutions in penicillin-binding protein 3 for the BLNAR strains. Of 191 H. influenzae strains isolated from middle ear fluid of pediatric AOM patients between October 2005 and March 2008, BLNAR strains determined by PCR accounted for 49.2%. Of the BLNAR strains, 91.5% possessed 4 aa substitutions: Met377Ile, Ser385Thr, Leu389Phe, and either Asn526Lys or Arg517His. Additionally, the emergence of BLNAR strains possessing a new aa substitution of Val329Ala in the conserved aa motif of Ser327-Thr-Val-Lys, or Val511Ala adjacent to the conserved aa motif of Lys512-Thr-Gly, was noted. Transformation of the ftsI gene into the Rd reference strain (ATCC 51907) demonstrated that these two aa substitutions reduced susceptibility to amoxicillin more than to cephalosporins. Pulsed-field gel electrophoretic profiles of BLNAR strains were highly diverse. These results suggested that inadequate antibiotic use may increase BLNAR strains by selecting mutations in the ftsI gene and that such use may have favored the new aa substitutions.

Improvements in antibiotic prescribing by community paediatricians in the Czech Republic

Repeated surveys among primary care paediatricians were performed annually from 1998 to 2002 in the Czech Republic. The task was to assess the prescription of antibiotics in treatment of respiratory infections in children. The results were evaluated in the light of existing guidelines and conclusions were used in a number of interventions aimed at reducing the inadequate use of antibiotics and hence preventing the potential increase of the antibiotic resistant bacteria. In addition, data on overall consumption of antibiotics in outpatient care and trends in the prevalence of resistant strains of Streptococcus pneumoniae and Streptococcus pyogenes are discussed.

Évaluation de la prescription antibiotique dans un centre hospitalier universitaire français

Objective The aim of this study was to evaluate antibiotic prescription in a French university hospital. Design Our hospital participated in an international European Surveillance of Antimicrobial Consumption (ESAC) project study, including a longitudinal survey of monthly antibiotic use between 1998 and 2005, and a point prevalence study in 2006. All patients in the hospital on the day of survey were included in the study. Antibiotic treatments were assessed according to local antibiotic guidelines. Results Between 1998 and 2005, antibiotic use increased from 551.9 to 628.5 defined daily doses per 1000 patient-days. This increase was linked to the increase of penicillin and fluoroquinolone consumption. In the point prevalence survey, 251 (27.0%) of the 930 included patients received one or several antibiotics for a total of 395 antibiotic prescriptions. Community-acquired infections were the first indication of treatment (41.8% of prescriptions), hospital-acquired infections accounted for 34.9% of prescriptions, surgical and medical antibiotic prophylaxis for 22.4%. The assessment of antibiotic prescriptions showed that 73.7% of them were in conformity with local recommendations. Conclusions This type of study is relevant to identify critical points of inadequate antibiotic use so as to suggest corrective measures to prescribers.

Community-Acquired Thoracic Empyema in Young Adults

To evaluate the clinical characteristics, bacteriology, and therapeutic outcomes of community-acquired thoracic empyema (CATE) in young adults. From December 2000 to December 2005, 428 adult patients with a diagnosis of thoracic empyema in a tertiary hospital were retrospectively reviewed. In total, there were 64 young adult patients who were diagnosed with CATE enrolled in our series, including 56 men (87.5%) and 8 women (12.5%). Ages ranged from 18 to 44 years old (mean = 37). The most common underlying disease was alcoholism (28%), and the most common isolated microorganism was Viridans streptococci (27.3%). Among the 62 patients who underwent an invasive drainage procedure, 40 (64%) patients who received pigtail tube drainage as their initial treatment yielded a success rate of 70%. Fifteen (24%) patients who received video-assisted thoracoscopic surgery as first-line treatment yielded a success rate of 100%. To evaluate the risk factors for developing septic shock, we found that serum C-reactive protein (CRP) level on the first admission day (22.9 +/- 9.1 versus 13.2 +/- 8.1 mg/dL), presence of bacteremia (60 versus 13%), occurrence of polymicrobial infection (30 versus 5%) and inadequate antibiotic use (30 versus 7%) had statistical significance (P < 0.05). Viridans streptococci was the most frequently isolated causative microorganism in young adults with CATE and alcoholism was the most common underlying disease. Moreover, a higher serum CRP level on the first day of admission, occurrence of bacteremia, presence of polymicrobial infection and inadequate antibiotic use were significant risk factors for developing septic shock.

Etiology and risk factors of adult pneumonia.

The authors point out the remarkable importance that pneumonia has today among infectious diseases, and survey the main risk factors and etiological agents both of the forms acquired in the community and in the hospital, also considering the data from the international literature. The authors stress the high incidence of gram-positive microorganisms, among which Streptococcus pneumoniae is the most widespread in the forms acquired in the community, and the absolute prevalence of the gram-negatives in the nosocomial forms and, among the gram-positives, the pre-eminence of Staphylococcus aureus; these are "difficult" bacterial species, whose prevalence has been determined mainly by induced selective pressure through the inadequate use of antibiotics. The authors also point out the principal factors that favor the onset of pneumonia; they are connected to the host and to the environment; their combination with the infectious agent causes the infective event.

Prophylactic antibiotics and the insertion of permanent transvenous cardiac pacemakers

Prophylactic antibiotics are prescribed frequently for patients requiring permanent transvenous cardiac pacemakers, despite a paucity of data indicating effectiveness. A 10 year retrospective analysis was performed of 298 pacemaker insertion procedures involving 204 patients. On the basis of prestudy criteria relating to timing and dosage of antibiotics, the use of prophylactic antibiotics was judged as adequate or inadequate. There were no postoperative infections in the 108 battery pack replacement procedures despite no or inadequate use of antibiotics in 49 procedures. There were nine infections in the 190 battery pack plus pacing wire procedures for an infection rate of 5 percent. There was no significant difference in infection rate between the group given prophylactic antibiotics and the group given no or inadequate prophylactic antibiotics. Of the 190 battery pack plus pacing wire procedures, no infections occurred in the 50 procedures in which surgical drains were not used (p less than 0.003). In the 140 procedures in which drains were used, there was no correlation between wound infection and absent or inadequate coverage with prophylactic antibiotics. Two severe bacteremic Staphylococcus aureus infections occurred in two patients not given prophylactic antibiotics. The other seven infections were clinically indolent. These results suggest the following: (1) There is no need for prophylactic antibiotics in battery pack replacement procedures; (2) prophylactic antibiotics may decrease the severity of infection in battery pack plus pacing wire procedures; (3) surgical drains should be avoided in battery pack plus pacing wire procedures. A prospective controlled study is necessary to confirm these results.

Management of supratentorial intracranial abscess: a review of 200 cases.

TWO HUNDRED CASES OF INTRACRANIAL SUPRATENTORIAL ABSCESS HAVE BEEN REVIEWED: 100 spanned the years 1951 to 1957, and 100 the years 1962 to 1967. The mortality rate of 40% was the same in both series, chiefly owing to continuing inaccurate localization of the abscess and inadequate use of antibiotics. The hazards of lumbar puncture are real, and this procedure is contra-indicated when convulsions, signs of a hemisphere disturbance, or papilloedema are present. Of the methods for localizing intracranial abscess the site of E.N.T. sepsis, ventriculography, and brain scanning were found to be the most valuable. Penicillin in high dosage continues to be the most important antibiotic. The results of assiduously repeated burrhole aspiration compare favourably with those of later excision.