Second-line Antimicrobials Research Articles

Trends and disease burden of enteric fever in Guangxi province, China, 1994-2004.

To determine the burden of enteric fever through trends in morbidity and mortality, bacterial species and antimicrobial resistance in Guangxi, a southern, subtropical, coastal province of China with a disproportionally large burden of enteric fever. Data on morbidity and mortality caused by enteric fever between 1994 and 2004 were extracted from the Guangxi Center for Disease Control and Prevention. Laboratory-based surveillance and outbreak investigations were integrated with reports of notifiable infectious diseases to estimate the bacterial species-specific incidence of enteric fever. To adjust for underreporting, survey data were collected from three prefectures that represent the hyper-, moderate- and low-endemic regions of Guangxi province. In Guangxi province, enteric fever incidence rate varied over the study period, with a peak of 13.5 cases per 100 000 population in 1995 and a low of 6.5 in 2003. The disease occurred most frequently during the summer and autumn months and in the group aged 10-49 years. The incidence of enteric fever varied by region within Guangxi province. During the 11-year period covered by the study, 61 outbreaks of enteric fever were reported, and Salmonella paratyphi A (SPA) became the predominant causative agent in the province. Prospective studies may provide a better understanding of the reason for the shifting epidemiology of enteric fever in Guangxi province. Given the emergence of resistance to first- and second-line antimicrobials for the treatment of enteric fever, a bivalent vaccine against both SPA and S. typhi would facilitate for disease control.

Use of antibacterial drugs in Jesenice General hospital in years 1998 to 2004

Background: Continuous monitoring of drug consumption is an important strategy for prudent and cost-effective use of drugs. Antimicrobials are among the most prescribed drugs in outpatient practice and in hospital care. In most cases antimicrobials are improperly prescribed or are even misused. Irrational use of antimicrobials is clinically ineffective and leads to higher treatment costs. Clinical ineffectiveness due to irrational use additionally leads to loss of confidence in antimicrobial drugs, unnecessary exposure of patients and development of antimicrobial resistance. Antimicrobial resistance has become a major global health problem as it presents an imperative for development of new potent antimicrobials which are necessarily associated with markedly higher treatment costs. Material and methods: This survey was focused on rational prescribing of antimicrobial drugs. The data on consumption of antimicrobials for various clinical departments of the Jesenice General Hospital were collected by the hospital pharmacy. WHO ATC 2005 classification system, which ranks antimicrobials in a large group J01: drugs for systemic treatment of bacterial infections and Defined Daily Dose as a measuring unit according to the WHO ATC/DDD methodology was used. Antimicrobial use at the Jesenice General Hospital in the period between 1998 and 2004 was estimated by the Department of Infectious Diseases, Medical Centre Ljubljana as a part of European Surveillance on Antibiotic Consumption project (ESAC). Statistical part of survey was performed by the Chair of Biopharmaceutics and Pharmacokinetics, Faculty of Pharmacy, University of Ljubljana. Results: After year 2000 a trend of decrease in antimicrobial consumption was observed. Compared to European Surveillance on Antibiotic Consumption results in the year 2003 higher usage of penicillins with extended spectrum, fluoroquinolones and 3rd generation cephalosporins in Slovenian hospitals was estimated. These three groups of antimicrobials were also among the most frequently prescribed antimicrobials at the Jesenice General Hospital. However, the increase of their use during the observation period in our study was not significant. On the other hand significant decrease in consumption of cephalosporins was observed in correlation with increased consumption of aminoglycosides. According to the observed proportions of various antimicrobial groups in the total consumption of the ATC group J01 drugs, it can be concluded that their prescribing was appropriate for empirical treatment, especially since the use of second-line antimicrobials (glycopeptides, carbapenems and 4th generation cephalosporins) was low. Conclusions: At the Jesenice General Hospital combinations of penicillins with beta-lactamase inhibitors are still overused and should be replaced with the increased empirical prescribing of amoxicillin or ampicillin when possible. Additionally, de-escalation methodology of empirically prescribed wide spectrum antimicrobials according to antibiotic susceptibility results of isolated bacteria should be improved. 2nd generation instead of 3rd generation cephalosporins should be used preferentially whenever possible, especially in cases of switching to peroral antimicrobial treatment. In the future continuous participation in the European Surveillance on Antibiotic Consumption project should be assured and according to its results appropriate strategy of prudent antimicrobials use at the Jesenice General Hospital should be developed.

Frequency of antimicrobial resistance among invasive and colonizing Group B streptococcal isolates.

BackgroundGroup B Streptococcus (GBS) remains susceptible to penicillin, however, resistance to second-line antimicrobials, clindamycin and erythromycin, has increased since 1996. We describe the age-specific antibiotic susceptibility profile and capsular type distribution among invasive and colonizing GBS strains.MethodsWe tested 486 invasive GBS isolates from individuals of all ages collected by a Wisconsin surveillance system between 1998 and 2002 and 167 colonizing strains collected from nonpregnant college students during 2001 in Michigan. Antimicrobial susceptibility testing was performed by disk diffusion or Etest and capsular typing was performed using DNA dot blot hybridizationResults20.0% (97/486) of invasive and 40.7% (68/167) of colonizing isolates were resistant to clindamycin (P < .001) and 24.5% (119/486) of invasive and 41.9% (70/167) of colonizing isolates were resistant to erythromycin (P < .001). Similarly, 19.8% (96/486) of invasive and 38.3% (64/167) of colonizing isolates were resistant to both antimicrobial agents (P < .001). 29.4% (5/17) of invasive isolates from persons 18–29 years of age and 24.3% (17/70) of invasive isolates from persons 30–49 years of age were resistant to clindamycin. Similarly, 35.3% (6/17) of invasive isolates from persons 18–29 years of age and 31.4% (22/70) of invasive isolates from persons 30–49 years of age were resistant to erythromycin. 34.7% (26/75) of invasive isolates from persons < 1 year of age were capsular type Ia, whereas capsular type V predominated among isolates from adults.ConclusionClindamycin and erythromycin resistance rates were high among isolates colonizing nonpregnant college students and invasive GBS isolates, particularly among the colonizing isolates. Susceptibility profiles were similar by age although the proportion of clindamycin and erythromycin resistance among invasive isolates was highest among persons 18–49 years of age. Increasing antimicrobial resistance has implications for GBS disease treatment and intrapartum prophylaxis among penicillin intolerant patients.

Antimicrobial management strategies for patients with community-acquired respiratory tract infections

Key factors in the selection of first- and second-line antimicrobials in the management of patients with community-acquired respiratory tract infections include spectrum of activity against common respiratory tract pathogens, blood and tissue pharmacokinetics, efficacy in the management of a wide variety of respiratory tract infections, incidence of adverse events, and dosing regimen. On the basis of these factors, the following antimicrobial formulary and algorithm for management of patients with community-acquired respiratory tract infections can be suggested: sinusitis—first-line, amoxicillin; second-line, amoxicillin/clavulanate or clarithromycin; acute bacterial exacerbation of chronic bronchitis—first-line, amoxicillin, erythromycin, or the tetracyclines; second-line, cefuroxime axetil or clarithromycin; outpatient pneumonia in patients without comorbidity who are 60 years of age or younger—first-line, erythromycin or the tetracyclines; second-line, clarithromycin; and pharyngitis—first-line, penicillin or erythromycin; second-line, cefuroxime axetil or clarithromycin.