Tract Infections In Outpatients Research Articles

Antimicrobial prescription pattern and appropriateness for respiratory tract infection in outpatients: a systematic review and meta-analysis

BackgroundMillions of people die every year as a result of antimicrobial resistance worldwide. An inappropriate prescription of antimicrobials (e.g., overuse, inadequate use, or a choice that diverges from established guidelines) can lead to a heightened risk of antimicrobial resistance. This study aimed to determine the rate and appropriateness of antimicrobial prescriptions for respiratory tract infections.MethodsThis review was conducted in accordance with the PRISMA guidelines. Web of Science, PubMed, ProQuest Health and Medicine, and Scopus were searched between October 1, 2023, and December 15, 2023, with no time constraints. Studies were independently screened by the first author and the co-authors. We included original studies reporting antimicrobial prescription patterns and appropriateness for respiratory tract infections. The quality of included studies’ was assessed via the Joanna Briggs Institute’s Critical Appraisal Checklists for Cross-Sectional Studies. The assessment of publication bias was conducted using a funnel plot and Egger’s regression test. A random effect model was employed to estimate the pooled antibiotic prescribing and inappropriate rates. Subgroup analysis was conducted by country, study period, data source, and age group.ResultsOf the total 1220 identified studies, 36 studies were included in the review. The antimicrobial prescribing rate ranged from 25% (95% CI 0.24–0.26) to 90% (95% CI 0.89–0.91). The pooled antimicrobial prescription rate was 66% (95% CI 0.57 to 0.73). Subgroup analysis by region revealed that the antimicrobial prescription rate was highest in Africa (79%, 95% CI 0.48–0.94) and lowest in Europe (47%, 95% CI 0.32–0.62). Amoxicillin and amoxicillin-clavulanate antimicrobials from the Access group, along with azithromycin and erythromycin from the Watch group, were the most frequently used antimicrobial agents. This study revealed that the major reasons for antimicrobial prescription were acute bronchitis, pharyngitis, sinusitis, and the common cold. The pooled inappropriate antimicrobial prescription rate was 45% (95% CI 0.38–0.52). Twenty-eight of the included studies reported that prescribing antimicrobials without proper indications was the main cause of inappropriate antimicrobial prescriptions. Additionally, subgroup analysis by region showed a higher inappropriate antimicrobial prescription rate in Asia at 49% (95% CI 0.38–0.60). The result of the funnel plot and Egger’s tests revealed no substantial publication bias (Egger’s test: p = 0.268).ConclusionThe prescribing rate and inappropriate use of antimicrobials remain high and vary among countries. Further studies should be conducted to generate information about factors contributing to unnecessary antimicrobial prescriptions in outpatients.Systematic review registrationSystematic review registration: CRD42023468353.

Risk factor analysis for urinary tract infection in outpatients at a hospital in Subang, Indonesia

Background: Urinary Tract Infection (UTI) is considered an infectious disease with a high incidence rate; this is due to the individual’s lifestyle, which is a factor in the occurrence of UTI. To reduce the incidence of UTI, it can be done by knowing the risk factors that can influence the occurrence of UTI with individual awareness and practicing good habits. Purpose: to analyze the risk factors for urinary tract infection in outpatients. Methods: This research used quantitative research with a cross-sectional design that has been carried out on 89 patients who came for treatment at the Urology Polyclinic at RSUD Subang, using purposive sampling through a questionnaire on risk factors and symptoms of UTI, and then the data was analyzed using multiple linear regression tests. Results: The results of the study found that there is a relationship between age, gender, urinary retention habits, genital hygiene, and drinking habits and the incidence of UTI, with a P-value of 0.000 (P < 0.05). Conclusion: Age, gender, urinary retention habits, genital hygiene, and water drinking habits are risk factors for urinary tract infections both independently and simultaneously. Screening for UTI in outpatients, Geriatric age, female gender, urinary retention habits, bad genitourinary tract hygiene, and less water intake should be adopted.

Age-Specific Cutoffs of the Sysmex UF-1000i Automated Urine Analyzer for Rapid Screening of Urinary Tract Infections in Outpatients.

We investigated the usefulness of age-specific cutoffs for screening of urinary tract infections (UTIs) in Korean outpatients, using the automated urine analyzer UF-1000i (Sysmex, Kobe, Japan). We retrospectively reviewed outpatient medical records. Urine samples of 7,443 outpatients from January 2010 to December 2017 were analyzed using urine culture and UF-1000i. ROC curves were calculated for each UF-1000i parameter based on the culture results. There were 1,398 culture positive samples, 5,774 culture negative samples, and 271 contaminated samples. UF-1000i had an area under the curve of ≥0.9 in outpatients >15 years. The appropriate cutoffs, which are the sum of bacterial (B-A-C) and white blood cell (WBC) counts, were 297.10/µL (15–24 years), 395.65/µL (25–44 years), 135.65/µL (45–64 years), 67.95/µL (65–74 years), and 96.5/µL (≥75 years). B-A-C and WBC counts differed among the three most frequently identified bacteria (Escherichia coli, Klebsiella pneumoniae, and Enterococcus faecalis). The UF-1000i system is useful for applying age-specific cutoffs to screen for UTIs, thereby preventing antibiotic abuse and reducing antibiotic resistance. Future studies can explore how its B-A-C and WBC counts can facilitate selection of empirical antibiotics by distinguishing between gram-positive and gram-negative bacteria.

Drug utilization pattern in out-patients with respiratory tract infections in a rural teaching hospital: a prospective observational study

Background: Respiratory tract infections are common clinical problems in the general population. Antimicrobials are the mainstay in the management and irrational use of them may increase resistance to bacteria and the total cost of treatment. Objectives: To evaluate the pattern of drug prescriptions for respiratory tract infections in Medicine and Pediatric outpatient departments of a rural teaching hospital.Methods: Over a period of 18 months, 391 prescriptions of outpatients with respiratory tract infection were collected. The drugs prescribed, their dose and duration of treatment were recorded. DU 90% was calculated.Results: The mean (±SEM) age of the patients was38.55±0.9 years and there were 204 (52.1%) men and 187 (42.1%) women. The most common disorder among the patients was acute rhinitis (61.1%) while the least common was acute bronchitis (1.3%). Microbial culture and sensitivity was done in 23 patients and Klebsiella pneumonia (8.2%) and enterococcus (0.07%) was the most common and least common organism respectively. Penicillins (50.9%), cephalosporins (26.7%), antitubercular drugs (8.5%), macrolides (4.8) constituted DU 90%. Monotherapy was advocated in 91.7% and multidrug therapy in 8.3% of patients. The average number of antimicrobials prescribed per prescription was 0.52. Two thirds (67.6%) of the prescribed drugs were from the national list of essential medicines 2011 (NLEM).Conclusions: Penicillins and cephalosporins were the commonly used antibiotics for respiratory tract infection in outpatients of a rural teaching hospital and two thirds of the prescribed drugs were essential medicines.

Effect of diabetes mellitus on postoperative endoscopic sinus surgery outcomes.

Endoscopic sinus surgery (ESS) has become the treatment of choice for a variety of nasal conditions. The purpose of this study was to analyze the effect of diabetes mellitus (DM) on postoperative outcomes in ESS. Data on endoscopic sinus surgery performed from 2005 to 2013 were collected from the American College of Surgeons National Surgical Quality Improvement (ACS-NSQIP) database. Two groups were created, based on the presence of a DM diagnosis, and were analyzed for preoperative variables, comorbidities, and postoperative complications using SPSS statistical software. There were 644 patients included in the analysis, 85 of whom (13.2%) had a diagnosis of DM. Patients with DM were more likely to have higher rates of preoperative dyspnea and hypertension. After accounting for confounding factors, DM patients undergoing ESS were at higher risk of overall medical complications, pneumonia, unplanned reintubation, ventilator use of >48 hours, and mortality. However, after separating patients into outpatient and inpatient groups, DM was found to be an independent predictor of urinary tract infection in outpatients and of ventilator use >48 hours in inpatients. DM patients undergoing ESS are at increased risk for postoperative medical complications. However, DM does not appear to increase the postoperative surgical complication rate in this population. Furthermore, DM does not appear to have an impact on ESS mortality, readmission, or reoperation rates.

Prevalence and current antibiogram trend of bacterial isolates of urinary tract infections in outpatients at Helping Hands Community Hospital, Kathmandu, Nepal

Prevalence and current antibiogram trend of bacterial isolates of urinary tract infections in outpatients at Helping Hands Community Hospital, Kathmandu, Nepal

ANTIMICROBIAL RESISTANCE OF ESCHERICHIA COLI STRAINS ISOLATED FROM URINE AT OUTPATIENT POPULATION: A SINGLE LABORATORY EXPERIENCE.

Objectives:The aim of this study was to examine antimicrobial resistance of Escherichia coli strains isolated from urine in outpatient population.Material and methods:We performed a retrospective study for tree months period, between January 1st and March 31st, 2015, at the Department of Microbiology and Parasitology, Faculty of Medicine, University of Sarajevo. We determined the E. coli antimicrobial resistance in 556 first urine samples from outpatient population of Hrasno community in Sarajevo, Bosnia and Herzegovina. E. coli is the most frequent agent causing urinary tract infections in outpatients as well. The standard methods of descriptive statistics were performed for data analysis.Results:We observed the highest antimicrobial resistance of E. coli for ampicillin (82,79%), followed by trimethoprim-sulfamethoxazole (40,86%), nalidixic acid (19,35%), cephazolin (7,52%), nitrofurantoin (5,37%), gentamicin (2,15%) and ciprofloxacin (4,30%).Conclusions:The results of study showed that E. coli has the highest resistance to ampicillin and trimethoprim-sulfamethoxazole in outpatient population of Hrasno community.

Pathogens Causing Upper Respiratory Tract Infections in Outpatients.

The aim of the present study was to determine the results of typical and atypical bacteria microbiological tests in patients with symptoms of chronic cough. We investigated 230 outpatients aged from 1 to 83 years (112 female, 72 male, and 46 children) who were free of any respiratory tract infection at the time of study. The material for the investigation consisted of pharyngeal swabs. Two hundred and thirty pharyngeal swabs were examined for Chlamydia pneumoniae antigen and for typical pathogens each. Chlamydia pneumoniae antigen was detected using an indirect immunofluorescence test and classical microbiological culture was used for the detection of typical bacteria. The antigen was found in 44/230 (19.1 %) patients with chronic cough (23 women, 13 men, and 8 children). Positive culture for typical pathogens was observed in 65/230 (28.3 %) patients (37 women, 14 men, and 14 children). Simultaneous occurrence of Chlamydia pneumoniae and typical pathogens such as Staphylococcus aureus, Streptococcus pyogenes, Moraxella catarrhalis, and Haemophilus influenzae, was observed in 11/230 (4.8 %) patients. The results show that in patients with chronic cough Chlamydia pneumoniae is detected less frequently than the typical pathogens are. A search for atypical bacteria in patients with chronic cough is needed to be able to conduct effective and sufficiently long therapy.

Prevalence of extended-spectrum beta-lactamase producing Escherichia coli in community-onset urinary tract infections in France in 2013

We sought to assess the importance of extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae in urinary tract infections in outpatients in France. Retrospective laboratory based survey analysing susceptibility patterns of Escherichia coli and Klebsiella pneumoniae isolates providing from urines collected from outpatients during three months in 2013. Four hundred and ninety-nine laboratories collected data on 51,643 E. coli and 3495 K. pneumoniae isolates. The overall proportion of ESBL-producing E. coli was 3.3%. The proportion was higher for males (4.8%) than for females (3.0%) and increased with age: 2% for patients <20 years to 5.4% for those aged >80 years. More than 95% of isolates we susceptible to cefixime, fosfomycin, and nitrofurantoin. In nursing homes, the ESBL-producing E. coli proportion was 12.1%. For K. pneumoniae, the proportion of ESBL-positive isolates was 6.6%, and this proportion increased with age. Data from 2010 collected from a subset of the network showed that the ESBL-producing E. coli proportion was 2.0%. ESBL-producing isolates were rather frequent in urines in French outpatients in 2013. Males and persons residing in nursing homes were at higher risk of ESBL-positive infection. Despite the increase in ESBL-positive isolates, the susceptibility to antibiotics used to treat cystitis remains high.

Susceptibility to β-lactams and quinolones of Enterobacteriaceae isolated from urinary tract infections in outpatients.

The antibiotic susceptibility profile was evaluated in 71 Enterobacteriaceae isolates obtained from outpatient urine cultures in July 2010 from two health institutions in Santa Fe, Argentina. The highest rates of antibiotic resistance were observed for ampicillin (AMP) (69%), trimethoprim/sulfamethoxazole (TMS) (33%), and ciprofloxacin (CIP) (25%). Meanwhile, 21% of the isolates were resistant to three or more tested antibiotics families. Thirty integron-containing bacteria (42.3%) were detected, and a strong association with TMS resistance was found. Third generation cephalosporin resistance was detected in only one Escherichia coli isolate, and it was characterized as a bla CMY-2 carrier. No plasmid-mediated quinolone resistance (PMQR) was found. Resistance to fluoroquinolone in the isolates was due to alterations in QRDR regions. Two mutations in GyrA (S83L, D87N) and one in ParC (S80I) were observed in all CIP-resistant E. coli. It was determined to be the main phylogenetic groups in E. coli isolates. Minimum Inhibitory Concentration (MIC) values against nalidixic acid (NAL), levofloxacin (LEV), and CIP were determined for 63 uropathogenic E. coli isolates as MIC50 of 4 μg/mL, 0.03125 μg/mL, and 0.03125 μg/mL, respectively, while the MIC90 values of the antibiotics were determined as 1024 μg/mL, 64 μg/mL, and 16 μg/mL, respectively. An association between the phylogenetic groups, A and B1 with fluoroquinolone resistance was observed. These results point to the importance of awareness of the potential risk associated with empirical treatment with both the families of antibiotics.

Comparative Effectiveness of Different Oral Antibiotics Regimens for Treatment of Urinary Tract Infection in Outpatients

Comparative Effectiveness of Different Oral Antibiotics Regimens for Treatment of Urinary Tract Infection in Outpatients

Urinary Tract Infections: Leading Initiatives in Selecting Empiric Outpatient Treatment (UTILISE).

Overuse of fluoroquinolone antibiotics is associated with outbreaks of methicillin-resistant Staphylococcus aureus and of Clostridium difficile-associated diarrhea and increasing resistance in gram-negative organisms. Over the past decade, resistance of Escherichia coli to ciprofloxacin has increased in the Regina Qu'Appelle Health Region. In August 2011, an exploratory audit of the Regina General Hospital (RGH) emergency department showed that 20% of new antibiotic orders were for fluoroquinolones, and 60% of these new fluoroquinolone orders were for ciprofloxacin. It was postulated that ciprofloxacin was predominantly prescribed for outpatients with urinary tract infection. To develop, implement, and evaluate a best-practice algorithm for the empiric treatment of uncomplicated urinary tract infection in the RGH emergency department, as part of an educational initiative for emergency physicians. A literature review was conducted and local antibiogram data were analyzed to establish a best-practice algorithm for treatment of uncomplicated urinary tract infection in outpatients seen in the emergency department. A chart review was conducted from January to March 2011 to establish a baseline of empiric antibiotic use. An educational strategy targeting emergency physicians described changes in antibiotic resistance patterns in the health region, principles of antimicrobial stewardship, drivers of resistance, and the results of a literature review of best practice for urinary tract infection in outpatients. A post-intervention audit was conducted from January to March 2012 to determine changes in practice. Comparison of results from the post-intervention audit with baseline data showed that adherence to best practice increased significantly, from 41% (39/96) before the intervention to 66% (50/76) after the intervention (odds ratio [OR] 2.81, 95% confidence interval [CI] 1.51-5.25; p < 0.001). There was also a significant change in overall antibiotic selection (OR 0.25, 95% CI 0.11-0.58; p < 0.001). Further analysis suggested that this significant change was driven by a decrease in use of ciprofloxacin, from 32% (31/96) to 11% (8/76). Creation of a best-practice algorithm and education focused on emergency physicians significantly increased adherence to best practice and optimized antibiotic prescribing for outpatients with uncomplicated urinary tract infection by limiting overuse of fluoroquinolones, primarily ciprofloxacin.

Prevalence and antimicrobial susceptibility of extended-spectrum beta-lactamase producing urinary isolates of Escherichia coli in outpatients

In Gram-negative bacteria, the production of beta-lactamases is the most important mechanism of resistance to beta-lactam antibiotics. In the Banja Luka region, there were no extensive researches on the prevalence and antimicrobial resistance of the extended-spectrum beta-lactamase (ESBL) producing Escherichia coli (E. coli) isolates. The aim of the present study was to determine the presence of ESBL producing E. coli isolates as the cause of the urinary tract infections in outpatients, the distribution of these ESBL isolates according to age and gender of patients and their susceptibility to antimicrobials. Urine specimens obtained from outpatients were cultured on chromogenic CPS-ID3 media. All plates showing significant (> 10(5) cfu/ml) growth of E. coli in pure culture were further processed. Antimicrobial susceptibility testing was performed on VITEK TWO Compact using AST-GN27 cards for testing Gram negative bacteria and detection of ESBL producers. Out of 2,195 isolates, 177 (8.1%) were ESBL producers. Ninety-two isolates were obtained from female patients (5% of E. coli isolated from women) and 85 isolates from male patients (23% of E. coli isolated from men). High percentage of ESBL isolates was detected in the infant age group under one year (36.7%) and in the age group over 60 years (28.8%). All ESBL isolates were susceptible to imipenem and resistant to ampicillin, piperacillin, cefazolin, cefotaxime, ceftazidime and cefepime. There was a significant resistance to amikacin (79.1%), gentamicin (76.8%), amoxicillin/clavulanate (54.8%) and trimethoprim/sulphamethoxazole (45.8%). Resistance to nutrofurantoin was 13.6%. This study has demonstrated the presence of ESBL producing E. coli urinary isolates in outpatients, and their extensive susceptibility to imipenem and nitrofurantoin.

Antibiotic prescription by general practitioners for urinary tract infections in outpatients

In July 2008, in France, guidelines for antibiotic prescriptions for urinary tract infections (UTIs) were amended. As general practitioners (GPs) treat numerous UTIs, we wanted to evaluate whether they followed these guidelines. In order to do this, we performed a prospective study. The point of call was urinalyses. Using this selection method together with criteria diagnostic for urinalysis, we confirmed that patients presented a UTI. Each GP was contacted. Prescriptions were analysed and compared to the 2008 French guidelines for UTIs. Our study included 185 urinalyses. UTIs diagnosed by GPs were as follows: acute cystitis: 72.4%, prostatitis: 13.5%, nephritis: 8.7% and asymptomatic bacteriuria: 5.4%. The principal antibiotics used were: quinolone (59.5%), furan (17.8%) and cotrimoxazole (6.5%). Only 20% of the prescriptions were compliant with the guidelines. The correct antibiotic but not the dose or the duration of prescription was selected in 8.1% of the prescriptions. For cystitis, inappropriate prescription was associated with an extra cost of 694 <euro>, namely, 7.4 <euro> per treatment. GP prescriptions for UTIs do not follow the guidelines. Even if GPs assert that they are aware of the emergence of resistant strains, it seems that they do not take into account the objective of quinolone restriction, which was one of the backbones of these guidelines.

Antimicrobial susceptibility patterns of community-acquired uropathogens in Tehran, Iran

Antibiotic resistance of urinary tract pathogens has increased worldwide. Knowledge of the antibiotic resistance patterns of uropathogens in specific geographical locations is an important factor for choosing an appropriate empirical antimicrobial treatment. The aim of this study was to provide information regarding local resistance patterns of urinary pathogens to the commonly used antibiotics in Tehran, Iran. Urine samples collected and submitted to two pathobiology laboratories in Tehran were identified by conventional methods over a period of three years (December 2006 to May 2009). Antimicrobial resistance testing was performed by the standard disk diffusion technique in accordance with the recommendations of the Clinical and Laboratory Standards Institute. Of the total 13,333 mid-stream urine samples collected from suspected cases of urinary tract infection, 840 (6.3%) were positive for pathogenic bacteria. Escherichia coli (E. coli) was the most common isolate (68.8%) followed by Proteus spp. (12.4%), and Klebsiella spp. (9.6%). E. coli isolates were mostly susceptible to nitrofurantoin (71.3%), followed by ciprofloxacin (68.1%); however, only 38.2% of E. coli isolates were susceptible to trimethoprim-sulfamethoxazole. Nitrofurantoin may be considered as a first-line empiric antibacterial agent for urinary tract infections in outpatients in Tehran, Iran.

POS-01.28: Changes in causative organisms and antimicrobial sensitivity of the urinary tract infection

We investigated the major pathogens of urinary tract infections in outpatients and inpatients, in whom significant bacilli were identified in urine culture tests conducted at the present hospital, and the antibiotic susceptibility of the pathogens in order to help the treatment of urinary tract infections.

Susceptibilities among bacterial pathogens isolated from patient groups frequently admitted to the emergency department, 2003-2004

Study objectives: Community-acquired pneumonia, hospital-acquired pneumoniae, skin and soft tissue infections, and urinary tract infections can be caused by a variety of Gram-positive and Gram-negative bacterial pathogens, often requiring physicians to use empiric therapy, especially when patients are encountered in the emergency department (ED). We reviewed recent in vitro susceptibility for ceftriaxone, fluoroquinolones, other β-lactams, and clinically relevant comparators. Methods: Susceptibility data from January 2003 to February 2004 were analyzed from the Surveillance Network Database-USA, an electronic network that collects data from more than 300 microbiology laboratories in the United States. Data were analyzed for Streptococcus pneumoniae (SP), Streptococcus pyogenes (SPY), oxacillin-susceptible Staphylococcus aureus (OSSA), Haemophilus influenzae (HI), Klebsiella pneumoniae (KP), and Escherichia coli (EC) isolates from lower respiratory tract, skin and soft tissue, and urinary tract infections of outpatients aged 18 years or older, hospitalized patients including ICU patients aged 18 years or older, and elderly (≥65 years) nursing home patients. National Committee for Clinical Laboratory Standards (2004) breakpoints were used to interpret as susceptible or resistant. Results: Resistance rates for lower respiratory tract infections among SP ICU patients and outpatients (n=2,863; 1,038), respectively, for amoxicillin-clavulanate (0.6, 1.5%), levofloxacin (1.7, 1.4%), and ceftriaxone (1.4, 0.9%) were the lowest of the agents tested. For SP from ICU patients and outpatients, penicillin resistance was greater than 16% and macrolide resistance was greater than 31%. For HI from ICU patients and outpatients (n=1,116 and 440), all isolates were susceptible to ceftriaxone and levofloxacin. Resistance rates were less than 5% for amikacin, cefepime, and ceftriaxone among lower respiratory tract infections for ICU patients and outpatients among KP (n=4,431 and 703) and EC (n=3,076 and 473), whereas fluoroquinolone resistance rates were greater than 9% among KP and greater than 29% among EC. For SST, 46.7% (n=31,726) and 57.1% (n=32,832) of SA were oxacillin-susceptible from ICU patients and outpatients, respectively. Among OSSA, 100% of ICU patient (n=2,082) and 99.6% of outpatient (n=2,082) isolates tested were susceptible to ceftriaxone. For skin and soft tissue infections, 100% of SPY were susceptible to ceftriaxone, cefepime, levofloxacin, and penicillin. For SST, resistance ranged from 1% to 3% for ceftriaxone and 15% to 24% for fluoroquinolones for EC and from 2% to 4% for ceftriaxone and 7% to 11% for fluoroquinolones for KP. According to resistance rates for urinary tract infection, amikacin, cefepime, and ceftriaxone were the most active agents tested, regardless of ICU patient or outpatient status. This same trend was seen for EC and KP from urinary tract infection of elderly patients in nursing homes. Conclusion: The prevalence of resistance varies by organism and drug. Traditional broad-spectrum cephalosporins such as ceftriaxone retain activity to a wide range of pathogens associated with infections commonly encountered in the ED, including resistant SP and HI. Of concern is the frequent occurrence of fluoroquinolone resistance for EC, as great as 32% for lower respiratory tract infections, 24% for skin and soft tissue infections, and 33% for nursing home urinary tract infections, in addition to the high prevalence of oxacillin resistance among SA from skin and soft tissue infections. These data confirm the importance of antibiograms in selecting appropriate therapies in the ED.

Clinical Efficacy of Newer Agents in Short-Duration Therapy for Community-Acquired Pneumonia

Streptococcus pneumoniae, the most important respiratory tract pathogen implicated in community-acquired pneumonia (CAP), is becoming increasingly resistant in vitro to the beta -lactams and macrolides, and fluoroquinolone resistance has been detected. A growing body of evidence suggests that prolonged antimicrobial use may contribute directly and indirectly to increased antimicrobial resistance among common respiratory pathogens. Long-term exposure to antimicrobial agents, especially less-potent agents, directly increases selection pressure for resistance. Indirectly, poor patient compliance, multiple daily dosing, and the increased risk of adverse events further complicate the resistance issue and diminish the efficacy of long-term antimicrobial use. Controlled clinical trials addressing the appropriate duration of therapy for CAP are lacking. However, available data suggest that with appropriate antibiotic selection, based on appropriate spectrum, potency, and pharmacokinetic/pharmacodynamic profile, lower respiratory tract infections in outpatients can be successfully treated in <7 days rather than the 7-14 days currently recommended.

Antibiotic resistance in Streptococcus pneumoniae, Haemophilus influenzae and Streptococcus pyogenes in respiratory tract infections in outpatients.

Sensitivity patterns of Streptococcus pneumoniae, Haemophilus influenzae and Streptococcus pyogenes were studied prospectively in an outpatient population seeking medical advice for respiratory tract infections (RTI) in the Southern parts of Stockholm. In total, 3,214 nasopharyngeal and 1,907 throat swabs were cultured during January-February 1996. 32% of the patients had received antibiotics during the previous year. Reduced penicillin sensitivity in S. pneumoniae was rare (1.3%) and only seen in patients treated with antibiotics during the previous 4 months. Beta-lactamase production in H. influenzae was found in 13.4% of patients who had been treated with antibiotics during the last 4 months and in 7.9% of the others. No resistance (< 1%) to erythromycin was seen in S. pyogenes. In this population-based surveillance, the levels of resistance in common respiratory tract pathogens were thus low and correlated to previous antibiotic treatment. Strict indications for antibiotic treatment in uncomplicated RTI are advocated to maintain a low resistance rate. Penicillin is still the drug of choice in patients without frequent recurrences of RTI in a setting similar to the one studied.

Efficacy and tolerance of norfloxacinin treatment of complicated urinary tract infection in outpatients with neurogenic bladder secondary to spinal cord injury

We studied the efficacy of a fourteen-day course of the fluoroquinolone, norfloxacin, in a group of 69 catheter-free spinal cord injury (SCI) outpatients who experienced a total of seventy-nine urinary tract infection (UTI) episodes. A total of 114 bacterial strains representing twenty species, including sixteen Pseudomonas aeruginosa, all susceptible to norfloxacin, were isolated from initial urine cultures. Mid-treatment cultures in 58/79 (73%) cases were negative. Cultures taken five to seven days after completing treatment in 42 cases (53%) were negative. In the remaining 37 there was persistence of initial or superinfecting pathogen(s), or early reinfection with new organisms. Cultures eight to twelve weeks later in 32 cases with initial eradication showed that 27 (84%) had either relapsed and/or become reinfected. Clinical cure occurred in 4/6 (67%) symptomatic episodes. Side effects occurred in 6 of 73 (8%) patients who received norfloxacin, 4 of whom required withdrawal from the study. Twenty of one hundred twenty-two (16%) bacterial strains isolated during or after treatment were resistant to norfloxacin. Given the limited oral treatment options and the constant risk of reinfection in the SCI population, norfloxacin appears to be a reasonable choice in many patients. However, as with other antimicrobials, when using norfloxacin in SCI patients, the emergence of resistant bacteria must be carefully monitored.