J Gen Intern Med. 1999 Mar;14(3):151-6.
The relation between purulent manifestations and antibiotic treatment of upper respiratory tract infections.

Gonzales R, Barrett PH Jr, Steiner JF.

Division of General Internal Medicine, University of Colorado Health Sciences Center, Denver, Colo. 80262, USA.

OBJECTIVE: To describe the clinical features of patients diagnosed with upper respiratory tract infections (URIs), and determine which clinical features are associated with antibiotic use. DESIGN: Prospective cohort study. SETTING: Three ambulatory care practices at a group-model HMO in the Denver metropolitan area. PATIENTS: Adults (aged 18 years or older) seeking care for acute respiratory illnesses. MEASUREMENTS: Clinical features were documented on standardized encounter forms. Clinician type, secondary diagnoses, and antibiotic treatment were extracted from administrative databases. Results are presented as adjusted odds ratios (ORs) with 95% confidence intervals (CIs). MAIN RESULTS: Antibiotics were prescribed to 33% (95% CI 28%, 38%) of patients diagnosed with URI, after excluding patients with coexisting antibiotic-responsive conditions (e.g., sinusitis, pharyngitis) or a history of cardiopulmonary disease. Multivariate logistic regression analysis identified tobacco use (OR 2.8; 95% CI 1.5, 5.1), history of purulent nasal discharge (OR 2.0; 95% CI 1.1, 3.6) or green phlegm (OR 4.8; 95% CI 2.1, 11.1), and examination findings of purulent nasal discharge (OR 5.2; 95% CI 2.4, 11.2) or tonsillar exudate (OR 3.7; 95% CI 1.1, 12.1) to be independently associated with antibiotic use. The majority of patients treated with antibiotics (82%) had at least one of these factors present. CONCLUSIONS: Antibiotic treatment of URIs is most common when purulent manifestations are present. Efforts to reduce antibiotic treatment of URIs should educate clinicians about the limited value of purulent manifestations in predicting antibiotic-responsive disease.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10203620&dopt=Abstract antibiotic, antibiotics



Aliment Pharmacol Ther. 2003 Jul 15;18(2):209-15.
Antibiotic prophylaxis for percutaneous endoscopic gastrostomy--a prospective, randomised, double-blind trial.

Ahmad I, Mouncher A, Abdoolah A, Stenson R, Wright J, Daniels A, Tillett J, Hawthorne AB, Thomas G.

Department of Gastroenterology, University Hospital of Wales, Heath Park, Cardiff, Wales, UK.

BACKGROUND: Peristomal infection can sometimes complicate percutaneous endoscopic gastrostomy (PEG) placement. Antibiotic prophylaxis has, in some studies, been shown to reduce the incidence. However, the use of prophylaxis varies widely, possibly because the design and findings of the studies have differed, making their relevance to clinical practice difficult to interpret. AIM: To determine the efficacy of antibiotics, either prophylaxis or concurrent antibiotics at the time of the procedure, in reducing peristomal infection after PEG insertion in the context of a study designed to reflect current practice. METHODS: One hundred and forty-one patients undergoing PEG placement were randomised to group one to receive either a single dose of 750 mg of intravenous cefuroxime (n=50) or placebo (n=51) 30 min before PEG insertion. Forty patients who, for various reasons, were already receiving antibiotics were allocated to group two. The peristomal site was evaluated on day 3, 5 and 7 following insertion. Erythema and exudate were scored on a scale from 0 to 4; induration was scored on a scale of 0-3. A maximum combined score of 8 or higher or the presence of pus was criteria for infection. The primary outcome measure was the occurrence of a peristomal wound infection at any time within one week of PEG insertion. RESULTS: Peristomal wound infection was significantly reduced in patients who received antibiotics either as a single dose of cefuroxime [one of 33 (3%)], or in those on antibiotics for prior indications [one of 36 (3%)], compared with placebo [six of 33 (18%)], P=0.04 and 0.03, respectively. CONCLUSION: Antibiotics, either prophylaxis or concurrent, reduce the incidence of peristomal wound infection after PEG placement.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12869081&dopt=Abstract antibiotic, antibiotics [PubMed - in process]



Salud Publica Mex. 2003 May-Jun;45(3):159-64.
Use of antibiotics in upper respiratory infections on patients under 16 years old in private ambulatory medicine.

Pelaez-Ballestas I, Hernandez-Garduno A, Arredondo-Garcia JL, Viramontes-Madrid JL, Aguilar-Chiu A.

Departamento de Investigacion Clinica, Hospital General de Mexico, Mexico, DF, Mexico.

OBJECTIVE: To assess antibiotic use for upper respiratory infections (URI) treatment on patients under 16 years-old who are beneficiaries of a pre-paid health care scheme. MATERIAL AND METHODS: A database containing the record of all the medical prescriptions for URI treatment, from May 1997 to April 1998 was analyzed. Patients were under 16 years old and had been diagnosed with common colds, pharyngitis, bronchitis, sinusitis, otitis, and other unspecified upper respiratory tract infections. Three hundred and fifty-one physicians of seven different specialties who attended 25,300 beneficiaries wrote such prescriptions. RESULTS: A total of 30,889 assorted medications were prescribed to 5,533 patients with the above diagnoses. Antibiotics were prescribed for 77.5% of all diagnoses, ranging from 58% for pharyngitis to 91% for laryngitis. The most frequently used antibiotics were: penicillin, cephalosporins, and macrolides. CONCLUSIONS: This study presents the information of antibiotics prescription practices for URI in a pre-paid health plan in Mexico. These findings may be used to support specific campaigns for rational use of antibiotics among children attended at private ambulatory health care practices.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12870416&dopt=Abstract antibiotic, antibiotics [PubMed - in process]



Environ Microbiol. 2003 Aug;5(8):711-6.
Impact of antibiotics on conjugational resistance gene transfer in Staphylococcus aureus in sewage.

Ohlsen K, Ternes T, Werner G, Wallner U, Loffler D, Ziebuhr W, Witte W, Hacker J.

Institute for Molecular Biology of Infectious Diseases, The University of Wurzburg, Rontgenring 11, D-97070 Wurzburg, Germany. knut.ohlseail.uni-wuerzburg.de

The growing rate of microbial pathogens becoming resistant to standard antibiotics is an important threat to public health. In order to assess the role of antibiotics in the environment on the spread of resistance factors, the impact of subinhibitory concentrations of antibiotics in sewage on gene transfer was investigated using conjugative gentamicin resistance (aacA-aphD) plasmids of Staphylococcus aureus. Furthermore, the concentration of antibiotics in hospital sewage was measured by high-performance liquid chromatography (HPLC)-electrospray tandem mass spectrometry. Several antibiotics were found to be present in sewage, e.g. ciprofloxacin up to 0.051 mgl(-1) and erythromycin up to 0.027 mgl(-1). Resistance plasmid transfer occurred both on solidified (dewatered) sewage and in liquid sewage in a bioreactor with a frequency of 1.1x10(-5)-5.0x10(-8). However, low-level concentrations of antibiotics measured in sewage are below concentrations that can increase plasmid transfer frequencies of gentamicin resistance plasmids of staphylococci.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12871238&dopt=Abstract antibiotic, antibiotics



Equine Vet J. 2003 Jul;35(5):465-71.
Clostridium difficile: prevalence in horses and environment, and antimicrobial susceptibility.

Baverud V, Gustafsson A, Franklin A, Aspan A, Gunnarsson A.

Department of Bacteriology, National Veterinary Institute, SE-751 89 Uppsala, Sweden.

REASONS FOR PERFORMING STUDY: Clostridium difficile has been associated with acute colitis in mature horses. OBJECTIVES: To survey C. difficile colonisation of the alimentary tract with age, occurrence of diarrhoea and history of antibiotic therapy; and to study the occurrence and survival of C. difficile in the environment and antimicrobial susceptibility of isolated strains. METHODS: A total of 777 horses of different breeds, age and sex were studied. Further, 598 soil samples and 434 indoor surface samples were examined. Antimicrobial susceptibility of 52 strains was investigated by Etest for 10 antibiotics. RESULTS: In horses that developed acute colitis during antibiotic treatment, 18 of 43 (42%) were positive to C. difficile culture and 12 of these (28%) were positive in the cytotoxin B test. Furthermore, C. difficile was isolated from a small number of diarrhoeic mature horses (4 of 72 [6%]) with no history of antibiotic treatment, but not from 273 healthy mature horses examined or 65 horses with colic. An interesting new finding was that, in normal healthy foals age < 14 days, C. difficile was isolated from 1/3 of foals (16 of 56 [29%]). All older foals (170) except one were negative. Seven of 16 (44%) nondiarrhoeic foals treated with erythromycin or gentamicin in combination with rifampicin were also excretors of C. difficile. On studfarms, 14 of 132 (11%) outdoor soil samples were positive for C. difficile in culture, whereas only 2 of 220 (1%) soil samples from farms with mature horses were positive for C. difficile (P = < 0.001). By PCR, it was demonstrated that strains from the environment and healthy foals can serve as a potential reservoir of toxigenic C. difficile. The experimental study conducted here found that C. difficile survived in nature and indoors for at least 4 years in inoculated equine faeces. The susceptibility of 52 strains was investigated for 10 antibiotics and all were susceptible to metronidazole (MIC < or = 4 mg/l) and vancomycin (MIC < or = 2 mg/l). CONCLUSIONS: C. difficile is associated with acute colitis in mature horses, following antibiotic treatment. Furthermore, C. difficile was isolated from 1 in 3 normal healthy foals age < 14 days. POTENTIAL RELEVANCE: Strains from healthy foals and the environment can serve as a potential reservoir of toxigenic C. difficile.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12875324&dopt=Abstract antibiotic, antibiotics [PubMed - in process]



Ann Epidemiol. 2003 Jul;13(6):479-83.
Antibiotic prescribing for cystitis: how well does it match published guidelines?

McEwen LN, Farjo R, Foxman B.

From the Department of Epidemiology, The University of Michigan School of Public Health, Ann Arbor, MI 48109, USA.

PURPOSE: Cystitis is one of the most common bacterial infections seen by physicians in outpatient settings. Published clinical guidelines by the Infectious Disease Society of America and other organizations have been established to enable effective treatment, while attempting to decrease cost and limit antibiotic resistance. METHODS: Insurance claims data for employees and dependents of a single Midwest corporation, with Preferred Provider Organization coverage, diagnosed with cystitis between 1996 and 1999 were matched to prescription drug claims for those who filled an antibiotic prescription within 3 days of diagnosis. RESULTS: For acute and recurrent cystitis physicians prescribed trimethoprim-sulfamethoxazole 37% and 18% respectively. The other most common antibiotics prescribed were the broad-spectrum flouroquinolones, and nitrofurantoin. The mean duration for these prescriptions was 10 days regardless of whether the infection was acute or recurrent. CONCLUSIONS: The first line recommended antibiotic, trimethoprim-sulfamethoxazole, was prescribed in 37% of acute infections, and for considerably longer than the suggested 3-day course of therapy. Steps should be taken to educate physicians and patients on the choice and dosage of antibiotics for cystitis to minimize emergence of antibiotic resistance.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12875808&dopt=Abstract antibiotic, antibiotics [PubMed - in process]



Fam Pract. 2003 Aug;20(4):417-9.
Acute otitis media--a brief explanation to parents and antibiotic use.

Pshetizky Y, Naimer S, Shvartzman P.

Family Medicine Department, Sial Research Center for Family Medicine and Primary Care, Division of Community Health, Ben-Gurion University of the Negev, Clalit Health Services, 84105 Beer-Sheva, Israel. familgumail.bgu.ac.il

BACKGROUND: Acute otitis media (AOM) is a common self-limiting disease in children. Antibiotic use is controversial. Physicians in the USA and in Israel prescribe antibiotics almost universally, while physicians in other countries report good outcome without any treatment. Parents' expectation is an important factor influencing a physician's decision to prescribe antibiotics. OBJECTIVES: Our aim was to assess whether a brief explanation to parents regarding the self-limited nature of AOM and the controversy regarding antibiotic prescription for the disease will influence the parents' decision regarding antibiotics use. METHODS: Parents of the children participating in the study in two primary care clinics belonging to HMO-Clalit Health Services (CHS) in the southern district of Israel were randomly assigned to an intervention (44) and control (37) group. The intervention group received the brief explanation. The two groups received prescription for antibiotics. The subjects comprised 81 children aged 3 months to 4 years visiting the family practice clinics and diagnosed with AOM. The rate of antibiotics purchase, using the prescription given and the factors influencing the decision were evaluated. RESULTS: Fewer parents administered antibiotics to their children in the intervention group compared with the control group (37% versus 63%, respectively, P < 0.0001). Mother's education level was the only factor found to be significantly lower in the group that eventually purchased antibiotics (P < 0.05). CONCLUSIONS: In children with AOM, a brief explanation by the family physician to the child's parents about the disease and the expected spontaneous recovery could decrease antibiotic use by approximately 50%.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12876113&dopt=Abstract antibiotic, antibiotics [PubMed - in process]