Macrolides in children: judicious use, avoiding resistance and reducing adverse effects

2021 ◽  
pp. edpract-2020-320357
Author(s):  
Anisha Patel ◽  
Kevin Meesters
Keyword(s):  
Antimicrobial Resistance ◽  
Adverse Effects ◽  
Antibacterial Action ◽  
Immunomodulatory Effects ◽  
Macrocyclic Ring ◽  
Exacerbation Frequency ◽  
Prophylactic Use

Macrolides, a group of antibiotics molecularly characterised by a macrocyclic ring, are among the most frequently prescribed antibiotics for children. Beyond their antibacterial action, macrolides exert immunomodulatory effects. Prophylactic use is increasing. Macrolides are usually well tolerated in children, and dosing schedules are convenient. Furthermore, increasing data suggests that their prophylactic usage reduces the exacerbation frequency in children with bronchiectasis. Yet, to preserve their antibacterial action, each macrolide prescription should be judiciously considered. For prophylactic use, the indication should be regularly reviewed, and usage longer than 6 months should be avoided to reduce antimicrobial resistance.

Antimicrobial use at the end of life: a scoping review

2020 ◽  
pp. bmjspcare-2020-002558
Author(s):  
Jack Fairweather ◽  
Lesley Cooper ◽  
Jacqueline Sneddon ◽  
R Andrew Seaton
Keyword(s):  
Antimicrobial Resistance ◽  
Adverse Effects ◽  
End Of Life ◽  
Scoping Review ◽  
Antibiotic Use ◽  
Prescribing Patterns ◽  
Cochrane Library ◽  
Antibiotic Prescribing ◽  
Ovid Medline ◽  
Tract Infections

ObjectiveTo examine antibiotic use in patients approaching end of life, in terms of frequency of prescription, aim of treatment, beneficial and adverse effects and contribution to the development of antimicrobial resistance.DesignScoping reviewData sourcesAn information scientist searched Ovid MEDLINE, Ovid EMBASE, The Cochrane library, PubMed Clinical Queries, NHS Evidence, Epistemonikos, SIGN, NICE, Google Scholar from inception to February 2019 for any study design including, but not limited to, randomised clinical trials, prospective interventional or observational studies, retrospective studies and qualitative studies. The search of Ovid MEDLINE was updated on the 10 June 2020.Study selectionStudies reporting antibiotic use in patients approaching end of life in any setting and clinicians’ attitudes and behaviour in relation to antibiotic prescribing in this populationData extractionTwo reviewers screened studies for eligibility; two reviewers extracted data from included studies. Data were analysed to describe antibiotic prescribing patterns across different patient populations, the benefits and adverse effects (for individual patients and wider society), the rationale for decision making and clinicians behaviours and attitudes to treatment with antibiotics in this patient group.ResultsEighty-eight studies were included. Definition of the end of life is highly variable as is use of antibiotics in patients approaching end of life. Prescribing decisions are influenced by patient age, primary diagnosis, care setting and therapy goals, although patients’ preferences are not always documented or adhered to. Urinary and lower respiratory tract infections are the most commonly reported indications with outcomes in terms of symptom control and survival variably reported. Small numbers of studies reported on adverse events and antimicrobial resistance. Clinicians sometimes feel uncomfortable discussing antibiotic treatment at end of life and would benefit from guidelines to direct care.ConclusionsUse of antibiotics in patients approaching the end of life is common although there is significant variation in practice. There are a myriad of intertwined biological, ethical, social, medicolegal and clinical issues associated with the topic.

scholarly journals Sociodemographic Impact and Acquaintance on Antibiotic Resistance Among Outpatients in Specialist Hospital, Malaysia

2021 ◽  
Vol 20 (3) ◽  
Author(s):  
Hanish Singh Jayasingh Chellammal ◽  
Mohamed Mansor Manan ◽  
Thayashini Kupusamy ◽  
Long Chiau Ming ◽  
Shafeeq Mohd Faizal
Keyword(s):  
Antimicrobial Resistance ◽  
Adverse Effects ◽  
Cross Sectional Study ◽  
Antibiotics Resistance ◽  
Cross Sectional ◽  
Global Issues ◽  
Validated Questionnaire ◽  
Significant Difference ◽  
The Mean ◽  
Knowledge And Attitude

INTRODUCTION: Awareness on antibiotics resistance among outpatients in hospital settings is reasonably explored and this study aimed to investigate the sociodemographic impact and the level of acquaintance towards antibiotics practice and resistance. MATERIALS AND METHODS: This cross-sectional study was conducted on 270 patients from the outpatient department of KPJ Seremban Specialist Hospital (KPJSSH), Malaysia. A pre-validated questionnaire was used to collect the data on the demographics of the patients, their knowledge, attitude, and usage of antibiotics. The study was approved by the KPJUC ethics committee (KPJUC/RMC/BPH/EC/2017/104). RESULTS: The mean age of the respondents was 36 ± 11.07 years and 50.37% of them have moderate knowledge on antibiotics. The knowledge and attitude on antibiotics usage exhibited a significant difference (p=0.001) amongst these patients in association with literacy. The results showed that the literate respondents have significant knowledge on the identification of antibiotics (p=0.021), their roles, and adverse effects (p=0.004). The attitude of the respondents towards following the prescription was significantly associated with their literacy (p=0.004). CONCLUSION: This study reveals that respondents have the least knowledge on antibiotic course compliance and termination of therapy, which could lead to antimicrobial resistance. In conclusion, inculcating the knowledge of antimicrobial resistance, adverse effects, and course compliance among the patients may help overcome the national and global issues on multi-drug-resistant diseases.

scholarly journals Acinetobacter baumannii Infections and Antibiotic Resistance in Hospitalized Patients in an Education and Research Hospital: A Six-Year Analysis

2020 ◽  
Vol 25 (4) ◽  
pp. 563-571
Author(s):  
Tuğba Arslan Gülen ◽  
Ayfer İmre ◽  
İlker Ödemiş ◽  
Üner Kayabaş
Keyword(s):  
New York ◽  
Antimicrobial Resistance ◽  
Adverse Effects ◽  
Antimicrobial Therapy ◽  
Antimicrobial Agents ◽  
Resistance Rate ◽  
Adult Patients ◽  
Acinetobacter Baumanii ◽  
Research Hospital ◽  
Resistance Rates

Introduction: Acinetobacter baumanii causes difficulties in the treatment of nosocomial infections due to increasing resistance worldwide. With an increase in resistant infections, the use of colistin has come to the fore. We aimed to investigate the antimicrobial resistance profile of A. baumanii strains isolated from clinical specimens as hospital-acquired colonizations and infection agents and to evaluate the clinical and microbiologic responses and adverse effects of antibiotic regimens used in patients who were isolated because of having infectious agents. Materials and Methods: A retrospective descriptive study of 326 adult patients with nosocomial A. baumannii colonizations and infections was conducted between January 2012 and December 2017 in Niğde Education and Research Hospital. In addition, a total of 212 adult patients who received at least 72 hours of antimicrobial therapy were evaluated. Standard and automated methods were used to identify isolated strains and antibiotic susceptibility. The antimicrobial susceptibility profile change over the 6-year period was evaluated. Adverse effects, and clinical and microbiologic response were evaluated in patients receiving antimicrobial therapy. Analysis of the variables was performed using SPSS 22.0 (IBM Corporation, Armonk, New York, United States). Results: When antimicrobial resistance rates were examined, it was seen that imipenem (99.7%), ampicillin sulbactam (81.6%), cefoperazone sulbactam (60.3%), netilmicin (89.4%), tobramycin (88.4%), gentamicin (83.1%), amikacin (91.6%) and tigecycline (33.7%) had resistance rates; colistin resistance was not detected in the isolates. Resistance rate to other antibiotic groups was 100%. The resistance rates of ampicillin sulbactam, cefoperazone sulbactam, gentamicin, amikacin, and tigecycline were found to be statistically significant (p< 0.05). There were no significant differences in terms of nephrotoxicity, and clinical and microbiologic response among patients in whom colistin was used in combination with carbapenem, ampicillin/sulbactam, cefoperazone/sulbactam, and tigecycline (p> 0.05). Conclusion: In accordance with the global data, antimicrobial resistance rate in A. baumanii isolates was found to be high in our study. Treatment regimens in which colistin is used with other antimicrobial agents have no superiority in terms of efficacy and adverse effects. There is a clear need for new and effective antimicrobial agents in the treatment of resistant A. baumanii infections.

scholarly journals The Philosophical and Evidentiary Basis of Homoeopathic Immunisation: a Response to Teixeira

2021 ◽  
Vol 13 (46) ◽  
pp. 45-53
Author(s):  
Isaac Golden
Keyword(s):  
Adverse Effects ◽  
Disease Prevention ◽  
Scientific Evidence ◽  
Double Standard ◽  
Short Term ◽  
Toxic Damage ◽  
Prophylactic Use

Homeopathic immunisation was first used in 1798, but remains controversial with some homeopathic practitioners. Teixeira supported the use of genus epidemicus (GE) remedies, but strongly condemned the use of nosodes for disease prevention. However Teixeira failed to fully understand the Principal of Similars, he used a double standard when comparing evidence using GE remedies and nosodes, he misread information demonstrating the safety of long-term HP, and he appeared to be unaware of scientific evidence which is available supporting the prophylactic use of nosodes. These four areas are addressed in turn, and evidence from 1798 to 2012 is presented showing that appropriate homoeopathic immunisation using GE remedies and/or nosodes has the potential to prevent much suffering without any risk of possible short-term toxic damage or long-term energetic adverse effects.

scholarly journals Streptococcus suis Research: Progress and Challenges

Pathogens ◽  
2020 ◽  
Vol 9 (9) ◽  
pp. 707 ◽  
Author(s):  
Mariela Segura
Keyword(s):  
Antimicrobial Resistance ◽  
Close Contact ◽  
Streptococcus Suis ◽  
Control Measures ◽  
Health Concern ◽  
Research Progress ◽  
Economic Losses ◽  
Swine Industry ◽  
Host Animal ◽  
Prophylactic Use

Streptococcus suis is considered among the top bacterial pathogens leading to important economic losses to the swine industry, with the incidence of disease increasing as the prophylactic use of antimicrobial is being vanished worldwide. S. suis is also a zoonotic agent afflicting people in close contact with infected pigs or pork meat. Besides, in some Asian countries, it is considered a major public health concern for the general population as well. Antimicrobial resistance is one of the most important global health challenges, and in the absence of preventive measures (such as effective vaccines), S. suis remains a risk for increased antimicrobial resistance and transmission of resistance genes to other bacteria beyond the host animal species. The studies in this Special Issue have evidenced the importance of swine population demographics and management on disease control, progress in molecular tools to better understand the epidemiology of S. suis infections in swine and humans, and the mechanisms involved in different aspects of the immuno-pathogenesis of the disease. The importance of reducing the prophylactic use of antimicrobials in livestock productions and the development of alternative control measures, including vaccination, are herein discussed.

scholarly journals Temporal Resistome and Microbial Community Dynamics in an Intensive Aquaculture Facility with Prophylactic Antimicrobial Treatment

2020 ◽  
Vol 8 (12) ◽  
pp. 1984
Author(s):  
Hemant J. Patil ◽  
Joao Gatica ◽  
Avihai Zolti ◽  
Ayana Benet-Perelberg ◽  
Alon Naor ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Bacterial Community ◽  
Community Composition ◽  
Relative Abundance ◽  
Resistance Genes ◽  
Bacterial Community Composition ◽  
Seasonal Abundance ◽  
Antimicrobial Resistance Genes ◽  
Prophylactic Use ◽  
Intensive Aquaculture

Excessive use of antimicrobials in aquaculture is concerning, given possible environmental ramifications and the potential contribution to the spread of antimicrobial resistance (AR). In this study, we explored seasonal abundance of antimicrobial resistance genes and bacterial community composition in the water column of an intensive aquaculture pond stocked with Silver Carp (Hypophthalmichthys molitrix) prophylactically treated with sulfamethoprim (25% sulfadiazine; 5% trimethoprim), relative to an adjacent unstocked reservoir. Bacterial community composition was monitored using high-throughput sequencing of 16S rRNA gene amplicons in eight sampling profiles to determine seasonal dynamics, representing principal stages in the fish fattening cycle. In tandem, qPCR was applied to assess relative abundance of selected antimicrobial resistance genes (sul1, sul2, dfrA1, tetA and blaTEM) and class-1 integrons (int1). Concomitantly, resistomes were extrapolated from shotgun metagenomes in representative profiles. Analyses revealed increased relative abundance of sulfonamide and tetracycline resistance genes in fishpond-03, relative to pre-stocking and reservoir levels, whereas no significant differences were observed for genes encoding resistance to antimicrobials that were not used in the fishpond-03. Seasons strongly dictated bacterial community composition, with high abundance of cyanobacteria in summer and increased relative abundance of Flavobacterium in the winter. Our results indicate that prophylactic use of sulfonamides in intensive aquaculture ponds facilitates resistance suggesting that prophylactic use of these antimicrobials in aquaculture should be restricted.

Dazoxiben, a Prototype Inhibitor of Thromboxane Synthesis, has Little Toxicity in Laboratory Animals

1985 ◽  
Vol 4 (3) ◽  
pp. 311-315 ◽  
Author(s):  
E. Irisarri ◽  
M.J. Kessedjian ◽  
C. Charuel ◽  
J.M. Faccini ◽  
P. Greaves ◽  
...  
Keyword(s):  
Platelet Count ◽  
Adverse Effects ◽  
Clinical Medicine ◽  
Specific Inhibitor ◽  
Plasma Calcium ◽  
Laboratory Animals ◽  
Thromboxane Synthetase ◽  
Prophylactic Use ◽  
Dose Levels ◽  
Orally Active

1 Dazoxiben, an orally active specific inhibitor of thromboxane synthetase, was administered by mouth daily to dogs and rats for 6 months. 2 Dogs showed no evidence of toxicity up to 300 mg day-1 kg-1, the highest dose level used. 3 Rats showed no evidence of toxicity after 100 mg day-1 kg-1, but at 300 mg day-1 kg-1 there were slight increases in plasma calcium and urea concentrations and a moderate incidence of focal nephrosis; males showed a slightly increased platelet count. 4 Studies in rats and rabbits at dose levels up to 400 mg day-1 kg-1, by mouth, revealed no adverse effects on male or female fertility, embryogenesis, parturition or postnatal development. 5 As dazoxiben is well absorbed after oral administration, the generally negative outcome to these toxicity studies suggests that selective inhibitors of thromboxane synthesis may be largely free of adverse effects which might impede their therapeutic or prophylactic use in clinical medicine.

The Influence of Specimen Thickness in Quantitative Electron Energy Loss Spectroscopy

1980 ◽  
Vol 38 ◽  
pp. 112-113
Author(s):  
Nestor J. Zaluzec
Keyword(s):  
Quantitative Analysis ◽  
Adverse Effects ◽  
Energy Loss ◽  
Electron Energy ◽  
Electron Energy Loss Spectroscopy ◽  
Materials Science ◽  
Light Element ◽  
Specimen Thickness ◽  
Element Analysis ◽  
Electron Energy Loss

The application of electron energy loss spectroscopy (EELS) to light element analysis is rapidly becoming an important aspect of the microcharacterization of solids in materials science, however relatively stringent requirements exist on the specimen thickness under which one can obtain EELS data due to the adverse effects of multiple inelastic scattering.1,2 This study was initiated to determine the limitations on quantitative analysis of EELS data due to specimen thickness.

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