Correction to: Diarrhoea Management using Over-thecounter Nutraceuticals in Daily practice (DIAMOND): a feasibility RCT on alternative therapy to reduce antibiotic use

Abstract Background Although rarely indicated, antibiotics are commonly used for acute diarrhoea in China. We conducted a randomised, double blind exploratory clinical trial of loperamide, berberine and turmeric for treatment of acute diarrhoea. Methods Adults with acute uncomplicated diarrhoea aged 18 to 70 were randomised to 4 groups: (A) loperamide; (B) loperamide and berberine; (C) loperamide and turmeric; (D) loperamide, berberine and turmeric. All participants were given rescue ciprofloxacin for use after 48 h if symptoms worsened or were unimproved. Primary endpoints were feasibility and ciprofloxacin use during the 2-week follow-up period. Semi-structured interviews were conducted following recruitment and were analysed thematically. Recruiting doctors, delivery pharmacists and research assistants were blinded to treatment allocation. Results Only 21.5% (278/1295) of patients screened were deemed eligible, and 49% (136/278) of these consented and were entered into the final analysis. Most participants had mild symptoms, because most patients with moderate or severe symptoms wanted to be given antibiotics. Follow-up was good (94% at 2 weeks). Only three participants used rescue antibiotics compared to 67% of acute diarrhoea patients in the hospital during the recruitment period. The median symptom duration was 14 h in group B (interquartile range (IQR) 10-22), 16 h in group D (IQR 10-22), 18 h in group A (IQR 10-33) and 20 h in group C (IQR 16-54). Re-consultation rates were low. There were no serious treatment-related adverse events. Most interviewed participants said that although they had believed antibiotics to be effective for diarrhoea, they were surprised by their quick recovery without antibiotics in this trial. Conclusion Although recruitment was challenging because of widespread expectations for antibiotics, patients with mild diarrhoea accepted trying an alternative. The three nutraceuticals therapy require further evaluation in a fully powered, randomised controlled trial among a broader sample. Trial registration ChiCTR-IPR-17014107

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Diarrhoea Antibiotic Management Using Over-the-Counter Nutraceuticals in Daily Practice (DIAMOND): A Feasibility RCT on Alternative Therapy to Reduce Antibiotic Use

10.20944/preprints202010.0280.v1 ◽

2020 ◽

Author(s):

Yanhong Jessika Hu ◽

Xudong Zhou ◽

Shanjuan Wang ◽

Merlin Willcox ◽

Colin Garner ◽

...

Keyword(s):

Controlled Trial ◽

Alternative Therapy ◽

Acute Diarrhoea ◽

Final Analysis ◽

Daily Practice ◽

Antibiotic Use ◽

Symptom Duration ◽

Structured Interviews ◽

Double Blind

Background: Although rarely indicated, antibiotics are commonly used for acute diarrhoea in China. We conducted a randomized, double blind exploratory clinical trial of loperamide, berberine and turmeric for treatment of acute diarrhoea. Methods: Adults with acute uncomplicated diarrhoea were randomized to 4 groups: (A) loperamide; (B) loperamide and berberine; (C) loperamide and turmeric; (D) loperamide, berberine and turmeric. All participants were given rescue ciprofloxacin for use after 48 hours if symptoms worsened or were unimproved. Primary endpoints were feasibility and ciprofloxacin use during the 2 week follow-up period. Semi-structured interviews were conducted following recruitment. Results: Only 21.5% (278/1295) of patients screened were deemed eligible, and 49% (136/278) of these consented and entered into the final analysis. Most participants had mild symptoms, because most patients with moderate or severe symptoms wanted to be given antibiotics. Follow-up was good (94% at 2 weeks). Only two participants used rescue antibiotics compared to 65% of acute diarrhoea patients in the hospital during the recruitment period. The median symptom duration was: 14 hours in group B (IQR 10-22), 16 hours in group D (IQR 10-22), 18 hours in group A (IQR 10-33), 20 hours in group C (IQR 16-54). Re-consultation rates were low. There were no serious treatment-related adverse events. Most interviewed participants said the treatment was effective. Conclusion: Although recruitment was challenging because of widespread expectations for antibiotics, patients with mild diarrhoea accepted to try an alternative. This therapy requires further evaluation in a fully powered, randomised controlled trial among a broader sample.

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Use and efficacy of homeopathy in prevention and treatment of bovine mastitis

Open Agriculture ◽

10.1515/opag-2019-0019 ◽

2019 ◽

Vol 4 (1) ◽

pp. 203-212 ◽

Cited By ~ 1

Author(s):

Johanna Zeise ◽

Jürgen Fritz

Keyword(s):

Alternative Therapy ◽

Bovine Mastitis ◽

Antibiotic Use ◽

Self Healing ◽

Long Term Effect ◽

Positive Treatment ◽

Homeopathic Drug ◽

Primary Focus ◽

Quality Ranking

AbstractBovine mastitis is an important disease in dairy farming. As alternative therapy to antibiotics, whose use is seen as increasingly critical, farmer try to treat mastitis with homeopathy, for example. The present study examined i) whether homeopathic treatments for bovine mastitis can have positive treatment outcomes, ii) which treatments have been successful and under which conditions, iii) indications for future studies and applications for homeopathy to treat mastitis. 32 studies published to date have been evaluated. Assessment criteria and a rating score of 0 to 5 points were fixed for the appraisal. Healing and prophylaxis of mastitis were the primary focus to highlight the medication success and its framework for suitable mastitis therapy. The top eight studies of this quality ranking were subjected to differentiated evaluation. The selected studies showed a positive treatment outcome of homeopathy. Due to the homeopathic effect and the most used remedies in the selected studies, the medication should be chosen according to the homeopathic drug picture. With homeopathic drugs it was possible to reduce the antibiotic use by up to 75%. Some studies indicated that homeopathy might have a positive long-term effect. Furthermore, the results suggested a high self-healing ability in bovine mastitis.

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A systematic review of quality indicators for appropriate antibiotic use in hospitalized adult patients

Infectious Disease Reports ◽

10.4081/idr.2017.6821 ◽

2017 ◽

Vol 9 (1) ◽

Cited By ~ 15

Author(s):

Marlot C. Kallen ◽

Jan M. Prins

Keyword(s):

Tract Infection ◽

Quality Indicators ◽

Outcome Measures ◽

Validation Cohort ◽

Daily Practice ◽

Antibiotic Use ◽

Blood Cultures ◽

Adult Patients ◽

Modified Delphi ◽

Development Methodology

Many quality indicators for appropriate antibiotic use have been developed. We aimed to make a systematic inventory, including the development methodology and validation procedures, of currently available quality indicators (QIs) for appropriate antibiotic use in hospitalized adult patients. We performed a literature search in the Pubmed interface. From the included articles we abstracted i) the indicators developed ii) the type of infection the QIs applied to iii) study design used for the development of the QIs iv) relation of the QIs to outcome measures v) whether the QIs were validated and vi) the characteristics of the validation cohort. Fourteen studies were included, in which 200 QIs were developed. The most frequently mentioned indicators concerned empirical antibiotic therapy according to the guideline (71% of studies), followed by switch from IV to oral therapy (64% of studies), followed by drawing at least two sets of blood cultures and change to pathogen-directed therapy based on culture results (57% of studies). Most QIs were specifically developed for lower respiratory tract infection, urinary tract infection or sepsis. A RAND-modified Delphi procedure was used in the majority of studies (57%). Six studies took outcome measures into consideration during the procedure. Five out of fourteen studies (36%) tested the clinimetric properties of the QIs and 65% of the tested QIs were considered valid. Many studies report the development of quality indicators for appropriate antibiotic use in hospitalized adult patients. However, only a small number of studies validated the developed QIs. Future validation of QIs is needed if we want to implement them in daily practice.

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Thinking Beyond the “Core” Antibiotic Stewardship Interventions: Shifting the Onus for Appropriate Antibiotic Use from Stewardship Teams to Prescribing Clinicians

Clinical Infectious Diseases ◽

10.1093/cid/ciaa1003 ◽

2020 ◽

Cited By ~ 1

Author(s):

Timothy C Jenkins ◽

Pranita D Tamma

Keyword(s):

Antibiotic Stewardship ◽

Paradigm Shift ◽

Daily Practice ◽

Antibiotic Use ◽

Audit And Feedback ◽

Prior Authorization ◽

Prospective Audit ◽

The Core ◽

Primary Focus ◽

Prospective Audit And Feedback

Abstract United States guidance for hospital antibiotic stewardship has emphasized prospective audit and feedback and prior authorization of select antibiotics as core interventions. These remain the most common interventions implemented by stewardship programs. Although these approaches have been shown to reduce unnecessary antibiotic use, they incorrectly put the onus for appropriate antibiotic use on the stewardship team rather than the prescribing clinician. We propose that a primary focus of stewardship programs should be implementation of broader interventions that engage frontline clinicians and equip them with tools to integrate antibiotic stewardship into their own daily practice, thus reducing the need for day-to-day stewardship team oversite. We discuss a framework of broader interventions and policies that will facilitate this paradigm shift.

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BEKAM SEBAGAI TERAPI ALTERNATIF UNTUK NYERI

Majalah Kedokteran Neurosains Perhimpunan Dokter Spesialis Saraf Indonesia ◽

10.52386/neurona.v36i2.69 ◽

2019 ◽

Vol 36 (2) ◽

Author(s):

Hanik Badriyah Hidayati ◽

Mohammad Hasan Machfoed ◽

Kuntoro Kuntoro ◽

Soetojo Soetojo ◽

Budi Santoso ◽

...

Keyword(s):

Side Effects ◽

Pain Treatment ◽

Alternative Therapy ◽

Daily Practice ◽

Cupping Therapy ◽

Traditional Therapy ◽

New Therapies ◽

Relieve Pain ◽

The World ◽

Traditional Therapies

CUPPING AS PAIN ALTERNATIVE THERAPYABSTRACTPain is still a world’s problem. Current pain treatment is still unsatisfactory due to its chronicity and existing drugs’ side effects. Due to dissatisfaction with the existing treatment, many patients are choosing a traditional therapy for their pain treatment. Cupping therapy is one of the traditional therapies that is widely used to relieve pain. Cupping therapy has been used in many countries in the world. Some of these countries have used cupping therapy as a pain treatment in hospitals. Neurologists are handling pain cases in their daily practice. Nearly 80% of patients come to the doctor with one of their complaint related to pain directly. The knowledge of cupping therapy for pain is important for the development of new therapies in order to solve the pain problems that so far have not reached a satisfactory level.Keyword: Alternative therapy, cupping therapy, pain, pain problemsABSTRAKNyeri masih merupakan masalah dunia. Pengobatan nyeri saat ini masih belum sampai tahap yang memuaskan terkait kronisitas dan efek samping obat yang ada. Akibat ketidakpuasan dengan pengobatan yang ada, banyak pasien yang memilih terapi tradisional untuk pengobatan nyerinya. Terapi bekam merupakan salah satu terapi tradisional yang banyak dipakai untuk meredakan keluhan nyeri. Terapi bekam telah dipakai di banyak negara di dunia. Sebagian negara tersebut telah menggunakan bekam sebagai terapi nyeri di rumah sakit. Bekam menurunkan nyeri melalui efek antinosiseptifnya, dengan cara stimulasi sistem saraf perifer dan menurunkan stres oksidatif. Studi terbaru menunjukkan bahwa terapi bekam basah dapat meningkatkan ekspresi ß-endorphin dan HSP70 keratinosit pada lokasi bekam. Dalam praktek sehari-hari dokter spesialis saraf menangani kasus nyeri. Hampir 80% pasien datang ke dokter dengan disertai salah satu keluhan yang berkaitan dengan nyeri secara langsung. Pengetahuan tentang terapi bekam untuk nyeri penting diketahui untuk pengembangan terapi baru guna menyelesaikan permasalahan nyeri yang sampai saat ini belum sampai pada tahap yang memuaskan.Kata kunci: Masalah nyeri, nyeri, terapi alternatif, terapi bekam

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Postoperative Antibiotics And Time To Reach Discharge Criteria After Appendectomy For Complex Appendicitis

10.21203/rs.3.rs-1092655/v1 ◽

2021 ◽

Author(s):

A.L. van den Boom ◽

E.M.L. de Wijkerslooth ◽

L. J. X. Giesen ◽

C. C. van Rossem ◽

B. R. Toorenvliet ◽

...

Keyword(s):

Cohort Study ◽

Hospital Stay ◽

Retrospective Cohort ◽

Oral Intake ◽

Length Of Hospital Stay ◽

Daily Practice ◽

Antibiotic Use ◽

Infectious Complications ◽

Safe Discontinuation ◽

Discharge Criteria

Abstract Background: Postoperative antibiotic treatment is indicated for 3 – 5 days following appendectomy for complex appendicitis. However, meeting discharge criteria may allow for safe discontinuation of antibiotics and discharge. This study assessed the association between time to reach discharge criteria and duration of postoperative antibiotic use and length of hospital stay. Methods: This was a multicenter retrospective cohort study including patients who underwent appendectomy for complex appendicitis and received postoperative antibiotics for >24 hours. Main outcome measures were time to reach discharge criteria, duration of postoperative antibiotic use, length of hospital stay and postoperative infectious complications. Discharge criteria were defined as absence of fever (temperature ≤38°C) for 24 hours, ability to tolerate oral intake and pain controlled by oral analgesics.Results: A total of 124 patients were included between May 2014 and January 2015. Median time to reach discharge criteria was 2 days (interquartile range 1 – 3). Postoperative antibiotics duration and hospital stay were 5 (IQR 3 – 5) and 5 (IQR 4 – 6) days, respectively. Infectious complications occurred in 15 of 124 patients (12%) and was not different between patients reaching discharge criteria before or after 2 postoperative days.Conclusions: Discharge criteria were met by a median of 2 days after appendectomy for complex appendicitis. This suggests that postoperative antibiotics and hospital stay can be reduced without an increase in infectious complications. In daily practice this is not done, prescribed antibiotics are not reduced in total days given. Prospective studies that evaluate limited postoperative antibiotic use, based on these criteria, are necessary.

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Optimising the quality of antibiotic prescribing in out-of-hours primary care in Belgium: a study protocol for an action research project

BMJ Open ◽

10.1136/bmjopen-2017-017522 ◽

2017 ◽

Vol 7 (10) ◽

pp. e017522 ◽

Cited By ~ 6

Author(s):

Annelies Colliers ◽

Samuel Coenen ◽

Hilde Philips ◽

Roy Remmen ◽

Sibyl Anthierens

Keyword(s):

Action Research ◽

General Practitioners ◽

Study Protocol ◽

Daily Practice ◽

Antibiotic Use ◽

Antibiotic Prescribing ◽

Out Of Hours ◽

Prescribing Quality ◽

Tract Infections

IntroductionAntimicrobial resistance is a major public health threat driven by inappropriate antibiotic use, mainly in general practice and for respiratory tract infections. In Belgium, the quality of general practitioners’ (GPs) antibiotic prescribing is low. To improve antibiotic use, we need a better understanding of this quality problem and corresponding interventions. A general practitioners cooperative (GPC) for out-of-hours (OOH) care presents a unique opportunity to reach a large group of GPs and work on quality improvement. Participatory action research (PAR) is a bottom-up approach that focuses on implementing change into daily practice and has the potential to empower practitioners to produce their own solutions to optimise their antibiotic prescribing.MethodsThis PAR study to improve antibiotic prescribing quality in OOH care uses a mixed methods approach. In a first exploratory phase, we will develop a partnership with a GPC and map the existing barriers and opportunities. In a second phase, we will focus on facilitating change and implementing interventions through PDSA (Plan-Do-Study-Act) cycles. In a third phase, antibiotic prescribing quality outside and antibiotic use during office hours will be evaluated. Equally important are the process evaluation and theory building on improving antibiotic prescribing.EthicsThe study protocol was approved by the Ethics Committee of the Antwerp University Hospital/University of Antwerp. PAR unfolds in response to the needs and issues of the stakeholders, therefore new ethics approval will be obtained at each new stage of the research.DisseminationInterventions to improve antibiotic prescribing are needed now more than ever and outcomes will be highly relevant for GPCs, GPs in daily practice, national policymakers and the international scientific community.Trial registration numberNCT03082521; Pre-results.

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A Retrospective Surveillance of the Antibiotics Prophylactic Use of Surgical Procedures in Private Hospitals in Indonesia

Hospital Pharmacy ◽

10.1177/0018578718792804 ◽

2018 ◽

Vol 54 (5) ◽

pp. 323-329 ◽

Cited By ~ 1

Author(s):

Fauna Herawati ◽

Rika Yulia ◽

Eelko Hak ◽

Adriaan H. Hartono ◽

Timo Michiels ◽

...

Keyword(s):

Surgical Procedures ◽

Bacterial Resistance ◽

Elective Surgery ◽

Daily Practice ◽

Antibiotic Use ◽

Private Hospitals ◽

Defined Daily Doses ◽

Hospitalization Costs ◽

Precision Therapy ◽

Prophylactic Use

Background: According to international guidelines, prophylactic antibiotics in elective surgery should be given as a single dose 30 to 60 minutes before the operation is conducted. Postoperative administration of antibiotics should be discontinued 24 hours after surgery to minimize bacterial resistance and to keep control over hospitalization costs. There is a lack of data on the actual antibiotic use around surgical procedures in Indonesia. Objective: This retrospective surveillance study aimed to obtain defined daily doses (DDD) and DDDs per 100 bed days (DDD-100BD) for prophylactically used antibiotics in two private hospitals in Surabaya, East Java. These hospitals are considered to be representative for the current situation in Indonesia. Method: Data from a total of 693 patients over a nearly 1-year period (2016) were collected and evaluated. Results: The overall DDD per patient was 1.5 for hospital A and 1.7 for hospital B. The overall DDD-100BD was 30 for hospital B. Of the 24 antibiotics given prophylactically, ceftriaxone was the most commonly used in both hospitals. Conclusion: There was a clear discrepancy between daily practice in both hospitals and the recommendations in the guidelines. This study shows that better adherence to antibiotic stewardship is needed in Indonesia. Substantial improvements need to be made toward guided precision therapy regarding quantity (dose and frequency), route of administration (prolonged intravenous), and choice of the type of antibiotic.

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A questionnaire base survey on the knowledge, attitude and practices about antimicrobial resistance and usage among the faculty and resident doctor of teaching tertiary care hospital, Chittoor, India

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20192670 ◽

2019 ◽

Vol 8 (7) ◽

pp. 1673

Author(s):

Vishnu Priya G. ◽

Sankara Babu Gorle ◽

Madhav P.

Keyword(s):

Antimicrobial Resistance ◽

Tertiary Care ◽

Daily Practice ◽

Antibiotic Use ◽

Care Hospital ◽

Senior Faculty ◽

Over The Counter ◽

Antibiotic Resistant ◽

Strongly Agree ◽

Prescription Writing

Background: 10million could die every year due to antibiotic resistant infections by 2050 unless the threat is addressed. Irrational use of antibiotic use is a global phenomenon. So, 50% all anti bionics are prescribed, sold are dispensed inappropriately, while 50% of patients are not taking antibiotics correctly (WHO 2004).Methods: This was a cross section study it was a conducted in RVS institute, tertiary care teaching hospital. Chittoor. The questionnaire was distributed along the faculty resident doctors and senior faculty of this RVS institute Where their knowledge, attitude, practice regarding antibiotic prescription and resistance was assessed by a five point likert scale, whose response ranged from strongly agree to disagree. Some questionnaire were of useful or nor useful and yes or no.Results: Irrational prescription of antibiotics is worldwide problem and also in India was known to most of the physicians in our institute (n=95%) of participants. 80% subjects answered that prescription writing influenced by senior faculty and medical representatives. 50% subjects answered that antimicrobial resistance is a problem in daily practice.80 % subjects answered that most of the antibiotics available as over the counter drugs (OTC).Conclusions: This study concludes, prescription writing influences by senior faculty and medical representatives. It’s important to monitor and auditing prescription writing based on WHO Antibiotic guidelines to prevent resistance. Strict vigilance of OTC sales of antibiotics to prevent resistance.

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