scholarly journals TERAPI SULIH (SWITCH THERAPY) ANTIBIOTIK PADA PASIEN PNEUMONIA KOMUNITI DI RSUD WANGAYA KOTA DENPASAR

2021 ◽  
Vol 4 (1) ◽  
pp. 63-73
Author(s):  
Dewi Puspita Apsari ◽  
◽  
Ni Made Krisna Dwiyanti ◽  
I.B.N. Maharjana I.B.N. Maharjana ◽  

Hospitalized community-acquired pneumonia (CAP) patients are always prescribed intravenous (IV) antibiotics. Inappropriate and unnecessary IV antibiotics usage leads to an increase in healthcare costs and bacterial resistance. IV to per oral (PO) conversion therapy can overcome these problems. The aim of the study was to evaluate the practice of switching from intravenous to oral antibiotics of inpatients with community-acquired pneumonia (CAP). This retrospective observational study was conducted by taking patient medical record from january until december 2019. Outcomes of the study are patient characteristics, pattern use, antibiotic and type conversion therapy. Adult inpatients on conversion therapy were eligible for study enrollment. Data were analyzed descriptively using SPSS 17.0. The study showed that among 78 patients who were eligible for conversion therapy. Most of the patient has mean duration conversion therapy 48-72 hours as much as 55 (70,5%). Beta-lactams were the most commonly converted antibiotics. However, the step-down therapy was the major type of conversion practiced in this study as much as 48 (61,5) followed by sequential and switch over with numbers 21 (27%) and 9 (11,5%) respectively. Based on the study findings wangaya hospital should improve the practice of sequential therapy in order to reduce the burden of CAP.

Author(s):  
Sabrina Handayani Tambun ◽  
Ika Puspitasari ◽  
Ida Safitri Laksanawati

Community Acquired Pneumonia (CAP) is an infectious disease which is one of the main causes of child mortality in developing countries. The pattern of giving antibiotics at the hospital is usually still empirical. Inappropriate use of antibiotics may cause failure of therapy or bacterial resistance. This study aims to determine the empirical antibiotic rationality and the relationship of rationality to the clinical outcome of CAP-pediatric inpatients at RSUP. Dr. Sardjito Yogyakarta. The study conducted using a descriptive analytic method with a retrospective cohort design. The subjects were CAP-pediatric inpatients at RSUP. Dr. Sardjito Yogyakarta period 1 January-31 December 2018. The rationality of empirical antibiotics is evaluated using the Gyssens algorithm. The clinical outcome was either good or bad outcome according to the clinician stating in the medical record. Patient characteristics, empirical antibiotic therapy and rationality patterns were analyzed descriptively. The relationship between empirical antibiotic rationality and clinical outcome were evaluated using Chi square test. There were 73 patients who met the inclusion and exclusion criteria (132 empirical antibiotic regimens). Rational antibiotic therapy accounted 76.5% (category 0). Types of irrationality of antibiotic found were IIIB (5.3%) and IIA categories (18.2%). Chi-square analysis showed that empirical antibiotic rationality related to good clinical outcome of CAP children (p = 0.011; OR = 2.957; 95% CI = 1,263 - 6,923).


Author(s):  
Juan González del Castillo ◽  
◽  
Agustín Julián-Jiménez ◽  
Francisco Javier Candel

Pneumonia is a major cause of global mortality in developed countries. The adequacy of the antibiotic treatment is essential for the good evolution of the patients. When selecting the antimicrobial, the severity of the patient, the characteristics of the antibiotics, and the profile of the patient to be treated should be considered. Recommendations for the selection of antibiotic treatment may differ between the patient who requires admission and the one who can be treated as outpatient. Beta-lactams, fluoroquinolones, and macrolides are the most widely used antimicrobials in this last circumstance. However, not all are the same in terms of efficacy, safety and ecological impact. This review delves into the aforementioned aspects to improve decision-making and offers concrete recommendations for the selection of antibiotic treatment. Likewise, it includes recommendations for performing sequential therapy. Finally, a brief review is made about the impact of SARS-CoV-2 infection on this pathology.


Chemotherapy ◽  
2016 ◽  
Vol 62 (2) ◽  
pp. 100-104 ◽  
Author(s):  
Stephanie E. Giancola ◽  
Monica V. Mahoney ◽  
Michael D. Hogan ◽  
Brian R. Raux ◽  
Christopher McCoy ◽  
...  

Background: Bacterial resistance among uropathogens is on the rise and has led to a decreased effectiveness of oral therapies. Fosfomycin tromethamine (fosfomycin) is indicated for uncomplicated urinary tract infections (UTIs) and displays in vitro activity against multidrug-resistant (MDR) isolates; however, clinical data assessing fosfomycin for the treatment of complicated or MDR UTIs are limited. Methods: We conducted a retrospective evaluation of patients who received ≥1 dose of fosfomycin between January 2009 and September 2015 for treatment of a UTI. Patients were included if they had a positive urine culture and documented signs/symptoms of a UTI. Results: Fifty-seven patients were included; 44 (77.2%) had complicated UTIs, 36 (63.2%) had MDR UTIs, and a total of 23 (40.4%) patients had a UTI that was both complicated and MDR. The majority of patients were female (66.7%) and elderly (median age, 79 years). Overall, the most common pathogens isolated were Escherichia coli (n = 28), Enterococcus spp. (n = 22), and Pseudomonas aeruginosa (n = 8). Twenty-eight patients (49.1%) were clinically evaluable; the preponderance achieved clinical success (96.4%). Fifteen out of 20 (75%) patients with repeat urine cultures had a microbiological cure. Conclusions: This retrospective study adds to the limited literature exploring alternative therapies for complicated and MDR UTIs with results providing additional evidence that fosfomycin may be an effective oral option.


2008 ◽  
Vol 137 (2) ◽  
pp. 194-202 ◽  
Author(s):  
S. A. SKULL ◽  
R. M. ANDREWS ◽  
G. B. BYRNES ◽  
D. A. CAMPBELL ◽  
H. A. KELLY ◽  
...  

SUMMARYThis study describes the epidemiology of community-acquired pneumonia (CAP) in elderly Australians for the first time. Using a case-cohort design, cases with CAP were in-patients aged ⩾65 years with ICD-10-AM codes J10-J18 admitted over 2 years to two tertiary hospitals. The cohort sample was randomly selected from all hospital discharges, frequency-matched to cases by month. Logistic regression was used to estimate risk ratios for factors predicting CAP or associated mortality. A total of 4772 in-patients were studied. There were 1952 cases with CAP that represented 4% of all elderly admissions: mean length of stay was 9·0 days and 30-day mortality was 18%. Excluding chest radiograph, 520/1864 (28%) cases had no investigations performed. The strongest predictors of CAP were previous pneumonia, history of other respiratory disease, and aspiration. Intensive-care-unit admission, renal disease and increasing age were the strongest predictors of mortality, while influenza vaccination conferred protection. Hospitalization with CAP in the elderly is common, frequently fatal and a considerable burden to the Australian community. Investigation isad hocand management empirical. Influenza vaccination is associated with reduced mortality. Patient characteristics can predict risk of CAP and subsequent mortality.


2018 ◽  
Vol 9 (4) ◽  
pp. 219-221 ◽  
Author(s):  
Amber Onoh ◽  
Sunny A. Linnebur ◽  
Danielle R. Fixen

An increased risk of bacterial resistance toward fluoroquinolones and the increased risk of disabling and serious adverse effects prompted the US Food and Drug Administration to recommend limiting fluoroquinolone use to the treatment of community-acquired pneumonia, skin and skin-structure infections, bacterial sinusitis, plague, chronic bronchitis exacerbations, and complicated intra-abdominal infections. We report a case of moxifloxacin-induced tinnitus in an older adult prescribed oral moxifloxacin 400 mg for 5 days for the treatment of acute diverticulitis, due to allergies to nonfluoroquinolone preferred agents. A thorough literature review provided few other reported incidents of this rare and serious adverse event.


1990 ◽  
Vol 3 (1) ◽  
pp. 13-31 ◽  
Author(s):  
T D Gootz

The unprecedented growth in the number of new antibiotics over the past two decades has been the result of extensive research efforts that have exploited the growing body of knowledge describing the interactions of antibiotics with their targets in bacterial cells. Information gained from one class of antimicrobial agents has often been used to advance the development of other classes. In the case of beta-lactams, information on structure-activity relationships gleaned from penicillins and cephalosporins was rapidly applied to the cephamycins, monobactams, penems, and carbapenems in order to discover broad-spectrum agents with markedly improved potency. These efforts have led to the introduction of many new antibiotics that demonstrate outstanding clinical efficacy and improved pharmacokinetics in humans. The current review discusses those factors that have influenced the rapid proliferation of new antimicrobial agents, including the discovery of new lead structures from natural products and the impact of bacterial resistance development in the clinical setting. The development process for a new antibiotic is discussed in detail, from the stage of early safety testing in animals through phase I, II, and III clinical trials.


2021 ◽  
Vol 45 ◽  
pp. 1
Author(s):  
Silvia Boni ◽  
Gustavo H. Marin ◽  
Laura Campaña ◽  
Lupe Marin ◽  
Alejandra Corso ◽  
...  

Objective. To describe bacterial resistance and antimicrobial consumption ratio at the subnational level in Argentina during 2018, considering beta-lactams group as a case-study. Methods. Antimicrobial consumption was expressed as defined daily doses (DDD)/1000 inhabitants. Resistance of Escherichia coli, Streptococcus pneumoniae, Pseudomonas aeruginosa, Klebsiella pneumoniae and Staphylococcus aureus to beta-lactams was recorded. Resistance/consumption ratio was estimated calculating “R” for each region of Argentina, and this data was compared with other countries. Results. The most widely consumed beta-lactams in Argentina were amoxicillin (3.64) for the penicillin sub-group, cephalexin (0.786) for first generation cephalosporins, cefuroxime (0.022) for second generation; cefixime (0.043) for third generation and cefepime (0.0001) for the fourth generation group. Comparison between beta-lactams consumption and bacterial resistance demonstrated great disparities between the six regions of the country. Conclusions. The case-study of Argentina shows that antimicrobial consumption and resistance of the most common pathogens differed among regions, reflecting different realities within the same country. Because this situation might also be occurring in other countries, this data should be taken into account to target local efforts towards better antimicrobial use, to improve antimicrobial stewardship programs and to propose more suitable sales strategies in order to prevent and control antimicrobial resistance.


2019 ◽  
Vol 1 (1) ◽  
pp. 3-15
Author(s):  
Eduardo Esteban-Zubero ◽  
◽  
Cristina García-Muro ◽  
Moisés Alejandro Alatorre-Jiménez ◽  
Alejandro Marín-Medina ◽  
...  

The incidence of community-acquired pneumonia (CAP) ranges from 2-15 cases/1,000 inhabitants/year, being higher in those over 65 or in patients with comorbidities. In Emergency Room (ER) it represents up to 1.35% of the care. Approximately 75% of all diagnosed CAPs are treated in ER. The CAP represents the origin of the majority of septic sepsis and shock diagnosed in ER, the leading cause of death and admission to the intensive care unit (ICU) for infectious disease. A global mortality of 10-14% is attributed according to age and associated risk factors. 40-60% of CAPs will require hospital admission, including observation areas (with very variable ranges of 22-65% according to centers, time of year and patient characteristics), and between them 2-10% will be in the ICU. From all that has been said, the importance of CAP in ER is translated, and also of the “impact of emergency care on patients with CAP”, as it is the device where initial, but fundamental, decisions are made for evolution of process. The great variability among clinicians in the management of diagnostic-therapeutic aspects in the CAP is known, which is one of the reasons that explain the large differences in admission rates, of achieving the microbiological diagnosis, request for complementary studies, the choice of antimicrobial regime or the diversity of care applied. In this sense, the implementation of clinical practice guidelines with the use of prognostic severity scales and the new tools available in HUSs such as biomarkers can improve the care of patients with CAP in ER. Therefore, based on a multidisciplinary group of emergency professionals and specialists participating in the CAP care process, this clinical guide has been designed with various recommendations for decisions and key moments in the process of patient care with NAC in the Emergency Room.


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