Pediatr Infect Dis J. 2002 Nov;21(11):1023-8.
Decreased number of antibiotic prescriptions in office-based settings from 1993 to 1999 in children less than five years of age.

Halasa NB, Griffin MR, Zhu Y, Edwards KM.

Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA.

OBJECTIVE: Increasing rates of antibiotic resistance have stimulated efforts to decrease antibiotic use. To assess the success of these efforts, we analyzed antibiotic prescribing trends in children younger than 5 years old, the group with the highest use, from 1993 to 1999. METHODS: Data from the National Ambulatory Medical Care Survey were analyzed to determine antibiotic prescribing patterns for office-based visits from 1993 to 1999 for children <5 years old. Data were stratified by US regions, patient's race and gender. Antibiotic prescription rates per 1,000 population were calculated with population data from the US Census Bureau as the denominator. Specific prescribing of penicillins, cephalosporins, macrolides and sulfas was also assessed. RESULTS: Overall antibiotic prescribing in the office-based setting peaked in 1995 at 1,191 antibiotic courses per 1,000 children, then declined to 698 per 1,000 in 1999, a decrease of 41%. Antibiotic prescribing was consistently higher in whites than blacks; however, declines in prescribing over time were observed in both groups. Although there was wide regional variation in antibiotic prescribing in the early 1990's, by the late 1990's prescribing rates were similar in all regions. Prescriptions for penicillins and cephalosporins combined comprised 77 and 70% of total prescriptions during 1993 to 1997 and 1998 to 1999, respectively. Macrolide prescriptions reached a nadir during 1993 to 1997, accounting for 9% of the total, but increased to 16% during 1998 to 1999. CONCLUSION: Since 1995 the rates of antibiotic prescriptions in children <5 years of age have declined substantially. At the same time changes have occurred in the types of antibiotics prescribed. It appears that efforts to reduce antibiotic use have been successful. Whether this decrease in use will be accompanied by lower rates of antibiotic resistance will need to be determined.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12442023&dopt=Abstract antibiotic, antibiotics



Arch Pediatr Adolesc Med. 2002 Dec;156(12):1230-4.
The effect of rapid respiratory viral diagnostic testing on antibiotic use in a children's hospital.

Byington CL, Castillo H, Gerber K, Daly JA, Brimley LA, Adams S, Christenson JC, Pavia AT.

Department of Pediatric Infectious Diseases, University of Utah, 50 N Medical Drive, Salt Lake City, UT 84132, USA. cbyingtoed.utah.edu

BACKGROUND: Acute viral respiratory disease is the most common reason for pediatric hospitalization in the United States. Viral illnesses may be mistaken for bacterial infection, and antibiotic therapy may be prescribed. Overprescribing of antimicrobials for viral illness is a factor contributing to increasing antimicrobial resistance among bacterial pathogens encountered in pediatrics. OBJECTIVE: To determine if the availability of a rapid diagnostic test for respiratory viruses would affect antibiotic use in a children's hospital. DESIGN: Retrospective medical record review. SETTING: A 232-bed urban children's hospital. PARTICIPANTS: All hospitalized infants and children who underwent rapid testing (SimulFluor Respiratory Screen; Chemicon International Inc, Temecula, Calif) for respiratory viruses by direct fluorescent assay (DFA) during 2 successive winter seasons. MAIN OUTCOME MEASURES: Rates of antibiotic prescribing in DFA-positive and DFA-negative patients during the 2 study periods. RESULTS: During the first winter season, DFA-positive patients had fewer days using intravenous antibiotics (2.4 vs 4, P =.04), fewer days using oral antibiotics (0.25 vs 2.5, P =.04), and fewer discharge prescriptions for oral antibiotics (37% vs 52%, P =.02) when compared with DFA-negative patients. Intravenous antibiotics were initiated less often for DFA-positive patients during the second winter season than during the first (26% vs 44%, P =.008). CONCLUSIONS: Direct fluorescent assay testing was associated with a decrease in inappropriate antibiotic use. The availability of rapid viral diagnostics is an important tool for decreasing antibiotic prescribing in pediatric patients.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12444835&dopt=Abstract antibiotic, antibiotics



Eur J Intern Med. 2002 Dec;13(8):514-517.
Use of antibiotics in patients admitted to the hospital due to acute exacerbation of chronic obstructive pulmonary disease (COPD).

Jacobsen SK, Weis N, Almdal T.

The Herlev University Hospital, Department of Internal Medicine and Endocrinology, DK 2730, Herlev, Denmark

BACKGROUND: The purpose of this study was to assess to what extent symptoms and signs of bacterial infection are present and evaluated in patients admitted to the hospital for exacerbation of chronic obstructive pulmonary disease (COPD) in relation to initiation of antibiotic treatment. METHODS: All adult patients (>18 years of age) discharged from a department of internal medicine in Copenhagen in 1997 with a diagnosis of exacerbation of COPD were included in our study and their reports were retrospectively reviewed. Gender, age, number of admissions and length of hospital stay, use of antibiotics and steroids prior to admission, temperature, white blood cell (WBC) count, results of lung auscultation and X-ray examination of the thorax at admittance, and growth of sputum culture and antibiotic treatment in the hospital were all registered. RESULTS: A total of 400 admissions took place. In 104 of them, chest X-ray was compatible with pneumonia, and 99 cases were treated with antibiotics. In 44% of the remaining 296 cases, antibiotics were given. It was found that 25-45% of the patients with very little evidence of infection-i.e. the absence of, or only the presence of, one of the following indicators of infection: fever (temperature>37.5 degrees C), a raised WBC count (>9 billion/l), or crepitation at lung auscultation-were given antibiotics. In cases presenting with two or three of these indicators, 50-75% were given antibiotics. In 85% of the cases, penicillin or a macrolide was the initial antibiotic of choice. The median hospital stay was 6 days for the entire group of patients. CONCLUSION: These data suggest that, in patients with acute exacerbation of COPD, a relatively high number of patients with only weak symptoms or signs of bacterial infection are treated with antibiotics.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12446197&dopt=Abstract antibiotic, antibiotics [PubMed - as supplied by publisher]



Plast Reconstr Surg. 2002 Dec;110(7):1680-7.
Wet wound healing.

Vranckx JJ, Slama J, Preuss S, Perez N, Svensjo T, Visovatti S, Breuing K, Bartlett R, Pribaz J, Weiss D, Eriksson E.

Laboratory of Tissue Repair and Gene Transfer, Division of Plastic Surgery, Brighton and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.

Wound treatment in a flexible transparent chamber attached to the perimeter of the wound and containing a liquid has been extensively tested in preclinical experiments in pigs and found to offer several advantages. It protects the wound; the liquid medium or saline in the chamber provides in vivo tissue culture-like conditions; and antibiotics, analgesics, and various molecules can be delivered to the wound through the chamber. The wound chamber causes no injury to the wound itself or to the surrounding intact skin. Topical delivery of, for instance, antibiotics can provide very high concentrations at the wound site and with a favorable direction of the concentration gradient. A series of 28 wounds in 20 patients were treated with a wound chamber containing saline and antibiotics. Most patients had significant comorbidity and had not responded to conservative or surgical management with debridement and delayed primary closure or skin grafts. Six wounds had foreign bodies present; four of these were joint prostheses. Seven patients were on corticosteroids for rheumatoid arthritis, lupus, or chronic obstructive pulmonary disease, and four patients had diabetes. Most patients were treated with the wound chamber in preparation for a delayed skin graft or flap procedure, but one was treated with a wound chamber until the wound healed. Twenty-five of the wounds (89 percent) healed, and five wounds (18 percent) required additional conservative management after the initial chamber treatment and grafting procedure. Of the three wounds that did not heal, one healed after additional chamber treatment, one had a skin graft that did not take, and one required reamputation at a higher level. Antibiotic delivery was less than one intravenous dose daily, which avoided the potential for systemic absorption to toxic levels. Antibiotics such as vancomycin and gentamicin could be used in concentrations of up to 10,000 times the minimal inhibitory concentration. Forty-eight hours after application, 20 percent or more of the original antibiotic concentration was present in the wound chamber fluid. In conclusion, the wound chamber provides a safe, powerful tool in the treatment of difficult infected wounds.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12447049&dopt=Abstract antibiotic, antibiotics



Tidsskr Nor Laegeforen. 2002 Oct 10;122(24):2376-8.
[Use of systemic antibiotics in a Norwegian nursing home]

[Article in Norwegian]

Tobiassen T, Berild D, Hjortdahl P.

Torshov helsesenter Chr. Michelsens gate 65 0474 Oslo. toretnline.no

BACKGROUND: The population in the industrialised world is ageing; this brings an increase in the nursing home population. MATERIAL AND METHODS: In a 175-bed Norwegian nursing home a retrospective analysis was done by a manual search of all patient records for the year 1998, to establish the use of all systemic antibiotics that year. RESULTS: Out of 223 residents, 111 (50%) received 239 antibiotic treatments during the year. An average of 4.5% of the residents received antibiotics at any one time. Urinary tract infections accounted for 50% of antibiotics use followed by lower respiratory tract infections (27%) and skin and soft-tissue infections (11%). Trimethoprim and penicillin V accounted for 56% of the antibiotics used. INTERPRETATION: The choice of antibiotics was by and large in accordance with national guidelines for use of antibiotics in primary care. There is a need for further studies in order to develop consensus criteria for rational use of antibiotics in nursing homes.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12448254&dopt=Abstract antibiotic, antibiotics



Lakartidningen. 2002 Oct 10;99(41):4048-50.
[STRAMA questionnaire on general practitioners' knowledge concerning antibiotics and resistance. Lack of time impedes exchange of information]

[Article in Swedish]

Tammelin A, Hartvig P, Schwan A, Tidestrom L, Torell E.

Akademiska sjukhuset, Uppsala. ann.tammeliactlab.hs.sll.se

The Uppsala county regional group of the Swedish Strategic Programme for the Rational Use of Antimicrobial Agents and Surveillance of Resistance (STRAMA) sent a questionnaire to all the general practitioners in the county concerning their knowledge of antibiotics and bacterial resistance. The questionnaire also asked which sources were used for information on these topics, and inquired as to their views concerning the services provided by the local clinical microbiological laboratory. A third part of the questionnaire contained descriptions of three patients with infectious diseases, and each general practitioner was asked to indicate appropriate diagnostic tests and/or antibiotic treatment. The questionnaire was completed by 70% (100/145). The general awareness of which antibiotics to use for empirical treatment of urinary tract infection was good. Awareness of antibiotic resistance in S. pyogenes, H. influenzae, S. pneumoniae and MRSA was moderately good (59-80%). About 60% thought it was difficult to find information concerning resistance and use of antibiotics. Lack of time was the main reason for not being able to seek such information actively. The regional STRAMA-group believes that this kind of survey followed by reporting back of results with informative comments on the topics concerned is a useful model for education.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12451942&dopt=Abstract antibiotic, antibiotics



Int J Antimicrob Agents. 2002 Dec;20(6):399-406.
Attitudinal classification of patients receiving antibiotic treatment for mild respiratory tract infections.

Pechere JC, Cenedese C, Muller O, Perez-Gorricho B, Ripoll M, Rossi A, Stahl JP, Stahlmann R, Tramarin A.

Department of Microbiology, University of Geneva, 19 Krieg, 1208 Geneva, Switzerland. pechermu.unige.ch

The aim of this study was to determine patients' perceptions of antibiotic therapy and the doctor's skill in the management of ambulatory respiratory tract infections. Standardized face-to-face interviews were used with more than 3000 randomized patients or parents from four European countries. Attitudinal dimensions relating to their doctor identified four patient types: Involved (30%), Deferent (23%), Ignored (13%) and Critical (17%). Involved and Deferent patients were the most satisfied by the information received from their doctor (43%/39% compared with 17%/16% for Ignored/Critical, respectively, P < 0.01). They also scored more highly on the accurate use of antibiotics, with 80%/80% vs. 38%/62%, respectively (P < 0.01), understanding dosing intervals and 77%/77% vs. 36%/60% (P < 0.01), understanding the course length. Involved and Deferent patients showed better compliant behaviour, with 91% of both groups vs. 86% of the Ignored and Critical claiming to have taken every dose (P < 0.001) and 92%/87% vs. 84%/85% claiming to have finished the course (P < 0.001 for Involved only). Involved and Deferent patients were less prone to save part of a course of antibiotics than the Ignored and Critical (46%/41% vs. 20%/31%, P < 0.001), and they perceived the antibiotics prescribed to be more effective (36%/31% vs. 21%/15%, P < 0.001). By analysing patient perceptions, this study identifies an important mirror effect, whereby a more sympathetic attitude from the doctor should increase the patient's involvement in disease management, for a more appropriate use of antibiotics in common infections. 2002 Publushed by Elsevier Science B.V. and International Society of Chemotherapy


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12458132&dopt=Abstract antibiotic, antibiotics