Pharmacotherapy. 2002 May;22(5):630-6.
Risk of clinical blood dyscrasia in a cohort of antibiotic users.

Huerta C, Garcia Rodriguez LA.

Centro Espanol de Investigacion Farmacoepidemiologica, Madrid, Spain.

Blood dyscrasias, although rare, can be fatal. Many drugs, including antibiotics, are associated with these dyscrasias. We conducted a cohort study with a nested case-control analysis using data from the General Practice Research Database to estimate incidence rates of clinical blood dyscrasias in the general population and to examine their association with use of antibiotic drugs. The study population consisted of patients aged 5-69 years receiving at least one antibiotic prescription from January 1994-September 1998. The final cohort consisted of 822,048 persons who received 1,507,307 antibiotic prescriptions during the study period. The main outcome measure was a diagnosis of neutropenia, agranulocytosis, hemolytic anemia, thrombocytopenia, bicytopenia, pancytopenia, or aplastic anemia. We confirmed 122 patients who developed clinical blood dyscrasias. The incidence was 3.3/100,000 person-years in the general population. Patients older than 60 years (relative risk [RR] 2.8, 95% confidence interval [CI] 1.6-5.0) and those who took phenothiazines (RR 49.0, 95% CI 4.9-488.2) had an increased risk of blood dyscrasia. Users of antibiotics had an RR of 4.4 (95% CI 2.6-7.5), and patients taking more than one class of antibiotics had an RR of 29.1 (95% CI 9.1-92.8). Among individual antibiotic classes, the greatest risk was with cephalosporins (RR 13.8, 95% CI 3.6-52.6). Although uncommon, our study supports an association between blood dyscrasias and antibiotics.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12013362&dopt=Abstract antibiotic, antibiotics



J Antimicrob Chemother. 2002 Dec;50(6):989-97.
Antibiotic prescribing in general practice: striking differences between Italy (Ravenna) and Denmark (Funen).

Vaccheri A, Bjerrum L, Resi D, Bergman U, Montanaro N.

Interuniversity Research Centre on Pharmacoepidemiology, Department of Pharmacology, University of Bologna, Via Irnerio 48, I-40126 Bologna, Italy. vaccheriocfarm.unibo.it

OBJECTIVE: To compare antibiotic prescribing in primary care in two European populations, one in Denmark (Funen), the other in Italy (Ravenna). METHODS: Reimbursement data (1999) were retrieved from the Odense Pharmacoepidemiologic Database (Denmark) and the Emilia Romagna Health Authority Database (Italy). The extent of antibiotic use (ATC J01) was analysed as the number of defined daily doses per 1000 inhabitants per day (DDD/1000 inhabitants/day), and as annual prevalence of use. A qualitative analysis was carried out according to the Drug Utilization 90% (DU90%) approach. RESULTS: Antibiotic consumption was 16.5 DDD/1000 inhabitants/day in Ravenna and 10.4 DDD/1000 inhabitants/day in Funen; the annual prevalence of use was 40 and 30 subjects/100 inhabitants, respectively. Italian children received a greater amount (four-fold in DDDs) of antibiotics than Danish ones, whereas consumption was only slightly higher in Italy than in Denmark in the other age groups. In Italy, injectable antibiotics (third generation cephalosporins or aminoglycosides) accounted for 4% of total DDDs and 11% of exposed subjects. In Funen, use of injectable antibiotics was negligible. The bulk of prescription (90% of total DDDs) was made up of eight (out of 38) different antibiotics in Denmark, mainly narrow-spectrum penicillins and macrolides (1st: phenoxymethylpenicillin), and of 18 (out of 74) antibiotics in Italy, mainly broad-spectrum penicillins, macrolides, fluoroquinolones and cephalosporins. CONCLUSIONS: These data show remarkable differences in antibiotic prescribing between Italy and Denmark, and suggest possible overuse and misuse of antibiotics in Italy.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12461022&dopt=Abstract antibiotic, antibiotics



Med Clin (Barc). 2002 Apr 27;118(15):561-8.
[Trends in antibiotic consumption in Spain, 1985-2000]

[Article in Spanish]

Lazaro Bengoa E, Madurga Sanz M, Abajo Iglesias FJ.

Division de Farmacoepidemiologia y Farmacovigilancia. Agencia Espanola del Medicamento. Madrid. Spain.

BACKGROUND: The purpose of this study was to analyse the trend in antibiotics consumption to draw on the National Health System (NHS) over the last 16 years in Spain and its different Autonomous Communities (AC). MATERIAL AND METHOD: Consumption data for all antibiotics used in Spain, either alone or in fixed-dose combinations, were obtained using the database ECOM. This database includes all the packages sold through retail pharmacies and reimbursed by the NHS. Data are expressed as defined dairy doses per 1,000 inhabitants per day (DHD), in accordance with the methodology recommended by the World Health Organization. Demographic data were provided by the National Institute of Statistics. RESULTS: In 1985 the overall consumption of antibiotics was 21.9 DHD, while in 2000 it was 20.4 DHD. It was possible to distinguish three phases over the study period. The first phase lasts until 1989, where a mild decreasing trend was observed (1.1 DHD; 5.0%), mainly due to the fall of fixed-dose combinations of antibiotics and the association of sulfamethoxazole-trimethoprim. The second phase, lasting until 1996, was characterized by a generalized increase in the consumption in all AC, with an average of 2.3 DHD (+ 11.1%), ranging from 0.4 to 4.6 DHD; this increase was mainly due to the marketing of new macrolides, cephalosporins and quinolones. Finally, there was a third phase beginning in 1996, where the consumption of antibiotics came into a sustained and generalized decline, ranging from 0.5 to 5.1 DHD, and depending on the AC (national average 2.7 DHD, 11.7% lower than that in 1996). This latter trend was mainly due to the fall of wide-spectrum penicillins. Differences between AC regarding the level of consumption were huge over the study period, although the pattern of use was quite similar. There was, for instance, a difference of 10.4 DHD between Region de Murcia and Islas Baleares in 2000, or 9.9 DHD between the former and Madrid in the same year. CONCLUSIONS: The consumption of antibiotics in Spain and all its AC has declined since 1996, probably related to the campaigns launched by public administrations to promote the rational use of these agents. The main subgroup involved in this trend is wide-spectrum penicillins. Differences in antibiotics use between AC are too big to be accounted for by different epidemic patterns and, therefore, should be analysed further.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12015944&dopt=Abstract antibiotic, antibiotics



J Antimicrob Chemother. 2002 Dec;50(6):1051-4.
Additive, indifferent and antagonistic effects in combinations of epigallocatechin gallate with 12 non-beta-lactam antibiotics against methicillin-resistant Staphylococcus aureus.

Hu ZQ, Zhao WH, Yoda Y, Asano N, Hara Y, Shimamura T.

Department of Microbiology and Immunology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan. zqhed.showa-u.ac.jp

Additive, indifferent and antagonistic effects were observed in combinations of epigallocatechin gallate (EGCg, a main constituent of tea catechins) with12 non-beta-lactam antibiotics against methicillin-resistant Staphylococcus aureus (MRSA). The combinations of EGCg with the inhibitors of either protein or nucleic acid synthesis showed additive or indifferent effects. These antibiotics included tetracycline, minocycline, chloramphenicol, streptomycin, gentamicin, kanamycin, erythromycin, rifampicin and ofloxacin. In contrast, EGCg showed an antagonistic tendency against glycopeptide antibiotics (vancomycin, teicoplanin and polymyxin B). The common property of these antibiotics is the peptide backbone structure, suggesting a direct binding of EGCg with the antibiotics. The above results indicate that tea catechins may affect the activities of antibiotics both positively and negatively.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12461032&dopt=Abstract antibiotic, antibiotics



J Chemother. 2002 Apr;14(2):166-74.
The application of cost effectiveness analysis to derive a formulary for urinary tract infections.

Tramarin A, Bragagnolo L, Tolley K, Sartorelli S, Tositti G, Lazzarini L, Scagnelli M, Gallo R, Postma MJ, de Lalla F.

Department of Infectious Diseases, San Bortolo Hospital, Vicenza, Italy. tramaripnet.it

According to economic principles an inappropriate prescription is the choice of an antimicrobial with higher/equivalent cost and lower effectiveness (or higher cost and equivalent/lower efficacy) than an alternative (in this case, the former is specified as a "dominated" drug). To identify cost-effective antibiotics we applied the principles of incremental cost-effectiveness analysis (ICEA) to microbiological data of San Bortolo Hospital. Its 27 wards were grouped in 9 functional areas. The resistance patterns of 8 urinary pathogens in the 1997 microbiology data base were assessed. The measure of antibiotic effectiveness was expressed as the percentage of isolates susceptible to each antibiotic tested. The difference in cost (i.e. the incremental change) between each antibiotic and the next more expensive alternative was calculated, and compared with the incremental change in effectiveness. Calculations were made for each pathogen. The antibiotics remaining after exclusion of all "dominated" antibiotics were pooled on a list defined as "Specific Area Formulary". The implications of the use of economic principles within a general antimicrobial policy are discussed.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12017372&dopt=Abstract antibiotic, antibiotics



J Dairy Sci. 2002 Apr;85(4):1009-14.
Effective treatment of Streptococcus uberis clinical mastitis to minimize the use of antibiotics.

Hillerton JE, Kliem KE.

Institute for Animal Health, Compton, United Kingdom. eric.hillertobsrc.ac.uk

Antibiotic regimens (intramammary antibiotic, penicillin-based parenteral treatment) and intramuscular oxytocin were tested for effectiveness against experimental infection by Streptococcus uberis with the following results from 54 animals: a) no treatment led to deterioration of infected quarters, requiring intervention within 48 h for cow health; b) aggressive intramammary antibiotic at every milking achieved 70% clinical cure in 3 d and 100% cure within 6 d; overall bacteriological cure was 80%; c) parenteral treatment alone used about 14 times as much antibiotic with 18% clinical cure in 3 d and 91% within 6 d; overall bacteriological cure was 80%; d) combination of aggressive intramammary and parenteral treatments achieved 61% clinical cure in 3 d and 100% within 6 d; overall bacteriological cure was 72%; e) intramammary antibiotic at labeled rates (1x for 3 d) achieved 27% clinical cure in 3 d but 91% within 6 d of treatment; overall bacteriological cure was 64%; f) use of oxytocin alone for 3 d failed to achieve clinical improvement with an increase in the severity of mastitis; g) combining oxytocin with labeled use of intramammary antibiotic (1x for 3 d) was unsuccessful: 0% clinical cures in 3 d, 10% in 6 d; significantly poorer than intramammary antibiotic alone. Extended treatment periods with parenteral or intramammary antibiotics resulted in positive inhibitory tests for milk from individual quarters up to 8 d after treatment. Aggressive intramammary antibiotic was the most effective treatment for fastest cure clinically and bacteriologically using least antibiotic.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12018412&dopt=Abstract antibiotic, antibiotics



Ann Pharmacother. 2002 Jun;36(6):975-80.
Clinical outcomes of ambulatory acute exacerbations of chronic bronchitis with older versus newer antimicrobials.

Madaras-Kelly KJ, Magdanz SB, Johnson CK, Jue SG.

Department of Pharmacy Practice, College of Pharmacy, Idaho State University, Boise 83702-4598, USA. kmtc.isu.edu

OBJECTIVE: To determine whether the cure rate was similar between traditional and newer antibiotics in the treatment of acute exacerbations of chronic bronchitis (AECB), to determine whether antibiotic selection during the first AECB of the season influences the frequency of subsequent AECB, and to identify variables associated with poor short- and long-term treatment outcome. METHODS: A retrospective analysis of subjects seen for management of their first seasonal AECB was conducted. Subjects were stratified into traditional therapies (n = 95) or newer therapies (n = 101) by antibiotic prescription. RESULTS: There was no difference in initial cure rates between older versus newer antibiotics (93% vs. 95%; p = 0.48). There was no difference in the number of subjects that remained AECB-free for 6 months after initial treatment with older versus newer antibiotic regimens (34% vs. 28%; p = 0.37). Oxygen initiation or increased dose (OR 10.9; 95% CI 1.4 to 84.2; p = 0.02) was the only variable independently associated with lack of AECB resolution. Nonsmoking status trended toward an association with remaining AECB-free at 180 days (OR 0.39; 95% CI 0.15 to 1.01; p = 0.053). CONCLUSIONS: The use of older versus newer antibiotics did not independently predict short-term outcome or future AECB.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12022895&dopt=Abstract antibiotic, antibiotics