Obstet Gynecol. 2002 Sep;100(3):525-33.
Perinatal antibiotic usage and changes in colonization and resistance rates of group B streptococcus and other pathogens.

Spaetgens R, DeBella K, Ma D, Robertson S, Mucenski M, Davies HD.

Child Health Research Unit, Alberta Children's Hospital, University of Calgary, Canada.

OBJECTIVE: To quantify current antibiotic usage during the perinatal period and impact on vaginal-rectal colonizing organism resistance rates. METHODS: Swabs were obtained for culture of group B streptococcus and other bacteria from a cohort of 1207 pregnant women in Calgary, Alberta, at 36 weeks' gestation. Those women who received antibiotics during labor or after pregnancy and a 10% subset who received no antibiotics had repeat cultures at 6 weeks postpartum. Cultured organisms were tested for sensitivity to several antibiotics. RESULTS: Group B streptococcus was identified in 235 women (19.5%) in the antepartum period. Fifty-one percent of all participants received antibiotics (31.4% intrapartum). Group B streptococcus prophylaxis was given to 215 (17.8%), whereas 83 (6.9%) group B streptococcus-negative women without fever during labor received antibiotics. Ampicillin (49%), cefazolin (28%), and penicillin (18%) were the most frequently used antibiotics. Resistance rates among group B streptococcus to erythromycin and clindamycin were 5.6% and 3.0%, respectively, whereas 20.6% of Escherichia coli were ampicillin resistant. Among antibiotic recipients, 6.3% of all bacteria that were initially sensitive on prenatal cultures to a specific antibiotic became resistant in the postnatal period, whereas 6.5% that were initially resistant became sensitive. CONCLUSION: Current prevention practices in our region were associated with perinatal antibiotic administration in over half of pregnant women. Ampicillin was the most common antibiotic administered. Some physicians are treating women who are group B streptococcus culture negative at term, a practice that is of no proven value. However, this was not associated with increased resistance for group B streptococcus or other organisms identified from maternal vaginal-rectal tracts.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12220773&dopt=Abstract antibiotic, antibiotics



Fam Pract. 2003 Feb;20(1):69-73.
Understanding variation in quality improvement: the treatment of sore throats in primary care.

Marshall T, Mohammed MA.

Department of Public Health and Epidemiology, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK. T.P.Marshalham.ac.uk

BACKGROUND: In 1988, two practices attempted to improve the prescribing of antibiotics for sore throat. The initiative produced only modest improvements in prescribing practice, a finding the authors found difficult to explain. This paper reanalyses the data from an audit of antibiotic prescribing for sore throat in general practice. OBJECTIVE: Our aim was to demonstrate the use of Shewhart control charts and to obtain fresh insight into the variations in clinical practice revealed in clinical audit data. METHODS: We use Shewhart control charts to explore variation in antibiotic prescribing between GPs and to suggest the action most likely to result in improvement. RESULTS: Using control charts, it is possible to distinguish two categories of GPs: low prescribers of antibiotics and high prescribers of antibiotics. Low prescribers of antibiotics show common cause variation, indicating that their prescribing is a stable process. Among low prescribers, improvement can best be achieved by changing the common underlying process. One high prescriber of antibiotics is affected by special cause variation. Among high prescribers, improvement can best be achieved by investigating the special causes affecting this GP and learning lessons from the findings. CONCLUSION: The original improvement effort took the same action on all GPs in both practices. Our analysis suggests that such an approach was unlikely to be successful and that different actions were needed for high and low prescribers. The control charts provide fresh insights on the original data and guide improvement efforts.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12509374&dopt=Abstract antibiotic, antibiotics



Antimicrob Agents Chemother. 2002 Oct;46(10):3168-74.
In vitro antimicrobial activity of GSQ1530, a new heteroaromatic polycyclic compound.

Ge Y, Difuntorum S, Touami S, Critchley I, Burli R, Jiang V, Drazan K, Moser H.

Genesoft Inc., South San Francisco, California 94080, USA. jgenesoft.com

GSQ1530 is a compound derived from a newly identified class of antibiotics referred to as heteroaromatic polycyclic (HARP) antibiotics. The aim of this study was to assess the in vitro antimicrobial activity of GSQ1530. By using an NCCLS broth microdilution assay, the activities of GSQ1530 and other antibiotics were coevaluated against 215 clinical isolates. The MICs at which 90% of isolates are inhibited (MIC(90)s) of GSQ1530 for methicillin-susceptible Staphylococcus aureus and methicillin-resistant S. aureus (MRSA) were 2 and 4 micro g/ml, respectively. The MIC(90)s of GSQ1530 for the streptococci tested were 2 micro g/ml or less, regardless of their susceptibilities to other antibiotics. The MIC(90) of GSQ1530 for the enterococci tested (including vancomycin-resistant enterococci) was 4 micro g/ml. No cross-resistance was found between GSQ1530 and other known antibiotics. In a separate assay, GSQ1530 demonstrated excellent activity against vancomycin-intermediate-susceptible staphylococci (MIC(90), 1 micro g/ml). The minimal bactericidal concentration test was conducted with 73 clinical isolates; GSQ1530 was cidal against streptococci and staphylococci but static against enterococci. An in vitro killing kinetic study revealed a time-dependent profile, with at least a 3-log reduction of bacterial growth within 6 h after exposure to four times the MICs of GSQ1530 for both S. aureus and Streptococcus pneumoniae. The checkerboard study showed that GSQ1530 had a synergistic interaction with rifampin against MRSA. The test medium was found to have little effect on in vitro antimicrobial potency. The MICs of GSQ1530 for gram-positive cocci were 4- to 32-fold higher in the presence of serum proteins. GSQ1530 has high levels of plasma protein binding (91 and 89% for rat and human plasma, respectively). These preliminary results demonstrate that GSQ1530, a representative compound of our novel HARP antibiotics, has broad-spectrum activity against gram-positive bacteria. This novel class of antibacterial compounds is profiled in vivo to assess the therapeutic potential in humans. Ongoing in vivo studies will assess whether this class of molecules has promising in vivo efficacy and safety profiles.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12234840&dopt=Abstract antibiotic, antibiotics



Dermatol Surg. 2002 Sep;28(9):841-4.
Antibiotic prophylaxis guideline awareness and antibiotic prophylaxis use among New York State dermatologic surgeons.

Scheinfeld N, Struach S, Ross B.

Department of Dermatology, Beth Israel Medical Center and St. Luke's-Roosevelt Hospital Center, New York, New York, USA.

BACKGROUND: Use of antibiotic prophylaxis in dermatologic surgery patients remains controversial and several sets of guidelines exist. OBJECTIVE: We investigated dermatologic surgeon's awareness of the American Heart Association (AHA) 1997 antibiotic prophylaxis guidelines, their use of prophylactic antibiotics, and their practices as compared with the Haas and Grekin's 1995 antibiotic prophylaxis guidelines. METHODS: We mailed postage-paid questionnaires regarding AHA guideline awareness and antibiotic prophylaxis use to the 235 New York State members of the American Society for Dermatologic Surgery (ASDS). We received 87 replies. RESULTS: Most participants recognize AHA guidelines and claim to follow them. We reiterate previous studies' findings. Most dermatologic surgeons use antibiotics appropriately. However, antibiotics are occasionally overused or dosed outside the guidelines. Many participants prescribe antibiotics based on a patient's other physicians' recommendations. Notably, erythromycin is sometimes used, an antibiotic the AHA no longer recommends. CONCLUSION: Dermatologic surgeons commonly use antibiotic prophylaxis to prevent bacterial endocarditis. Based on previous studies, though, the risk of endocarditis following cutaneous surgery is low and thus the use of antibiotic prophylaxis is controversial. Although this practice is appropriate for high-risk patients when skin is contaminated, it is not recommended for noneroded, noninfected skin. We report that dermatologists may be aware of the guidelines, but only seem to partially follow them. Further studies are still needed to establish optimal guidelines.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12269880&dopt=Abstract antibiotic, antibiotics



Contracept Technol Update. 1995 Jun;16(6):72, 77-8.
Data lacking to support antibiotics at IUD insertion.

[No authors listed]

PIP: Despite a lack of clinical evidence to support prophylactic antibiotic use at the time of IUD insertion, many clinicians continue this practice. A 1994 survey of "Contraceptive Technology Update" readers found that 75% of clinicians who provide IUDs supported prophylactic antibiotic use in case the woman had chlamydia or gonorrhea bacteria at the cervix. Two large, independent, controlled studies conducted in Kenya and Nigeria failed to detect significantly lower rates of pelvic inflammatory disease (PID) 3 months after IUD insertion in women treated with antibiotics compared to a placebo. In fact, in the Nigerian study, the rate of PID was 0.6% among the 721 women who received antibiotics and only 0.3% among the 708 women in the placebo group. The Planned Parenthood Federation of America does not endorse the routine prophylactic use of antibiotics at IUD insertion. A Los Angeles (California) Regional Family Planning Council study is underway of 1800 women administered 500 mg of azithromycin before IUD insertion; findings should help to clarify the issue.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12292270&dopt=Abstract antibiotic, antibiotics



Appl Environ Microbiol. 2002 Oct;68(10):4731-9.
Engineering of primary carbon metabolism for improved antibiotic production in Streptomyces lividans.

Butler MJ, Bruheim P, Jovetic S, Marinelli F, Postma PW, Bibb MJ.

Department of Molecular Microbiology, John Innes Centre, Norwich, NR4 7UH, United Kingdom. michael.butlebsrc.ac.uk

Deletions were made in Streptomyces lividans in either of two genes (zwf1 and zwf2) encoding isozymes of glucose-6-phosphate dehydrogenase, the first enzyme in the oxidative pentose phosphate pathway (PPP). Each mutation reduced the level of Zwf activity to approximately one-half that observed in the wild-type strain. When the mutants were transformed with multicopy plasmids carrying the pathway-specific transcriptional activator genes for either the actinorhodin (ACT) or undecylprodigiosin (RED) biosynthetic pathway, they produced higher levels of antibiotic than the corresponding wild-type control strains. The presumed lower flux of carbon through the PPP in each of the Deltazwf mutants may allow more efficient glucose utilization via glycolysis, resulting in higher levels of antibiotic production. This appears to occur without lowering the concentration of NADPH (the major biochemical product of the oxidative PPP activity) to a level that would limit antibiotic biosynthesis. Consistent with this hypothesis, deletion of the gene (devB) encoding the enzyme that catalyzes the next step in the oxidative PPP (6-phosphogluconolactonase) also resulted in increased antibiotic production. However, deletion of both zwf genes from the devB mutant resulted in reduced levels of ACT and RED production, suggesting that some of the NADPH made by the PPP is utilized, directly or indirectly, for antibiotic biosynthesis. Although applied here to the model antibiotics ACT and RED, such mutations may prove to be useful for improving the yield of commercially important secondary metabolites.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12324314&dopt=Abstract antibiotic, antibiotics



Support Care Cancer. 2002 Oct;10(7):538-41. Epub 2002 Aug 10.
Antibiotic prescription for fever episodes in hospice patients.

Chen LK, Chou YC, Hsu PS, Tsai ST, Hwang SJ, Wu BY, Lin MH, Chen TW.

Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Sec 2, Taiwan 11217.

Bacterial infection usually plays an important part in the fever episodes that are common in patients in the hospice palliative care unit. The physicians' attitude to use of antibiotics in such cases is usually complex. We retrospectively studied 535 admissions to a hospice and palliative care unit in a medical center in Taiwan. Ninety-three fever episodes (16.7%) were identified among these admissions, and 79 fever episodes (84.9%) were treated with antibiotics. The Karnofsky performance status (KPS), verbal communication ability (VCA) and Glasgow Coma Scale (GCS) were all significantly compromised in these febrile patients. Although KPS, VCA and GCS were similar among all patients at the date of admission, these parameters became significantly worse in fever episodes that were left untreated than in those treated with antibiotics. Patients without antibiotic treatment showed a shorter mean survival (8.7 +/- 9.9 days vs 14.6 +/- 13.1 days; P = 0.03) and a higher 3-day mortality rate than those patients with antibiotic treatment (50% vs 15.2%; P = 0.015). In conclusion, appropriate antibiotic use may cause fever to subside and thus decrease the fever-related discomfort. Physicians may tend to withhold antibiotic treatment because of the poorer KPS, VCA, and GCS and poorer estimated prognosis of patients at the time of fever.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12324808&dopt=Abstract antibiotic, antibiotics