Int J Antimicrob Agents. 2002 Oct;20(4):253-7.
Over-the-counter acquisition of antibiotics in the Maltese general population.

Borg MA, Scicluna EA.

Infection Control Unit, St. Luke's Hospital, MSD 07, Guardamangia, Malta. michael.a.borov.mt

Few studies have studied the frequency of over-the-counter acquisition of antibiotics in western countries. In order to provide an insight into these practices in Malta, attitudes towards antibiotic use in the general public were researched through a structured interview. Nineteen percent admitted that they took antibiotics without prescription and 11% of parents replied that they had given antibiotics to their children without prescription. These antibiotics were mainly self-administered for upper respiratory tract symptoms, particularly sore throat, with community pharmacies being the major source in more than 85% of cases. The study indicates the need for an educational campaign on proper antibiotic use amongst the Maltese general public.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12385680&dopt=Abstract antibiotic, antibiotics



Int J Antimicrob Agents. 2002 Sep;20(3):153-64.
A risk analysis framework for the long-term management of antibiotic resistance in food-producing animals.

Salisbury JG, Nicholls TJ, Lammerding AM, Turnidge J, Nunn MJ.

Biotext, 113 Hopetoun Circuit, Yarralumla, ACT 2600, Australia. janet.salisburiotext.com.au

In recent years, there has been increasing concern that the use of antibiotics in food-producing animals, particularly their long-term use for growth promotion, contributes to the emergence of antibiotic-resistant bacteria in animals. These resistant bacteria may spread from animals to humans via the food chain. They may also transfer their antibiotic-resistance genes into human pathogenic bacteria, leading to failure of antibiotic treatment for some, possibly life-threatening, human conditions. To assist regulatory decision making, the actual risk to human health from antibiotic use in animals needs to be determined (risk assessment) and the requirements for risk minimisation (risk management and risk communication) determined. We propose a novel method of risk analysis involving risk assessment for three interrelated hazards: the antibiotic (chemical agent), the antibiotic-resistant bacterium (microbiological agent) and the antibiotic-resistance gene (genetic agent). Risk minimisation may then include control of antibiotic use and/or the reduction of the spread of bacterial infection and/or prevention of transfer of resistance determinants between bacterial populations. 2002 Elsevier Science B.V. and International Society of Chemotherapy


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12385693&dopt=Abstract antibiotic, antibiotics



J Infect. 2002 Oct;45(3):144-51.
Pre-hospital parenteral antibiotic treatment of meningococcal disease and case fatality: a Danish population-based cohort study.

Norgard B, Sorensen HT, Jensen ES, Faber T, Schonheyder HC, Nielsen GL.

Department of Clinical Epidemiology, Aarhus University Hospital, Vennelyst Boulevard 6, DK-8000 Aarhus C, Denmark. boci.au.dk

OBJECTIVES: Studies about the efficiency of pre-hospital antibiotic treatment of meningococcal disease are conflicting. We examined the case fatality rate in patients with meningococcal disease treated with pre-hospital antibiotics. METHODS: A cohort study of 534 patients hospitalized with meningococcal disease from two Danish counties. Clinical data were obtained from referral letters from general practitioners and hospital records. Complete follow-up for all patient until death or discharge. RESULTS: Seventy-seven patients (16% of the patients seen by a general practitioner) received parenteral antibiotics before hospital admission; 9 (12%) of them died. Of 402 patients who did not receive pre-hospital parenteral antibiotics, 26 (7%) died. The overall risk of case fatality among antibiotic-treated patients was increased with adjusted odds ratio (OR) = 2.4 (95% CI, 1.0-5.6). Meningococcus serogroup B was associated with increased case fatality in patients who received pre-hospital parenteral antibiotics (OR = 2.6; 95% CI, 0.8-8.3) in contrast to other serogroups. In Aarhus County there were no deaths in patients who received pre-hospital parenteral antibiotics, but in North Jutland County the case fatality was high (OR = 2.9; 95% CI, 1.2-6.8). CONCLUSIONS: The efficiency of pre-hospital parenteral antibiotic treatment seems to be dependent on hospital care and may vary with the serogroup.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12387769&dopt=Abstract antibiotic, antibiotics



Arch Intern Med. 2002 Oct 28;162(19):2210-6.
Antibiotic resistance: a survey of physician perceptions.

Wester CW, Durairaj L, Evans AT, Schwartz DN, Husain S, Martinez E.

Collaborative Research Unit, Department of Medicine, Cook County Hospital, Room 1600, Administration Building, 1900 W Polk St, Chicago, IL 60612, USA.

BACKGROUND: Antibiotic resistance is caused partly by excessive antibiotic prescribing, yet little is known about prescribers' views on this problem. METHODS: We surveyed 490 internal medicine physicians at 4 Chicago-area hospitals to assess their attitudes about the importance of antibiotic resistance, knowledge of its prevalence, self-reported experience with antibiotic resistance, beliefs about its causes, and attitudes about interventions designed to address the problem. RESULTS: The response rate was 87% (424 of 490 physicians). Antibiotic resistance was perceived as a very important national problem by 87% of the respondents, but only 55% rated the problem as very important at their own hospitals. Nearly all physicians (97%) believed that widespread and inappropriate antibiotic use were important causes of resistance. Yet, only 60% favored restricting use of broad-spectrum antibiotics, although this percentage varied by hospital and physician group. CONCLUSIONS: Although most physicians view antibiotic resistance as a serious national problem, perceptions about its local importance, its causes, and possible solutions vary more widely. Disparities in physician knowledge, beliefs, and attitudes may compromise efforts to improve antibiotic prescribing and infection control practices.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12390064&dopt=Abstract antibiotic, antibiotics



J Hosp Infect. 2002 Oct;52(2):136-40.
Impact of antibiotic changes in empirical therapy on antimicrobial resistance in intensive care unit-acquired infections.

Allegranzi B, Luzzati R, Luzzani A, Girardini F, Antozzi L, Raiteri R, Di Perri G, Concia E.

Department of Infectious Diseases, University of Verona, Italy. beneallahoo.com

We conducted a one-year prospective study on intensive care unit (ICU)-acquired infections and antimicrobial resistance patterns in an 18-bed medical-surgical ICU of a tertiary-care university hospital. We divided the study into two six-month periods in order to evaluate the impact of antibiotic changes in empirical therapy on antimicrobial resistance profiles of the principal isolated micro-organisms. In the first period no changes were made to the previously applied empirical antibiotic protocol; at the end of this period we found high rates of methicillin resistance (MR) among staphylococci, 93% for Staphylococcus aureus (69 isolates) and 79% for coagulase-negative staphylococci (CNS) (48 isolates), and of multiple drug resistance for Pseudomonas aeruginosa (57 isolates), in particular 67% resistance to piperacillin/tazobactam (PIP/TZ). We therefore decided to substitute PIP/TZ with imipenem in nosocomial pneumonia and with cefepime plus metronidazole in peritonitis. We also considered the previous use of amoxicillin/clavulanate (AM/CL) at admission in critically ill patients inadequate; we therefore advised that no antibiotics should be given unless fever developed and eventually to replace AM/CL with trimethoprim/sulfamethoxazole (TMP/SMX). At the end of this intervention period, we observed a significant decrease of S. aureus MR (93 vs. 73%, P = 0.003) and of P. aeruginosa resistance to PIP/TZ (67 vs. 29%, P < 0.001). A reduction in MR was also seen in CNS (79 vs. 64%, P = 0.09). Other resistance patterns also improved among staphylococci; in contrast P. aeruginosa resistance to imipenem increased in the second period (24 vs. 41%, P = 0.06). A non-premeditated change of antibiotics in empirical therapy, on the basis of detected resistance patterns, provided promising results in reducing some antimicrobial resistance rates. We believe, however, that antibiotic changes must be tailored to local microbiological situation monitoring, and that a repeated rotation is crucial to limit the emergence of new resistance profiles. Furthermore the adoption of this policy should be accompanied by other infection control practices aimed at reducing antimicrobial resistance and nosocomial infection rates. 2002 The Hospital Infection Society


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12392905&dopt=Abstract antibiotic, antibiotics



Arch Pediatr. 1999 Mar;6(3):321-3.
[Prevention of antibiotic resistance needs informed parents]

[Article in French]

Ovetchkine P.

Service de pediatrie generale, centre hospitalier intercommunal de Creteil, France.

Antibiotic resistance is becoming worldwide a major challenge. Increasing rate of multidrug resistant bacteria is directly linked with the consumption of antibiotic. Children are the greatest consumers of antibiotics, but this large pediatric prescription is not justified, and responds, at least in part, to a "parental pressure". Therefore information to the parents about antibiotic is recommended. In order to promote this information the American Academy of Pediatrics recently wrote a booklet entitled "Your child and antibiotics" which is presented.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10191903&dopt=Abstract antibiotic, antibiotics



Patient Educ Couns. 2002 Oct -Nov;48(2):161-9.
Cross-cultural differences in lay attitudes and utilisation of antibiotics in a Belgian and a Dutch city.

Deschepper R, Vander Stichele RH, Haaijer-Ruskamp FM.

Department of Comparative Study of Culture, Ghent University, Ghent, Belgium. reginald.descheppeug.ac.be

Cultural differences are probably an important factor in the considerable variation in antibiotic use between countries. The objective of this study was to explore local cultural differences in the lay perspective on coping with URTD and using antibiotics. We interviewed 30 persons in a Dutch and a Belgian city. Twenty-one were interviewed a second time after 3 months. Between the first and second interview, they noted in a diary all URTD episodes experienced by themselves and their family members (N=69) and how they coped with them. The Dutch participants labelled most URTD episodes as "common cold" or "flu". The Flemish participants labelled most of their URTD episodes as "bronchitis" and used more antibiotics. Four categories of antibiotic users could be distinguished. Participants with a Protestant background were more sceptical about medicines than those with a Catholic background. A thorough understanding of the cultural context is necessary to design effective campaigns to promote rational antibiotic use.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12401419&dopt=Abstract antibiotic, antibiotics