Hosp Pharm. 1994 Jan;29(1):48-50, 53.
Comprehension of antibiotic instructions in an outpatient Malaysian practice.

Hassan Y, Abd Aziz N, Sarriff A, Darwis Y, Ibrahim P.

Department of Clinical Pharmacy, Universiti Sains Malaysia, Kelatan.

Patients may not comply with antibiotic instructions because they do not understand them. The aim of this study was to assess outpatients' ability to comprehend their antibiotic prescription labels. Two hundred and five subjects on oral antibiotic regimens from an outpatient clinic and pharmacy of a district hospital were selected in this survey. All patients were interviewed by trained clinical pharmacy students. They were asked to read the labels and then how they would take their antibiotics. The results show that 119 (58.1%) patients could interpret the label. Forty-nine (23.9%) patients knew the name of antibiotics and interpreted the directions of use correctly. One hundred sixteen (56.6%) subjects were able to recall the auxiliary information. However, only 44 (21.4%) patients were able to comprehend complete antibiotic instruction. This study demonstrates that a significant proportion of patients could not interpret the labeling instruction. The comprehension level of patients was low and significantly associated (P < 0.05) with the ability of patient to read the label contents. These observations illustrate the need for physicians and pharmacists to provide antibiotic instructions and review these instructions with the patient.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10131493&dopt=Abstract antibiotic, antibiotics



J Antimicrob Chemother. 2005 May 19.
Invasive Gram-negative bacilli are frequently resistant to standard antibiotics for children admitted to hospital in Kilifi, Kenya.

Bejon P, Mwangi I, Ngetsa C, Mwarumba S, Berkley JA, Lowe BS, Maitland K, Marsh K, English M, Scott JA.

Wellcome Trust/Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research -- Coast, PO Box 230, Kilifi, Kenya; Nuffield Department of Clinical Medicine, Oxford University, John Radcliffe Hospital, Oxford, UK.

OBJECTIVES: To determine the pattern of resistance among Gram-negative bacilli causing invasive bacterial disease for the antibiotics that are already in common use in Kilifi, Kenya and for two potential alternatives, ciprofloxacin and cefotaxime. Also, to determine whether prevalence and severity of resistance was increasing over time, to identify patients who are particularly at risk of resistant infections, and to explore which factors are associated with the development of resistance in our setting. METHODS: We used Etest to study antibiotic susceptibility patterns of 90 Gram-negative bacilli cultured in blood or CSF from paediatric inpatients over 8 years. RESULTS: Susceptibility to amoxicillin 28%, cefotaxime 95% and ciprofloxacin 99% did not vary significantly with age. Susceptibilities for isolates from children aged less than 14 days were: chloramphenicol, 81%; trimethoprim/sulfamethoxazole, 71%; and gentamicin, 91%. From older children, susceptibilities were: chloramphenicol, 62%; trimethoprim/sulfamethoxazole, 39%; and gentamicin, 73%. Chloramphenicol susceptibility was significantly more common among non-typhi salmonellae than other species (79% versus 53%, P<0.0005). The combination of gentamicin and chloramphenicol covered 91% of all isolates. The prevalence of resistance did not increase over time and was not more common in patients with HIV or malnutrition. Age was the only clinical feature that predicted resistance. CONCLUSIONS: Gentamicin or chloramphenicol alone was suboptimal therapy for Gram-negative sepsis, although in this retrospective study, there was no association between resistance and mortality.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15905304&dopt=Abstract antibiotic, antibiotics



Hosp Formul. 1993 Jan;28 Suppl 1:23-7.
Cost control of therapy for i.v. catheter infections.

Arnow P.

University of Chicago Hospital, IL 60637.

Intravenous catheter sepsis is an important challenge for physicians because it is associated with a high incidence of complications, and treatment can be very costly. Significant complications occur in about 25% of cases and include septic shock, suppurative thrombophlebitis, metastatic infection, and endocarditis. The risk of such complications is increased when catheter removal or appropriate antibiotic therapy is delayed, when Staphylococcus aureus is the pathogen, and probably when a prosthetic heart valve or pulmonary artery catheter is present. The optimum duration of antibiotic therapy for intravenous catheter sepsis has not been established and depends on the pathogen and on the presence of other risk factors for complications. A treatment duration of 1 week may be adequate for pathogens, such as coagulase-negative staphylococci or Candida, that are unlikely to cause complications, while > or = 2 weeks of antibiotic therapy is warranted for S aureus. Recent approaches that may help to reduce costs include shortening the duration of parenteral antibiotic treatment either by giving oral agents for part of the treatment period or by using a synergistic combination of antibiotics. Also, for infections in subcutaneously tunneled catheters, intraluminal administration of small volumes of highly concentrated antibiotics often is an effective alternative to prolonged systemic antibiotic therapy.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10123834&dopt=Abstract antibiotic, antibiotics



Health Trends. 1993;25(3):84-7.
Prophylactic antibiotics at caesarean section do not reduce costs.

Keane D, James D.

National Maternity Hospital, Dublin.

A prospective audit of 200 patients was undertaken to determine the effectiveness of prophylactic antibiotics at caesarean section in reducing the cost of postnatal care. The main outcome measures were the cost-effectiveness of this treatment in reducing the cost of care and incidence of infection. The results show that the routine administration of prophylactic antibiotics had no significant effect on infection rates, the prescribing of puerperal antibiotics or the duration of stay in the postnatal period. The total cost of antibiotics in the prophylaxis group was over four times that in the non-prophylaxis group. The results of this study suggest that routine administration of antibiotics at caesarean section does not reduce the costs of care in the puerperium.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10131868&dopt=Abstract antibiotic, antibiotics



Hosp Pharm. 1994 Feb;29(2):100-1, 104-5, 120.
Oral antibiotic usage in hospitalized patients.

Piscitelli SC, Hoffman H, Danziger LH.

College of Pharmacy, University of Illinois at Chicago 60612.

With the introduction of the fluoroquinolones, oral antibiotic usage is becoming an increasingly important issue. The medical record of 119 patients receiving oral antibiotics at a university hospital were reviewed to examine demographics and patterns of usage. The population was predominantly female and below 50 years of age. Urinary tract infections were most common followed by infections of the respiratory tract and skin and skin structure. The majority of usage was empiric in nature. The most commonly prescribed antibiotics were trimethoprim/sulfamethoxazole, cephalexin, and ampicillin/amoxicillin. Monotherapy with an oral agent was observed in 82% of the cases. Intravenous antibiotics were administered prior to oral therapy in 61% of the patients studied. The authors observed a trend from combination intravenous therapy to single-agent oral therapy. Of the patients discharged on an oral antibiotic, 84% received a prescription for the agent originally prescribed for them in the hospital. Tracking of oral antibiotic inpatient use is effective at assessing major trends in usage.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10132148&dopt=Abstract antibiotic, antibiotics



Hosp Pharm. 1993 Jan;28(1):20-8.
Home parenteral antibiotic therapy for patients with cystic fibrosis.

Munzenberger PJ, Levin S.

Wayne State University, College of Pharmacy and Allied Health Professions, Detroit, MI 48201.

Cystic fibrosis is a genetic disease that affects multiple organ systems. Pulmonary complications associated with it frequently require intense intravenous antibiotic therapy. Home care allows patients to be treated at home, reducing the disruption of family life. New drug administration devices allow the patient increased mobility and independence. With adequate family and nursing support, patients may be able to attend work or school. Reduced hospital stays are good for the patient and cost effective for the hospital. The success of home antibiotic therapy depends on careful selection of the candidate, antibiotic regimen, nursing agency, and home care company. Many patients and families, though motivated, cannot manage the additional stress and time commitment required for home intravenous antibiotic and chest physical therapy. This time commitment may be reduced somewhat by limiting the number of antibiotics and the frequency of their administration.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10124005&dopt=Abstract antibiotic, antibiotics



Hosp Pharm. 1995 Feb;30(2):132-4, 137.
Antibiotic utilization and cost analysis in hospitalized patients with community-acquired pneumonia.

Stein GE, Mantz SL.

Michigan State University, Department of Medicine, East Lansing 48824.

All cases of presumptive community-acquired pneumonia (CAP) in adult patients admitted to a community/teaching hospital during the first 6 months of 1993 were reviewed. A total of 67 patients ranging in age from 20-90 years (73% > 60 years) had CAP. Fifteen (22%) patients were receiving antibiotics before admission. A typical respiratory pathogen was identified in only 18 (27%) patients. Empiric parenteral antibiotics were initiated in all but 2 patients. These agents usually included cefuroxime (42%), ampicillin/sulbactam (28%), or ceftriaxone (14%). Concomitant erythromycin (25%) or clarithromycin (17%) was used empirically in 42% of patients. Parenteral antibiotics were given for a mean of 5.2 days (median, 4 days). The mean therapy cost of these common parenteral agents ranged from $69.50 (cefuroxime, 750 mg every 8 hours) to $271 (ceftriaxone, 1 gram every 12 hours). Hospitalization ranged from 2-37 days (mean, 8.3 days; median, 6 days). A total of 50 patients were switched to oral antibiotics. Prescriptions for outpatient therapy ranged from 5-21 days (mean, 8.6 days; median, 7 days). The most common oral antibiotics included cefuroxime (33%), clarithromycin (20%), and amoxicillin/clavulanate (20%). The mean therapy cost for these drugs ranged from $85.19 (cefuroxime, 500 mg every 12 hours) to $39.24 (clarithromycin, 500 mg every 12 hours). This study found that empiric therapy with low-dose parenteral cefuroxime, with or without erythromycin, followed by outpatient clarithromycin was less costly than other common regimens used to treat CAP.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10140526&dopt=Abstract antibiotic, antibiotics



J Aerosol Med. 1994 Winter;7(4):345-50.
Nebulizer therapy with antibiotics in chronic suppurative lung disease.

el-Din MA, Palmer LB, el-Tayeb MN, Khalil I, Gabr MS.

Chest Department, Ain Shams University, Abassia, Cairo, Egypt.

Aerosolized antibiotics have been shown to be a useful modality of treatment in patients with cystic fibrosis. In this investigation we examined the utility of this treatment in patients with other chronic suppurative lung disorders. These included forty patients, thirty men and ten women with chronic airway infection (27 with bronchiectasis, 6 with chronic abscess and 7 with chronic suppurative bronchitis). Pathogenic organisms were isolated from the affected part of the lung by a fiberoptic bronchoscopy using a sterile disposable bronchial microbiology brush. Cultures from these specimens were used to determine the appropriate antibiotic. A second control group of 20 patients was treated with systemic antibiotics alone. Both systemic and aerosolized antibiotics were administered in 20 patients. A statistically significant improvement in clinical, and ventilatory functions was recorded in the first group compared to the second. Nebulized antibiotics used as adjunctive therapy in association with systemic antibiotics may offer a therapeutic advantage in chronic suppurative lung diseases.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10150487&dopt=Abstract antibiotic, antibiotics



Curr Infect Dis Rep. 1999 Oct;1(4):371-378.
Pharmacologic Basis for the Treatment of Pyelonephritis.

Beauchamp D, Bergeron MG.

Centre de Recherche en Infectiologie, RC 709, CHUQ, Pavillon CHUL, 2705 Boul. Laurier, Ste-Foy, P.Q., G1V 4G2, Quebec, Canada.

Urinary tract infections (UTIs) are among the most common bacterial infections in humans. Even though physicians have been treating UTIs for 60 years, there has been no standardized approach regarding the rational choice of antimicrobial agents and optimal treatment duration for these infections. This review discusses the pharmacologic basis for the treatment of UTIs. Although most antibiotics concentrate well in the urine and can eradicate most of the sensitive uropathogens that cause lower UTI, antibiotics given for the treatment of pyelonephritis must concentrate and kill bacteria embedded within the renal parenchyma. Investigators once believed that antibiotics must concentrate in sufficient amounts in the urine of infected patients to be effective in treating pyelonephritis. In fact, the efficacy of an antibiotic in the treatment of pyelonephritis is proportional to its capacity to converge in high concentration not only in urine but also in the renal parenchyma because serum and urine levels of antibiotics are poor predictors of the intrarenal levels. Other factors should also be taken into consideration in the management of UTIs, such as the time of day antibiotics are given because significant time-dependent differences have been observed in the pharmacokinetics and rate of excretion in urine of several antibiotics. Finally, the authors review the recent development in the inflammatory response in the urinary tract that may explain the clinical features of UTI and may be useful in the diagnosis as well as better management of UTI.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11095811&dopt=Abstract antibiotic, antibiotics [PubMed - as supplied by publisher]