Schweiz Med Wochenschr. 2000;Suppl 125:20S-22S.
[Effect of antibiotics on the occurrence and course of acute mastoiditis]

[Article in German]

Romer M, Briner HR, Linder T.

Klinik fur Otorhinolaryngologie, Hals- und Gesichtschirurgie, Universitatsspital Zurich.

Acute mastoiditis is the most common complication of acute otitis media. In the last years routine antibiotic treatment of acute otitis media was questioned and even abandoned in some countries. The goal of our study was to investigate the influence of antibiotic treatment on the occurrence and clinical outcome of acute mastoiditis and to analyse the bacteriological findings. In a retrospective chart review we identified all patients with the diagnosis of acute mastoiditis who had been referred to our tertiary-care centre between 1992 and 1999. We identified 48 patients with 50 episodes. 23 patients (48%) had received antibiotic treatment before admission whereas 25 (52%) had not. The patients with antibiotic pretreatment were older (18 years) than patients without antibiotics (6 years) and their referral was delayed. The most common isolated single pathogen was Streptococcus pneumoniae. All pneumococci were sensitive to penicillin. Acute mastoiditis may be the first clinical sign of a middle ear infection, especially in very young children. Adequate antibiotic pretreatment can not always prevent the development of acute mastoiditis even in the absence of penicillin resistant pathogens.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11141931&dopt=Abstract antibiotic, antibiotics



Schweiz Med Wochenschr. 2000;Suppl 125:7S-10S.
[Appropriateness of antibiotic prescription in ENT surgery]

[Article in German]

Gerber M, Fluckiger U, Wolfensberger M.

HNO-Universitatsklinik Basel.

INTRODUCTION: Although extensive studies on the use of antibiotics during and after surgery exist, antibiotics are still used too liberally. PURPOSE: To analyse the appropriateness of antibiotic use in ENT surgery. PATIENTS AND METHODS: Retrospective study of all surgical procedures performed at the Department of Otolaryngology, Head and Neck Surgery of the University of Basel between April and June 1999. Of the 174 procedures 30 were classified clean, 50 clean-contaminated (group A), 69 clean-contaminated (group B), 14 contaminated, and 11 dirty. RESULTS: 9% of all patients received inappropriate antibiotic prophylaxis and 4% inappropriate primary antibiotic treatment. 22% of antibiotic prophylaxis, 39% of primary antibiotic treatments and 29% of secondary antibiotic treatments were considered inappropriate. DISCUSSION: The too liberal use of antibiotics during and after surgery is largely due to the surgeon's fear of infectious complications. Only a peer-review process of all antibiotic prescriptions can reduce the inappropriate use of antibiotics.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11141948&dopt=Abstract antibiotic, antibiotics



Ir Med J. 2000 Oct;93(7):211-2.
Antibiotics for sore throat: impact of feedback to patients on the probability of bacterial infection.

Macnamara J, Harrington P, Walsh M, Walsh M, Burke M, Walsh N.

Antibiotics are overused in the management of sore throat. Using a scoring system with 108 attenders, we provided feedback on the likelihood of bacterial infection and measured the impact on initial patient expectation for antibiotic therapy. Patient attitudes and beliefs regarding antibiotics were also examined. Of sixty two patients whose score suggested viral infection, 18(29%) opted not to take an antibiotic prescription. The 42(67%) who still wanted an antibiotic, despite being told it was "unlikely or highly unlikely" to help, had a higher mean attendance rate for sore throat (1.63 v 0.83 (p = 0.14)) and other illness (6.53 v 4.22 (p = 0.22)), and a higher mean re-attendance rate following the study (1.68 v 0.50 (p = 0.025)). Qualitative analysis suggests that this subgroup may believe in the analgesic properties of antibiotics.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11142957&dopt=Abstract antibiotic, antibiotics



Pediatr Infect Dis J. 2000 Dec;19(12):1172-7.
Frequency of penicillin-resistant pneumococci in children is correlated to community utilization of antibiotics.

Melander E, Ekdahl K, Jonsson G, Molstad S.

Clinical Microbiology Laboratory, Lund University Hospital, Sweden. eva.z.melandekane.se

OBJECTIVE: To study the impact of the utilization of antibiotics in children at the population level on the frequency of penicillin-nonsusceptible pneumococci (PNSP). DESIGN: Children ages 0 to 6 years with a nasopharyngeal culture of PNSP were registered on place of residency in the 20 municipalities of the former Malmohus County (since 1998 a part of Skane County). Where possible the total number of nasopharyngeal cultures with growth of pneumococci was registered as well. All antibiotic prescriptions for 0- to 6-year-old children were analyzed in the 20 municipalities. MAIN OUTCOME MEASURES: Correlation between the utilization of antibiotics and the frequency of PNSP in children at the municipality level. RESULTS: The proportion of PNSP among all isolates of pneumococci from nasopharyngeal cultures varied between 0 and 49.5%. The antibiotic utilization in children varied among the 20 neighboring municipalities from 8.5 to 19.7 defined daily doses per 1000 children per day. The municipalities with high total utilization also had more frequent use of macrolides and broad spectrum antibiotics. The was a significant correlation between antibiotic use and the proportion of PNSP (correlation coefficient, 0.96; P = 0.002), and the correlation coefficients for trimethoprim-sulfamethoxazole, amoxicillins, macrolides and cephalosporins were significant at the 0.001 level. There was no significant correlation between the use of penicillin V and the frequency of PNSP. CONCLUSIONS. There was a significant correlation between the frequency of PNSP and the utilization of antibiotics in children at the population level.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11144379&dopt=Abstract antibiotic, antibiotics



aol.com

The purpose of our study was to determine the extent to which patients use antibiotics without consulting a physician and to examine patient characteristics associated with such oral antibiotic misuse. The study design was a prospective survey. The setting was a suburban, community, emergency department (ED). The participants were a convenience sample of oriented, ED patients who were enrolled during an 8-week period. Subjects provided written answers to standardized questions regarding their use of oral antibiotics over the 12 months preceding their ED visit. Categorical and continuous data were analyzed by chi-square and t-tests respectively. All test were 2-tailed with alpha set at 0.05. One thousand three hundred sixty three subjects were enrolled; 80% were White, 54% were female, 58% had attended college, 85% had a private physician, and 88% had health insurance. The mean age was 45 +/- 19 years. 43% of patients had used oral antibiotics within the past year. Twenty-two percent of patients indicated that their physicians routinely prescribed antibiotics for their cold symptoms. Seventeen percent of patients had taken "left-over" antibiotics without consulting their physician, most commonly for a cough (11%) or sore throat (42%), and much less frequently for urinary tract infection symptoms (0.7%). Women (19% versus 15% men; P =.04) and patients who attended college (19% versus 14% no college; P =.01) were more likely to have taken "left-over" antibiotics. A significant percentage of our ED patients had taken oral antibiotics without consulting a physician for symptoms frequently caused by viruses. Further study is warranted to examine whether local patterns of outpatient self-prescribing affect community oral antibiotic resistance.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11146021&dopt=Abstract antibiotic, antibiotics



Arch Intern Med. 2001 Jan 8;161(1):61-5.
Early discharge of infected patients through appropriate antibiotic use.

Eron LJ, Passos S.

Lawrence.Erop.org

BACKGROUND: Patients with infections are usually discharged from the hospital with antibiotics when afebrile and clinically improved. OBJECTIVES: To compare outcomes of early vs conventionally discharged patients and to examine the role of antibiotic use in the discharge process. METHODS: One hundred eleven patients hospitalized with cellulitis, community-acquired pneumonia, or pyelonephritis (urinary tract infection) discharged from the hospital early in their clinical course before defervescence by an infectious diseases hospitalist (L.J.E.) were compared in a case-controlled study with 112 patients discharged from the hospital according to conventional standards of care by internal medicine (IM) hospitalists. Patients were matched for age, sex, diagnosis, and comorbidities. Outcomes were determined for average lengths of stay, readmission to the hospital within 30 days with the same diagnosis, satisfaction with their discharge program, and time to return to their normal activities of daily living. RESULTS: Patients cared for by the infectious diseases hospitalist had a shorter average length of stay (mean difference, 1.7 days), no readmissions, higher satisfaction scores, and a shorter time to return to their activities of daily living, compared with those cared for by the IM hospitalists. Analysis of the antibiotics that patients were discharged with revealed that the infectious diseases hospitalist used outpatient parenteral antibiotic therapy more frequently than IM hospitalists in the treatment of cellulitis, and switched from intravenous to oral antibiotics sooner than IM hospitalists for patients with community-acquired pneumonia and urinary tract infection. CONCLUSIONS: The infectious diseases hospitalist discharged patients from the hospital earlier than the IM hospitalists by more efficient use of antibiotics. The earlier discharge did not adversely affect outcomes.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11146699&dopt=Abstract antibiotic, antibiotics



Enferm Infecc Microbiol Clin. 2000 Nov;18(9):445-51.
[Analysis of the cost-effectiveness relationship in the empirical treatment in patients with infections of the lower respiratory tract acquired in the community]

[Article in Spanish]

Bertran MJ, Trilla A, Codina C, Carne X, Ribas J, Asenjo MA.

Epidemiologia Hospitalaria-Centro de Epidemiologia, Evaluacion, Soporte y Prevencion (CEASP).

BACKGROUND: Cost of treatment of community-acquired infections in Spain is an important factor in overall health expenditures. The aim of this study was to assess the direct health costs related with the treatment of patients with community-acquired pneumonia (CAP) and acute exacerbations of chronic bronchitis (AECB) due to infection, using different antibiotic options, and to identify main cost drivers. METHODS: A basic decision analysis model was developed, including probabilities estimation derived from the literature review, supplemented when needed by the opinion of a panel of 8 Spanish physicians (Delphi technique). Four groups of antibiotics were included (macrolides, beta-lactam, fluoroquinolones and cephalosporins) in two different groups: patients with CAP without hospital admission criteria and patients with AECB due to respiratory infection. The analytic horizon and the perspective used were those of the Spanish National Health Service. Direct cost were assessed (drugs, outpatient visits, hospital admissions, diagnostic tests). Indirect cost were not included in the model. Final costs uses as main outcome measure the average cost per patient treated. All results were calculated following a fold-back technique. Sensitivity analysis were included allowing for variations in several clinically relevant parameters. RESULTS: 1. Patients with CAP: Hospital admissions, directly related to the effectiveness rate of initial empirical antibiotic therapy, were the main cost driver (50%-70%). Acquisition costs of initial antibiotic therapy only account for 2%-13% of total costs. 2. Patients with AECB: Outpatient visits are the main cost driver for these group of patients (49% of total costs). Hospital admission costs are also an important cost driver (40%-51% of total costs). Acquisition costs of initial antibiotic therapy account for 4%-28% of total costs. Clinical effectiveness of first antibiotic option is the main variable regarding the cost-effectiveness rate. CONCLUSION: The model here presented showed that acquisition costs of first empirical antibiotic therapy are only a small proportion of total costs related with the management of community acquired lower respiratory tract infections in Spain. The clinical effectiveness rate of the first antibiotic used is the main variable which determines the final average cost per patient cured. For patients with lower respiratory tract infections the therapeutic option with a better cost-effectiveness ratio must be chosen, in order to minimize the risk of therapeutic failure after first line therapy, and should not be selected only by its lower acquisition costs.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11149168&dopt=Abstract antibiotic, antibiotics