J Chemother. 2000 Dec;12(6):471-4.
National and local antibiotic policies in Central and Eastern Europe.

Krcmery V, Jeljaszewicz J, Grzesiowski P, Hryniewicz W, Metodiev K, Stratchounski L, Cizman M, Schonwald S, Barsic B, Krupova Y, Svetlansky I, Kovacicova G, Lovaszova M, Georgopoulos A, Ludwig E, Graninger W, Naber K, Gould IM.

Central ATB Committee of the Ministry of Health and University of Trnava, Bratislava, Slovakia.

To assess the antibiotic policies of Central European countries, we performed an overview of antibiotic stewardship, prescription habits and antibiotic prescription regulatory procedures. Since most Central European countries have had centralized health care and drug policies, the situation 10 years after decentralization is surprising. Only 3 of 10 Central European countries have some regulation of prescription of antibiotics, only 4 restrict some antibiotics, only 5 have hospital and only 3 national antibiotic policies. In all but 3 countries physicians can prescribe quinolones and/or 3rd generation oral cephalosporins as first-line antibiotics. Information on local and national antibiotic policies in Central and Eastern European countries is given including prescription guidelines for antibiotic use in community and hospital.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11154027&dopt=Abstract antibiotic, antibiotics



Presse Med. 2000 Dec 2;29(37):2033-5.
[Resistance and new antibiotic strategies. Consequences of the use of antibiotics: how to preserve they efficacy]

[Article in French]

Bergogne-Berezin E.

berezbiool.com

FACTORS CONTRIBUTING TO RESISTANCE: Several factors contribute to the spread of resistance (international travel, grouping together severely ill patients, etc.) and others contribute to the emergence of resistance (e.g., catheters for S. epidermidis). The effect of these different factors on the spread and expression of resistance cannot be predicted. How can antibiotic efficacy be preserved? Less overuse of antibiotics, for example for bronchial infections, would be helpful. Educational programs, for patients and physicians alike, is also a crucial point, although its impact has been somewhat disappointing. OTHER ATTITUDES COULD ALSO BE IMPLEMENTED: Use of the most powerful member of a given antibiotic family, overall restriction on antibiotic use, improved diagnostic and laboratory methods. All of these propositions must be examined in light of real experience.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11155726&dopt=Abstract antibiotic, antibiotics



J Antimicrob Chemother. 2001 Feb;47(2):233-7.
Antibiotic prescribing knowledge of National Health Service general dental practitioners in England and Scotland.

Palmer NO, Martin MV, Pealing R, Ireland RS, Roy K, Smith A, Bagg J.

Department of Clinical Dental Sciences, University of Liverpool, Liverpool L69 3BX, UK. NikolausPalmeompuserve.com

The inappropriate use of antibiotics has contributed to the worldwide problem of antimicrobial resistance. Information on the knowledge, understanding and training of dental practitioners in the use of antibiotics in clinical practice is scarce. This study assessed the level of knowledge of general dental practitioners and the need for educational initiatives. An anonymous postal questionnaire was sent to National Health Service dental practitioners working in 10 Health Authorities in England (1544) and four Health Boards in Scotland (672). Each correct answer to the questionnaire was given a score of one mark; there were 84 questions. The scores for each section of the questionnaire were compared. Responses were received from 1338 (60.4%) of practitioners, of whom 22.1% had attended postgraduate courses in the previous 2 years on antibiotic prescribing. Practitioners who had attended courses had a significantly greater knowledge of antibiotic use (P < 0.05) than those who had not. There was no significant difference in knowledge between all age groups under 60 years of age. There were significant differences in knowledge between dentists practising in English Health Authorities and Scottish Health Boards (P < 0.01). Knowledge was good for clinical signs that are indicators for prescribing antibiotics and for a number of non-clinical factors, e.g. patient expectation. Knowledge of therapeutic prescribing for commonly presenting clinical conditions and prophylactic prescribing for medically compromised patients, however, was generally poor. This study has shown that an urgent review of dental undergraduate and postgraduate education in antibiotic prescribing is required. Provision of prescribing guidelines may improve knowledge and encourage the appropriate use of antibiotics in clinical dental practice.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11157915&dopt=Abstract antibiotic, antibiotics



Mol Microbiol. 2001 Feb;39(3):553-66.
Genetic and transcriptional analysis of absA, an antibiotic gene cluster-linked two-component system that regulates multiple antibiotics in Streptomyces coelicolor.

Anderson TB, Brian P, Champness WC.

Department of Microbiology and Molecular Genetics, Michigan State University, East Lansing, MI 48824-1101, USA.

In Streptomyces coelicolor, the AbsA1-AbsA2 two-component system regulates the expression of multiple antibiotic gene clusters. Here, we show that the response regulator encoded by the absA2 gene is a negative regulator of these antibiotic gene clusters. A genetic analysis shows that the phosphorylated form of the AbsA2 response regulator (phospho-AbsA2), generated by the cognate AbsA1 sensor histidine kinase, is required for normal growth phase regulation of antibiotic synthesis. In the absence of phospho-AbsA2, antibiotics are produced earlier and more abundantly. Overexpression of AbsA1 also deregulates antibiotic synthesis, apparently shifting the AbsA1 protein from a kinase-active to a phospho-AbsA2 phosphatase-active form. The absA1 and absA2 genes, which are adjacent, are located in one of the antibiotic gene clusters that they regulate, the cluster for the calcium-dependent antibiotic (CDA). The absA genes themselves are growth phase regulated, with phospho-AbsA2 responsible for growth phase-related positive autoregulation. We discuss the possible role and mechanism of AbsA-mediated regulation of antibiotic synthesis in the S. coelicolor life cycle.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11169098&dopt=Abstract antibiotic, antibiotics



Pediatr Infect Dis J. 2001 Jan;20(1):1-5.
Compliance issues related to the selection of antibiotic suspensions for children.

Steele RW, Thomas MP, Begue RE.

Department of Pediatrics, LSU School of Medicine, New Orleans, LA, USA. RWSteelol.com

OBJECTIVE: To evaluate the palatability, cost and other compliance issues as variables in the selection of antibiotic suspensions for children. METHODS: Eighty-six physicians and health care personnel randomly sampled amoxicillin (used as a standard for comparison) and 11 other antibiotics, evaluating them in categories of appearance, smell, texture, taste and aftertaste. Overall scoring was then adjusted for cost, duration of therapy and dosing intervals. RESULTS: Overall taste (palatability) ranking of antibiotics, highest to lowest, was as follows: loracarbef, cefdinir, cefixime, azithromycin, ciprofloxacin, trimethoprim-sulfamethoxazole, clarithromycin, trimethoprim, amoxicillin/clavulanate, cefpodoxime and cefuroxime. Overall rating of antibiotics was greatly influenced by other compliance variables, in order of their impact: cost; duration of therapy (5 vs. 10 days); and dosing intervals. Cost was not judged to be a major factor by most participants unless antibiotic expense was >$50.00 for treatment of otitis media in our hypothetical 2-year-old, 13-kg child. Taking all variables into consideration, final ranking from highest to lowest was azithromycin, cefdinir, loracarbef, cefixime, amoxicillin, trimethoprim-sulfamethoxazole, cefpodoxime, trimethoprim, clarithromycin, ciprofloxacin, cefuroxime and amoxicillin/clavulanate. CONCLUSIONS: Variables related to compliance for families filling antibiotic prescriptions and children taking these products are important in the selection of antimicrobial therapy. Because final assessment is likely to vary considerably among health care personnel, decisions must be made on an individual basis.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11176558&dopt=Abstract antibiotic, antibiotics



Curr Infect Dis Rep. 2001 Feb;3(1):29-34.
Influence of Pharmacokinetic and Pharmacodynamic Principles on Antibiotic Selection.

Zhanel GG.

Faculties of Medicine and Pharmacy, University of Manitoba; Departments of Medicine and Microbiology, Health Sciences Centre, 820 Sherbrook Street, Room MS673, Winnipeg, Manitoba R3A 1R9 Canada. ggzhanecs.mb.ca.

When evaluating the efficacy of antibiotics for the treatment of respiratory tract infections, such as community acquired pneumonia and acute exacerbations of chronic bronchitis, assessment of clinical cure may not be the most relevant parameter, as it may not be related to microbiological eradication or to the minimum inhibitory concentration (MIC) of the infecting pathogen. It is more relevant to study the efficacy of the antibiotic in eradicating the bacterial pathogen, because this is frequently related to both the MIC of the pathogen and the antibiotic dosage regimen. Pharmacodynamics correlates the concentration of antibiotic in the blood or at the infection site with its biological effect against the organism (bacteriological eradication). For beta-lactams, the pharmacodynamic parameter that best correlates with eradication is time (T) above MIC (T > MIC); for aminoglycosides and fluoroquinolones, it is the area under the curve at 24 hours (AUC(24))-to-MIC ratio (AUC(24)/MIC). Knowledge of pharmacodynamics allows optimum use of antibiotics; in vitro models, animal models, and retrospective and prospective clinical trials have shown that the use of such knowledge optimizes bacteriological eradication and enhances patient outcome. In the future, pharmacodynamic studies will be used not only to assess optimal ways for antibiotics to eradicate resistant pathogens, but also to investigate the ability of antibiotics to prevent the development of resistance on therapy and to eradicate pathogens from colonizing sites.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11177728&dopt=Abstract antibiotic, antibiotics [PubMed - as supplied by publisher]



Contemp Top Lab Anim Sci. 2000 Jan;39(1):32-8.
Therapeutic efficacy of oral lactobacillus preparation for antibiotic-associated enteritis in guinea pigs.

Wasson K, Criley JM, Clabaugh MB, Koch MA, Peper RL.

College of Veterinary Medicine, Department of Veterinary Pathobiology, 2001 South Lincoln Ave., Urbana, IL 61802, USA.

Enteritis is a potential complication of antimicrobial agent use, particularly in certain species of rodents. The organism most frequently implicated in this disease is Clostridium difficile. Anecdotal information suggests that administration of yogurt or other Lactobacillus-containing products in conjunction with antimicrobial agents will prevent or minimize the effects of antibiotic-associated enteritis. We wanted to determine whether a single subcutaneous injection of clindamycin phosphate could induce enteritis in guinea pigs and whether a commercial Lactobacillus preparation would ameliorate the clinical effects of antibiotic administration in these animals. Juvenile male guinea pigs were divided into three treatment groups. Group 1 guinea pigs (n=8) received a single saline injection followed by an oral Lactobacillus preparation twice daily; group 2 (n=8) received a single antibiotic injection followed by an oral Lactobacillus preparation twice daily; group 3 (n=8) received a single antibiotic injection. Attitude, body temperature, body weight, and feed and water consumption were recorded for each guinea pig 7 days prior to and after treatment. Fecal samples were collected and necropsies performed on each guinea pig at the time of euthanasia. C. difficile and other enteric pathogens were not isolated from any group before or after treatment, although some guinea pigs receiving the antibiotic developed enteritis. There were no significant clinical differences between guinea pigs receiving antibiotics with the oral Lactobacillus preparation, and those receiving antibiotics alone. The results of this study suggest that a single injection of clindamycin phosphate can induce enteritis in guinea pigs and that oral administration of a Lactobacillus-containing product is ineffective in preventing clinical disease in guinea pigs administered clindamycin phosphate.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11178313&dopt=Abstract antibiotic, antibiotics