J Antimicrob Chemother. 2000 Dec;46(6):1033-5.
An analysis of antibiotic prescriptions from general dental practitioners in England.

Palmer NO, Martin MV, Pealing R, Ireland RS.

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

The aim of this study was to determine the antibiotics prescribed by general dental practitioners (GDPs). Adult antibiotic prescriptions issued by GDPs from 10 Health Authorities (HAs) in England were analysed. The type of antibiotic prescribed, dose, frequency and duration were investigated. Most of the 17007 prescriptions were for generic antibiotics; nine different antibiotics were prescribed. Many practitioners prescribed antibiotics inappropriately with inconsistent frequency and dose, and for prolonged periods.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11102428&dopt=Abstract antibiotic, antibiotics



J Am Dent Assoc. 2000 Nov;131(11):1600-9.
A survey of antibiotic use in dentistry.

Epstein JB, Chong S, Le ND.

Department of Dentistry, Vancouver Hospital and Health Sciences Centre, British Columbia, Canada. joelbe.washington.edu

BACKGROUND: Antibiotics are important in the management and prophylaxis of infection in patients at risk of experiencing microbial disease. As a result of the increase in antimicrobial resistance, the authors conducted a survey to assess current antibiotic use in dental practice. METHODS: The authors mailed a two-page, pretested survey to all licensed dental practitioners in British Columbia, Canada. A total of 2,542 surveys were mailed; 19.9 percent were returned by fax or mail. The authors examined an association between factors analyzed using a chi 2 test. RESULTS: Respondents were demographically consistent with all registered dentists in British Columbia. They reported writing an average of 4.45 prescriptions per week. Antibiotics prescribed after treatment primarily were penicillin and its derivatives. Recommended adult doses of penicillin were prescribed by 59.2 percent of respondents; recommended daily doses of amoxicillin were prescribed by 72.2 percent of respondents. The average prescription duration was 6.92 days. Respondents prescribed prophylactic antibiotics an average of 1.15 times per week for prophylaxis of bacterial endocarditis; 17.5 percent reported postoperative dosing for prophylaxis, ranging from a one- to seven-day prescription with an average of 6.91 postoperative doses. Preoperative antibiotics were prescribed for patients with a history of rheumatic fever or any heart murmur or prosthetic hip. Antibiotics were prescribed more frequently for surgical procedures and patients with acquired immunodeficiency syndrome than for other circumstances. CONCLUSIONS: More than 80 percent of respondents reported that they followed current American Heart Association prophylaxis guidelines. The authors, however, noted discrepancies in prophylactic use of antibiotics for bacterial endocarditis and for patients with large joint prostheses, as well as in prescribing antibiotics in the presence of clinical infection. In therapeutic use, approximately 85 percent of respondents followed appropriate prescription guidelines for dosing and duration of therapy. CLINICAL IMPLICATIONS: Appropriate and correct use of antibiotics is essential to ensure that effective and safe treatment is available and that practices that may enhance microbial resistance are avoided. To improve standards of care, dentists need up-to-date pharmacology in dental education, as well as continuing education, further outcome studies and continuous assessment of dental practices.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11103580&dopt=Abstract antibiotic, antibiotics



Cancer Res. 2000 Nov 15;60(22):6376-80.
Risk for gastric cancer after antibiotic prophylaxis in patients undergoing hip replacement.

Akre K, Signorello LB, Engstrand L, Bergstrom R, Larsson S, Eriksson BI, Nyren O.

Department of Medical Epidemiology, Karolinska Institute, Stockholm, Sweden. Katja.Akrep.ki.se

Despite strong evidence of an association between Helicobacter pylori and gastric cancer, the benefit of eradicating H. pylori infection is unknown. Our aim was to test the hypothesis that exposure to high doses of antibiotics reduces risk for gastric cancer via possible eradication of H. pylori We conducted a nationwide case-control study nested in a cohort of 39,154 patients who underwent hip replacement surgery between 1965 and 1983. Such patients frequently receive prophylactic antibiotic treatment. During follow-up through 1989, we identified 189 incident cases of gastric cancer. For each case, three controls were selected from the cohort. Exposure data were abstracted from hospital records. Blood samples from a separate cohort undergoing hip replacement surgery were analyzed for anti-H. pylori IgG before and after surgery. Both long-term antibiotic treatment before surgery [odds ratio (OR), 0.3; 95% confidence interval (CI), 0.1-0.7] and prophylactic antibiotic treatment (OR, 0.7; 95% CI, 0.5-1.1) conferred a reduction in gastric cancer risk. The reduction appeared stronger after 5 years (OR, 0.6; 95% CI, 0.3-1.2) than during shorter follow-up after hip replacement (OR, 0.8; 95% CI, 0.4-1.7). There was an apparent decrease in risk with increasing body weight-adjusted doses of antibiotics (P = 0.13). However, the rate of H. pylori antibody disappearance was not strikingly higher in the cohort of patients undergoing hip replacement than in a control cohort. Our findings provide indirect support for the hypothesis that treatment with antibiotics at a relatively advanced age reduces the risk of gastric cancer.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11103800&dopt=Abstract antibiotic, antibiotics



Presse Med. 2000 Nov 4;29(33):1807-12.
[Good clinical practice in using antibiotics in the hospital. Current status in 207 public and private hospitals in 1999]

[Article in French]

Gindre I, Maisonneuve H, Riche B, Durocher A.

Service Pharmacie, CHU Brabois Adultes, Vandoeuvre-les-Nancy. zzgindrlub-internet.fr

OBJECTIVES: The purpose of this study was to map activities developed in hospitals to monitor antibiotic usage and evaluate implementation of French guidelines for good clinical practice on use of antibiotics in the hospital setting. METHODS: A questionnaire was mailed to the head of the pharmacy of 300 French hospitals. The questionnaire targeted methods developed to monitor antibiotic usage (antibiotic committees, local recommendations, types of prescription and dispensing, surveillance, information and evaluation activities). RESULTS: The response rate was 69% (207 answers). A local committee supervised antibiotic usage in 49% of the hospitals (nosocomial, drug or antibiotic committees). Local recommendations existed in 120 hospitals (59%) and 42% of the hospitals had a validation process before dispensing drug in accordance with the recommendations. Antibiotic prescription was nominal in 65% of the hospitals and specific monitoring was carried out in 42% of them. Antibiotic consumption was monitored in 80% of the hospitals and resistance was monitored in 53%. Twelve percent of the hospitals used an electronic network to share information on prescription and bacteriological results. Regular internal training existed in 20% of the hospitals and evaluation methods (medical audits, impact measures) in 14%. DISCUSSION: Careful monitoring of antibiotics is implemented in most hospitals. Strict application of guidelines, definition and implementation of indicators, and evaluation methods must be improved. Implementation of better hospital monitoring of antibiotics requires: i) a local consensus to limit the antibiotics available and guidelines to adapt to local infections; ii) dissemination of guidelines and training for prescribers; iii) implementation of a dispensing system to check the validity of prescriptions according to local guidelines; iv) implementation of indicators to monitor bacterial resistance and the volume of antibiotics used.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11109433&dopt=Abstract antibiotic, antibiotics



Biochemistry (Mosc). 2000 Nov;65(11):1299-304.
Cytotoxic activity, accumulation, and intracellular distribution of anthracycline antibiotics and their conjugates with the epidermal growth factor in sensitive and resistant MCF-7 cells.

Lutsenko SV, Feldman NB, Gumanov SG, Rodina AV, Severin SE.

Moscow Research Institute of Medical Ecology, Moscow, 113149, Russia.

Cytotoxic activities, accumulation levels and dynamics, and intracellular distribution of the anthracycline antibiotics doxorubicin (DR) and carminomycin (CM) in the free forms or within conjugates with the epidermal growth factor (EGF) were for the first time compared in human breast carcinoma cell lines MCF-7Wt and MCF-7AdrR. The cytotoxic activities of DR and CM conjugates with EGF were higher than the cytotoxic activities of the free antibiotics in both cell lines. The accumulation levels of the free anthracyclines in both cell lines were lower than those of the conjugates and significantly depended on the cell sensitivities to the antibiotics. On receptor-mediated endocytosis of the anthracycline-EGF conjugates, the accumulation levels did not significantly depend on the cell sensitivities to the antibiotics. Both DR and CM, either free or conjugated with EGF, were mainly accumulated in nuclei. The free drugs were accumulated more rapidly, and the accumulation rates of both free and EGF-conjugated CM were higher than those of DR preparations. The intracellular distribution of the free antibiotics significantly depended on the cell sensitivities to the anthracyclines, whereas the cell sensitivities had no effect on the distribution of the conjugates between the nucleus and cytoplasm. The rate of intracellular degradation of DR and CM delivered to target cells within conjugates with EGF was twice lower than that of the free antibiotics. The difference in the accumulation levels and dynamics and in the intracellular distribution of the free and conjugated DR and CM is likely to underlie the higher cytotoxic activities of the anthracycline conjugates with EGF compared to the free drugs.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11112847&dopt=Abstract antibiotic, antibiotics



Am J Infect Control. 2000 Dec;28(6):415-20.
Antibiotic use and cost indicators at a rural hospital: a pilot project.

Mylotte JM, Weislo P.

Departments of Medicine and Microbiology, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, USA.

BACKGROUND: Recently, simple antibiotic use and cost indicators were developed for use in long-term care facilities. It was hypothesized that these indicators also may be applicable to the acute hospital setting. METHODS: For a 24-month period, data were collected quarterly on antibiotic use and cost indicators for 11 primary care physicians in a 40-bed rural hospital. Indicators included antimicrobial use ratio (AUR, ratio of the number of antibiotic days to the number of patient care days), cost per antibiotic day, and cost of antibiotics per patient care day. One-way analysis of variance and simple linear regression were used to analyze data. RESULTS: Quinolones (oral plus parenteral) accounted for 26% of the total antibiotic days (N = 6020) followed by ceftriaxone (19%) and cefuroxime (11.8%; oral plus parenteral). Overall trends in antibiotic use and cost included a significant increase in quarterly AUR (R(2) = 0.78, P =.004) and cost per patient care day (R(2) = 0. 82, P =.002) but no significant change in quarterly total antibiotic costs or cost per antibiotic day. Among physicians there was a significant difference in mean quarterly AUR (P <.001) and mean quarterly cost per patient care day (P <.001) but no significant difference in mean quarterly cost per antibiotic day. Variation in physician-specific cost per patient care day was best explained by variation in AUR (R(2) = 0.75, P <.001). CONCLUSIONS: Significant variation in simple antibiotic use and cost indicators was identified at a rural hospital from both the facility and physician perspective. Standardized methods for antibiotic use and cost monitoring, like the one described in this article, are required before the relationship between antibiotic use and resistance can be fully understood.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11114611&dopt=Abstract antibiotic, antibiotics



Zentralbl Bakteriol [Orig A]. 1978 Nov;242(2):239-44.
Computer survey of antibiotic resistance--developments during 1973 to 1977.

Grunt J, Krcmery V, Rosival L, Calpas S.

Results of antibiotic resistance of strains belonging to 9 species of so-called Problem bacteria, recorded by 10 District Public Health Laboratories in Slovakia during 6 months of 1977 (altogether 32641 strains) have been compared with results, obtained with identical computer-assisted system in 1973. The position of "Reserve antibiotics" (gentamicin, colistin, cotrimoxazole, oxacillin, lincomycin, spiramycin) remained favourable during precedent 4 years and even improved (with exception of gentamicin in P. aeruginosa). In classical antibiotics a typical steady-state situation was establishedin that period. Beta-lactam antibiotics in general deteriorated in gramnegatives, with certain improvements in special cases. In "specific pathogens", i.e. enteropathogenic strains of E. coli and in strains of P. aeruginosa, resistance to antibiotics generally increased. On the other hand, in S. aureus strains a better susceptibility to almost all antibiotics could be recorded. Surgical services still seem to use the bacteriological services infrequently and this should improve on an all-nation basis.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=104482&dopt=Abstract antibiotic, antibiotics