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Principles of Antibiotic Stewardship in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
The last important ASP problem in the CCU relates to empiric antibiotic coverage for “fevers and leukocytosis,” i.e., malignancies, which are unlikely due to infection. Another major area of antibiotic misuse is in treating drug fevers and non-bacterial infections with empiric antibiotics. In addition, treating non-infectious disorders with fever, e.g., adult Still’s disease, is another ASP pitfall encountered daily. From an ASP perspective, if with well-chosen empiric or specific antibiotic therapy, fevers persist, the response should be diagnostic, i.e., search for the source of the fever. Instead, the typical response is to add additional antibiotics that also have no effect on the fever. The usual mistaken assumption in this setting is to assume coverage that is not broad enough or a resistant strain has encouraged drug therapy. In this setting, resistance is rarely the cause [2,5]. Broader spectrum implies that there was a problem with the diagnostic approach and assumptions were made that other unusual pathogens are responsible for the continued fevers. Again, this is another false assumption taking the place of another diagnostic assessment as to the cause of the fever (Tables 31.6 and 31.7).
Shorter Course Antibiotic Therapy (SCAT): Principles, Current Data, and Caveats
Published in Robert C. Owens, Lautenbach Ebbing, Antimicrobial Resistance, 2007
Donald E. Craven, Daniel P. McQuillen, Winnie W. Ooi, George A. Jacoby, Efren L. Rael, Kathleen Steger Craven
Appropriate antibiotic therapy should target bacterial pathogens rather than viruses, treating individuals who are symptomatic or have evidence of infection rather than those with colonization, streamlining, or de-escalating antibiotic therapy when possible, and discontinuing antibiotics in patients with undocumented infection (14,15). Implementing such strategies will require better education of healthcare providers and consumers about the risks of antibiotic misuse, along with more effective systems to monitor and control antibiotic use. Use of a computerized pharmacy surveillance system or the use of targeted surveillance by pharmacists have also been cost-effective intervention strategies (16).
Role of Computer-Assisted Programs in Optimizing the Use of Antimicrobial Agents
Published in Robert C. Owens, Paul G. Ambrose, Charles H. Nightingale, Antibiotic Optimization, 2004
John P. Burke, Rajesh R. Mehta
The continuing emergence of antimicrobial resistance has been attributed to two main factors: the extensive and often inappropriate use of antimicrobials and lapses in infection control measures such as hand hygiene and isolation. Computerized hospital information systems can help with both of these problems, but this chapter focuses on the former. Assessing the epidemiology ofhospital-acquired infections and antibiotic use and providing regularly updated information about antimicrobial drug resistance in hospitals are essential first steps. Because antibiotic misuse more often results from inadequate information than from inappropriate behavior, providing access to useful information at the point of care and meeting the needs of physicians to use the data more efficiently in their daily work should become the focal point for optimizing antibiotic use. On the other hand, efforts to reduce the use of antibiotics by administrative means and formulary controls rather than by methods to optimize use for individual patients have been compared with squeezing a balloon: constraining one end causes the other end to bulge (8). Addressing the problems of antibiotic resistance by limiting the use of one class of compounds may be counteracted by corresponding changes in prescribing and drug resistance that are even more challenging (9).
Understanding treatment guidelines with bismuth and non-bismuth quadruple Helicobacter pylori eradication therapies
Published in Expert Review of Anti-infective Therapy, 2018
David Y. Graham, Maria Pina Dore, Hong Lu
Because of the generally low cure rates with triple therapies, the recent Maastricht, Toronto, and American College of Gastroenterology H. pylori treatment consensus statements of guidelines recommended the use of bismuth quadruple therapy or concomitant therapy as first-line therapies [17,31,32]. As noted above, the success of concomitant therapy is inversely related to the proportion with dual clarithromycin-metronidazole resistance. In western countries this proportion is often low in treatment naïve patients undergoing H. pylori treatment. However, even in these populations it is easy to identify those likely to fail based on their prior antimicrobial exposure or country of origin (e.g. prior use of macrolide or metronidazole or coming from a region where macrolide or metronidazole resistance is known to be common such as Central America or Southern Europe [7,8,10,33,34]. Such data is considered standard practice for deciding on which antibiotics to prescribe for other diseases [1]. Consensus guidelines recommendations have attempted to deal with the lack of population, region, or city-wide susceptibility data needed to accurately inform regarding the likely best empiric regimen(s). Even when effective, the 4-drug regimens containing clarithromycin and metronidazole foster antibiotic misuse [8,35]. For example, all patients receiving concomitant therapy receive at least one antibiotic that has no beneficial effect in curing their infection (e.g. those with clarithromycin susceptibility receive unneeded metronidazole, etc).
The natural plant compound carvacrol as an antimicrobial and anti-biofilm agent: mechanisms, synergies and bio-inspired anti-infective materials
Published in Biofouling, 2018
Anna Marchese, Carla Renata Arciola, Erika Coppo, Ramona Barbieri, Davide Barreca, Salima Chebaibi, Eduardo Sobarzo-Sánchez, Seyed Fazel Nabavi, Seyed Mohammad Nabavi, Maria Daglia
Infectious diseases still pose a serious threat to public health, in spite of tremendous progress in human medicine. Although infectious diseases are no longer the leading cause of death, due to the use of vaccines and antibiotics, improved nutrition and water and food safety, they still remain a major problem in many countries and are responsible for more than 20% of all deaths worldwide (http://www.who.int/mediacentre/factsheets/fs310/en/index2.html; accessed October 2016). Antibiotic misuse has led to the selection of drug-resistant pathogens. Antimicrobial resistance has become an ever-increasing multi-national public health problem causing hospitalization, especially for elderly patients, patients with diabetes or other chronic diseases, and oncology or AIDS patients, where immune-depression and the peculiar conditions of proneness to infection require new strategies and advanced technologies, without turning exclusively to antibiotics (http://www.who.int/mediacentre/factsheets/fs194/en) (Nolte 2014).
Egyptian community pharmacists’ attitudes and practices towards antibiotic dispensing and antibiotic resistance; a cross-sectional survey in Greater Cairo
Published in Current Medical Research and Opinion, 2019
Mohamed Zakaa El-din, Fatma Samy, Alaa Mohamed, Fatma Hamdy, Salwa Yasser, Moataz Ehab
Antibiotic resistance and inappropriate antibiotic use have been recognized to be a worldwide threat. Despite the recent global concerns and warnings about this problem, the threat of antibacterial resistance is spreading and has become worse1. In 2014, the World Health Organization (WHO) reported that resistant bacteria had spread, causing infections worldwide, and only 33 out of 133 countries that were part of the global survey had an action plan to counteract antibiotic resistance2. Antibiotic misuse has many negative consequences, such as increasing the cost of treatment, and accelerating the antibiotic resistance rate, which causes treatment failures, as well as high mortality rates3–5.