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Severe Community-Acquired Pneumonia in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Optimal empiric therapy is based on covering the usual pathogens associated with CAP, based on correlating chest X-ray (CXR) and clinical findings. Selection of empiric antimicrobial therapy of severe CAP is done in the same way as for non-severe CAP. However, severe CAP patients may have a longer length of stay (LOS), stormy clinical course, and longer courses of antibiotic therapy. Therapy is continued as the diagnostic workup is in progress. If the causative pathogen is identified, there is no rationale for changing the antibiotics to one with a narrower spectrum. It is a popular antibiotic myth that de-escalation to a narrower spectrum has some advantages. Antibiotic resistance potential is related to specific antibiotics and not antibiotic class. Changing to a narrow-spectrum antibiotic is of no benefit, and, if chosen wisely, e.g., using a “low resistance potential,” antibiotic has no effect on antibiotic resistance. With Streptococcus pneumoniae, there is no rationale to change from ceftriaxone to penicillin because of a narrower spectrum. Therapy of severe CAP is usually for 2‒3 weeks in total [10–12]. Ceftriaxone is as effective as penicillin and may be given less frequently. Importantly, there is no increased resistance with S. pneumoniae, even with prolonged use.
Children and the ethics of primary care
Published in Andrew Papanikitas, John Spicer, Handbook of Primary Care Ethics, 2017
From the point of view of a single patient, broad spectrum but generally safe antibiotics like amoxicillin are a better choice than narrow-spectrum antibiotics like penicillin V. However, from the point of view of future patients, narrow spectrum would be a better choice.
Infections of the Skin, Soft Tissues, Joints and Bone
Published in Keith Struthers, Clinical Microbiology, 2017
In the non-septic patient, the orthopaedic team will usually initiate a broad-spectrum combination of vancomycin and meropenem after operation, unless the immediate or previous microbiology results direct otherwise. Once an organism is identified, the necessary narrow-spectrum antibiotics are used. As most infections are caused by gram-positive bacteria, antibiotics for relevant organisms identified include benzylpenicillin, flucloxacillin, vancomycin, teicoplanin and daptomycin. Rifampicin is often added as a second agent, especially as it is considered to have better penetration into biofilm. The quinolones such as ciprofloxacin are used to treat infections caused by susceptible gram-negative bacteria, as their oral bioavailability and tissue penetration is good. In certain patients where the prosthesis cannot be removed, long-term suppressive antibiotic treatment is given.
Association between asthma status and prenatal antibiotic prescription fills among women in a Medicaid population
Published in Journal of Asthma, 2022
Brittney M. Snyder, Megan F. Patterson, Tebeb Gebretsadik, Ferdinand Cacho, Tan Ding, Kedir N. Turi, Andrew Abreo, Pingsheng Wu, Tina V. Hartert
Analyses were carried out using all pregnant women or restricted to women with at least one prenatal antibiotic fill, when appropriate. The associations between maternal asthma status and prenatal antibiotic prescription fill (yes, no) and number of prenatal antibiotic prescription fills were examined among all pregnant women using modified Poisson regression with robust sandwich covariance estimator (22). We used Kaplan-Meier curves to depict the relationship between maternal asthma and time to first prenatal antibiotic fill, defined by gestational age in days, among women with at least one prenatal antibiotic fill. We then used Cox proportional hazards regression to estimate the hazard ratio. We additionally assessed the association between maternal asthma status and broad-spectrum (versus narrow-spectrum) antibiotic prescription fills during pregnancy among women with at least one prenatal antibiotic fill using logistic regression. Analyses were performed using R software version 4.0.4 (R foundation for statistical computing, Vienna, Austria).
Antibiotic consumption among hospitalized neonates and children in Punjab province, Pakistan
Published in Expert Review of Anti-infective Therapy, 2022
Zia Ul Mustafa, Muhammad Salman, Muhammad Yasir, Brian Godman, Hafiz Abdul Majeed, Mahpara Kanwal, Maryam Iqbal, Muhammad Bilal Riaz, Khezar Hayat, Syed Shahzad Hasan
Infectious diseases are the leading cause of morbidity and mortality among children [1]. Globally, more than five million children die every year principally from preventable causes, including diarrhea, malaria, and pneumonia, with South Asia and Sub-Saharan African countries contributing more than 80% of this burden [2]. Pakistan is ranked third in countries with the highest child mortality rate, followed by Nigeria and India [1]. Naz and colleagues reported that 20–30% of child deaths in Pakistan are related to respiratory tract infections [3]. We are aware that hospitalized children are usually given multiple antibiotics to treat their illnesses in lower- and middle-income countries (LMICs) [4–8]. Moreover, they are frequently prescribed with broad-spectrum antibiotics in conditions where narrow-spectrum antibiotics can provide beneficial effects. This increases the risk of multidrug-resistance (MDR) and extensively drug-resistance (XDR) bacterial infections caused by methicillin-resistant Staphylococcus aureus (MRSA), Salmonella typhi, Carbapenems-resistant Pseudomonas aeruginosa, Enterobacteriaceae, Streptococcus pneumonia, Mycobacterium tuberculosis, and Vancomycin-resistant enterococci (VRE) in hospitals [9–11].
Antibiotic resistance among major pathogens compared to hospital treatment guidelines and antibiotic use in Nordic hospitals 2010–2018
Published in Infectious Diseases, 2021
Vidar Möller, Åse Östholm-Balkhed, Dag Berild, Mats Fredriksson, Magnus Gottfredsson, Martin Holmbom, Asko Järvinen, Mar Kristjansson, Ulf Rydell, Ute Wolff Sönksen, Hans Joern Kolmos, Håkan Hanberger
Antibiotic stewardships have several goals, including optimization of clinical outcomes; lowered costs; and minimizing unintended consequences of antibiotic therapy such as toxicity, Clostridium difficile diarrhoea, and the emergence of antibiotic-resistant bacteria [38]. This may be implemented, for example, by promoting compliance to PG including use of narrow-spectrum antibiotics while still effective, and surveillance of antibiotic use and resistance. Data on antibiotic exposure of the individual patient are needed to evaluate appropriate use but were not available in this study. This made it difficult to determine any causal relationship between, for example, consumption of 3rd generation cephalosporins and risk for emergence of ESBL-producing E. coli and K. pneumoniae. Even so, it is important to monitor antibiotic use and promote the use of narrow-spectrum antibiotics, since it is well known that broad-spectrum antibiotics have a negative effect on the microbiome and are a risk factor for the emergence of antibiotic resistance [39]. National antibiotic resistance data are also crucial when revising national antibiotic treatment guidelines. Furthermore, aggregated antibiotic consumption may also be used as one parameter when evaluating stewardship interventions, or to identify the need for such interventions.