[Clinical impact of appropriate use of antibiotic in hospital according to CARAT criteria].
Humans; *Practice Guidelines as Topic; Intensive Care Units; Anti-Bacterial Agents/pharmacology/*therapeutic use; Evidence-Based Medicine; Organizational Policy; Europe/epidemiology; Clinical Trials as Topic; *Guideline Adherence; Bacterial Infections/drug therapy/epidemiology; Drug Utilization; Hospitals/*standards; Patients' Rooms; *Drug Resistance; Multiple; Bacterial
In response to the overuse and misuse of antibiotics, leading to increasing bacterial resistance and the decreasing development of new antibiotics, the Council for Appropriate and Rational Antibiotic Therapy (an independent, interdisciplinary panel of healthcare professionals established to advocate the appropriate use of antibiotics) has developed criteria to guide proper antibiotic selection. These criteria include: establishment of a need to justify use of antibiotics (e.g., colonization versus disease); evidence-based results; therapeutic benefits; safety; use of pharmacodynamic indices for optimal drug and optimal duration; cost-effectiveness. Promoting the appropriate use of antibiotics should provide for optimal outcomes for our patients.
File Thomas M Jr
Le infezioni in medicina : rivista periodica di eziologia, epidemiologia, diagnostica, clinica e terapia delle patologie infettive
2008
2008-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
230. Molecular Typing of Streptococcus pyogenes Isolates Collected at Mongolian Hospital (Ulaanbaatar, Mongolia).
mortality; epidemiology; antibiotic resistance; medical; surveillance; genes; bacterial; morbidity; infection; molecular; mongolia; antimicrobial susceptibility; china; communicable diseases; DRUG resistance in bacteria; LOW-income countries; disclosure; polymerase chain reaction; CENTERS for Disease Control & Prevention (U.S.); clone cells; communicable diseases; disease outbreaks; ichthyosis; low income; MOLECULAR epidemiology; mongolia; multi-antibiotic resistance; sequence tagged sites; sodium thiosulfate; streptococcus pyogenes; streptococcus pyogenes; TOXIC shock syndrome; ULAANBAATAR (Mongolia); vaccine development; x-linked
Background Streptococcus pyogenes is a significant cause of morbidity and mortality worldwide causing an estimated 1.8 million cases and 517,000 deaths each year. S. pyogenes infections disproportionately affect low-income countries where routine surveillance is not available. The objective of this study was to investigate the molecular epidemiology and antibiotic resistance of clinically relevant S. pyogenes isolates in Ulaanbaatar, Mongolia, to better understand the burden in this under-served population. Methods Clinical S. pyogenes isolates (n = 41) collected at the Bacteriological Reference Laboratory, National Center for Communicable Diseases, Ulaanbaatar, Mongolia, were cultured and characterized using PCR techniques. The emm gene was sequenced and emm type was assigned as per Centers for Disease Control and Prevention (CDC) methods and guideline. Multi-locus sequence typing (MLST) was carried out on selected isolates (n = 15). Antibiotic susceptibility testing (AST) was done via the Vitek-2 system as per manufacturer's instructions. Results We observed 18 distinct emm types among the 41 S. pyogenes isolates. stG6792.0 was the most common emm type, accounting for more than one-third of the isolates (15/41) followed by emm 2.0 (ST55) (5/41) and emm 82.0 (ST314) (2/41). A total of seven sequence types (STs) were detected among 15 tested isolates. The most common ST type was ST55 accounting for one-third of the isolates (5/15). Most of the isolates were susceptible to all tested drugs. Conclusion The findings of this study provided some insights regarding the molecular characteristics of S. pyogenes in Mongolia that will be crucial for future surveillance studies. Five isolates of this study had similar emm types (emm74.0, emm66.0, stG480.0, emm83.1, emm89.0) compared with a previous surveillance study. emm89.0 (ST101) was a major epidemiological isolate in the United States between 2000 and 2004. emm89.0 was also implicated with a recent single-clone outbreak in China. This information suggests the possibility of a shifting epidemiological trend of S. pyogenes on the global stage. The information about antibiotic susceptibility patterns and molecular types can help to devise better treatment strategies for S. pyogenes infections, and potentially inform vaccine development. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]
Thapaliya Dipendra; Mackey Samantha; Kadariya Jhalka; Davaadash Bulgan; Smith Tara
Open Forum Infectious Diseases
2019
2019-10-02
Journal Article
<a href="http://doi.org/10.1093/ofid/ofz360.305" target="_blank" rel="noreferrer noopener">10.1093/ofid/ofz360.305</a>
A formidable foe: carbapenem-resistant Acinetobacter baumannii and emerging nonantibiotic therapies.
*Carbapenem-resistant Acinetobacter baumannii; *decolonization; *hospital-acquired infections; *therapies; *vaccination; Acinetobacter baumannii/drug effects/*isolation & purification; Acinetobacter Infections – Microbiology; Acinetobacter Infections – Therapy; Acinetobacter Infections/microbiology/*therapy; Animals; Anti-Bacterial Agents/pharmacology; Antibiotics – Pharmacodynamics; Bacterial; Carbapenems – Pharmacodynamics; Carbapenems/pharmacology; Drug Resistance; Gram-Negative Aerobic Bacteria; Gram-Negative Aerobic Bacteria – Drug Effects; Humans; Microbial; Microbial Culture and Sensitivity Tests; Microbial Sensitivity Tests
Watkins Richard R
Expert review of anti-infective therapy
2018
2018-08
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1080/14787210.2018.1503054" target="_blank" rel="noreferrer noopener">10.1080/14787210.2018.1503054</a>
Antibiotic-Resistant Infections and Treatment Challenges in the Immunocompromised Host.
*Anti-Bacterial Agents/administration & dosage/pharmacology/therapeutic use; *Bacterial Infections/drug therapy/microbiology; *Drug Resistance; *HIV/AIDS; *Immunocompromise; *Immunocompromised Host; *Infection; *MDRO; *Organ transplant recipients; Bacteria/drug effects/pathogenicity; Bacterial; HIV Infections; Humans; Multiple; Transplant Recipients
This article reviews antibiotic resistance and treatment of bacterial infections in the growing number of patients who are immunocompromised: solid organ transplant recipients, the neutropenic host, and persons with human immunodeficiency virus and AIDS. Specific mechanisms of resistance in both gram-negative and gram-positive bacteria, as well as newer treatment options are addressed elsewhere, and are only briefly discussed in the context of the immunocompromised host.
Dumford Donald M 3rd; Skalweit Marion
Infectious disease clinics of North America
2016
2016-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.idc.2016.02.008" target="_blank" rel="noreferrer noopener">10.1016/j.idc.2016.02.008</a>
Clinical implications and treatment of multiresistant Streptococcus pneumoniae pneumonia.
Anti-Infective Agents/*therapeutic use; Bacterial; Community-Acquired Infections/*drug therapy/economics/*microbiology; Drug Resistance; Fluoroquinolones/*therapeutic use; Humans; Ketolides/therapeutic use; Multiple; Pneumococcal/*drug therapy/economics/*microbiology; Pneumonia; Streptococcus pneumoniae/*growth & development
Streptococcus pneumoniae is the leading bacterial cause of community-acquired respiratory tract infections. Prior to the 1970s this pathogen was uniformly susceptible to penicillin and most other antimicrobials. However, since the 1990s there has been a significant increase in drug-resistant Streptococcus pneumoniae (DRSP) due, in large part, to increased use of antimicrobials. The clinical significance of this resistance is not definitely established, but appears to be most relevant to specific MICs for specific antimicrobials. Certain beta-lactams (amoxicillin, cefotaxime, ceftriaxone), the respiratory fluoroquinolones, and telithromycin are among several agents that remain effective against DRSP. Continued surveillance studies, appropriate antimicrobial usage campaigns, stratification of patients based on known risk factors for resistance, and vaccination programmes are needed to appropriately manage DRSP and limit its spread.
File T M Jr
Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases
2006
2006-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/j.1469-0691.2006.01395.x" target="_blank" rel="noreferrer noopener">10.1111/j.1469-0691.2006.01395.x</a>
Community-acquired pneumonia.
*Community-Acquired Infections/diagnosis/drug therapy/microbiology; *Pneumonia; Adult; Anti-Bacterial Agents/pharmacology/therapeutic use; Bacteria/drug effects/isolation & purification; Bacterial; Bacterial/diagnosis/drug therapy/microbiology; Drug Resistance; Female; Humans; Male
This seminar reviews important features and management issues of community-acquired pneumonia (CAP) that are especially relevant to immunocompetent adults in light of new information about cause, clinical course, diagnostic testing, treatment, and prevention. Streptococcus pneumoniae remains the most important pathogen; however, emerging resistance of this organism to antimicrobial agents has affected empirical treatment of CAP. Atypical pathogens have been quite commonly identified in several prospective studies. The clinical significance of these pathogens (with the exception of Legionella spp) is not clear, partly because of the lack of rapid, standardised tests. Diagnostic evaluation of CAP is important for appropriate assessment of severity of illness and for establishment of the causative agent in the disease. Until better rapid diagnostic methods are developed, most patients will be treated empirically. Antimicrobials continue to be the mainstay of treatment, and decisions about specific agents are guided by several considerations that include spectrum of activity, and pharmacokinetic and pharmacodynamic principles. Several factors have been shown to be associated with a beneficial clinical outcome in patients with CAP. These factors include administration of antimicrobials in a timely manner, choice of antibiotic therapy, and the use of a critical pneumonia pathway. The appropriate use of vaccines against pneumococcal disease and influenza should be encouraged. Several guidelines for management of CAP have recently been published, the recommendations of which are reviewed.
File Thomas M
Lancet (London, England)
2003
2003-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/S0140-6736(03)15021-0" target="_blank" rel="noreferrer noopener">10.1016/S0140-6736(03)15021-0</a>
Community-acquired pneumonia.
Disease Progression; Community-Acquired Infections; Immunocompetence; Drug Resistance; Pneumonia; Bacterial; Microbial; Severity of Illness; Antibiotics – Therapeutic Use; Community-Acquired Infections – Diagnosis; Community-Acquired Infections – Drug Therapy; Community-Acquired Infections – Microbiology; Bacterial – Drug Therapy; Bacterial – Microbiology; Bacterial – Prevention and Control; Community-Acquired Infections – Prevention and Control; Bacterial – Diagnosis; Streptococcus – Drug Effects; Vaccines – Therapeutic Use
File T M Jr
Lancet
2003
2003-12-13
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/s0140-6736(03)15021-0" target="_blank" rel="noreferrer noopener">10.1016/s0140-6736(03)15021-0</a>
Epidemiology, microbiology, and treatment considerations for bacterial pneumonia complicating influenza
human; pneumonia; Infectious Diseases; pneumonia; Influenza; community-acquired pneumonia; bacterial; randomized controlled-trial; streptococcus-pneumoniae; Influenza; virus; respiratory-tract; a h1n1 virus; Antibacterial agents; Antiviral agents; asian influenza; bacteremic pneumococcal; hong-kong influenza; Influenza A; pandemic; pregnant-women
Post-influenza bacterial pneumonia is a major cause of morbidity and mortality associated with both seasonal and pandemic influenza virus illness. However, despite much interest in influenza and its complications in recent years, good clinical trial data to inform clinicians in their assessment of treatment options are scant. This paucity of evidence needs to be addressed urgently in order to improve guidance on the management of post-influenza bacterial pneumonia. The objectives of the current article are to evaluate the emergence of the 2009 H1N1 influenza pandemic and use this information as background for an in-depth review of the epidemiology of bacterial pneumonia complicating influenza, to review the bacterial pathogens most likely to be associated with post-influenza bacterial pneumonia, and to discuss treatment considerations in these patients. When determining optimal management approaches, both antiviral and antibacterial agents should be considered, and their selection should be based upon a clear understanding of how their mechanisms of action intervene in the pathogenesis of post-influenza acute bacterial pneumonia. (C) 2012 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
Metersky M L; Masterton R G; Lode H; File T M; Babinchak T
International Journal of Infectious Diseases
2012
2012-05
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1016/j.ijid.2012.01.003" target="_blank" rel="noreferrer noopener">10.1016/j.ijid.2012.01.003</a>
Evolution of amoxicillin/clavulanate in the treatment of adults with acute bacterial rhinosinusitis and community-acquired pneumonia in response to antimicrobial-resistance patterns.
Amoxicillin-Potassium Clavulanate Combination/*therapeutic use; Anti-Bacterial Agents/pharmacology; Bacteria/drug effects/isolation & purification; Bacterial; Combination/*therapeutic use; Community-Acquired Infections/drug therapy/microbiology; Drug Resistance; Drug Therapy; Humans; Microbial Sensitivity Tests; Pneumonia/*drug therapy/microbiology; Sinusitis/*drug therapy/microbiology
Current treatment guidelines for community-acquired respiratory tract infections no longer depend solely on the characteristics of the patient and the clinical syndrome, but on those of the offending pathogen, including presence and level of antimicrobial resistance. The most common respiratory tract pathogens known to cause acute bacterial rhinosinusitis (ABRS) and community-acquired pneumonia (CAP) include Streptococcus pneumoniae and Haemophilus influenzae. The prevalence of antimicrobial resistance, especially b-lactum and macrolide resistance, among S pneumoniae and H influenzae has increased dramatically during the past 2 decades, diminishing the activity of many older antimicrobials against resistant organisms. A pharmacokinetically enhanced formulation of amoxicillin/clavulanate has been developed to fulfill the need for an oral b-lactam antimicrobial that achieves a greater time that the serum drug concentration exceeds the minimum inhibitory concentration (T \textgreater MIC) of antimicrobials against pathogens than conventional formulations to improve activity against S pneumoniae with reduced susceptibility to penicillin. The b-lactamase inhibitor clavulanate allows for coverage of b-lactamase-producing pathogens, such as H influenzae and M catarrhalis. This article reviews the rationale for, and evolution of, oral amoxicillin clavulanate for ABRS and CAP
File Thomas M Jr; Benninger Michael S; Jacobs Michael R
Clinics in Laboratory Medicine
2004
2004-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.cll.2004.03.003" target="_blank" rel="noreferrer noopener">10.1016/j.cll.2004.03.003</a>
Guidelines for empiric antimicrobial prescribing in community-acquired pneumonia.
Humans; United States; Practice Guidelines as Topic; Canada; Europe; Community-Acquired Infections/drug therapy; Fluoroquinolones/therapeutic use; Lactams/therapeutic use; Macrolides/therapeutic use; Drug Resistance; Pneumonia; Bacterial; Bacterial/*drug therapy
Empiric antimicrobial prescribing for community-acquired pneumonia remains a challenge, despite the availability of treatment guidelines. A number of key differences exist between North American and European guidelines, mainly in the outpatient setting. The North American approach is to use initial antimicrobial therapy, which provides coverage for Streptococcus pneumoniae plus atypical pathogens. Europeans tend to focus on providing pneumococcal coverage with less emphasis on covering for an atypical pathogen. Ambulatory patients without comorbidity are more likely to receive macrolide therapy in North America, whereas in Europe these patients would probably receive a beta-lactam agent. Major issues that are fundamental to this difference include the importance of providing therapy for atypical pathogens and the clinical significance of macrolide-resistant S pneumoniae. Prospective data are required to evaluate which of these two approaches offers clinical superiority.
File Thomas M Jr; Garau Javier; Blasi Francesco; Chidiac Christian; Klugman Keith; Lode Hartmut; Lonks John R; Mandell Lionel; Ramirez Julio; Yu Victor
Chest
2004
2004-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1378/chest.125.5.1888" target="_blank" rel="noreferrer noopener">10.1378/chest.125.5.1888</a>
Impact of community-acquired methicillin-resistant Staphylococcus aureus in the hospital setting.
Humans; Hospitals; Community-Acquired Infections/epidemiology/microbiology/*prevention & control; Cross Infection/epidemiology/microbiology/*prevention & control; Infection Control; Methicillin Resistance/*genetics; Staphylococcal Infections/drug therapy/epidemiology/*prevention & control; Staphylococcus aureus/*drug effects/genetics; DNA; Bacterial
The epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) is undergoing a transformation as isolates of this historically health care-associated pathogen are reported with increasing frequency in otherwise healthy community-dwelling individuals. This article provides a brief review of the differences between health care-associated and community-acquired MRSA and discusses the potential impact of the changing epidemiology of MRSA on the hospital setting.
File Thomas M Jr
Cleveland Clinic journal of medicine
2007
2007-08
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.3949/ccjm.74.suppl_4.s6" target="_blank" rel="noreferrer noopener">10.3949/ccjm.74.suppl_4.s6</a>
International guidelines for the treatment of community-acquired pneumonia in adults: the role of macrolides.
Adult; Humans; Microbial Sensitivity Tests; Anti-Infective Agents/*therapeutic use; Outpatients; Practice Guidelines as Topic; Clinical Trials as Topic; Community-Acquired Infections/drug therapy/microbiology; Treatment Failure; Inpatients; Macrolides/pharmacology/*therapeutic use; Drug Resistance; Pneumonia; Bacterial; Bacterial/*drug therapy/microbiology; Adjuvants; Immunologic/pharmacology/therapeutic use
The significance of community-acquired pneumonia (CAP) has led to the publication of guidelines from numerous international organisations. Because the macrolide class of antimicrobials is active against most of the key pathogens associated with CAP, agents from this class are commonly included in recommendations from these guidelines. However, there are differences among the various guidelines concerning the positioning of the macrolides for empirical therapy. An important factor concerning the use of macrolides for CAP is the emergence of resistance of Streptococcus pneumoniae over the past decade. The rate of S. pneumoniae resistance to macrolides ranges from 4 to 70% of strains in worldwide surveillance studies. The most common mechanisms of resistance include methylation of a ribosomal target encoded by the erm gene and efflux of the macrolides by a cell membrane protein transporter, encoded by the mef gene. S. pneumoniae strains with the mef gene are resistant at a lower level (with minimum inhibitory concentration [MIC] values generally 1-16 microg/ml) than erm resistant strains; and it is possible that such strains may be inhibited if sufficiently high levels of macrolide can be obtained at the infected site. Currently mef-associated resistance predominates in North America, whereas erm predominates in Europe. Until recently, reports of failure of treatment of CAP with macrolides has been rare, particularly for patients with low-risk for drug-resistant strains. However, since 2000, several patients treated with an oral macrolide who have subsequently required admission to the hospital for macrolide-resistant S. pneumoniae (MRSP) bacteraemia have been reported in the literature. Major issues, which are fundamental to the use of the macrolides as recommended in the various guidelines, include the importance of providing therapy for 'atypical' pathogens and the clinical significance of MRSP. Presently, the macrolides are more prominently recommended in the North American guidelines than in other parts of the world. The difference in the emphasis placed on the importance of the atypical pathogens as well as the expression of MRSP in North America compared with Europe partly explains this variance.
File Thomas M Jr; Tan James S
Drugs
2003
1905-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.2165/00003495-200363020-00005" target="_blank" rel="noreferrer noopener">10.2165/00003495-200363020-00005</a>
New recommendations for the treatment of tuberculosis.
Adult; Antitubercular Agents – Administration and Dosage; Antitubercular Agents – Adverse Effects; Antitubercular Agents – Pharmacodynamics; Antitubercular Agents – Therapeutic Use; Antitubercular Agents/adverse effects/pharmacology/*therapeutic use; Bacterial; Chemical and Drug Induced Liver Injury; Child; Drug Resistance; Female; Hepatitis; HIV Infections – Complications; HIV Infections/complications; Humans; Infant; Microbial; Multiple; Practice Guidelines; Practice Guidelines as Topic; Preschool; Prescribing Patterns – Standards; Tuberculin Test; Tuberculosis – Drug Therapy; Tuberculosis – Epidemiology; Tuberculosis – Prevention and Control; Tuberculosis/*drug therapy/epidemiology/prevention & control; United States
PURPOSE OF REVIEW: The aim of this article is to give practicing physicians a practical approach to the treatment of latent and active tuberculosis and to review newer recommendations and common problems encountered in the treatment of patients with tuberculosis. RECENT FINDINGS: Recently published literature documents the increased incidence of multidrug resistant strains of Mycobacterium tuberculosis, the importance of antituberculosis drug toxicities and drug-drug interactions, persistent problems in the correct interpretation of the tuberculin skin test and ongoing problems with treatment compliance and treatment completion. SUMMARY: This article provides a practical approach to the interpretation of the tuberculin skin test, the proper approach to the treatment of latent tuberculosis infection, and a structured approach to the treatment of presumed or documented active tuberculosis infection. Questions about tuberculosis that are often asked of infectious disease and pulmonary specialists are addressed in a very practical manner.
Myers Joseph P
Current Opinion in Infectious Diseases
2005
2005-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/01.qco.0000160902.48942.31" target="_blank" rel="noreferrer noopener">10.1097/01.qco.0000160902.48942.31</a>
Nonresponses and treatment failures with conventional empiric regimens in patients with community-acquired pneumonia.
Anti-Bacterial Agents/therapeutic use; Bacterial; Community-Acquired Infections/drug therapy/mortality; Diagnostic Errors; Drug Resistance; Humans; Pneumonia/diagnosis/*drug therapy/mortality; Risk Factors; Treatment Failure
Although most patients with suspected CAP respond to empiric therapy,a small number of patients do not respond in the expected fashion. Age and underlying comorbid conditions have a strong influence on the course of illness. Less common causes of treatment failures include overwhelming infection, antimicrobial resistance, and misdiagnosis. It is a common practice for empiric antimicrobial treatment of CAP to be initiated without microbiologic studies. Clinicians carefully should observe these patients for unusual or slow responses and should be ready to pursue a more extensive search for the cause of treatment failure.
Tan James S
Infectious disease clinics of North America
2004
2004-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.idc.2004.07.009" target="_blank" rel="noreferrer noopener">10.1016/j.idc.2004.07.009</a>
Nucleotide sequence of a region duplicated in Escherichia coli toc mutants.
*Genes; *Multigene Family; Bacterial; Base Sequence; DNA Topoisomerases; Escherichia coli/*genetics; Molecular Sequence Data; Type I/genetics
We have sequenced about 5 kb of the Escherichia coli chromosome downstream from the tolC gene, looking for a topoisomerase gene. This region does not contain a topoisomerase gene.
Yang T P; Depew R E
Biochimica et biophysica acta
1992
1992-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/0167-4781(92)90535-8" target="_blank" rel="noreferrer noopener">10.1016/0167-4781(92)90535-8</a>
On the path to untreatable infections: colistin use in agriculture and the end of 'last resort' antibiotics.
*agriculture; *Agriculture; *antibiotic resistance; *Colistin; *Drug Resistance; Agriculture; Animal Husbandry; Anti-Bacterial Agents/*therapeutic use; Antibiotics – Therapeutic Use; Bacterial; Colistin – Analogs and Derivatives; Colistin – Therapeutic Use; Colistin/analogs & derivatives/*therapeutic use; Comparative Studies; Drug Resistance; Escherichia Coli; Escherichia Coli – Physiology; Escherichia coli Proteins/genetics; Escherichia coli/genetics/*physiology; European Union; Evaluation Research; Human; Humans; Microbial; Multicenter Studies; Multiple; Proteins; Validation Studies
Watkins Richard R; Smith Tara C; Bonomo Robert A
Expert review of anti-infective therapy
2016
2016-09
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1080/14787210.2016.1216314" target="_blank" rel="noreferrer noopener">10.1080/14787210.2016.1216314</a>
Outcome of treatment of respiratory tract infections due to Streptococcus pneumoniae, including drug-resistant strains, with pharmacokinetically enhanced amoxycillin/clavulanate.
*Treatment Outcome; 80 and over; Adolescent; Adult; Aged; Amoxicillin-Potassium Clavulanate Combination/administration & dosage/*pharmacokinetics/pharmacology/*therapeutic use; Amoxicillin/adverse effects/therapeutic use; Bacterial; Bacterial/drug therapy/immunology; Bronchitis/drug therapy/microbiology; Combination/adverse effects/*therapeutic use; Double-Blind Method; Drug Administration Schedule; Drug Resistance; Drug Therapy; Female; Follow-Up Studies; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Multicenter Studies as Topic; Pneumonia; Respiratory Tract Infections/*drug therapy/metabolism/microbiology; Streptococcal Infections/*drug therapy/metabolism/microbiology; Streptococcus pneumoniae/*drug effects
The efficacy of a new pharmacokinetically enhanced formulation of amoxycillin/clavulanate (AMX/CA) 2000/125 mg, twice daily, designed to provide adequate levels of amoxycillin over the 12-h dosing interval to eradicate penicillin-resistant Streptococcus pneumoniae (PRSP) with amoxycillin (+/-clavulanic acid) MICs of
File Thomas M Jr; Jacobs Michael R; Poole Michael D; Wynne Brian
International journal of antimicrobial agents
2002
2002-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/s0924-8579(02)00130-9" target="_blank" rel="noreferrer noopener">10.1016/s0924-8579(02)00130-9</a>
Overview: Global and Local Impact of Antibiotic Resistance.
*Agriculture; *Antibiotic resistance; *Bacterial Infections/drug therapy/microbiology/prevention & control; *Drug Resistance; *Global Health; *Infections; *Public health; *Public Health; Agriculture; Anti-Bacterial Agents/pharmacology/therapeutic use; Bacteria/drug effects; Bacterial; Humans; United States
The rapid and ongoing spread of antibiotic resistance poses a serious threat to global public health. The indiscriminant use of antibiotics in agriculture and human medicine along with increasingly connected societies has fueled the distribution of antibiotic-resistant bacteria. These factors together have led to rising numbers of infections caused by multidrug-resistant and pan-resistant bacteria, with increases in morbidity and mortality. This article summarizes the trends in antibiotic resistance, discusses the impact of antibiotic resistance on society, and reviews the use of antibiotics in agriculture. Feasible ways to tackle antibiotic resistance to avert a post-antibiotic era are suggested.
Watkins Richard R; Bonomo Robert A
Infectious disease clinics of North America
2016
2016-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.idc.2016.02.001" target="_blank" rel="noreferrer noopener">10.1016/j.idc.2016.02.001</a>
Physical map of the tolC-htrP region of the Escherichia coli chromosome.
*Chromosome Mapping; *Chromosomes; *Escherichia coli Proteins; *Intramolecular Transferases; Bacterial; Bacterial Outer Membrane Proteins/genetics; Bacterial Proteins/*genetics; Deoxyribonucleases; Escherichia coli/*genetics; Heat-Shock Proteins; Membrane Transport Proteins; Molecular Sequence Data; Restriction Mapping; Type II Site-Specific/metabolism
Yang T P; Depew R E
Journal of bacteriology
1992
1992-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1128/jb.174.5.1700-1701.1992" target="_blank" rel="noreferrer noopener">10.1128/jb.174.5.1700-1701.1992</a>
SOLITAIRE-IV: A Randomized, Double-Blind, Multicenter Study Comparing the Efficacy and Safety of Intravenous-to-Oral Solithromycin to Intravenous-to-Oral Moxifloxacin for Treatment of Community-Acquired Bacterial Pneumonia.
*clinical trial; *community-acquired; *pneumonia; *solithromycin; *Streptococcus pneumoniae; 80 and over; Administration; Adult; Aged; Anti-Bacterial Agents/*administration & dosage/adverse effects; Bacterial; Bacterial/diagnosis/*drug therapy/*microbiology; Community-Acquired Infections/diagnosis/*drug therapy/*microbiology; Comorbidity; Drug Resistance; Female; Fluoroquinolones/*administration & dosage/adverse effects; Humans; Intravenous; Macrolides/*administration & dosage/adverse effects; Male; Microbial Sensitivity Tests; Middle Aged; Moxifloxacin; Oral; Pneumonia; Treatment Outcome; Triazoles/*administration & dosage/adverse effects
BACKGROUND: Solithromycin, a novel macrolide antibiotic with both intravenous and oral formulations dosed once daily, has completed 2 global phase 3 trials for treatment of community-acquired bacterial pneumonia. METHODS: A total of 863 adults with community-acquired bacterial pneumonia (Pneumonia Outcomes Research Team [PORT] class II-IV) were randomized 1:1 to receive either intravenous-to-oral solithromycin or moxifloxacin for 7 once-daily doses. All patients received 400 mg intravenously on day 1 and were permitted to switch to oral dosing when clinically indicated. The primary objective was to demonstrate noninferiority (10% margin) of solithromycin to moxifloxacin in achievement of early clinical response (ECR) assessed 3 days after first dose in the intent-to-treat (ITT) population. Secondary endpoints included demonstrating noninferiority in ECR in the microbiological ITT population (micro-ITT) and determination of investigator-assessed success rates at the short-term follow-up (SFU) visit 5-10 days posttherapy. RESULTS: In the ITT population, 79.3% of solithromycin patients and 79.7% of moxifloxacin patients achieved ECR (treatment difference, -0.46; 95% confidence interval [CI], -6.1 to 5.2). In the micro-ITT population, 80.3% of solithromycin patients and 79.1% of moxifloxacin patients achieved ECR (treatment difference, 1.26; 95% CI, -8.1 to 10.6). In the ITT population, 84.6% of solithromycin patients and 88.6% of moxifloxacin patients achieved clinical success at SFU based on investigator assessment. Mostly mild/moderate infusion events led to higher incidence of adverse events overall in the solithromycin group. Other adverse events were comparable between treatment groups. CONCLUSIONS: Intravenous-to-oral solithromycin was noninferior to intravenous-to-oral moxifloxacin. Solithromycin has potential to provide an intravenous and oral option for monotherapy for community-acquired bacterial pneumonia. CLINICAL TRIALS REGISTRATION: NCT01968733.
File Thomas M Jr; Rewerska Barbara; Vucinic-Mihailovic Violeta; Gonong Joven Roque V; Das Anita F; Keedy Kara; Taylor David; Sheets Amanda; Fernandes Prabhavathi; Oldach David; Jamieson Brian D
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
2016
2016-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1093/cid/ciw490" target="_blank" rel="noreferrer noopener">10.1093/cid/ciw490</a>
Solutions to the problem of bacterial resistance.
Humans; *Practice Guidelines as Topic; Anti-Bacterial Agents/*therapeutic use; Drug Administration Schedule; Drug Utilization; Drug Prescriptions/standards; Professional Practice/*standards; Unnecessary Procedures; *Drug Resistance; Dose-Response Relationship; Drug; Bacterial
The recent increase in bacterial resistance has been, and continues to be, unmatched by drug discovery and development. The judicious use of antibacterials must be observed so as to contain bacterial resistance and maintain the utility of agents currently on the market. Appropriate antibacterial use involves antibacterial avoidance when not indicated. When indicated, appropriate antibacterial use dictates that the optimal drug, dose and duration be utilized. Professional society guidelines facilitate drug selection as well as outline diagnostic criteria and important considerations for patient stratification. Pharmacodynamics is also key for drug selection and often guides determination of not only the optimal drug but also the optimal dose and duration. Importantly, bacterial eradication is essential, as it will reduce clinical failure, recurrence, or relapse and prevent the selection of resistance. Additional strategies to influence antibacterial prescribing and use such as formal continuing medical education, printed educational materials, better diagnostic tests, and vaccination contribute to the efforts to minimize bacterial resistance and are also addressed.
File Thomas M Jr
Treatments in respiratory medicine
2005
1905-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.2165/00151829-200504001-00007" target="_blank" rel="noreferrer noopener">10.2165/00151829-200504001-00007</a>
Strategies for improving antimicrobial use and the role of antimicrobial stewardship programs.
*Drug Resistance; Anti-Bacterial Agents/administration & dosage/*therapeutic use; Bacterial; Bacterial Infections/*drug therapy/prevention & control; Bacterial/drug therapy; Bacteriuria/drug therapy; Centers for Medicare and Medicaid Services (U.S.); Community-Acquired Infections/drug therapy; Cross Infection/drug therapy; Drug Utilization; Hospitals; Humans; Pneumonia; Practice Guidelines as Topic; Public Health; Quality of Health Care/*standards; Surgical Wound Infection/drug therapy; United States
File Thomas M Jr; Solomkin Joseph S; Cosgrove Sara E
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
2011
2011-08
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1093/cid/cir364" target="_blank" rel="noreferrer noopener">10.1093/cid/cir364</a>
The Evolving Role of Antimicrobial Stewardship in Management of Multidrug Resistant Infections.
*Anti-Bacterial Agents/administration & dosage/therapeutic use; *Antibiotics; *Antimicrobial resistance; *Antimicrobial stewardship; *Drug Resistance; *Medication Therapy Management; Bacterial; Bacterial Infections/drug therapy; Humans; Multiple
This article summarizes the current literature describing how antimicrobial stewardship interventions impact antimicrobial resistance. Discussion includes why we need stewardship, how to collaborate with team members, and the evidence of stewardship's impact on resistance.
Goff Debra A; File Thomas M Jr
Infectious disease clinics of North America
2016
2016-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.idc.2016.02.012" target="_blank" rel="noreferrer noopener">10.1016/j.idc.2016.02.012</a>
The science of selecting antimicrobials for community-acquired pneumonia (CAP).
Humans; Microbial Sensitivity Tests; Anti-Bacterial Agents/*therapeutic use; Practice Guidelines as Topic; Streptococcus pneumoniae/isolation & purification; Community-Acquired Infections/drug therapy; *Drug Resistance; beta-Lactams/*therapeutic use; Chlamydophila pneumoniae/isolation & purification; Fluoroquinolones/*therapeutic use; Legionnaires' Disease/drug therapy; Macrolides/*therapeutic use; Pneumonia; Bacterial; Drug Therapy; Bacterial/*drug therapy; Combination
BACKGROUND: Among infectious diseases, community-acquired pneumonia (CAP) is the leading cause of death in the United States and is associated with a substantial economic burden to the health care system. Initiating appropriate empiric therapy can be challenging given elevated resistance rates among Streptococcus pneumoniae strains. OBJECTIVE: To present current recommendations for management of CAP with respect to (a) choosing the appropriate site of care, and (b) antimicrobial selection based on bacterial etiology and the prevalence of resistance. SUMMARY: Mortality prediction tools, such as the PORT (Pneumonia Outcomes Research Team) Severity Index, CURB-65 (Confusion, Urea concentration, Respiratory rate, Blood pressure, and age\textgreater65), or CRB-65 (Confusion, Respiratory rate, Blood pressure, and age\textgreater65), can be invaluable in determining which CAP patients require hospitalization. These tools can help reduce overall costs for CAP by limiting hospitalizations of low-risk patients. S. pneumoniae remains the most common causative pathogen for CAP across all disease severities, and elevated rates of resistance to penicillin and macrolides can hinder selection of appropriate antimicrobial therapy. Antimicrobial resistance can impact clinical outcomes, including increasing the risk of treatment failure and breakthrough bacteremia. Current management guidelines recommend monotherapy with a respiratory fluoroquinolone or combination therapy with a beta-lactam and a macrolide (for patients admitted to the general medical ward) or with a beta-lactam and either a respiratory fluoroquinolone or a macrolide (for patients admitted to the intensive care unit [ICU] and who do not have risk factors for methicillin-resistant S. aureus or Pseudomonas). Optimized dosing regimens aim to ensure that pharmacokinetic and pharmacodynamic targets are met to achieve successful clinical outcomes and minimize resistance development. CONCLUSION: Effective management of patients with CAP requires selection of the proper site of care and appropriate empiric antimicrobial. Given the elevated rates of resistance among S. pneumoniae, local resistance patterns must be considered when choosing empiric therapy.
File Thomas M
Journal of managed care pharmacy : JMCP
2009
2009-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.18553/jmcp.2009.15.s2.5" target="_blank" rel="noreferrer noopener">10.18553/jmcp.2009.15.s2.5</a>
Treating CAP caused by penicillin-resistant S pneumoniae.
Community-Acquired Infections; Diagnosis; Drug Resistance; Differential; Pneumonia; Bacterial; Microbial; Streptococcal Infections; Bacterial – Diagnosis
Over the last decade, the incidence of penicillin resistance among Streptococcus pneumoniae isolates has markedly increased. This trend is unsettling because infections caused by S pneumoniae are among the leading causes of morbidity and mortality in young children, the elderly, and persons with debilitating medical conditions. There is evidence that drug-resistant S pneumoniae affects clinical outcome in patients with meningitis and otitis media, but the clinical relevance of drug resistance in managing communityacquired pneumonia has been less clear. Furthermore, penicillin-resistant strains may also be resistant to other antimicrobials, including cephalosporins, macrolides, tetracyclines, trimethoprim-sulfamethoxazole, and chloramphenicol. Newer antimicrobials that have enhanced activity against S pneumoniae (including resistant strains) are available, and other agents are being investigated. However, to minimize antimicrobial resistance, the CDC recommends improving vaccination rates and using antibiotics judiciously.
File T M Jr
Journal of Respiratory Diseases
1999
1999-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Using Procalcitonin to Differentiate Bacterial from Viral Meningitis.
Antibiotics; Viral; Bacterial; Meningitis; Biological Markers; Calcitonin; Meningitis – Diagnosis
The article presents a study which reveals the consideration of an elevated serum procalcitonin to be an accurate test for differentiating bacterial from viral meningitis in adults.
Watkins Richard R
Internal Medicine Alert
2015
2015-12-15
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).