Evolution of amoxicillin/clavulanate in the treatment of adults with acute bacterial rhinosinusitis and community-acquired pneumonia in response to antimicrobial-resistance patterns.
Antibiotics; Drug Resistance; Microbial; Microbial Culture and Sensitivity Tests; Pneumonia – Drug Therapy; Community-Acquired Infections – Drug Therapy; Pneumonia – Microbiology; Community-Acquired Infections – Microbiology; Bacteria – Drug Effects; Combined – Therapeutic Use; Rhinosinusitis – Drug Therapy; Rhinosinusitis – 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. Copyright © 2004 by Elsevier Science (USA).
File T M Jr; Benninger MS; Jacobs MR
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>
The Science of Selecting Antimicrobials for Community-Acquired Pneumonia (CAP)
Antibiotics; Human; Practice Guidelines; Drug Resistance; Pneumonia; Drug Therapy; Microbial; Combination; Microbial Culture and Sensitivity Tests; Antiinfective Agents; Streptococcus; Gram-Negative Bacteria; Antibiotics – Therapeutic Use; Community-Acquired Infections – Drug Therapy; Bacterial – Drug Therapy; Macrolide – Therapeutic Use; Quinolone – Therapeutic Use; Lactam – Therapeutic Use; Legionnaires' Disease – Drug Therapy
File T M
Journal of Managed Care Pharmacy
2009
2009-03-02
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>
Continuous Infusion of Beta-lactams for Sepsis Improves Outcomes.
Prospective Studies; Human; Multicenter Studies; Infusions; Microbial Culture and Sensitivity Tests; Randomized Controlled Trials; Double-Blind Studies; Antibiotics – Administration and Dosage; Intravenous – Utilization; Sepsis – Drug Therapy
Despite notable advances in critical care medicine, mortality from severe sepsis remains unacceptably high. With current therapeutic strategies, nothing has proven more crucial than early and effective antibiotics. Among the most commonly utilized antibiotics in intensive care units (ICUs) are beta-lactams, such as piperacillin-tazobactam and meropenem. These agents are usually administered by intermittent bolus dosing. However, pharmocodynamic data have shown that continuous infusion administration results in greater blood and fluid exposure with more time above the minimum inhibitory concentration (MIC) compared to intermittent dosing. Dulhunty and colleagues sought to determine the clinical and pharmacokinetic differences between continuous and intermittent bolus dosing of beta-lactam antibiotics in patients with severe sepsis. The study was a prospective, double-blind, randomized controlled trial conducted at several hospitals in Australia and Hong Kong between April 2010 and November 2011. Patient inclusion criteria included \textgreater 18 years of age, severe sepsis in the preceding 24 hours, treatment within the previous 24 hours with ticarcillin-clavulanate, piperacillin-tazobactam or meropenem, and expected or actual ICU stay greater than 24 hours. Patients were excluded if they were on continuous renal replacement therapy, lacked a central access catheter with at least 3 lumens, or received the study drug for \textgreater 24 hours. They were randomized to receive active infusion and placebo boluses (intervention group), or placebo infusion and active boluses (control group). On days 3 and 4 blood samples were taken to ascertain plasma trough levels. The primary endpoint was the time that antibiotic concentration was above the MIC. Secondary endpoints were clinical response at days 7 to 14 after study drug cessation, time to clinical resolution, status at ICU and hospital discharge, and number of days alive and free of ICU admission in the first 28 days post-randomization. Sixty patients were enrolled, 30 in the continuous infusion group and 30 in the intermittent bolus group. The most common source of infection in both groups was lung, followed by blood, intra-abdominal, skin or skin structure, urinary tract, and central nervous system. The patients who received continuous infusion compared to intermittent bolus administration achieved higher times above the MIC (82% vs. 29%, P = .001) and higher clinical cure (76.7% vs. 50%, P = .032). Moreover, there was less time to clinical resolution (11 days vs. 16.5 days, P = .14), lower ICU length of stay (7.5 days vs. 9 days, P = .50), better hospital survival (90% vs 80% P = .47), and higher ICU survival (93.3% vs. 86.7%, P = .67) in the continuous infusion group, but these did not reach statistical significance. Plasma antibiotic concentration of meropenem was greater than the MIC in 100% of patients who received continuous infusion compared to 22% in the intermittent bolus group. Piperacillin-tazobactam and ticarcillin-clavulanate continuous infusions resulted in concentrations above the MIC 75% and 50% of the time, respectively. The corresponding- intermittent bolus administration achieved concentrations above the MIC 36% and 0% of the time with piperacillin-tazobactam and ticarcillin-clavulanate.
Watkins Richard R
Infectious Disease Alert
2013
2013-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Antimicrobial Effects of Virgin Coconut Oil and Its Medium-Chain Fatty Acids on Clostridium difficile.
Staining and Labeling; Microscopy; Descriptive Statistics; Comparative Studies; Microbial Culture and Sensitivity Tests; In Vitro Studies; Alternative Therapies; Cell Membrane; Coconut; Clostridium Infections – Prevention and Control; Antiinfective Agents – Pharmacodynamics; Fatty Acids – Analysis; Lipids – Pharmacodynamics; Plant Oils – Pharmacodynamics
Clostridium difficile is the leading cause of hospital-acquired antibiotic-associated diarrhea worldwide; in addition, the proliferation of antibiotic-resistant C. difficile is becoming a significant problem. Virgin coconut oil (VCO) has been shown previously to have the antimicrobial activity. This study evaluates the lipid components of VCO for the control of C. difficile. VCO and its most active individual fatty acids were tested to evaluate their antimicrobial effect on C. difficile in vitro. The data indicate that exposure to lauric acid (C12) was the most inhibitory to growth ( P\textless.001), as determined by a reduction in colony-forming units per milliliter. Capric acid (C10) and caprylic acid (C8) were inhibitory to growth, but to a lesser degree. VCO did not inhibit the growth of C. difficile; however, growth was inhibited when bacterial cells were exposed to 0.15-1.2% lipolyzed coconut oil. Transmission electron microscopy (TEM) showed the disruption of both the cell membrane and the cytoplasm of cells exposed to 2 mg/mL of lauric acid. Changes in bacterial cell membrane integrity were additionally confirmed for VCO and select fatty acids using Live/Dead staining. This study demonstrates the growth inhibition of C. difficile mediated by medium-chain fatty acids derived from VCO.
Shilling Michael; Matt Laurie; Rubin Evelyn; Visitacion Mark Paul; Haller Nairmeen A; Grey Scott F; Woolverton Christopher J
Journal of Medicinal Food
2013
2013-12
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/10.1089/jmf.2012.0303" target="_blank" rel="noreferrer noopener">10.1089/jmf.2012.0303</a>
Importance of Culture for Group A Strep Pharyngitis after a Negative Rapid Test.
Adult; Incidence; Sensitivity and Specificity; Medical Records; Multicenter Studies; Adolescence; Retrospective Design; Washington; Diagnosis; Differential; Microbial Culture and Sensitivity Tests; Patient Care – Standards; Pharyngitis – Etiology; Streptococcal Infections – Complications; Streptococcal Infections – Diagnosis
Watkins Richard R
Infectious Disease Alert
2014
2014-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
The Growing Threat of Pyelonephritis Caused by Antibiotic-resistant Escherichia coli.
Adult; Female; Male; Pregnancy; Urinalysis; Community-Acquired Infections; Cell Culture Techniques; Emergency Service; Drug Resistance; Microbial; Microbial Culture and Sensitivity Tests; Antiinfective Agents; Escherichia Coli; Escherichia Coli Infections; Biological Phenomena; Immunocompromised Host; Fluoroquinolone; Antibiotics – Administration and Dosage; Escherichia Coli Infections – Diagnosis; Pyelonephritis – Complications; Pyelonephritis – Diagnosis; Pyelonephritis – Etiology; Pyelonephritis – Risk Factors
The article focuses on a bacteria Escherichia coli which lead to occurrence of pyelonephritis with increasing resistance of Escherichia coli for empiric antibiotics. Topics discussed include need for making choices of empiric antibiotic by clinicians which will be based on patterns of local resistance, association of extended spectrum beta lactamase (ESBL) with healthcare acquisition and mentions drawback of ertapenem like difficulty in oral conversion.
Watkins Richard R
Infectious Disease Alert
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 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>