The inventory of antibiotics in Russian home medicine cabinets.

The objective of this study was to inventory the stock of antimicrobials in the home medicine cabinets (HMCs) of the general population in Russia and to find out for which indications people report that they would use antibiotics without a physician's recommendation. The research was performed in 9 Russian cities by physicians who visited households. An inventory of antibiotics in HMCs was made, and respondents were asked about instances in which they would choose automedication with antibiotics. We found that 83.6% of families had antibiotics for systemic use in HMCs. The most common antibiotics in HMCs were trimethoprim-sulfamethoxazole (46.3% of HMCs), ampicillin (45.1%), chloramphenicol (32.7%), erythromycin (25.5%), and tetracycline (21.8%). The major indications for automedication with antibiotics were acute viral respiratory tract infections (12.3% of total indications), cough (11.8%), intestinal disorders (11.3%), fever (9%), and sore throat (6.8%). According to this study, antibiotics are widely stocked among the general population in Russia, and people use antibiotics in an uncontrolled and imprudent manner

Controlled trials of antibiotic treatment in patients with post-treatment chronic Lyme disease.

Some patients have persistence of profound fatigue, myalgias, arthralgias without arthritis, dysesthesia/paresthesia, and mood and memory disturbances after standard courses of antibiotic treatment for Lyme disease. This constellation of symptoms has been variously referred to as "chronic Lyme disease," "post-Lyme disease syndrome," and "post-treatment chronic Lyme disease." Persistent symptoms have been reported in patients who are seropositive for IgG antibodies against Borrelia burgdorferi as well as in patients who are seronegative. The cause or causes of persistent symptoms in these patients have not been clearly defined and are controversial. Because of the temporal association of these symptoms with infection with B. burgdorferi, some patients have been treated with prolonged courses of antibiotics. Case reports and uncontrolled trials have reported the efficacy of prolonged antibiotic therapy, often with relapse of the symptoms after discontinuation of therapy. To date, only one randomized, placebo-controlled, double-blind trial of antibiotic therapy for these patients has been published. An abstract of a second placebo-controlled trial of antibiotic therapy in a smaller cohort has also been presented. This paper will describe this patient population in detail and will review the clinical, microbiological, and selected biochemical and immunologic parameters and their responses to antibiotic treatment in the setting of a controlled trial

Side effects of antibiotics in patients with thermal burns

The possibilities of antibacterial therapy in the clinics of burn diseases has at present decreased because of increasing microflora resistance to antibiotics. This phenomenon is one of the most often causes of antibacterial drug side effects in burn patients. For control of infections complications in burn patients which are most often lethal it is necessary to use biologically active subtance, such as prodigiozan and lysozime in addition to the directed antibiotic therapy. The use of specific antitoxic antistaphylococcal drugs, such as antistaphylococcal plasma and antistaphylococcal gamma-globulin in combination with the antibiotics of the direct action provided effective control of infectious complications and sepsis of staphylococcal genesis in burn patients. Decamine proved to be effective along with the usual use of nystatin in cases with dysbacteriosis as a result of the antibiotic side effects. In the patients treated with decamine the sings of candidosis disappeared by the 5th--7th day. Therefore, for decreasing the side effects of antibiotics in the clinics of burn patients it is expedient to use antibiotics in combination with the biologically active and immune preparations which increases the efficacy of antibiotic therapy, impfoves the treatment results and decreases the antibiotic side effects

Women's experience of post-antibiotic vulvovaginitis.

OBJECTIVES: To examine the frequency of post-antibiotic vulvovaginitis (PAV); describe how women prevent and treat PAV; and determine whether concern about PAV affects their decisions about taking antibiotics. DESIGN: Cross-sectional survey using a written questionnaire. SETTING AND PARTICIPANTS: Five general practice waiting rooms in north-western Melbourne, in February 2000. 1298 women aged 18-70 years were surveyed. MAIN OUTCOME MEASURES: Self-reported symptoms and management of vulvovaginitis and PAV. RESULTS: The response rate was 86%. Thirty-five per cent of women reported ever having PAV and 73% reported ever having symptoms suggestive of vulvovaginal candidiasis. Antifungal medications and lactobacillus products or yoghurt were most popular for both prevention (49%, 40%) and treatment (63%, 43%) of PAV. Other home remedies such as tea tree oil, vinegar, and dietary and clothing modification were infrequently used by the women surveyed. Twenty-three per cent of women who had taken antibiotics in the previous month had experienced symptoms of vulvovaginitis. Of women who had ever had vulvovaginitis, 35% were moderately to very concerned about developing PAV when prescribed antibiotics. Because of this concern, around a fifth of these women would not take prescribed antibiotics. CONCLUSIONS: Concern about PAV affects women's decision-making regarding antibiotic use. Many women use unproven complementary therapies to prevent or treat PAV. When prescribing antibiotics, doctors should discuss the risks of PAV and its management with patients.

Genetic determinants of microbial resistance to antibiotics.

Emergence of antibiotic resistance is related to the ease of mutation, to the extent of exchange of genetic information in bacteria by conjugation, transformation, and transduction, and to the large-scale use of antimicrobial agents in the biosphere. In addition to the development of resistance through chromosomal mutation and exchange of chromosomal genes among organisms, there is a more profound enlargement of the gene pool by the dissemination and amplification of plasmids. Two examples of the exchange of antibiotic resistance are analyzed: the transfer of plasmids from Bacteroides fragilis to Escherichia coli and the emergence of antibiotic-resistant strains of STreptococcus pneumoniae. Plasmids encoding antibiotic resistance in B. fragilis were transferred to E. coli by DNA-mediated transformation and conjugation. The beta-lactamase in the transformants and transconjugants displayed the same substrate specificity and electrophoretic mobility as the donor strain. The plasmid apparently was integrated rapidly into the chromosome of the recipient strain. Multiple antibiotic-resistant strains of S. pneumoniae were analyzed for plasmids, and none were detected. Furthermore, no evidence of linkage between the traits of multiple antibiotic resistance was observed. beta-Lactamase was not detected in the penicillin-resistant strains; therefore, it is likely that the resistance in these strains was chromosomal rather than plasmid-mediated. The range of genetic exchange and the use of Koch's postulates in determining the genetic mechanism of antibiotic resistance are illustrated and discussed

Antimicrobial resistance and enterotoxin production among isolates of Escherichia coli in the Far East.

The frequency of association between transferable extrachromosomal D.N.A. (plasmid) mediated antibiotic resistance and enterotoxin productin is unknown. The antimicrobial susceptibility of 176 enterotoxigenic Escherichia coli from 57 children and adults in the Philippines, Korea, Taiwan, and Indonesia has been examined. 126 isolates (72%) were resistant to one or more antibiotic(s); 77 (44%) were resistant to four or more antibiotics. 43 E. coli which produced both heat-labile and heat-stable toxin, 110 isolates which produced only heat-labile toxin, and 23 which produced only heat-stable toxin were frequently resistant to multiple antibiotics. 25 of 31 resistant isolates tested, 80% transferred antibiotic resistance in bacterial mating experiments. In 35% of the matings transferring antibiotic resistance, the ability to produce enterotoxin was also conferred on the recipients. This in-vitro observation suggests that the widespread use of antibiotics could increase the distribution of enterotoxigenic E. coli, as genes coding for antibiotic resistance and enterotoxin production are frequently transferred together

Natural antibiotic susceptibility of Salmonella enterica strains.

The susceptibility of 100 Salmonella enterica strains belonging to S. enterica subsp. enterica (n=90) and S. enterica subsp. arizonae (n=10) was examined to 71 antibiotics. Within S. enterica subsp. enterica, strains of different serovars (typhimurium (n=17), enteritidis (n=17), dublin (n=10), typhi (n=16), paratyphi A (n=6), others (n=24)) were studied. MICs were determined using a microdilution procedure and apart from fosfomycin there were no significant differences in susceptibility between the subspecies and serovars of S. enterica. All salmonellae were sensitive or intermediately resistant to tetracyclines, aminoglycosides, most beta-lactam antibiotics, quinolones, co-trimoxazole group antibiotics, chloramphenicol, nitrofurantoin and azithromycin ( Zithromax ). S. enterica strains were intrinsically resistant to benzylpenicillin, oxacillin, most macrolides, rifampicin, lincosamides, streptogramins, glycopeptides and fusidic acid. Apart from some slight differences in antibiotic susceptibility between strains of S. enterica subsp. enterica and S. enterica subsp. arizonae, only the susceptibility to fosfomycin varied among the taxa studied. Whereas 'enteric' salmonellae including S. enterica subsp. arizonae were sensitive to fosfomycin, 'typhoid' salmonellae were intrinsically resistant. A database of the antibiotic susceptibility of S. enterica was set up. It may be of use to validate antibiotic susceptibility test results of these bacteria

Restriction of third generation cephalosporin use reduces the incidence of Clostridium difficile-associated diarrhoea in hospitalised patients.

Third generation cephalosporin antibiotics (3GC) have become the antibiotics of choice in many hospitals in recent years for the treatment of infections such as community-acquired pneumonia. However, increased use of 3GCs has also been associated with a rise in the occurrence of antibiotic-associated diarrhoea due to Clostridium difficile, as well as an increase in the prevalence of antibiotic resistant organisms such as methicillin resistant Staphylococcus aureus, vancomycin resistant entrococci, and extended-spectrum beta-lactamase-producing gram negative bacilli. In Western Australia, greater use of 3GCs was shown to correlate with more Clostridium difficile-associated diarrhoea (CDAD) in a large acute care teaching hospital during the 1980s. During the 1990s, the use of 3GCs in this hospital remained high and, at the end of 1998, a policy was introduced to prevent the use of ceftriaxone (the only 3GC in use) without prior approval. This resulted in a decline in 3GC use and a 50 per cent reduction in the incidence of CDAD during 1999 and 2000. To strengthen these observations, the impact of the 3GC policy on the occurrence of CDAD was analysed using time-series intervention analysis that showed a statistically significant decrease in the occurrence of CDAD during the post-intervention period after controlling for exogenous factors. Thus, changes in antibiotic prescribing practices can influence the incidence of CDAD and, potentially, antibiotic resistant pathogens

Treatment of severe Gram-positive infections: current situation and new opportunities

METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS (MRSA) INFECTIONS: A growing number of MRSA strains with an increased minimum inhibitory concentration (MIC) and intermediary susceptibility to glycopeptides (GISA) or vancomycin (VISA) are encountered in clinical practice. In patients on mechanical ventilation who develop acute pneumonia, it would appear appropriate to achieve a vancomycin concentration in serum and the lung 2 to 4 times above the MIC, while carefully monitoring the risk of toxicity. POSSIBLE SOLUTIONS: Better prevention of severe MRSA infections, a more rational use of glycopeptides, using a recycling scheme, i.e. altering prescriptions with antibiotics other than glycopeptides or using combinations. OTHER AGENTS CURRENTLY AVAILABLE: Several antibiotic classes can now be used to preserve the efficacy of glycopeptides: cotrimoxazole, quinupristine/dalfopristine and linezolide. Linezolide is the first compound of a new family of antibiotics called oxazolidinones which are active against aerobic and anaerobic Gram positive strains, particularly those exhibiting intermediary sensitivity or resistance to other antibiotics. Its pharmacokinetic properties are quite favorable. ANTIBIOTIC COMBINATIONS: In case of severe MRSA infection, antibiotics that can be combined with vancomycin include gentamycin, rifampicin, or fosfonycine. For GISA infections, vancomycin could be combined with a ss-lactam, or quinupristine/dalfopristine. Combination with linezolide appears to be antagonistic

Pharmacologic Basis for the Treatment of Pyelonephritis.

Urinary tract infections (UTIs) are among the most common bacterial infections in humans. Even though physicians have been treating UTIs for 60 years, there has been no standardized approach regarding the rational choice of antimicrobial agents and optimal treatment duration for these infections. This review discusses the pharmacologic basis for the treatment of UTIs. Although most antibiotics concentrate well in the urine and can eradicate most of the sensitive uropathogens that cause lower UTI, antibiotics given for the treatment of pyelonephritis must concentrate and kill bacteria embedded within the renal parenchyma. Investigators once believed that antibiotics must concentrate in sufficient amounts in the urine of infected patients to be effective in treating pyelonephritis. In fact, the efficacy of an antibiotic in the treatment of pyelonephritis is proportional to its capacity to converge in high concentration not only in urine but also in the renal parenchyma because serum and urine levels of antibiotics are poor predictors of the intrarenal levels. Other factors should also be taken into consideration in the management of UTIs, such as the time of day antibiotics are given because significant time-dependent differences have been observed in the pharmacokinetics and rate of excretion in urine of several antibiotics. Finally, the authors review the recent development in the inflammatory response in the urinary tract that may explain the clinical features of UTI and may be useful in the diagnosis as well as better management of UTI