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Jones RN, Sader HS, Flamm RK, Watters AA. More potency assay results for generic non-USA lots of piperacillin/tazobactam and initial reports for generic meropenem compounds marketed in the USA. Diagn Microbiol Infect Dis 2013; 76:110-2. [DOI: 10.1016/j.diagmicrobio.2013.01.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 01/31/2013] [Indexed: 11/30/2022]
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Jones RN, Watters AA, Flamm RK, Sader HS. Comparative potencies of contemporary generic vancomycin lot: in vitro assay results from nine products and a reference reagent-grade sample. Diagn Microbiol Infect Dis 2013; 76:237-8. [PMID: 23434498 DOI: 10.1016/j.diagmicrobio.2013.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Accepted: 01/09/2013] [Indexed: 10/27/2022]
Abstract
Numerous studies of generic vancomycin (GV) lots have emerged since the 1980s, casting some doubt on product quality. Publications question the in vivo activity, even when concurrent in vitro and chemical assays meet regulatory guidelines. This study assessed contemporary GV lots by an in vitro assay capable of measuring small variations from target-benchmark (BM) activity. Nine GV lots (Hospira [6 lots; 0.5- or 1.0-g vials], Akorn [1 lot; 1.0-g vial], APP [2 lots; 1.0-g vials]) were obtained from local United States distributors. A reagent-grade lot (Sigma lot 080M1341V) was tested as BM component due to the inability to purchase branded product vials in the USA. All lots of GV did not vary significantly from the analytical control when testing the 3 Staphylococcus aureus (wild-type 4B25, ATCC 25923, and 29213) and Enterococcus faecalis (ATCC 29212) strains. These MIC end points were read at 18 h of incubation, and Hospira lots averaged +3.5% potency (range, -3% to +8%), and Akorn and APP at 0% variance, e.g., acceptable performance. In conclusion, with a validated, precise multi-organism assay, current GV lots marketed in the USA showed minimal activity variations from a selected BM control lot. Generic antimicrobial products, in general, should be regularly monitored for potency, chemical purity, and in vivo activity before routine use in medical centers.
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Use of antibacterial agents in the neonate: 50 years of experience with vancomycin administration. Semin Fetal Neonatal Med 2013; 18:28-34. [PMID: 23137927 DOI: 10.1016/j.siny.2012.10.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Neonatal sepsis, classified as either early or late onset, has specific pathogen distribution and infection rates in the different neonatal age groups. It is a major cause of mortality and morbidity and administration of antibiotics is urgently required for suspected or proven infection. Vancomycin is the first choice treatment of late onset sepsis due to resistant staphylococci. Although it has been used for more than 50 years, prescription remains a challenge in neonatal intensive care units for many reasons, including: high pharmacokinetic variability, numerous presentations, lack of consensus on dosing regimen and therapeutic drug monitoring. In addition, recent concerns about the increase in minimal inhibition concentration and other more generic problems have prompted reappraisal of the rational use of vancomycin. This article highlights the goal of optimising vancomycin therapy in the neonate and discusses future research directions. Specific attention is given to dosing optimisation of vancomycin to avoid resistance and maximise the likelihood of achieving the therapeutic target. Modelling and simulation approaches have clear advantages in dosing optimisation of antimicrobial agents in the neonate. Neonatologists and paediatric pharmacologists should work closely together to achieve this goal.
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54
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Bhattacharya S. Early diagnosis of resistant pathogens: how can it improve antimicrobial treatment? Virulence 2013; 4:172-84. [PMID: 23302786 PMCID: PMC3654618 DOI: 10.4161/viru.23326] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Infections with organisms that are resistant to various anti-microbial agents pose a serious challenge to effective management of infections. Resistance to antimicrobial agents, which may be intrinsic or acquired, has been noted in a wide variety of microorganisms causing human infections. These include resistance to antiviral agents in HIV, HBV, CMV and influenza virus, anti-parasitic agents in Plasmodium falciparum, anti-fungal agents in certain Candida species and MDR (multidrug-resistant) tuberculosis. It is however, the problem of multidrug-resistant bacterial infections (caused by MRSA, VRE, ESBL/AmpC/metallo-β lactamase producers and colistin-resistant Gram-negative bacilli) that has become a cause of major concern in clinical settings. Infections with these organisms can increase morbidity, mortality, increase the cost of therapy and increase the duration of hospitalization. The objective of this article is to review the question how early diagnosis of these infections, affects the overall management of infected or colonized patients, with regard to antimicrobial therapy.
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55
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Levêque D, Gourieux B. Commentaires sur les génériques d’antibiotiques. Med Mal Infect 2013; 43:35-6. [DOI: 10.1016/j.medmal.2012.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 11/18/2012] [Indexed: 11/25/2022]
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56
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Comparison of six generic vancomycin products for treatment of methicillin-resistant Staphylococcus aureus experimental endocarditis in rabbits. Antimicrob Agents Chemother 2012; 57:1157-62. [PMID: 23254435 DOI: 10.1128/aac.01669-12] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Concerns have recently emerged about the potency and the quality of generic vancomycin (VAN) products approved for use in humans, based on experiments in a neutropenic mouse thigh infection model. However, other animal models may be more appropriate to decipher the bactericidal activities of VAN generics in vivo and to predict their efficacy in humans. We aimed to compare the bactericidal activities of six generic VAN products currently used in France (Mylan and Sandoz), Spain (Hospira), Switzerland (Teva), and the United States (Akorn-Strides and American Pharmaceutical Products [APP]) in a rabbit model of aortic valve endocarditis induced by 8 × 10(7) CFU of methicillin-resistant Staphylococcus aureus (MRSA) strain COL (VAN MIC, 1.5 μg/ml). In vitro, there were no significant differences in the time-kill curve studies performed with the six generic VAN products. Ten rabbits in each group were treated with intravenous (i.v.) VAN, 60 mg/kg of body weight twice a day (b.i.d.) for 4 days. Mean peak serum VAN levels, measured 45 min after the last injection, ranged from 35.5 (APP) to 45.9 μg/ml (Teva). Mean trough serum VAN levels, measured 12 h after the last injection, ranged from 2.3 (Hospira) to 9.2 (APP) μg/ml. All generic VAN products were superior to controls (no treatment) in terms of residual organisms in vegetations (P < 0.02 for each comparison) and in the spleen (P < 0.005 for each comparison). Pairwise comparisons of generic VAN products found no significant differences. In conclusion, a stringent MRSA endocarditis model found no significant differences in the bactericidal activities of six generic VAN products currently used in Europe and America.
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57
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Amábile-Cuevas CF. Antibiotic resistance: from Darwin to Lederberg to Keynes. Microb Drug Resist 2012; 19:73-87. [PMID: 23046150 DOI: 10.1089/mdr.2012.0115] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The emergence and spread of antibiotic-resistant bacteria reflects both, a gradual, completely Darwinian evolution, which mostly yields slight decreases in antibiotic susceptibility, along with phenotypes that are not precisely characterized as "resistance"; and sudden changes, from full susceptibility to full resistance, which are driven by a vast array of horizontal gene transfer mechanisms. Antibiotics select for more than just antibiotic resistance (i.e., increased virulence and enhanced gene exchange abilities); and many non-antibiotic agents or conditions select for or maintain antibiotic resistance traits as a result of a complex network of underlying and often overlapping mechanisms. Thus, the development of new antibiotics and thoughtful, integrated anti-infective strategies is needed to address the immediate and long-term threat of antibiotic resistance. Since the biology of resistance is complex, these new drugs and strategies will not come from free-market forces, or from "incentives" for pharmaceutical companies.
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Gauzit R, Lakdhari M. Generic antibiotic drugs: is effectiveness guaranteed? Med Mal Infect 2012; 42:141-8. [PMID: 22480963 DOI: 10.1016/j.medmal.2011.10.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 10/11/2011] [Indexed: 10/28/2022]
Abstract
There are recently published arguments suggesting all generic antibiotic drugs do not present the full reliability needed to claim therapeutic equivalence with branded drugs. The problem is especially crucial for generic intravenous drugs, which do not need any bioequivalence study before they can be marketed. The evaluation of generic antibiotic drug effectiveness yields an important dispersion of results according to antibiotic agents and for the same antibiotic agent all generic drugs are not equivalent. There are differences at all levels: drug components, levels of impurity, pharmacokinetics, pharmacokinetic/pharmacodynamic relationship, in vitro effectiveness, therapeutic effectiveness in experimental models, etc. So that finally, the specifications approved in the initial submission file of a brand name drugs are not always respected by a generic drug. There is also a specific problem of taste and treatment acceptability for pediatric oral antibiotic drugs. Available data on clinical effectiveness is excessively rare. The marketing of a great number of generic drugs of the same specialty is followed by a sometimes very important increase of their use, even in countries where consumption is low. The corollary of this increase in consumption is an increase of resistance, and this is especially true for oral fluoroquinolones. Even if most of this information needs to be verified, it seems necessary to review regulations for marketing authorization of generic antibiotic drugs.
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Affiliation(s)
- R Gauzit
- Unité de réanimation, Hôtel Dieu, place du Parvis-de-Notre-Dame, Paris cedex 04, France.
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59
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Hunter RP, DeRidder E, Lucas A, Smedley KO, Yordy DW. How do you define equivalence of the API of biomass products? J Vet Pharmacol Ther 2012; 35 Suppl 1:99-101. [PMID: 22413797 DOI: 10.1111/j.1365-2885.2012.01374.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- R P Hunter
- Elanco Animal Health, 2500 Innovation Way, Greenfield, IN, USA.
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60
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Quality assessment of U.S. marketplace vancomycin for injection products using high-resolution liquid chromatography-mass spectrometry and potency assays. Antimicrob Agents Chemother 2012; 56:2824-30. [PMID: 22371900 DOI: 10.1128/aac.00164-12] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In response to a published concern about the potency and quality of generic vancomycin products, the United States Food and Drug Administration investigated a small sampling of the vancomycin products available in North America with regard to purity, content, and potency. To facilitate identification of impurities, a new liquid chromatography method was developed using high-resolution mass spectrometry in addition to diode array detection to characterize impurities in several commercial products. Furthermore, a microbiological assay was utilized to link the analytical profiles with an in vitro potency. All products tested met the quality specifications outlined in the United States Pharmacopeia (USP) (vancomycin hydrochloride for injection monograph) for impurities and potency (USP, Vancomycin hydrochloride for injection. United States Pharmacopeia and National Formulary, vol USP 34-NF 29, 2011).
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61
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Therapeutic equivalence requires pharmaceutical, pharmacokinetic, and pharmacodynamic identities: true bioequivalence of a generic product of intravenous metronidazole. Antimicrob Agents Chemother 2012; 56:2659-65. [PMID: 22330928 DOI: 10.1128/aac.06012-11] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Animal models of infection have been used to demonstrate the therapeutic failure of "bioequivalent" generic products, but their applicability for this purpose requires the accurate identification of those products that are truly bioequivalent. Here, we present data comparing one intravenous generic product of metronidazole with the innovator product in a neutropenic mouse thigh anaerobic infection model. Simultaneous experiments allowed comparisons (generic versus innovator) of potency and the concentration of the active pharmaceutical ingredient (API), analytical chemistry (liquid chromatography/mass spectrometry [LC/MS]), in vitro susceptibility testing, single-dose serum pharmacokinetics (PK) in infected mice, and in vivo pharmacodynamics (PD) against Bacteroides fragilis ATCC 25825 in synergy with Escherichia coli SIG-1 in the neutropenic mouse thigh anaerobic infection model. The Hill dose-response model followed by curve-fitting analysis was used to calculate and compare primary and secondary PD parameters. The generic and the innovator products were identical in terms of the concentration and potency of the API, chromatographic and spectrographic profiles, MIC and minimal bactericidal concentrations (MBC) (2.0 mg/liter), and mouse PK. We found no differences between products in bacteriostatic doses (BD) (15 to 22 mg/kg of body weight per day) or the doses needed to kill 1 log (1LKD) (21 to 29 mg/kg per day) or 2 logs (2LKD) (28 to 54 mg/kg per day) of B. fragilis under dosing schedules of every 12 h (q12h), q8h, or q6h. The area under the concentration-time curve over 24 h in the steady state divided by the MIC (AUC/MIC ratio) was the best PD index to predict the antibacterial efficacy of metronidazole (adjusted coefficient of determination [AdjR(2)] = 84.6%), and its magnitude to reach bacteriostasis in vivo (56.6 ± 5.17 h) or to kill the first (90.8 ± 9.78 h) and second (155.5 ± 22.2 h) logs was the same for both products. Animal models of infection allow a thorough demonstration of the therapeutic equivalence of generic antimicrobials.
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62
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Product quality of parenteral vancomycin products in the United States. Antimicrob Agents Chemother 2012; 56:2819-23. [PMID: 22314525 DOI: 10.1128/aac.05344-11] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In response to concerns raised about the quality of parenteral vancomycin products, the U.S. Food and Drug Administration (FDA) is investigating the product quality of all FDA-approved parenteral vancomycin products available in the United States. Product quality was evaluated independently at two FDA Office of Testing and Research (FDA-OTR) sites. In the next phase of the investigation, being done in collaboration with the National Institute of Allergy and Infectious Diseases, the in vivo activity of these products will be evaluated in an appropriate animal model. This paper summarizes results of the FDA investigation completed thus far. One site used a validated ultrahigh-pressure liquid chromatography method (OTR-UPLC), and the second site used the high-performance liquid chromatography (HPLC) method for related substances provided in the British Pharmacopeia (BP) monograph for vancomycin intravenous infusion. Similar results were obtained by the two FDA-OTR laboratories using two different analytical methods. The products tested had 90 to 95% vancomycin B (active component of vancomycin) by the BP-HPLC method and 89 to 94% vancomycin by OTR-UPLC methods. Total impurities were 5 to 10% by BP-HPLC and 6 to 11% by OTR-UPLC methods. No single impurity was >2.0%, and the CDP-1 level was ≤ 2.0% across all products. Some variability in impurity profiles of the various products was observed. No adverse product quality issues were identified with the six U.S. vancomycin parenteral products. The quality parameters of all parenteral vancomycin products tested surpassed the United States Pharmacopeia acceptance criteria. Additional testing will characterize in vivo performance characteristics of these products.
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63
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Menkès CJ, Bontoux D, Bounhoure JP, Bouvenot G, Buffet C, Couvreur P, Delatour P, Delaveau P, Eléfant E, Gonthier R, Goullé JP, Imbs JL, Jaillon P, Joly P, Juillet Y, Lhermitte M, Menkès CJ, Montastruc JL, Netter P, Queneau P, Safavian AA, Sassard J, Tillement JP, Trèves R, Vigneron C, Doucet J. Place des génériques dans la prescription. BULLETIN DE L ACADEMIE NATIONALE DE MEDECINE 2012. [DOI: 10.1016/s0001-4079(19)31843-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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In Vivo Inferiority of Generic Product Compared With Branded Vancomycin: A Paradigm Shift. Ther Drug Monit 2012; 34:2-3. [DOI: 10.1097/ftd.0b013e318243e739] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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65
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Rodriguez CA, Agudelo M, Zuluaga AF, Vesga O. Generic vancomycin enriches resistant subpopulations of Staphylococcus aureus after exposure in a neutropenic mouse thigh infection model. Antimicrob Agents Chemother 2012; 56:243-7. [PMID: 22064531 PMCID: PMC3256022 DOI: 10.1128/aac.05129-11] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 10/24/2011] [Indexed: 11/20/2022] Open
Abstract
Previous studies have shown that "bioequivalent" generic products of vancomycin are less effective in vivo against Staphylococcus aureus than the innovator compound. Considering that suboptimal bactericidal effect has been associated with emergence of resistance, we aimed to assess in vivo the impact of exposure to innovator and generic products of vancomycin on S. aureus susceptibility. A clinical methicillin-resistant S. aureus (MRSA) strain from a liver transplant patient with persistent bacteremia was used for which MIC, minimum bactericidal concentration (MBC), and autolytic properties were determined. Susceptibility was also assessed by determining a population analysis profile (PAP) with vancomycin concentrations from 0 to 5 mg/liter. ICR neutropenic mice were inoculated in each thigh with ∼7.0 log(10) CFU. Treatment with the different vancomycin products (innovator and three generics; 1,200 mg/kg of body weight/day every 3 h) started 2 h later while the control group received sterile saline. After 24 h, mice were euthanized, and the thigh homogenates were plated. Recovered colonies were reinoculated to new groups of animals, and the exposure-recovery process was repeated until 12 cycles were completed. The evolution of resistance was assessed by PAP after cycles 5, 10, 11, and 12. The initial isolate displayed reduced autolysis and higher resistance frequencies than S. aureus ATCC 29213 but without vancomycin-intermediate S. aureus (VISA) subpopulations. After 12 cycles, innovator vancomycin had significantly reduced resistant subpopulations at 1, 2, and 3 mg/liter, while the generic products had enriched them progressively by orders of magnitude. The great capacity of generic vancomycin to select for less susceptible organisms raises concerns about the role of therapeutic inequivalence of any antimicrobial on the epidemiology of resistance worldwide.
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Affiliation(s)
- Carlos A. Rodriguez
- GRIPE (Grupo Investigador de Problemas en Enfermedades Infecciosas)
- Department of Pharmacology and Toxicology
| | - Maria Agudelo
- GRIPE (Grupo Investigador de Problemas en Enfermedades Infecciosas)
- Department of Pharmacology and Toxicology
| | - Andres F. Zuluaga
- GRIPE (Grupo Investigador de Problemas en Enfermedades Infecciosas)
- Department of Pharmacology and Toxicology
| | - Omar Vesga
- GRIPE (Grupo Investigador de Problemas en Enfermedades Infecciosas)
- Department of Pharmacology and Toxicology
- Section of Infectious Diseases at the Department of Internal Medicine, University of Antioquia Medical School, Medellin, Colombia
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66
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Levy-Hara G, Amábile-Cuevas CF, Gould I, Hutchinson J, Abbo L, Saxynger L, Vlieghe E, Cardoso FLL, Methar S, Kanj S, Ohmagari N, Harbarth S. "Ten Commandments" for the Appropriate use of Antibiotics by the Practicing Physician in an Outpatient Setting. Front Microbiol 2011; 2:230. [PMID: 22164154 PMCID: PMC3225075 DOI: 10.3389/fmicb.2011.00230] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Accepted: 10/29/2011] [Indexed: 12/25/2022] Open
Abstract
A multi-national working group on antibiotic stewardship, from the International Society of Chemotherapy, put together ten recommendations to physicians prescribing antibiotics to outpatients. These recommendations are: (1) use antibiotics only when needed; teach the patient how to manage symptoms of non-bacterial infections; (2) select the adequate ATB; precise targeting is better than shotgun therapy; (3) consider pharmacokinetics and pharmacodynamics when selecting an ATB; use the shortest ATB course that has proven clinical efficacy; (4) encourage patients' compliance; (5) use antibiotic combinations only in specific situations; (6) avoid low quality and sub-standard drugs; prevent prescription changes at the drugstore; (7) discourage self-prescription; (8) follow only evidence-based guidelines; beware those sponsored by drug companies; (9) rely (rationally) upon the clinical microbiology lab; and (10) prescribe ATB empirically - but intelligently; know local susceptibility trends, and also surveillance limitations.
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Affiliation(s)
- Gabriel Levy-Hara
- Division of Infectious Diseases, Hospital Carlos Durand, University of Buenos AiresBuenos Aires, Argentina
| | | | - Ian Gould
- Medical Microbiology, Aberdeen Royal Infirmary, ForesterhillAberdeen, UK
| | - Jim Hutchinson
- Division of Medical Microbiology, Island Medical Program, University of British ColumbiaVictoria, BC, Canada
| | - Lilian Abbo
- Division of Infectious Diseases, Jackson Memorial Hospital, University of MiamiCoral Gables, FL, USA
| | - Lynora Saxynger
- Division of Infectious Diseases, University of AlbertaEdmonton, AB, Canada
| | - Erika Vlieghe
- Department of Clinical Sciences, Institute of Tropical MedicineAntwerp, Belgium
| | - Fernando L. Lopes Cardoso
- Infectious Diseases and Hospital Infection Control, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de JaneiroRio de Janeiro, Brazil
| | - Shaheen Methar
- Unit for Infection Prevention and Control, Tygerberg Hospital and Faculty of Health Sciences, Stellenbosch UniversityCape Town, South Africa
| | - Souha Kanj
- Division of Infectious Diseases and Infection Control Program, American University of Beirut Medical CenterBeirut, Lebanon
| | - Norio Ohmagari
- Division of Infectious Diseases, Shizuoka Cancer Center HospitalShizuoka, Japan
| | - Stephan Harbarth
- Service Prévention et Contrôle de l’Infection, Hôpitaux Universitaires de GenèveGenève, Switzerland
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García C, Llamocca LP, García K, Jiménez A, Samalvides F, Gotuzzo E, Jacobs J. Knowledge, attitudes and practice survey about antimicrobial resistance and prescribing among physicians in a hospital setting in Lima, Peru. BMC CLINICAL PHARMACOLOGY 2011; 11:18. [PMID: 22085536 PMCID: PMC3231801 DOI: 10.1186/1472-6904-11-18] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Accepted: 11/15/2011] [Indexed: 11/17/2022]
Abstract
Background Misuse of antimicrobials (AMs) and antimicrobial resistance (AMR) are global concerns. The present study evaluated knowledge, attitudes and practices about AMR and AM prescribing among medical doctors in two large public hospitals in Lima, Peru, a middle-income country. Methods Cross-sectional study using a self-administered questionnaire Results A total of 256 participants completed the questionnaire (response rate 82%). Theoretical knowledge was good (mean score of 6 ± 1.3 on 7 questions) in contrast to poor awareness (< 33%) of local AMR rates of key-pathogens. Participants strongly agreed that AMR is a problem worldwide (70%) and in Peru (65%), but less in their own practice (22%). AM overuse was perceived both for the community (96%) and the hospital settings (90%). Patients' pressure to prescribing AMs was considered as contributing to AM overuse in the community (72%) more than in the hospital setting (50%). Confidence among AM prescribing was higher among attending physicians (82%) compared to residents (30%, p < 0.001%). Sources of information considered as very useful/useful included pocket-based AM prescribing guidelines (69%) and internet sources (62%). Fifty seven percent of participants regarded AMs in their hospitals to be of poor quality. Participants requested more AM prescribing educational programs (96%) and local AM guidelines (92%). Conclusions This survey revealed topics to address during future AM prescribing interventions such as dissemination of information about local AMR rates, promoting confidence in the quality of locally available AMs, redaction and dissemination of local AM guidelines and addressing the general public, and exploring the possibilities of internet-based training.
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Affiliation(s)
- Coralith García
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Perú.
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68
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Bartlett JG. A call to arms: the imperative for antimicrobial stewardship. Clin Infect Dis 2011; 53 Suppl 1:S4-7. [PMID: 21795727 DOI: 10.1093/cid/cir362] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Antimicrobial resistance is a major public health crisis. The prevalence of drug-resistant organisms, such as the emerging NAP1 strain of Clostridium difficile, now highly resistant to fluoroquinolones, Acinetobacter species, Klebsiella pneumoniae carbapenemase-producing organisms, and methicillin-resistant Staphylococcus aureus, is increasing nationwide. The sources of antimicrobial resistance are manifold, but there is a well-documented causal relationship between antimicrobial use and misuse and the emergence of antimicrobial-resistant pathogens. As the development of new antimicrobial agents is on the decline, the medical community, across all specialties and in conjunction with public health services, must develop and implement programs and strategies designed to preserve the integrity and effectiveness of the existing antimicrobial armamentarium. Such strategies are collectively known as antimicrobial stewardship programs and have the potential to minimize the emergence of resistant pathogens.
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Affiliation(s)
- John G Bartlett
- Department of Medicine and Epidemiology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA.
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69
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Equal efficacy of a generic piperacillin/tazobactam formulation: results of a local screening protocol. Diagn Microbiol Infect Dis 2011; 69:286-7. [PMID: 21353954 DOI: 10.1016/j.diagmicrobio.2010.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Accepted: 10/08/2010] [Indexed: 11/21/2022]
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The insect peptide coprisin prevents Clostridium difficile-mediated acute inflammation and mucosal damage through selective antimicrobial activity. Antimicrob Agents Chemother 2011; 55:4850-7. [PMID: 21807975 DOI: 10.1128/aac.00177-11] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Clostridium difficile-associated diarrhea and pseudomembranous colitis are typically treated with vancomycin or metronidazole, but recent increases in relapse incidence and the emergence of drug-resistant strains of C. difficile indicate the need for new antibiotics. We previously isolated coprisin, an antibacterial peptide from Copris tripartitus, a Korean dung beetle, and identified a nine-amino-acid peptide in the α-helical region of it (LLCIALRKK) that had antimicrobial activity (J.-S. Hwang et al., Int. J. Pept., 2009, doi:10.1155/2009/136284). Here, we examined whether treatment with a coprisin analogue (a disulfide dimer of the nine peptides) prevented inflammation and mucosal damage in a mouse model of acute gut inflammation established by administration of antibiotics followed by C. difficile infection. In this model, coprisin treatment significantly ameliorated body weight decreases, improved the survival rate, and decreased mucosal damage and proinflammatory cytokine production. In contrast, the coprisin analogue had no apparent antibiotic activity against commensal bacteria, including Lactobacillus and Bifidobacterium, which are known to inhibit the colonization of C. difficile. The exposure of C. difficile to the coprisin analogue caused a marked increase in nuclear propidium iodide (PI) staining, indicating membrane damage; the staining levels were similar to those seen with bacteria treated with a positive control for membrane disruption (EDTA). In contrast, coprisin analogue treatment did not trigger increases in the nuclear PI staining of Bifidobacterium thermophilum. This observation suggests that the antibiotic activity of the coprisin analogue may occur through specific membrane disruption of C. difficile. Thus, these results indicate that the coprisin analogue may prove useful as a therapeutic agent for C. difficile infection-associated inflammatory diarrhea and pseudomembranous colitis.
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Diaz JA, Silva E, Arias MJ, Garzón M. Comparative in vitro study of the antimicrobial activities of different commercial antibiotic products of vancomycin. BMC CLINICAL PHARMACOLOGY 2011; 11:9. [PMID: 21777438 PMCID: PMC3158544 DOI: 10.1186/1472-6904-11-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Accepted: 07/21/2011] [Indexed: 11/17/2022]
Abstract
Background One of the most critical problems about antimicrobial therapy is the increasing resistance to antibiotics. Previous studies have shown that there is a direct relation between erroneous prescription, dosage, route, duration of the therapy and the antibiotics resistance. Other important point is the uncertainty about the quality of the prescribed medicines. Some physicians believe that generic drugs are not as effective as innovator ones, so it is very important to have evidence that shows that all commercialized drugs are suitable for therapeutic use. Methods Microbial assays were used to establish the potency, the Minimal Inhibitory Concentrations (MICs), the Minimal Bactericidal Concentration (MBCs), the critical concentrations, and the production of spontaneous mutants that are resistant to vancomycin. Results The microbial assay was validated in order to determine the Vancomycin potency of the tasted samples. All the products showed that have potency values between 90 - 115% (USP requirement). The products behave similarly because the MICs, The MBCs, the critical concentrations, the critical concentrations ratios between standard and samples, and the production of spontaneous mutants don't have significant differences. Conclusions All products analyzed by microbiological tests, show that both trademarks and generics do not have statistical variability and the answer of antimicrobial activity Show also that they are pharmaceutical equivalents.
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Affiliation(s)
- Jorge A Diaz
- Universidad Nacional de Colombia, Facultad de Ciencias, Departamento de Farmacia, Laboratorio de Asesorías e Investigaciones en Microbiología, 472. Ciudad Universitaria. Carrera 30 Calle 45. A.A.14490. Bogotá D. C. Colombia
| | - Edelberto Silva
- Universidad Nacional de Colombia, Facultad de Ciencias, Departamento de Farmacia, Laboratorio de Asesorías e Investigaciones en Microbiología, 472. Ciudad Universitaria. Carrera 30 Calle 45. A.A.14490. Bogotá D. C. Colombia
| | - Maria J Arias
- Vitalis Pharmaceutical, Proyectos Especiales, Carrera 7 No 156-80. Oficina No 1104. Bogotá D. C. Colombia
| | - María Garzón
- Universidad Nacional de Colombia, Facultad de Ciencias, Departamento de Farmacia, Laboratorio de Asesorías e Investigaciones en Microbiología, 472. Ciudad Universitaria. Carrera 30 Calle 45. A.A.14490. Bogotá D. C. Colombia
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Black E, Lau TTY, Ensom MHH. Vancomycin-induced neutropenia: is it dose- or duration-related? Ann Pharmacother 2011; 45:629-38. [PMID: 21521866 DOI: 10.1345/aph.1p583] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To systematically evaluate the literature to determine whether vancomycin-induced neutropenia is dose- or duration-related and provide clinicians with feasible treatment alternatives. DATA SOURCES A literature search of PubMed (1949-November 2010), MEDLINE (1950-November 2010), EMBASE (1980-November 2010), and International Pharmaceutical Abstracts (1970-November 2010) was performed using the terms vancomycin, neutropenia, and leukopenia. Citations from publications were reviewed for additional references. STUDY SELECTION AND DATA EXTRACTION Studies and case reports were included if they reported neutropenia with vancomycin administration and excluded if they did not describe vancomycin dosages and/or concentrations, or if neutropenia resolved while the patient was still receiving vancomycin. Cases with significant confounders and those in which authors provided minimal information about patients were also excluded. DATA SYNTHESIS Seven retrospective chart reviews (ie, case series) and 33 case reports were identified. Of these, 3 retrospective reviews and 26 case reports met inclusion criteria. To our knowledge, no prospective studies have assessed this clinical complication. Data suggest that vancomycin-induced neutropenia may not be completely related to daily dosages, total cumulative dosage, or supratherapeutic vancomycin concentrations. Furthermore, evidence suggests that neutropenia is more likely associated with therapy longer than 7 days, with the majority of episodes occurring beyond 20 days of therapy. Given these findings, a practical approach is to monitor white blood cell (WBC) count with a differential (including absolute neutrophil count) once a week in patients who are receiving vancomycin for more than 7 days. CONCLUSIONS Vancomycin-induced neutropenia is most likely associated with prolonged vancomycin exposure. Patients receiving vancomycin for longer than 7 days should have WBC count, differential, monitored weekly. Vancomycin should be discontinued if there is a high clinical suspicion of it causing neutropenia, and an alternative agent should be initiated. Prospective case-controlled studies are needed to better characterize this adverse event.
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Affiliation(s)
- Emily Black
- The University of British Columbia, Vancouver, British Columbia, Canada
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Lack of Health Insurance Coverage for Oral Vancomycin: It's Time to Tackle the Elephant in the Room. Clin Infect Dis 2011; 52:691-2. [DOI: 10.1093/cid/ciq219] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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