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Dinh A, Duran C, Ropers J, Bouchand F, Deconinck L, Matt M, Senard O, Lagrange A, Mellon G, Calin R, Makhloufi S, de Lastours V, Mathieu E, Kahn JE, Rouveix E, Grenet J, Dumoulin J, Chinet T, Pépin M, Delcey V, Diamantis S, Benhamou D, Vitrat V, Dombret MC, Renaud B, Claessens YE, Labarère J, Bedos JP, Aegerter P, Crémieux AC. Exclusive oral antibiotic treatment for hospitalized community-acquired pneumonia: a post-hoc analysis of a randomized clinical trial. Clin Microbiol Infect 2024; 30:1020-1028. [PMID: 38734138 DOI: 10.1016/j.cmi.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 04/09/2024] [Accepted: 05/05/2024] [Indexed: 05/13/2024]
Abstract
OBJECTIVES In this study, we aimed to assess the efficacy of different ways of administration and types of beta-lactams for hospitalized community-acquired pneumonia (CAP). METHODS In this post-hoc analysis of randomized controlled trials (RCT) on patients hospitalized for CAP (pneumonia short treatment trial) comparing 3-day vs. 8-day durations of beta-lactams, which concluded to non-inferiority, we included patients who received either amoxicillin-clavulanate (AMC) or third-generation cephalosporin (3GC) regimens, and exclusively either intravenous or oral treatment for the first 3 days (followed by either 5 days of oral placebo or AMC according to randomization). The choice of route and molecule was left to the physician in charge. The main outcome was a failure at 15 days after the first antibiotic intake, defined as temperature >37.9°C, and/or absence of resolution/improvement of respiratory symptoms, and/or additional antibiotic treatment for any cause. The primary outcome according to the route of administration was evaluated through logistic regression. Inverse probability treatment weighting with a propensity score model was used to adjust for non-randomization of treatment routes and potential confounders. The difference in failure rates was also evaluated among several sub-populations (AMC vs. 3GC treatments, intravenous vs. oral AMC, patients with multi-lobar infection, patients aged ≥65 years old, and patients with CURB65 scores of 3-4). RESULTS We included 200 patients from the original trial, with 93/200 (46.5%) patients only treated with intravenous treatment and 107/200 (53.5%) patients only treated with oral therapy. The failure rate at Day 15 was not significantly different among patients treated with initial intravenous vs. oral treatment [25/93 (26.9%) vs. 28/107 (26.2%), adjusted odds ratios (aOR) 0.973 (95% CI 0.519-1.823), p 0.932)]. Failure rates at Day 15 were not significantly different among the subgroup populations. DISCUSSION Among hospitalized patients with CAP, there was no significant difference in efficacy between initial intravenous and exclusive oral treatment. TRIAL REGISTRATION This trial is registered with ClinicalTrials.gov, NCT01963442.
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Affiliation(s)
- Aurélien Dinh
- Infectious Diseases Unit, Raymond-Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France; Epidemiology and Modeling of Bacterial Evasion to Antibacterials Unit (EMEA), Institut Pasteur, Paris, France.
| | - Clara Duran
- Infectious Diseases Unit, Raymond-Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Jacques Ropers
- Clinical Research Unit, Pitié-Salpétrière University Hospital, AP-HP, Paris, France
| | - Frédérique Bouchand
- Department of Pharmacy, Raymond-Poincaré University Hospital, AP-HP Paris Saclay, Garches, France
| | - Laurène Deconinck
- Department of Infectious Disease, Bichat University Hospital, AP-HP, University of Paris, Paris, France
| | - Morgan Matt
- Infectious Diseases Unit, Raymond-Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Olivia Senard
- Department of Infectious Disease, Marne La Vallée Hospital, GHEF, Marne La Vallée, France
| | - Aurore Lagrange
- Department of Pneumology, Pontoise Hospital, Pontoise, France
| | - Guillaume Mellon
- Infectious Diseases Unit, Raymond-Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Ruxandra Calin
- Infectious Diseases Unit, Raymond-Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Sabrina Makhloufi
- Infectious Diseases Unit, Raymond-Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | | | | | - Jean-Emmanuel Kahn
- Internal Medicine, Ambroise-Paré University Hospital, AP-HP Paris Saclay, Boulogne-Billancourt, France
| | - Elisabeth Rouveix
- Internal Medicine, Ambroise-Paré University Hospital, AP-HP Paris Saclay, Boulogne-Billancourt, France
| | - Julie Grenet
- Emergency Medicine, Ambroise-Paré University Hospital, AP-HP Paris Saclay, Boulogne-Billancourt, France
| | - Jennifer Dumoulin
- Department of Pneumology, Ambroise-Paré University Hospital, AP-HP Paris Saclay, Boulogne-Billancourt, France
| | - Thierry Chinet
- Department of Pneumology, Ambroise-Paré University Hospital, AP-HP Paris Saclay, Boulogne-Billancourt, France
| | - Marion Pépin
- Department of Geriatric, Ambroise-Paré University Hospital, AP-HP Paris Saclay, Boulogne-Billancourt, France
| | - Véronique Delcey
- Internal Medicine, Lariboisière University Hospital, AP-HP, Paris, France
| | | | - Daniel Benhamou
- Department of Pneumology, Rouen University Hospital, Rouen, France
| | | | | | - Bertrand Renaud
- Department of Emergency, Cochin University Hospital, AP-HP, Paris, France
| | | | - José Labarère
- Quality of Care Unit, Grenoble University Hospital, Grenoble Alpes University, Grenoble, France
| | | | - Philippe Aegerter
- UMRS 1168 VIMA, INSERM, Versailles Saint-Quentin University, Versailles, France
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Leforestier A, Vibet MA, Gentet N, Javaudin F, Le Bastard Q, Montassier E, Batard E. Modeling the risk of fluoroquinolone resistance in non-severe community-onset pyelonephritis. Eur J Clin Microbiol Infect Dis 2020; 39:1123-1127. [DOI: 10.1007/s10096-020-03830-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 01/26/2020] [Indexed: 11/24/2022]
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Batard E, Javaudin F, Kervagoret E, Caruana E, Le Bastard Q, Chapelet G, Goffinet N, Montassier E. Are third-generation cephalosporins associated with a better prognosis than amoxicillin-clavulanate in patients hospitalized in the medical ward for community-onset pneumonia? Clin Microbiol Infect 2018; 24:1171-1176. [PMID: 29964229 DOI: 10.1016/j.cmi.2018.06.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 06/14/2018] [Accepted: 06/18/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES We aimed to assess whether treatment with ceftriaxone/cefotaxime is associated with lower in-hospital mortality than amoxicillin-clavulanate in pati0ents hospitalized in medical wards for community-onset pneumonia. METHODS We conducted a retrospective and multicentre study of patients hospitalized in French medical wards for community-onset pneumonia between 2002 and 2015. Treatments with ceftriaxone/cefotaxime or amoxicillin-clavulanate were defined by their start in the emergency department for a duration of 5 days or more with no other β-lactam. A logistic regression analysis was performed on the overall population, and a propensity score analysis was restricted to patients treated with either ceftriaxone/cefotaxime or amoxicillin-clavulanate. RESULTS 1698 patients (median age, 80 y) were included, of which 716 and 198 were treated with amoxicillin-clavulanate and ceftriaxone/cefotaxime, respectively. In-hospital mortality was 10% (9-12%). In multivariate analysis, factors associated with in-hospital mortality were treatment with ceftriaxone/cefotaxime (aOR 2.9; (1.4-5.7)), pneumonia severity index class 4 or 5 (aOR 7.8 (4.3-15.7)), do-not-resuscitate order (aOR 8.7 (5.2-14.6)) and fluid therapy (aOR 6.3 (2.5-15.1)). The propensity score analysis was performed on 178 patients treated with ceftriaxone/cefotaxime matched with 178 patients treated with amoxicillin-clavulanate; no significant association between treatment with ceftriaxone/cefotaxime and in-hospital mortality was found (OR 1.5 (0.7-3.0)). CONCLUSION In the largest study aiming to compare amoxicillin-clavulanate and ceftriaxone/cefotaxime in community-onset pneumonia, ceftriaxone/cefotaxime was not associated with lower in-hospital mortality than amoxicillin-clavulanate. Our results suggest that ceftriaxone/cefotaxime should not be preferred over amoxicillin-clavulanate for patients hospitalized in medical wards with community-onset pneumonia.
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Affiliation(s)
- E Batard
- Université de Nantes, Microbiotas Hosts Antibiotics Bacterial Resistances (MiHAR), Institut de Recherche en Santé 2, Nantes, France; CHU Nantes, Emergency Department, Nantes, France.
| | - F Javaudin
- Université de Nantes, Microbiotas Hosts Antibiotics Bacterial Resistances (MiHAR), Institut de Recherche en Santé 2, Nantes, France; CHU Nantes, Emergency Department, Nantes, France
| | - E Kervagoret
- Université de Nantes, Microbiotas Hosts Antibiotics Bacterial Resistances (MiHAR), Institut de Recherche en Santé 2, Nantes, France
| | - E Caruana
- CHU Nantes, Emergency Department, Nantes, France
| | - Q Le Bastard
- Université de Nantes, Microbiotas Hosts Antibiotics Bacterial Resistances (MiHAR), Institut de Recherche en Santé 2, Nantes, France; CHU Nantes, Emergency Department, Nantes, France
| | - G Chapelet
- Université de Nantes, Microbiotas Hosts Antibiotics Bacterial Resistances (MiHAR), Institut de Recherche en Santé 2, Nantes, France; CHU Nantes, Clinical Gerontology Department, Nantes, France
| | - N Goffinet
- CHU Nantes, Emergency Department, Nantes, France
| | - E Montassier
- Université de Nantes, Microbiotas Hosts Antibiotics Bacterial Resistances (MiHAR), Institut de Recherche en Santé 2, Nantes, France; CHU Nantes, Emergency Department, Nantes, France
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Marquet A, Vibet MA, Caillon J, Javaudin F, Chapelet G, Montassier E, Batard E. Is There an Association Between Use of Amoxicillin-Clavulanate and Resistance to Third-Generation Cephalosporins in Klebsiella pneumoniae and Escherichia coli at the Hospital Level? Microb Drug Resist 2018; 24:987-994. [PMID: 29489447 DOI: 10.1089/mdr.2017.0360] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS Amoxicillin-clavulanate is extensively used in European hospitals. Whether the hospital use of amoxicillin-clavulanate is associated with nonsusceptibility to third-generation cephalosporins (3GC) in Klebsiella pneumoniae is unknown. Our aim was to assess the relationship between the hospital use of amoxicillin-clavulanate and 3GC nonsusceptibility in K. pneumoniae and Escherichia coli. METHODS Yearly data of antibiotic use and 3GC nonsusceptibility in K. pneumoniae and E. coli were obtained from 33 French hospitals between 2011 and 2016. Decreased susceptibility to 3GC and Extended-Spectrum Beta-Lactamase (ESBL) production were modelled from antibiotic use with linear mixed models on years 2011 to 2015, and validated on year 2016. RESULTS Nonsusceptibility to 3GC increased in K. pneumoniae and E. coli. In a multivariable model that included year and use of 3GC and fluoroquinolones as explanatory variables, amoxicillin-clavulanate use was protective against 3GC nonsusceptibility in K. pneumoniae (incidence rate ratio [IRR], 0.992 [0.988-0.997]), and with ESBL production in K. pneumoniae (IRR, 0.989 [0.985-0.992]). The correlation coefficient between observed and predicted numbers of 3GC-nonsusceptible K. pneumoniae in 2016 was 0.95 (95% confidence interval, 0.89-0.98). There was no significant association between amoxicillin-clavulanate use and 3GC nonsusceptibility in E. coli. CONCLUSION Amoxicillin-clavulanate hospital use was protective against nonsusceptibility to 3GC in K. pneumoniae. Conversely, it was not associated with susceptibility to 3GC in E. coli. To decrease the hospital use of 3GC and fluoroquinolones, and 3GC nonsusceptibility in K. pneumoniae, it may be acceptable to increase the hospital use of amoxicillin-clavulanate. Interventional studies are necessary to confirm this hypothesis.
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Affiliation(s)
| | - Marie-Anne Vibet
- 2 Laboratoire de Mathématiques Jean Leray, Université de Nantes , Nantes, France
| | - Jocelyne Caillon
- 1 OMEDIT des Pays de la Loire , Nantes, France .,3 Bacteriology and Infection Control, Centre Hospitalier Universitaire de Nantes , Nantes, France
| | - François Javaudin
- 4 Microbiotas Hosts Antibiotics and Bacterial Resistances (MiHAR) Lab, Institut de Recherche en Santé 2 , Université de Nantes, Nantes, France .,5 Emergency Department, Centre Hospitalier Universitaire de Nantes , Nantes, France
| | - Guillaume Chapelet
- 4 Microbiotas Hosts Antibiotics and Bacterial Resistances (MiHAR) Lab, Institut de Recherche en Santé 2 , Université de Nantes, Nantes, France
| | - Emmanuel Montassier
- 4 Microbiotas Hosts Antibiotics and Bacterial Resistances (MiHAR) Lab, Institut de Recherche en Santé 2 , Université de Nantes, Nantes, France .,5 Emergency Department, Centre Hospitalier Universitaire de Nantes , Nantes, France
| | - Eric Batard
- 1 OMEDIT des Pays de la Loire , Nantes, France .,4 Microbiotas Hosts Antibiotics and Bacterial Resistances (MiHAR) Lab, Institut de Recherche en Santé 2 , Université de Nantes, Nantes, France .,5 Emergency Department, Centre Hospitalier Universitaire de Nantes , Nantes, France
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Muller A, Bertrand X, Rogues AM, Péfau M, Alfandari S, Gauzit R, Dumartin C, Gbaguidi-Haore H. Higher third-generation cephalosporin prescription proportion is associated with lower probability of reducing carbapenem use: a nationwide retrospective study. Antimicrob Resist Infect Control 2018; 7:11. [PMID: 29387345 PMCID: PMC5778631 DOI: 10.1186/s13756-018-0302-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 01/12/2018] [Indexed: 12/22/2022] Open
Abstract
Background The ongoing extended spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) pandemic has led to an increasing carbapenem use, requiring release of guidelines for carbapenem usage in France in late 2010. We sought to determine factors associated with changes in carbapenem use in intensive care units (ICUs), medical and surgical wards between 2009 and 2013. Methods This ward-level multicentre retrospective study was based on data from French antibiotic and multidrug-resistant bacteria surveillance networks in healthcare facilities. Antibiotic use was expressed in defined daily doses per 1000 patient-days. Factors associated with the reduction in carbapenem use (yes/no) over the study period were determined from random-effects logistic regression model (493 wards nested within 259 healthcare facilities): ward characteristics (type, size…), ward antibiotic use (initial antibiotic use [i.e., consumption of a given antibiotic in 2009], initial antibiotic prescribing profile [i.e., proportion of a given antibiotic in the overall antibiotic consumption in 2009] and reduction in the use of a given antibiotic between 2009 and 2013) and regional ESBL-PE incidence rate in acute care settings in 2011. Results Over the study period, carbapenem consumption in ICUs (n = 85), medical (n = 227) and surgical wards (n = 181) was equal to 73.4, 6.2 and 5.4 defined daily doses per 1000 patient-days, respectively. Release of guidelines was followed by a significant decrease in carbapenem use within ICUs and medical wards, and a slowdown in use within surgical wards. The following factors were independently associated with a higher probability of reducing carbapenem use: location in Eastern France, higher initial carbapenem prescribing profile and reductions in consumption of fluoroquinolones, glycopeptides and piperacillin/tazobactam. In parallel, factors independently associated with a lower probability of reducing carbapenem use were ICUs, ward size increase, wards of cancer centres, higher initial third-generation cephalosporin (3GC) prescribing profile and location in high-risk regions for ESBL-PE. Conclusions Our study suggests that a decrease in 3GCs in the overall antibiotic use and the continuation of reduction in fluoroquinolone use, could allow reducing carbapenem use, given the well-demonstrated role of 3GCs and fluoroquinolones in the occurrence of ESBL-PE. Thus, antibiotic stewardship programs should target wards with higher 3GC prescription proportions to reduce them.
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Affiliation(s)
- Allison Muller
- 1University Hospital of Besançon, Infection Control Department, F-25030 Besançon, France.,University Bourgogne-Franche-Comte, UMR 6249 Chrono-Environnement, F-25030 Besançon, France
| | - Xavier Bertrand
- 1University Hospital of Besançon, Infection Control Department, F-25030 Besançon, France.,University Bourgogne-Franche-Comte, UMR 6249 Chrono-Environnement, F-25030 Besançon, France
| | - Anne-Marie Rogues
- 3University Bordeaux, Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, F-33000 Bordeaux, France.,4CHU Bordeaux, Southwestern Centre for Infection Prevention and Control, F-33000 Bordeaux, France
| | - Muriel Péfau
- 4CHU Bordeaux, Southwestern Centre for Infection Prevention and Control, F-33000 Bordeaux, France
| | - Serge Alfandari
- Gustave Dron Hospital, Infectious Diseases Department, F-59208 Tourcoing, France
| | - Rémy Gauzit
- 6AP-HP, Cochin University Hospital, Infectious Diseases Department, F-75014 Paris, France
| | - Catherine Dumartin
- 3University Bordeaux, Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, F-33000 Bordeaux, France.,4CHU Bordeaux, Southwestern Centre for Infection Prevention and Control, F-33000 Bordeaux, France
| | - Houssein Gbaguidi-Haore
- 1University Hospital of Besançon, Infection Control Department, F-25030 Besançon, France.,University Bourgogne-Franche-Comte, UMR 6249 Chrono-Environnement, F-25030 Besançon, France.,Service d'Hygiène Hospitalière, Centre Hospitalier Régional Universitaire, Hôpital Jean Minjoz, 3 Bd Fleming, 25030, Besançon, Cedex, France
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Use of broad-spectrum antibiotics in French EDs: different trends for third-generation cephalosporins and fluoroquinolones. Eur J Emerg Med 2017; 24:189-195. [DOI: 10.1097/mej.0000000000000331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Effect of a Health Care System Respiratory Fluoroquinolone Restriction Program To Alter Utilization and Impact Rates of Clostridium difficile Infection. Antimicrob Agents Chemother 2017; 61:AAC.00125-17. [PMID: 28348151 DOI: 10.1128/aac.00125-17] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 03/06/2017] [Indexed: 12/18/2022] Open
Abstract
Fluoroquinolones are one of the most commonly prescribed antibiotic classes in the United States despite their association with adverse consequences, including Clostridium difficile infection (CDI). We sought to evaluate the impact of a health care system antimicrobial stewardship-initiated respiratory fluoroquinolone restriction program on utilization, appropriateness of quinolone-based therapy based on institutional guidelines, and CDI rates. After implementation, respiratory fluoroquinolone utilization decreased from a monthly mean and standard deviation (SD) of 41.0 (SD = 4.4) days of therapy (DOT) per 1,000 patient days (PD) preintervention to 21.5 (SD = 6.4) DOT/1,000 PD and 4.8 (SD = 3.6) DOT/1,000 PD posteducation and postrestriction, respectively. Using segmented regression analysis, both education (14.5 DOT/1,000 PD per month decrease; P = 0.023) and restriction (24.5 DOT/1,000 PD per month decrease; P < 0.0001) were associated with decreased utilization. In addition, the CDI rates decreased significantly (P = 0.044) from preintervention using education (3.43 cases/10,000 PD) and restriction (2.2 cases/10,000 PD). Mean monthly CDI cases/10,000 PD decreased from 4.0 (SD = 2.1) preintervention to 2.2 (SD = 1.35) postrestriction. A significant increase in appropriate respiratory fluoroquinolone use occurred postrestriction versus preintervention in patients administered at least one dose (74/130 [57%] versus 74/232 [32%]; P < 0.001), as well as in those receiving two or more doses (47/65 [72%] versus 67/191 [35%]; P < 0.001). A significant reduction in the annual acquisition cost of moxifloxacin, the formulary respiratory fluoroquinolone, was observed postrestriction compared to preintervention within the health care system ($123,882 versus $12,273; P = 0.002). Implementation of a stewardship-initiated respiratory fluoroquinolone restriction program can increase appropriate use while reducing overall utilization, acquisition cost, and CDI rates within a health care system.
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How do hospital respiratory clinicians perceive antimicrobial stewardship (AMS)? A qualitative study highlighting barriers to AMS in respiratory medicine. J Hosp Infect 2017. [PMID: 28622980 DOI: 10.1016/j.jhin.2017.05.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Suboptimal antibiotic use in respiratory infections is widespread in hospital medicine and primary care. Antimicrobial stewardship (AMS) teams within hospitals, commonly led by infectious diseases physicians, are frequently charged with optimizing the use of respiratory antibiotics, but there is limited information on what drives antibiotic use in this area of clinical medicine, or on how AMS is perceived. AIM To explore the perceptions of hospital respiratory clinicians on AMS in respiratory medicine. METHODS In-depth interviews were conducted with 28 clinicians (13 doctors and 15 nurses) from two hospitals in Australia. Data were analysed thematically using the framework approach. FINDINGS Four key barriers to the integration of AMS processes within respiratory medicine, from the participants' perspectives, were identified: CONCLUSIONS: AMS processes are introduced in hospitals with established social structures and knowledge bases. This study found that AMS in respiratory medicine challenges and conflicts with many of these dynamics. If the influence of these dynamics is not considered, AMS processes may not be effective in containing antibiotic use in hospital respiratory medicine.
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Jia FF, Tan ZR, McLeod HL, Chen Y, Ou-Yang DS, Zhou HH. Effects of quercetin on pharmacokinetics of cefprozil in Chinese-Han male volunteers. Xenobiotica 2016; 46:896-900. [PMID: 26928207 DOI: 10.3109/00498254.2015.1132792] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 12/13/2015] [Indexed: 01/11/2023]
Abstract
1. The primary objective of this study was to evaluate the effects of quercetin on the pharmacokinetics of cefprozil. The secondary objective was to evaluate the safety of the combined use of cefprozil and quercetin. 2. An open-label, two-period, crossover phase I trial among 24 Han Chinese male subjects was conducted. Participants were given 500 mg of quercetin orally once daily for 15 d followed by single dose of cefprozil (500 mg) on day 15. Serum concentrations of cefprozil were then measured in all participants on day 15. A 15-d washout period was then assigned after which a 500 mg dose of cefprozil was administered and measured in the serum on day 36. 3. All subjects completed the trial, and no serious adverse events were reported. We measured mean serum concentrations of cefprozil in the presence and absence of quercetin in all participants. The maximum serum concentration of cefprozil in the presence of quercetin was 8.18 ug/ml (95% CI: 7.55-8.81) versus a maximum cefprozil concentration of 8.35 ug/ml (95% CI: 7.51-9.19) in the absence of quercetin. We conclude that the concurrent use of quercetin has no substantial effect on serum concentrations of orally administered cefprozil. 4. Co-administration of quercetin showed no statistically significant effects on the pharmacokinetics of cefprozil in healthy Chinese subjects.
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Affiliation(s)
- Fei-Fei Jia
- a Department of Clinical Pharmacology , Xiangya Hospital, Central South University , Changsha , China
- b Department of Cancer Epidemiology , DeBartolo Family Personalized Medicine Institute, Moffitt Cancer Center , Tampa , FL , USA , and
- c Hunan Key Laboratory of Pharmacogenetics, Institute of Clinical Pharmacology, Central South University , Changsha , China
| | - Zhi-Rong Tan
- a Department of Clinical Pharmacology , Xiangya Hospital, Central South University , Changsha , China
- c Hunan Key Laboratory of Pharmacogenetics, Institute of Clinical Pharmacology, Central South University , Changsha , China
| | - Howard L McLeod
- a Department of Clinical Pharmacology , Xiangya Hospital, Central South University , Changsha , China
- b Department of Cancer Epidemiology , DeBartolo Family Personalized Medicine Institute, Moffitt Cancer Center , Tampa , FL , USA , and
| | - Yao Chen
- a Department of Clinical Pharmacology , Xiangya Hospital, Central South University , Changsha , China
- c Hunan Key Laboratory of Pharmacogenetics, Institute of Clinical Pharmacology, Central South University , Changsha , China
| | - Dong-Sheng Ou-Yang
- a Department of Clinical Pharmacology , Xiangya Hospital, Central South University , Changsha , China
- c Hunan Key Laboratory of Pharmacogenetics, Institute of Clinical Pharmacology, Central South University , Changsha , China
| | - Hong-Hao Zhou
- a Department of Clinical Pharmacology , Xiangya Hospital, Central South University , Changsha , China
- c Hunan Key Laboratory of Pharmacogenetics, Institute of Clinical Pharmacology, Central South University , Changsha , China
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