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Ahmed S, Shree N, Narula AS, Nirala PK, Majid H, Garg A, Nayeem U, Khan MA. The prevalence of multidrug resistance in uropathogens of patients admitted in the intensive care unit of a tertiary care hospital. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024:10.1007/s00210-024-03108-5. [PMID: 38643454 DOI: 10.1007/s00210-024-03108-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 04/14/2024] [Indexed: 04/22/2024]
Abstract
Urinary tract infections (UTIs) are among the most common bacterial infections, posing significant public health challenges due to increasing antimicrobial resistance (AMR). This study aims to assess the prevalence, demographic characteristics, microbial profile, and antimicrobial resistance patterns in Indian patients with UTIs admitted to intensive care unit. A total of 154 patients with positive UTIs were included in this cross-sectional study. The prevalence data including demographics, microbial isolates, and antimicrobial susceptibility patterns were collected. Additionally, risk factors for multidrug resistance uropathogens were assessed using multivariate analyses. The patient cohort had diverse demographic, with a slight male predominance of 52.6% (n = 81). The most common comorbidities were hypertension 59.1% (n = 91) and diabetes mellitus 54.5% (n = 84). The microbial profile was dominated by gram-negative bacteria, particularly Escherichia coli 26.62% (n = 41) and Klebsiella pneumoniae 17.53% (n = 27). The predominant gram-positive and fungal isolate was Enterococcus faecium 7.14% (n = 11) and Candida spp. 18.83% (n = 29), respectively. Substantial resistance was noted against common antimicrobials, with variations across different pathogens. Gram-negative bacteria, particularly Escherichia coli and Klebsiella pneumoniae, exhibited high MDR rates, emphasizing the challenge of antimicrobial resistance. Multivariate logistic regression identified age groups 50-65 and over 65, and prolonged catheterization as significant risk factors for MDR infections. A significantly high resistance rate among pathogens emphasizes the need for judicious antimicrobial use. Our findings emphasize the necessity of ongoing surveillance and tailored interventions based on local pathogen prevalence and antibiogram data to effectively address the threat of AMR threat for better management of UTI management in ICU settings.
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Affiliation(s)
- Shaista Ahmed
- Department of Translational and Clinical Research, School of Chemical and Life Science, Jamia Hamdard, New Delhi, 110062, India
| | - Neetu Shree
- Department of Microbiology, Hamdard Institute of Medical Sciences & Research, New Delhi, 110062, India
| | - Ajit Singh Narula
- Department of Nephrology, Fortis Escort Heart Institute and Research Centre, New Delhi, 110025, India
| | - Purushottam Kr Nirala
- Department of Nephrology, Fortis Escort Heart Institute and Research Centre, New Delhi, 110025, India
| | - Haya Majid
- Department of Translational and Clinical Research, School of Chemical and Life Science, Jamia Hamdard, New Delhi, 110062, India
| | - Aakriti Garg
- Department of Translational and Clinical Research, School of Chemical and Life Science, Jamia Hamdard, New Delhi, 110062, India
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India
| | - Uzma Nayeem
- Department of Translational and Clinical Research, School of Chemical and Life Science, Jamia Hamdard, New Delhi, 110062, India
| | - Mohd Ashif Khan
- Department of Translational and Clinical Research, School of Chemical and Life Science, Jamia Hamdard, New Delhi, 110062, India.
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Mubarak A, Alwafi MM, Alharbi RM, Alserhani SA, Khushaim RF, Almadani GZ, Nourwali IM, Alassaf MS. Knowledge and Attitude Toward Antibiotic Prescription Among Dental Students and Interns at Multiple Universities in Saudi Arabia. Cureus 2024; 16:e51777. [PMID: 38187030 PMCID: PMC10771713 DOI: 10.7759/cureus.51777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2024] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND Dental students in Saudi Arabia are authorized to write prescriptions for antibiotics during practical training. Adverse side effects and resistance could result from inappropriate prescription. Accordingly, there is a need to evaluate the knowledge of dental students regarding guidelines and applications of antibiotic prescription. OBJECTIVES To assess the knowledge and attitude toward guidelines and applications of antibiotic prescription among dental students and interns at multiple universities in Saudi Arabia. METHODS A cross-sectional study was conducted among dental students in their final clinical years (4th to 6th year) and dental interns. The study data were collected using a valid and reliable structured questionnaire comprising three domains: 1) demographic characteristics, 2) knowledge, and 3) attitude toward antibiotic prescription for dental and systemic conditions. The data were analyzed and presented as frequency percentages, and the chi-square test was used to compare the knowledge and attitude items between the dental students and interns. The statistical significance level was set at p ≤ 0.05. RESULTS A total of 248 participants (women: 55.6%, men: 44.4%) were included in the study. Approximately 21.8% were 4th year students; 17.7%, 5th year students; 12.9%, 6th year students; and 47.6%, interns. For most items, the knowledge level was relatively high, and the attitude was generally positive among the participants. Approximately, 87.1% had good knowledge about current guidelines for antibiotic prophylaxis, 83.9% about antibiotic prescription, and 95.2% about antibiotic resistance. The interns showed significantly higher knowledge levels and favorable attitude, particularly for guidelines and applications of antibiotic prescription and correct use of antibiotics for oral cases, than did the students. Amoxicillin was the most frequently prescribed antibiotic among the participants. CONCLUSION The interns and 6th-year students demonstrated a relatively high knowledge level and positive attitude toward appropriate antibiotic prescriptions. However, deficiencies were observed among the students in their early clinical years, particularly for systemic conditions. These findings highlight the importance of implementing educational campaigns and providing guidelines to promote the appropriate use of antibiotics among dental students in their final clinical years.
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Affiliation(s)
| | - Malak M Alwafi
- Pediatric Dentistry and Orthodontics, Taibah University, Madinah, SAU
| | - Rahaf M Alharbi
- Department of Dental Education, Taibah University, Madinah, SAU
| | | | | | | | - Ibrahim M Nourwali
- Department of Oral and Maxillofacial Surgery, Taibah University, Madinah, SAU
| | - Muath S Alassaf
- Orthodontics and Dentofacial Orthopedics, Taibah University, Madinah, SAU
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Cuevas-Gonzalez MV, Cuevas-Gonzalez JC, Espinosa-Cristóbal LF, Donohue-Cornejo A, Reyes López SY, Saucedo Acuña RA, García Calderón AG, Guzmán Gastelum DA. Use or abuse of antibiotics as prophylactic therapy in oral surgery: A systematic review. Medicine (Baltimore) 2023; 102:e35011. [PMID: 37713865 PMCID: PMC10508532 DOI: 10.1097/md.0000000000035011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 08/08/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUD Antibiotics are a type of medication routinely prescribed by dental professionals; however, it is very common that the administration is not justified. Around 15% of dentists admit that they have administered antibiotics unnecessarily more than once a week. The objective of this project is to identify the effectiveness of the use of antibiotics as prophylactic therapy in oral surgery, and to carry out an analysis of the alternatives to pharmacological therapy. METHODS The search strategy was carried out in the PubMed, Scopus, and ScienceDirect databases. For study selection, a first filter was carried out by title and abstract, which mentioned the use of prophylactic antibiotics in some type of oral surgery. To establish the risk of bias, the JBI Critical Appraisal Checklist for Randomized Controlled Trials was utilized. RESULTS The type of antibiotics most prescribed as prophylactic therapy were beta-lactams, which were indicated in 100% of the studies. Penicillins predominated, observing amoxicillin as the most indicated drug in 54.1% of the studies (n = 13) followed by the use of amoxicillin in conjunction with clavulanic acid in 33.3% of the studies (n = 8). Of the 21 studies included, 17 mention that there is insufficient evidence to support the use of antibiotics as prophylactic therapy in patients who will undergo some type of oral surgery. CONCLUSIONS Without a doubt, the biggest challenge is to develop academic update strategies aimed at dentists with active clinical practice and dental students from educational and government institutions to provide updated information about the correct use of prescription drugs.
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Anderson E, Nair B, Nizet V, Kumar G. Man vs Microbes - The Race of the Century. J Med Microbiol 2023; 72. [PMID: 36748622 DOI: 10.1099/jmm.0.001646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The complexity of the antimicrobial resistance (AMR) crisis and its global impact on healthcare invokes an urgent need to understand the underlying forces and to conceive and implement innovative solutions. Beyond focusing on a traditional pathogen-centric approach to antibiotic discovery yielding diminishing returns, future therapeutic interventions can expand to focus more comprehensively on host-pathogen interactions. In this manner, increasing the resiliency of our innate immune system or attenuating the virulence mechanisms of the pathogens can be explored to improve therapeutic outcomes. Key pathogen survival strategies such as tolerance, persistence, aggregation, and biofilm formation can be considered and interrupted to sensitize pathogens for more efficient immune clearance. Understanding the evolution and emergence of so-called 'super clones' that drive AMR spread with rapid clonotyping assays may guide more precise antibiotic regimens. Innovative alternatives to classical antibiotics such as bacteriophage therapy, novel engineered peptide antibiotics, ionophores, nanomedicines, and repurposing drugs from other domains of medicine to boost innate immunity are beginning to be successfully implemented to combat AMR. Policy changes supporting shorter durations of antibiotic treatment, greater antibiotic stewardship, and increased surveillance measures can enhance patient safety and enable implementation of the next generation of targeted prevention and control programmes at a global level.
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Affiliation(s)
- Ericka Anderson
- Collaborative to Halt Antibiotic Resistant Microbes (CHARM), Department of Pediatrics University of California San Diego, La Jolla, CA, USA
| | - Bipin Nair
- School of Biotechnology, Amrita Vishwa Vidyapeetham, Kollam, Kerala, India
| | - Victor Nizet
- Collaborative to Halt Antibiotic Resistant Microbes (CHARM), Department of Pediatrics University of California San Diego, La Jolla, CA, USA.,Skaggs School of Pharmacy and Pharmaceutical Sciences University of California San Diego, La Jolla, CA, USA
| | - Geetha Kumar
- School of Biotechnology, Amrita Vishwa Vidyapeetham, Kollam, Kerala, India
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Dentists’ Habits of Antibiotic Prescribing May be Influenced by Patient Requests for Prescriptions. Int J Dent 2022; 2022:5318753. [PMID: 36046696 PMCID: PMC9424009 DOI: 10.1155/2022/5318753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 07/01/2022] [Accepted: 07/05/2022] [Indexed: 11/22/2022] Open
Abstract
Objective This study evaluates dentists' antibiotic prescribing habits and the frequency of facing patient pressure for prescriptions. Methods An online anonymous survey was used to collect data on antibiotic prescribing practices, including prescribing unnecessary antibiotics if requested by patients. Results The study population included 345 dentists; 227 (65.8%) were females and 118 (34.2%) were males. 54 (15.7%) reported that they prescribed unnecessary antibiotics more than once per week, 47 (13.6%) once per month, 135 (39.1%) rarely, and 109 (31.6%) never prescribed unnecessary antibiotics. 117 (33.9%) reported being pressured by patients to prescribe unnecessary antibiotics more than once per week. 110 (31.9%) reported being pressured by patients to do so at least once per month. There was a statistical difference between the two genders (P < 0.001) in reporting that patients pressured them to prescribe antibiotics when antibiotics were not necessary for treatment or prophylactic purposes and in prescribing unnecessary antibiotics sometimes if requested by a patient (P=0.008). In addition, there was a statistical difference in dentists' confidence in their knowledge and practice in the area of antibiotic prescribing (P < 0.001). Conclusions The results show that unnecessary antibiotic prescribing by dentists can be influenced by patient pressure.
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Goel D, Goel GK, Chaudhary S, Jain D. Antibiotic prescriptions in pediatric dentistry: A review. J Family Med Prim Care 2020; 9:473-480. [PMID: 32318367 PMCID: PMC7114004 DOI: 10.4103/jfmpc.jfmpc_1097_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/11/2020] [Accepted: 01/22/2020] [Indexed: 02/07/2023] Open
Abstract
Most commonly prescribed drugs in pediatric dentistry are “Antibiotics.” Among Dentists, there is a trend toward overuse of antibiotics for nonindicated clinical conditions. This insufficient knowledge of the appropriate clinical indications for antibiotic prescriptions promotes the overuse of antibiotics and contributes to the emergence of antibiotic resistance among children. According to the various surveys done on the dental students, dentists and pediatric dentists on the antibiotic prescribing practices, overall, adherence to the professional clinical guidelines was low. There was a wide variation in dosages for all the antibiotics prescribed and for prolonged periods which were inconsistent with the recommendations. This paper reviews the current literature from the year 2000 to 2019. An electronic literature search was conducted in MEDLINE/PubMed, EBSCO host, and Google Scholar databases. The data was also collected manually from comprehensive textbooks. Some recommendations were also based on the opinion of experienced researchers and clinicians. Thus, this review aims at highlighting clinical indications, dosages, and duration of therapeutic antibiotic prescriptions for orofacial infections in the pediatric outpatients and at the same time creating an awareness, regarding the necessity of strictly adhering to the clinical guidelines for antibiotic prescriptions.
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Affiliation(s)
- Dhirja Goel
- Department of Pediatric and Preventive Dentistry, School of Dental Sciences, Sharda University, Greater Noida, UP, India
| | | | - Seema Chaudhary
- Department of Pediatric and Preventive Dentistry, Kothiwal Dental College, Moradabad, UP, India
| | - Deshraj Jain
- Department of Prosthodontics, Govt. College of Dentistry, Indore, MP, India
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Hess LM, Burdick B, Minard CG, Dutta A. IV Antibiotic Durations for Nontyphoidal Salmonella Bacteremia. Hosp Pediatr 2019; 9:993-997. [PMID: 31704707 DOI: 10.1542/hpeds.2019-0231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVES The objective was to determine if shorter intravenous (IV) antibiotic (<7 days) for nontyphoidal Salmonella bacteremia (NTS-B) is noninferior to longer (≥7 days) in terms of 30-day emergency department (ER) or rehospitalization in healthy children. METHODS A retrospective observational study of otherwise healthy children admitted to a children's hospital in the United States from 2006 to 2017 with NTS-B was conducted. RESULTS Of 231 patients reviewed, 51 patients had NTS-B. Median IV duration for all patients was 5 days (range 2-17 days). The short-duration group (SDG) (<7 days; N = 32) had a median of 4 days (range 2-6 days) of IV antibiotics versus a median of 9 days (range 7-17 days) in the long-duration group (LDG) (≥7 days; N = 19). The hospital length of stay in the SDG was 3.5 days versus 7 days in the LDG (P < .001). The SDG was significantly noninferior to the LDG in terms of ER visits or hospital readmissions within 30 days (absolute risk difference 5.3%; 95% confidence interval -16% to -5%), with only 1 child in the LDG returning to the ER. CONCLUSIONS IV antibiotic durations for NTS-B in otherwise healthy children were variable within our study group. Shorter courses (<7 days) of IV antibiotics were noninferior to longer courses in healthy children and reduced hospital stay. ER visits and readmissions were rare, and there was no association between IV treatment duration and risk of relapse. Prospective studies are needed to study the safety of shorter courses, but given the absence of evidence favoring longer courses, shorter courses can be considered.
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Affiliation(s)
- Lauren M Hess
- Department of Pediatrics, .,Texas Children's Hospital, Houston, Texas; and.,Baylor College of Medicine, Houston, Texas
| | | | | | - Ankhi Dutta
- Department of Pediatrics.,Texas Children's Hospital, Houston, Texas; and.,Baylor College of Medicine, Houston, Texas
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Short versus long duration antimicrobial treatment for community-onset bacteraemia: A propensity score matching study. Int J Antimicrob Agents 2019; 54:176-183. [PMID: 31108223 DOI: 10.1016/j.ijantimicag.2019.05.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/06/2019] [Accepted: 05/11/2019] [Indexed: 11/21/2022]
Abstract
The efficacy and safety of short-course intravenous (i.v.) antimicrobial therapy for bloodstream infections is unknown. Therefore, a retrospective 8-year cohort study including 1431 hospitalised adults was conducted to compare the outcomes of patients receiving short-course (5-10 days) and long-course (11-16 days) i.v. antibiotic therapy for community-onset bacteraemia. Of 1010 patients who received short-course therapy, 726 were matched with 363 patients in the long-course group through propensity score matching at a ratio of 1:2 based on independent predictors of 30-day mortality identified in the multivariate regression model. Following appropriate matching, similarities between the two groups in the proportion of baseline characteristics (age, sex, major co-morbidities, co-morbidity severity, bacteraemia severity at onset and major bacteraemia sources) and 30-day crude mortality rate after bacteraemia onset were observed. Notably, clinical outcomes within 30 days after the end of i.v. therapy, in terms of proportions of post-treatment overall infections (2.2% vs. 6.1%; P = 0.001), infections caused by antimicrobial-resistant pathogens (ARPs) (1.7% vs. 4.4%; P = 0.007), and thereby post-treatment crude mortality (1.4% vs. 3.6%; P = 0.009), were lower in the short-course group. In conclusion, for adults with community-onset uncomplicated bacteraemia, short-course (5-10 days) i.v. antibiotic treatment did not result in an increased risk of mortality but instead decreased the odds of overall and ARP infections after the treatment course.
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Ramachandran P, Rachuri NK, Martha S, Shakthivel R, Gundala A, Battu TS. Implications of Overprescription of Antibiotics: A Cross-Sectional Study. J Pharm Bioallied Sci 2019; 11:S434-S437. [PMID: 31198382 PMCID: PMC6555336 DOI: 10.4103/jpbs.jpbs_62_19] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Introduction: The use of antibiotics in recent years has become more aggressive and more common. The inappropriate use, to be more precise, the abuse of these prescriptions, is the root cause for increasing bacterial resistance and adverse outcomes. Antisepsis can be suggested as an appropriate alternative to antibiotics, to control the increasing antibiotic resistance among individuals. Objective: The objective of this study was to compare the awareness of antibiotic prescription and resistance among BDS and MDS practitioners and students. Materials and Methods: A total of 361 dental professionals were included in this study. Each of them was given a questionnaire containing questions pertaining to antibiotic prescription and awareness. Results: Most of the participants prescribed antibiotics as pre and post treatment management of all the oral diseases during their routine interaction with the patients. Overprescription of antibiotics, amoxicillin being the most common, was significantly more among the BDS practitioners than the MDS practitioners. BDS practitioners (78%) preferred a 3-day antibiotic prescription whereas MDS practitioners (80%) prescribed a 5-day course, which was statistically significant. Mindfulness with respect to antimicrobial prophylaxis and antibiotic resistance was observed to be satisfactory in both the groups. However, there was a general absence of mindfulness with respect to the rules for antibiotic prescription recommendations in both the groups. Conclusion: Antibiotic prescription should be given with care to prevent its resistance, an upcoming iatrogenic health hazard.
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Affiliation(s)
- Punithavathy Ramachandran
- Department of Pedodontics and Preventive Dentistry, Lenora Institute of Dental Sciences, Rajahmundry, Andhra Pradesh, India
| | - Narendra Kumar Rachuri
- Department of Prosthodontics and Crown and Bridge, Lenora Institute of Dental Sciences, Rajahmundry, Andhra Pradesh, India
| | - Satyam Martha
- Department of Pedodontics and Preventive Dentistry, Lenora Institute of Dental Sciences, Rajahmundry, Andhra Pradesh, India
| | - Rekha Shakthivel
- Department of Oral Pathology and Microbiology, Thai Moogambigai Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Anusha Gundala
- Department of Periodontics, GSL Dental College, Rajahmundry, Andhra Pradesh, India
| | - Thilak Sravan Battu
- Department of Pedodontics and Preventive Dentistry, Lenora Institute of Dental Sciences, Rajahmundry, Andhra Pradesh, India
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AboAlSamh A, Alhussain A, Alanazi N, Alahmari R, Shaheen N, Adlan A. Dental Students' Knowledge and Attitudes towards Antibiotic Prescribing Guidelines in Riyadh, Saudi Arabia. PHARMACY 2018; 6:pharmacy6020042. [PMID: 29735914 PMCID: PMC6025366 DOI: 10.3390/pharmacy6020042] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 04/28/2018] [Accepted: 05/04/2018] [Indexed: 01/21/2023] Open
Abstract
Background: The use of antibiotics prophylactically and therapeutically in dentistry has become common practice. Inappropriate prescription may lead to adverse side effects and bacterial resistance. During clinical training, dental students in Saudi Arabia are authorized to prescribe antibiotics. Aim: To evaluate dental students’ knowledge and attitudes regarding antibiotic prescription in Riyadh, Saudi Arabia. Methods: A cross-sectional study based on a validated questionnaire consisting of 34 questions focusing on antibiotic indications in dentistry, antibiotic regimens, and knowledge regarding resistance was distributed amongst dental students in five leading dental colleges in Riyadh. Results: A large proportion of students (71.7%) were familiar with the concept of antibiotic resistance. When comparing junior and senior dental students’ knowledge with regards to indications of antibiotic use in commonly encountered conditions, it was found that there was no significant difference in antibiotic prescription frequency between these groups. Most dental students choose to prescribe amoxicillin as their first-choice of antibiotic (88.4%), and most also chose to use it for a duration of 3–5 days (69.2%). Conclusions: This study concludes that dental students may prescribe antibiotics inappropriately to manage various conditions when not indicated. This may indicate a defect in education of students with regards to current antibiotic guidelines.
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Affiliation(s)
| | | | - Nawaf Alanazi
- College of Dentistry, Al Jouf University (JU), Sakakah 72388, Saudi Arabia.
| | - Rakan Alahmari
- College of Dentistry, King Khalid University (KKU), Abha 62529, Saudi Arabia.
| | - Naila Shaheen
- King Abdullah International Medical Research Center (KAIMRC), Riyadh 14611, Saudi Arabia.
- King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh 14811, Saudi Arabia.
| | - Abdallah Adlan
- King Abdullah International Medical Research Center (KAIMRC), Riyadh 14611, Saudi Arabia.
- King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh 14811, Saudi Arabia.
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Levin BR, Baquero F, Ankomah PP, McCall IC. Phagocytes, Antibiotics, and Self-Limiting Bacterial Infections. Trends Microbiol 2017; 25:878-892. [PMID: 28843668 DOI: 10.1016/j.tim.2017.07.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 07/21/2017] [Accepted: 07/21/2017] [Indexed: 12/16/2022]
Abstract
Most antibiotic use in humans is to reduce the magnitude and term of morbidity of acute, community-acquired infections in immune competent patients, rather than to save lives. Thanks to phagocytic leucocytes and other host defenses, the vast majority of these infections are self-limiting. Nevertheless, there has been a negligible amount of consideration of the contribution of phagocytosis and other host defenses in the research for, and the design of, antibiotic treatment regimens, which hyper-emphasizes antibiotics as if they were the sole mechanism responsible for the clearance of infections. Here, we critically review this approach and its limitations. With the aid of a heuristic mathematical model, we postulate that if the rate of phagocytosis is great enough, for acute, normally self-limiting infections, then (i) antibiotics with different pharmacodynamic properties would be similarly effective, (ii) low doses of antibiotics can be as effective as high doses, and (iii) neither phenotypic nor inherited antibiotic resistance generated during therapy are likely to lead to treatment failure.
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Affiliation(s)
- Bruce R Levin
- Department of Biology, Emory University, Atlanta, GA, USA; Co-first authors.
| | - Fernando Baquero
- Ramón y Cajal Institute for Health Research (IRYCIS), Ramón y Cajal University Hospital, CIBERESP, Madrid, Spain; Co-first authors
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12
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Alattas HA, Alyami SH. Prescription of antibiotics for pulpal and periapical pathology among dentists in southern Saudi Arabia. J Glob Antimicrob Resist 2017; 9:82-84. [PMID: 28455077 DOI: 10.1016/j.jgar.2017.01.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 01/23/2017] [Accepted: 01/31/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Few dental conditions require treatment with antibiotics, yet dentists account for 7% of antimicrobial prescribing. In light of the emerging global problem of antibiotic resistance, this fact is problematic. Little is known about the antibiotic prescribing practices of dentists in Saudi Arabia. This study therefore aimed to investigate the attitudes of dentists in Saudi Arabia towards the prescription of antibiotics for pulpal and periapical pathology. METHODS This was a cross-sectional study involving an online questionnaire on antibiotic prescribing practices. A total of 195 dentists in three areas of southern Saudi Arabia (Najran, Gizan and Asser) completed the survey. RESULTS No significant differences in prescribing habits were found among respondents according to age, sex, level of education or time in endodontic practice. The percentage of respondents who reported that they would prescribe antibiotics for five endodontic conditions not requiring antibiotic treatment ranged from 8.1% to 28.1%. Most respondents (81.9%) would correctly prescribe antibiotics for a necrotic pulp with acute apical periodontitis and swelling; this result was consistent with previous studies. Reported antibiotic usage among the surveyed dentists was quite high. CONCLUSIONS Relatively high antibiotic use suggests a need to educate both dentists and patients about restricting the use of antibiotics to cases of severe infection and when indicated. More educational initiatives to rationalise the use of antibiotics in dental practice are needed to avoid further contributing to antibiotic resistance.
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Affiliation(s)
- Hussien A Alattas
- Department of Restorative Dental Sciences, College of Dentistry, Najran University, P.O. Box 1988, Najran, Saudi Arabia.
| | - Saif H Alyami
- Department of Restorative Dental Sciences, College of Dentistry, Najran University, P.O. Box 1988, Najran, Saudi Arabia
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13
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Hohn A, Heising B, Schütte JK, Schroeder O, Schröder S. Procalcitonin-guided antibiotic treatment in critically ill patients. Langenbecks Arch Surg 2016; 402:1-13. [PMID: 27283067 DOI: 10.1007/s00423-016-1458-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 06/01/2016] [Indexed: 12/29/2022]
Abstract
PURPOSE In critically ill patients, length of antibiotic treatment can be effectively guided by procalcitonin (PCT) protocols. International sepsis guidelines and guidelines on antibiotic stewardship strategies recommend PCT as helpful laboratory marker for a rational use of antibiotics. A number of studies and meta-analyses have confirmed the effectiveness of PCT-protocols for shortening antibiotic treatment without compromising clinical outcome in critically ill patients. But in clinical practice, there is still uncertainty how to interpret PCT levels and how to adjust antibiotic treatment in various infectious situations, especially in the perioperative period. METHODS This narrative review gives an overview on the application of PCT-protocols in critically ill patients with severe bacterial infections on the basis of 5 case reports and the available literature. Beside strengths and limitations of this biomarker, also varying kinetics and different maximum values with regard to the infectious focus and pathogens are discussed. RESULTS PCT-guided antibiotic treatment appears to be safe and effective. Most of the studies revealed a shorter antibiotic treatment without negative clinical outcomes. Cost effectiveness is still a matter of debate and effects on bacterial resistance due to shorter treatments, possible lower rates of drug-related adverse events, or decreased rates of Clostridium difficile infections are not yet evaluated. CONCLUSION Guidance of antibiotic treatment can effectively be supported by PCT-protocols. However, it is important to consider the limitations of this biomarker and to use PCT protocols along with antibiotic stewardship programmes and regular clinical rounds together with infectious diseases specialists.
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Affiliation(s)
- Andreas Hohn
- Department of Anaesthesiology and Intensive Care Medicine, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
| | - Bernhard Heising
- Department of Infectiology and Hospital Hygiene, Hospital Düren gem. GmbH, Roonstraße 30, 52351, Dueren, Germany
| | - Jan-Karl Schütte
- Department of Anaesthesiology, Surgical Intensive Care, Emergency Medicine and Pain Management, Hospital Düren gem. GmbH, Roonstraße 30, 52351, Düren, Germany
| | - Olaf Schroeder
- Department of Anaesthesiology, Surgical Intensive Care, Emergency Medicine and Pain Management, Hospital Düren gem. GmbH, Roonstraße 30, 52351, Düren, Germany
| | - Stefan Schröder
- Department of Anaesthesiology, Surgical Intensive Care, Emergency Medicine and Pain Management, Hospital Düren gem. GmbH, Roonstraße 30, 52351, Düren, Germany
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Bassetti M, Righi E, Carnelutti A. Bloodstream infections in the Intensive Care Unit. Virulence 2016; 7:267-79. [PMID: 26760527 PMCID: PMC4871677 DOI: 10.1080/21505594.2015.1134072] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 12/14/2015] [Accepted: 12/15/2015] [Indexed: 12/29/2022] Open
Abstract
Bloodstream infections (BSIs) represent a common complication among critically ill patients and a leading cause of morbidity and mortality. The prompt initiation of an effective antibiotic therapy is necessary in order to reduce mortality and to improve clinical outcomes. However, the choice of the empiric antibiotic regimen is often challenging, due to the worldwide spread of multi-drug resistant (MDR) organisms with reduced susceptibility to the available broad-spectrum antimicrobials. New therapeutic strategies are 5 to improve the effectiveness of antibiotic treatment while minimizing the risk of resistance selection.
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Affiliation(s)
- Matteo Bassetti
- Infectious Diseases Division, Santa Maria Misericordia Hospital, Udine, Italy
- Clinica Malattie Infettive, Azienda Ospedaliera Universitaria Santa Maria della Misericordia, Udine, Italy
| | - Elda Righi
- Infectious Diseases Division, Santa Maria Misericordia Hospital, Udine, Italy
- Clinica Malattie Infettive, Azienda Ospedaliera Universitaria Santa Maria della Misericordia, Udine, Italy
| | - Alessia Carnelutti
- Infectious Diseases Division, Santa Maria Misericordia Hospital, Udine, Italy
- Clinica Malattie Infettive, Azienda Ospedaliera Universitaria Santa Maria della Misericordia, Udine, Italy
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15
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[Short-course antibiotic regimens: Up-to-date]. Rev Med Interne 2016; 37:466-72. [PMID: 26775641 DOI: 10.1016/j.revmed.2015.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 11/11/2015] [Accepted: 12/07/2015] [Indexed: 11/22/2022]
Abstract
Antibiotic treatment durations are not well documented. Yet, dramatic emergence of multi-drug resistant organisms should lead to tend to decrease antibiotic selection pressure. Furthermore, it could lower health costs and reduce associated adverse events. Unfortunately, only few studies with rigorous methodology have been performed. We present the available data on frequent infections such as urinary tract infections, community acquired pneumonia, bone and joint infections and intra-abdominal infections. We underline the difficulties to perform such trials and discuss original options to a better evaluation of treatment duration.
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16
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Oberoi SS, Dhingra C, Sharma G, Sardana D. Antibiotics in dental practice: how justified are we. Int Dent J 2014; 65:4-10. [PMID: 25510967 DOI: 10.1111/idj.12146] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Antibiotics are prescribed by dentists in dental practice, during dental treatment as well as for prevention of infection. Indications for the use of systemic antibiotics in dentistry are limited because most dental and periodontal diseases are best managed by operative intervention and oral hygiene measures. The use of antibiotics in dental practice is characterised by empirical prescription based on clinical and bacteriological epidemiological factors, resulting in the use of a very narrow range of broad-spectrum antibiotics for short periods of time. This has led to the development of antimicrobial resistance (AMR) in a wide range of microbes and to the consequent inefficacy of commonly used antibiotics. Dentists can make a difference by the judicious use of antimicrobials--prescribing the correct drug, at the standard dosage and appropriate regimen--only when systemic spread of infection is evident. The increasing resistance problems of recent years are probably related to the over- or misuse of broad-spectrum agents. There is a clear need for the development of prescribing guidelines and educational initiatives to encourage the rational and appropriate use of drugs in dentistry. This paper highlights the need for dentists to improve antibiotic prescribing practices in an attempt to curb the increasing incidence of antibiotic resistance and other side effects of antibiotic abuse. The literature provides evidence of inadequate prescribing practices by dentists for a number of factors, ranging from inadequate knowledge to social factors.
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Affiliation(s)
- Sukhvinder S Oberoi
- Department of Public Health Dentistry, Sudha College of Dental Sciences and Research, Faridabad, India
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17
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Quality indicators on the use of antimicrobials in critically ill patients. Med Intensiva 2014; 38:567-74. [PMID: 25241269 DOI: 10.1016/j.medin.2014.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 04/14/2014] [Accepted: 04/24/2014] [Indexed: 01/18/2023]
Abstract
Quality indicators have been applied to many areas of health care in recent years, including intensive care. However, they have not been specifically developed and validated for antimicrobial use in critically ill patients. Antimicrobials play a key role in intensive care units not only in the prognosis of each individual patient, but also in the development of resistance and changes in the flora in this setting. Evaluating the use of these agents is complex in the intensive care unit, however, because the indications vary greatly and antimicrobial treatment is often changed during admission. We designed and developed specific quality indicators regarding the use of antimicrobials in critically ill patients admitted to the intensive care unit. These indicators are proposed as a tool for application in intensive care units to detect problems in the use of antimicrobials. Future trials are needed, however, to validate these indicators in a large population over time.
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18
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Duration of antibiotic therapy for critically ill patients with bloodstream infections: A retrospective cohort study. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2014; 24:129-37. [PMID: 24421823 DOI: 10.1155/2013/141989] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The optimal duration of antibiotic treatment for bloodstream infections is unknown and understudied. METHODS A retrospective cohort study of critically ill patients with bloodstream infections diagnosed in a tertiary care hospital between March 1, 2010 and March 31, 2011 was undertaken. The impact of patient, pathogen and infectious syndrome characteristics on selection of shorter (≤10 days) or longer (>10 days) treatment duration, and on the number of antibiotic-free days, was examined. The time profile of clinical response was evaluated over the first 14 days of treatment. Relapse, secondary infection and mortality rates were compared between those receiving shorter or longer treatment. RESULTS Among 100 critically ill patients with bloodstream infection, the median duration of antibiotic treatment was 11 days, but was highly variable (interquartile range 4.5 to 17 days). Predictors of longer treatment (fewer antibiotic-free days) included foci with established requirements for prolonged treatment, underlying respiratory tract focus, and infection with Staphylococcus aureus or Pseudomonas species. Predictors of shorter treatment (more antibiotic-free days) included vascular catheter source and bacteremia with coagulase-negative staphylococci. Temperature improvements plateaued after the first week; white blood cell counts, multiple organ dysfunction scores and vasopressor dependence continued to decline into the second week. Among 72 patients who survived to 10 days, clinical outcomes were similar between those receiving shorter and longer treatment. CONCLUSION Antibiotic treatment durations for patients with bloodstream infection are highly variable and often prolonged. A randomized trial is needed to determine the duration of treatment that will maximize cure while minimizing adverse consequences of antibiotics.
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Stupica D, Lusa L, Ruzić-Sabljić E, Cerar T, Strle F. Treatment of erythema migrans with doxycycline for 10 days versus 15 days. Clin Infect Dis 2012; 55:343-50. [PMID: 22523260 DOI: 10.1093/cid/cis402] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The efficacy of 10-day doxycycline treatment in patients with erythema migrans has been assessed in the United States but not in Europe. Experts disagree on the significance of post-Lyme borreliosis symptoms. METHODS In a noninferiority trial, the efficacies of 10 days and 15 days of oral doxycycline therapy were evaluated in adult European patients with erythema migrans. The prevalence of nonspecific symptoms was compared between patients with erythema migrans and 81 control subjects without a history of Lyme borreliosis. The efficacy of treatment, determined on the basis of clinical observations and microbiologic tests, was assessed at 14 days and at 2, 6, and 12 months. Nonspecific symptoms in patients and controls were compared at 6 months after enrollment. RESULTS A total of 117 patients (52%) were treated with doxycycline for 15 days, and 108 (48%) received doxycycline for 10 days. Twelve months after enrollment, 85 of 91 patients (93.4%) in the 15-day group and 79 of 86 (91.9%) in the 10-day group had complete response (difference, 1.6 percentage points; upper limit of the 95% confidence interval, 9.1 percentage points). At 6 months, the frequency of nonspecific symptoms in the patients was similar to that among controls. CONCLUSIONS The 10-day regimen of oral doxycycline was not inferior to the 15-day regimen among adult European patients with solitary erythema migrans. Six months after treatment, the frequency of nonspecific symptoms among erythema migrans patients was similar to that among control subjects. CLINICAL TRIALS REGISTRATION NCT00910715.
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Affiliation(s)
- Dasa Stupica
- Department of Infectious Diseases, University Medical Center Ljubljana, Slovenia.
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Havey TC, Fowler RA, Daneman N. Duration of antibiotic therapy for bacteremia: a systematic review and meta-analysis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2011; 15:R267. [PMID: 22085732 PMCID: PMC3388653 DOI: 10.1186/cc10545] [Citation(s) in RCA: 132] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Revised: 09/08/2011] [Accepted: 11/15/2011] [Indexed: 12/21/2022]
Abstract
Introduction The optimal duration of antibiotic therapy for bloodstream infections is unknown. Shorter durations of therapy have been demonstrated to be as effective as longer durations for many common infections; similar findings in bacteremia could enable hospitals to reduce antibiotic utilization, adverse events, resistance and costs. Methods A search of the MEDLINE, EMBASE and COCHRANE databases was conducted for the years 1947-2010. Controlled trials were identified that randomized patients to shorter versus longer durations of treatment for bacteremia, or the infectious foci most commonly causing bacteremia in critically ill patients (catheter-related bloodstream infections (CRBSI), intra-abdominal infections, pneumonia, pyelonephritis and skin and soft-tissue infections (SSTI)). Results Twenty-four eligible trials were identified, including one trial focusing exclusively on bacteremia, zero in catheter related bloodstream infection, three in intra-abdominal infection, six in pyelonephritis, thirteen in pneumonia and one in skin and soft tissue infection. Thirteen studies reported on 227 patients with bacteremia allocated to 'shorter' or 'longer' durations of treatment. Outcome data were available for 155 bacteremic patients: neonatal bacteremia (n = 66); intra-abdominal infection (40); pyelonephritis (9); and pneumonia (40). Among bacteremic patients receiving shorter (5-7 days) versus longer (7-21 days) antibiotic therapy, no significant difference was detected with respect to rates of clinical cure (45/52 versus 47/49, risk ratio 0.88, 95% confidence interval [CI] 0.77-1.01), microbiologic cure (28/28 versus 30/32, risk ratio 1.05, 95% CI 0.91-1.21), and survival (15/17 versus 26/29, risk ratio 0.97, 95% CI 0.76-1.23). Conclusions No significant differences in clinical cure, microbiologic cure and survival were detected among bacteremic patients receiving shorter versus longer duration antibiotic therapy. An adequately powered randomized trial of bacteremic patients is needed to confirm these findings.
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Affiliation(s)
- Thomas C Havey
- Department of Medicine, University of Toronto, 1 Kings College Circle, O, M5S 1A8, Canada
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21
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Hayashi Y, Paterson DL. Strategies for reduction in duration of antibiotic use in hospitalized patients. Clin Infect Dis 2011; 52:1232-40. [PMID: 21507920 DOI: 10.1093/cid/cir063] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
There is a global crisis of antibiotic resistance in part because of the collateral damage of antibiotic use. Reduction in antibiotic consumption is clearly important to minimize this problem. Limiting treatment duration may be the most clinically palatable means of reducing antibiotic consumption. Antimicrobial stewardship programs play an important role in this process. Their effectiveness may be increased by drawing on evidence from randomized controlled trials regarding optimal antibiotic duration. However, in most clinical scenarios, the recommended duration of therapy in published guidelines is based on expert opinion. Biological markers, such as procalcitonin, have been shown to reduce antimicrobial consumption with no adverse outcome in 11 randomized controlled trials. Although procalcitonin may not be the perfect biomarker, the concept of procalcitonin-guided antibiotic discontinuation after clinical stabilization, in conjunction with antimicrobial stewardship programs, appears to be ready for introduction into clinical practice.
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Affiliation(s)
- Yoshiro Hayashi
- The University of Queensland, Centre for Clinical Research, Brisbane, Australia
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Dar-Odeh NS, Abu-Hammad OA, Al-Omiri MK, Khraisat AS, Shehabi AA. Antibiotic prescribing practices by dentists: a review. Ther Clin Risk Manag 2010; 6:301-6. [PMID: 20668712 PMCID: PMC2909496 DOI: 10.2147/tcrm.s9736] [Citation(s) in RCA: 117] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2010] [Indexed: 01/04/2023] Open
Abstract
Antibiotics are prescribed by dentists for treatment as well as prevention of infection. Indications for the use of systemic antibiotics in dentistry are limited, since most dental and periodontal diseases are best managed by operative intervention and oral hygiene measures. However, the literature provides evidence of inadequate prescribing practices by dentists, due to a number of factors ranging from inadequate knowledge to social factors. Here we review studies that investigated the pattern of antibiotic use by dentists worldwide. The main defects in the knowledge of antibiotic prescribing are outlined. The main conclusion is that, unfortunately, the prescribing practices of dentists are inadequate and this is manifested by over-prescribing. Recommendations to improve antibiotic prescribing practices are presented in an attempt to curb the increasing incidence of antibiotic resistance and other side effects of antibiotic abuse.
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Drusano G, Liu W, Brown D, Rice L, Louie A. Impact of Short‐Course Quinolone Therapy on Susceptible and Resistant Populations ofStaphylococcus aureus. J Infect Dis 2009; 199:219-26. [DOI: 10.1086/595739] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Antibiotic Overuse: The Influence of Social Norms. J Am Coll Surg 2008; 207:265-75. [DOI: 10.1016/j.jamcollsurg.2008.02.035] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2007] [Revised: 01/28/2008] [Accepted: 02/26/2008] [Indexed: 11/25/2022]
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