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Andrade HND, Oliveira JFD, Siniscalchi LAB, Costa JDD, Fia R. Global insight into the occurrence, treatment technologies and ecological risk of emerging contaminants in sanitary sewers: Effects of the SARS-CoV-2 coronavirus pandemic. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 921:171075. [PMID: 38402973 DOI: 10.1016/j.scitotenv.2024.171075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/02/2024] [Accepted: 02/16/2024] [Indexed: 02/27/2024]
Abstract
The SARS-CoV-2 pandemic caused changes in the consumption of prescribed/non-prescribed drugs and the population's habits, influencing the detection and concentration of emerging contaminants (ECs) in sanitary sewage and harming environmental and health risks. Therefore, the present work sought to discuss current literature data on the effects of the "COVID-19 pandemic factor" on the quality of raw sewage produced over a five-year period (2018-2019: pre-pandemic; 2020-2022: during the pandemic) and biological, physical, chemical and hybrid treatment technologies, influencing factors in the removal of ECs and potential ecological risks (RQs). Seven hundred thirty-one publications correlating sewage and COVID-19 were identified: 184 pre-pandemic and 547 during the pandemic. Eight classes and 37 ECs were detected in sewage between 2018 and 2022, with the "COVID-19 pandemic factor" promoting an increase in estrogens (+31,775 %), antibiotics (+19,544 %), antiepileptics and antipsychotics (+722 %), pesticides (+200 %), analgesics, anti-inflammatories and anticoagulants (+173 %), and stimulant medications (+157 %) in sanitary sewage. Among the treatment systems, aerated reactors integrated into biomembranes removed >90 % of cephalexin, clarithromycin, ibuprofen, estrone, and 17β-estradiol. The absorption, adsorption, and biodegradation mechanisms of planted wetland systems contributed to better cost-benefit in reducing the polluting load of sewage ECs in the COVID-19 pandemic, individually or integrated into the WWTP. The COVID-19 pandemic factor increased the potential ecological risks (RQs) for aquatic organisms by 40 %, with emphasis on clarithromycin and sulfamethoxazole, which changed from negligible risk and low risk to (very) high risk and caffeine with RQ > 2500. Therefore, it is possible to suggest that the COVID-19 pandemic intensified physiological, metabolic, and physical changes to different organisms in aquatic biota by ECs during 2020 and 2022.
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Affiliation(s)
- Heloisa Nascimento de Andrade
- Department of Engineering and Technology, Federal University of the Semi-Arid Region, UFERSA, Pau dos Ferros, Rio Grande do Norte 59900-000, Brazil
| | - Jacineumo Falcão de Oliveira
- Department of Engineering and Technology, Federal University of the Semi-Arid Region, UFERSA, Pau dos Ferros, Rio Grande do Norte 59900-000, Brazil.
| | | | - Joseane Dunga da Costa
- Department of Engineering and Technology, Federal University of the Semi-Arid Region, UFERSA, Pau dos Ferros, Rio Grande do Norte 59900-000, Brazil
| | - Ronaldo Fia
- Department of Environmental Engineering, Federal University of Lavras, UFLA, Minas Gerais 37200-000, Brazil
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Thakral Y, Sahay S, Mukherjee A. Microfoundations of Data-Driven Antimicrobial Stewardship Policy (ASP). Antibiotics (Basel) 2023; 13:24. [PMID: 38247583 PMCID: PMC10812814 DOI: 10.3390/antibiotics13010024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 11/23/2023] [Accepted: 11/29/2023] [Indexed: 01/23/2024] Open
Abstract
This paper introduces a comprehensive framework that elucidates the microfoundations of data-driven antimicrobial stewardship programs (ASPs), specifically focusing on resource-constrained settings. Such settings necessitate the utilization of available resources and engagement among multiple stakeholders. The microfoundations are conceptualized as interlinked components: input, process, output, and outcome. Collectively, these components provide a comprehensive framework for understanding the development and implementation of data-driven ASPs in resource-constrained settings. It underscores the importance of considering both the social and material dimensions when evaluating microbiological, clinical, and social impacts. By harmonizing technology, practices, values, and behaviors, this framework offers valuable insights for the development, implementation, and assessment of ASPs tailored to resource-constrained environments.
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Affiliation(s)
- Yogita Thakral
- Department of Informatics, University of Oslo, 0373 Oslo, Norway;
- HISP India, New Delhi 110025, India
| | - Sundeep Sahay
- Department of Informatics, University of Oslo, 0373 Oslo, Norway;
- HISP India, New Delhi 110025, India
| | - Arunima Mukherjee
- HISP India, New Delhi 110025, India
- SUSTAINIT—Unit for sustainable health, Faculty of Medicine, University of Oslo, 0316 Oslo, Norway
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Tadesse BT, Keddy KH, Rickett NY, Zhusupbekova A, Poudyal N, Lawley T, Osman M, Dougan G, Kim JH, Lee JS, Jeon HJ, Marks F. Vaccination to Reduce Antimicrobial Resistance Burden-Data Gaps and Future Research. Clin Infect Dis 2023; 77:S597-S607. [PMID: 38118013 PMCID: PMC10732565 DOI: 10.1093/cid/ciad562] [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] [Indexed: 12/22/2023] Open
Abstract
Antimicrobial resistance (AMR) poses an immediate danger to global health. If unaddressed, the current upsurge in AMR threatens to reverse the achievements in reducing the infectious disease-associated mortality and morbidity associated with antimicrobial treatment. Consequently, there is an urgent need for strategies to prevent or slow the progress of AMR. Vaccines potentially contribute both directly and indirectly to combating AMR. Modeling studies have indicated significant gains from vaccination in reducing AMR burdens for specific pathogens, reducing mortality/morbidity, and economic loss. However, quantifying the real impact of vaccines in these reductions is challenging because many of the study designs used to evaluate the contribution of vaccination programs are affected by significant background confounding, and potential selection and information bias. Here, we discuss challenges in assessing vaccine impact to reduce AMR burdens and suggest potential approaches for vaccine impact evaluation nested in vaccine trials.
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Affiliation(s)
- Birkneh Tilahun Tadesse
- International Vaccine Institute, Seoul, Republic of Korea
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Center for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | | | - Nimesh Poudyal
- International Vaccine Institute, Seoul, Republic of Korea
| | - Trevor Lawley
- Wellcome Sanger Institute and Microbiotica, Cambridge, United Kingdom
| | - Majdi Osman
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Gordon Dougan
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Jerome H Kim
- International Vaccine Institute, Seoul, Republic of Korea
- Seoul National University, College of Natural Sciences, Seoul, Republic of Korea
| | - Jung-Seok Lee
- International Vaccine Institute, Seoul, Republic of Korea
| | - Hyon Jin Jeon
- International Vaccine Institute, Seoul, Republic of Korea
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
- Madagascar Institute for Vaccine Research, University of Antananarivo, Antananarivo, Madagascar
| | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
- Madagascar Institute for Vaccine Research, University of Antananarivo, Antananarivo, Madagascar
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
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Mustafa T, Niazi MRK, Lakdawala Z, Mirza S. Regional and National Trends in Consumption of Antimicrobials in Pakistan; Pre and Post-COVID (2019-2021). Clin Infect Dis 2023; 77:S569-S577. [PMID: 38118009 PMCID: PMC10732562 DOI: 10.1093/cid/ciad647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
BACKGROUND Efforts to combat antimicrobial resistance, a growing public health problem in Pakistan, have been hampered by the lack of high-quality national and provincial-level antimicrobial consumption data. The singular objective of this retrospective study was to measure antimicrobial consumption over 3 years between 2019 and 2021. METHODS The study was designed to estimate antimicrobial consumption at National and Regional levels. Antimicrobial consumption data was collected by IQVIA covering 110 districts of Pakistan in which 88% of sales are census (accurate sales collected directly from distributors), whereas 12% of sales (sales of 300 pharmacies) are projected on the national level. To determine the usage for 3 consecutive years, the consumption of antibiotics was calculated as defined daily doses (DDD) of antibiotics per 1000 inhabitants per day (DID). RESULTS The results of our study demonstrated a steep increase in the consumption of antimicrobials from 2019 to 2021. An increase in consumption of most classes of antibiotics was observed both nationally and Regionally. Quinolones, penicillins (co-amoxiclav), macrolides, and third-generation cephalosporins remained the most frequently used antibiotics nationally. A 40% increase in intravenous use of antimicrobials was observed between 2019 and 2021 at the national level. Moxifloxacin, Levofloxacin, Ciprofloxacin, and linezolid were the most commonly used intravenous antibiotics. Region 7 (Peshawar) demonstrated the highest consumption, followed by Region 1 (Karachi) and Region 6 (Faisalabad). Among the most commonly used antibiotics, the use of third-generation cephalosporin (cefixime), quinolones, penicillins (amoxicillin + clavulanic acid), and macrolides (azithromycin) was most noticeable in all regions, particularly in those with the higher consumption of antibiotics. CONCLUSIONS Although the increase in consumption of all antibiotics is concerning, the steep increase in the use of watch and reserve category antibiotics during the study period calls for immediate actions to limit and regulate their usage.
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Affiliation(s)
| | | | - Zahra Lakdawala
- Numerical Yield and Site Assessment Group, Fraunhofer Institute for Wind Energy Systems, Oldenburg, Germany
| | - Shaper Mirza
- Department of Life Sciences, SBASSE-LUMS, Lahore, Pakistan
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Patel J, Fernandes G, Mwamelo AJ, Sridhar D. Health systems appraisal of the response to antimicrobial resistance in low- and middle-income countries in relation to COVID-19: Application of the WHO building blocks. GLOBAL POLICY 2023; 14:790-796. [PMID: 38504997 PMCID: PMC10946709 DOI: 10.1111/1758-5899.13262] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 03/21/2024]
Abstract
COVID-19 has inflicted both beneficial and damaging effects on health systems responding to antimicrobial resistance (AMR). Data shows that the positive impacts of the pandemic (including enhanced hygiene, mask wearing and widespread use of personal protective equipment), are likely to have been overshadowed by the negative effects: emerging AMR pathogens and mechanisms; further outbreaks and geographic spread of AMR to non-endemic countries; rising infections from multidrug-resistant pathogen; an overall higher burden of AMR. The multisectoral complexities of AMR and the totality of health systems challenge our ability to understand the impact of the COVID-19 pandemic on country responses to AMR. In this analysis, we synthesise international evidence characterising the role of the pandemic on the six key building blocks of health systems in responding to AMR across low- and middle-income countries (LMICs). We apply systems thinking within and between the building blocks to contextualise the impact of one pandemic on another.
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Affiliation(s)
- Jay Patel
- Global Health Governance ProgrammeUsher Institute, University of EdinburghEdinburghUK
- Faculty of Medicine and Health, University of LeedsLeedsUK
| | - Genevie Fernandes
- Global Health Governance ProgrammeUsher Institute, University of EdinburghEdinburghUK
| | - Ambele Judith Mwamelo
- Global Health Governance ProgrammeUsher Institute, University of EdinburghEdinburghUK
| | - Devi Sridhar
- Global Health Governance ProgrammeUsher Institute, University of EdinburghEdinburghUK
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Hussain A, Kumar SHK, Prathiviraj R, Kumar AA, Renjith K, Kiran GS, Selvin J. The genome of Symbiodiniaceae-associated Stutzerimonas frequens CAM01 reveals a broad spectrum of antibiotic resistance genes indicating anthropogenic drift in the Palk Bay coral reef of south-eastern India. Arch Microbiol 2023; 205:319. [PMID: 37626254 DOI: 10.1007/s00203-023-03656-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023]
Abstract
An increase in antibiotic pollution in reef areas will lead to the emergence of antibiotic-resistant bacteria, leading to ecological disturbances in the sensitive coral holobiont. This study provides insights into the genome of antibiotics-resistant Stutzerimonas frequens CAM01, isolated from Favites-associated Symbiodiniaceae of a near-shore polluted reef of Palk Bay, India. The draft genome contains 4.67 Mbp in size with 52 contigs. Further genome analysis revealed the presence of four antibiotic-resistant genes, namely, adeF, rsmA, APH (3")-Ib, and APH (6)-Id that provide resistance by encoding resistance-nodulation-cell division (RND) antibiotic efflux pump and aminoglycoside phosphotransferase. The isolate showed resistance against 73% of the antibiotics tested, concurrent with the predicted AMR genes. Four secondary metabolites, namely Aryl polyene, NRPS-independent-siderophore, terpenes, and ectoine were detected in the isolate, which may play a role in virulence and pathogenicity adaptation in microbes. This study provides key insights into the genome of Stutzerimonas frequens CAM01 and highlights the emergence of antibiotic-resistant bacteria in coral reef ecosystems.
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Grants
- BT/PR40420/NDB/39/741/2020. Department of Biotechnology, Ministry of Science and Technology, India
- BT/PR40420/NDB/39/741/2020. Department of Biotechnology, Ministry of Science and Technology, India
- BT/PR40420/NDB/39/741/2020. Department of Biotechnology, Ministry of Science and Technology, India
- BT/PR40420/NDB/39/741/2020. Department of Biotechnology, Ministry of Science and Technology, India
- BT/PR40420/NDB/39/741/2020. Department of Biotechnology, Ministry of Science and Technology, India
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Affiliation(s)
- Afreen Hussain
- Department of Microbiology, Pondicherry University, Kalapet, Puducherry, 605014, India
| | - S Hari Krishna Kumar
- Department of Microbiology, Pondicherry University, Kalapet, Puducherry, 605014, India
| | - R Prathiviraj
- Department of Microbiology, Pondicherry University, Kalapet, Puducherry, 605014, India
| | - Ashish Ashwin Kumar
- Department of Microbiology, Pondicherry University, Kalapet, Puducherry, 605014, India
| | - Kalyani Renjith
- Department of Microbiology, Pondicherry University, Kalapet, Puducherry, 605014, India
| | - G Seghal Kiran
- Department of Food Science and Technology, School of Life Sciences, Pondicherry University, Puducherry, India
| | - Joseph Selvin
- Department of Microbiology, Pondicherry University, Kalapet, Puducherry, 605014, India.
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Ghiga I, Sidorchuk A, Pitchforth E, Stålsby Lundborg C, Machowska A. 'If you want to go far, go together'-community-based behaviour change interventions to improve antibiotic use: a systematic review of quantitative and qualitative evidence. J Antimicrob Chemother 2023; 78:1344-1353. [PMID: 37147849 PMCID: PMC10232266 DOI: 10.1093/jac/dkad128] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 04/19/2023] [Indexed: 05/07/2023] Open
Abstract
INTRODUCTION A large proportion of the burden of infections with antibiotic-resistant bacteria is linked to community-associated infections. This suggests that interventions set in community settings are needed. Currently there is a gap in understanding the potential of such interventions across all geographies. This systematic review aimed to synthesize the evidence on the value of community-based behaviour change interventions to improve antibiotic use. These are any interventions or innovations to services intended to stimulate behaviour changes among the public towards correct antibiotic use, delivered in a community setting and online. METHODS Systematic searches of studies published after 2001 were performed in several databases. Of 14 319 articles identified, 73 articles comprising quantitative, qualitative and mixed-methods studies met the inclusion criteria. RESULTS Findings showed positive emerging evidence of the benefits of community-based behaviour change interventions to improve antibiotic use, with multifaceted interventions offering the highest benefit. Interventions that combine educational aspects with persuasion may be more effective than solely educational interventions. The review uncovered difficulties in assessing this type of research and highlights the need for standardized approaches in study design and outcomes measurements. There is emerging, but limited, indication on these interventions' cost-effectiveness. CONCLUSIONS Policy makers should consider the potential of community-based behaviour change interventions to tackle antimicrobial resistance (AMR), complementing the clinical-based approaches. In addition to the direct AMR benefits, these could serve also as a means of (re)building trust, due to their inclusive participation leading to greater public ownership and use of community channels.
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Affiliation(s)
- Ioana Ghiga
- Department of Global Public Health, Karolinska Institutet, Stockholm 171 77, Sweden
| | - Anna Sidorchuk
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Emma Pitchforth
- Primary Care Research Group, University of Exeter Medical School, St Luke’s Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | | | - Anna Machowska
- Department of Global Public Health, Karolinska Institutet, Stockholm 171 77, Sweden
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Beyene AM, Andualem T, Dagnaw GG, Getahun M, LeJeune J, Ferreira JP. Situational analysis of antimicrobial resistance, laboratory capacities, surveillance systems and containment activities in Ethiopia: A new and one health approach. One Health 2023. [DOI: 10.1016/j.onehlt.2023.100527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023] Open
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Sheikh S, Vishwas G, Aggarwal M, Bhattacharya S, Kumari P, Parashar L, Meshram G. Antibiotic point prevalence survey at a tertiary healthcare hospital in India: Identifying strategies to improve the antibiotic stewardship program immediately after a COVID-19 wave. Infect Prev Pract 2022; 4:100253. [PMID: 36276168 PMCID: PMC9562613 DOI: 10.1016/j.infpip.2022.100253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/25/2022] [Indexed: 11/06/2022] Open
Abstract
Background The COVID-19 pandemic has substantially affected the antibiotic stewardship activities in most hospitals of India. Aims We conducted an antibiotic point prevalence survey (PPS) immediately after the decline of a major COVID-19 wave at a dedicated COVID-19 hospital. By doing so we aimed to identify the antibiotic prescription patterns, identify factors influencing the choice of antibiotics, and identify/develop strategies to improve the antibiotic stewardship program in such setups. Methods The PPS was single-centred, cross-sectional, and retrospective in nature. Patients admitted in various wards and intensive care units (ICUs) between September 2021 to October 2021 were included in our PPS. Results Of the included 460 patients, 192 were prescribed antibiotics. Of these 192 patients, ICU-admitted patients had the highest number of antibiotics prescribed i.e. 2.09 ± 0.92. Only a minor fraction (7.92 %) of antibiotics prescriptions were on the basis of culture reports. Most of the antibiotics were prescribed empirically by the parenteral route. The most common group of antibiotics prescribed were third-generation cephalosporins. Carbapenems were the most common designated antibiotics prescribed. A large number of patients (22.40 %) were prescribed a double anaerobic coverage. Conclusion The strategies that we identified to improve the antibiotic stewardship program at our institute included reviving the culture of sending culture reports to prescribe antibiotics, improving surgical prophylaxis guidelines, training resident doctors to categorize antibiotic prescriptions appropriately, closely monitoring prescriptions providing double anaerobic coverage, and improving the electronic medical record system for improving prescription auditing.
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Affiliation(s)
- S. Sheikh
- Department of Pharmacology, Employees' State Insurance Corporation Medical College and Hospital, Faridabad 121001, India,Department of Pharmacology, Dr. Baba Saheb Ambedkar Medical College and Hospital, Sector-6, Rohini, Delhi 110085, India
| | - G. Vishwas
- Department of Pharmacology, Employees' State Insurance Corporation Medical College and Hospital, Faridabad 121001, India
| | - M. Aggarwal
- Department of Pharmacology, Employees' State Insurance Corporation Medical College and Hospital, Faridabad 121001, India
| | - S. Bhattacharya
- Department of Pharmacology, Employees' State Insurance Corporation Medical College and Hospital, Faridabad 121001, India
| | - P. Kumari
- Department of Pharmacology, Employees' State Insurance Corporation Medical College and Hospital, Faridabad 121001, India
| | - L. Parashar
- Department of Community Medicine, Employees' State Insurance Corporation Medical College and Hospital, Faridabad 121001, India
| | - G.G. Meshram
- Department of Pharmacology, Employees' State Insurance Corporation Medical College and Hospital, Faridabad 121001, India,Department of Pharmacology, Maulana Azad Medical College and Associated Hospitals, New Delhi 110002, India,Corresponding author. Address: Department of Pharmacology, Maulana Azad Medical College and Associated Hospitals, New Delhi 110002. India. Tel.: +918376010560
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Impact of the COVID-19 Outbreak on the Antibiotic Use Patterns among a Rural Community Population in Eastern China. Antibiotics (Basel) 2022; 11:antibiotics11111544. [PMID: 36358199 PMCID: PMC9686520 DOI: 10.3390/antibiotics11111544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 10/26/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
There are growing concerns that the coronavirus disease of 2019 (COVID-19) pandemic may change antibiotic use patterns and accelerate antibiotic resistance, but evidence from the community level is lacking. This study aims to estimate the impact of the COVID-19 outbreak on the antibiotic use patterns among a community population in Eastern China. A self-administered medicine diary was used to collect information on antibiotic use from July 2019 to June 2021 among a rural community in Eastern China. We analyzed the changes in antibiotic use patterns over five months from August to December 2019 and the corresponding months in 2020. The risk of antibiotic use and its changes were measured with the incidence rate (IR) and relative risk (RR). In total, 1111 participants were eligible for the final analysis (440 in 2019 and 671 in 2020). After the COVID-19 outbreak, antibiotic use increased by 137% (5.43 per 100 person months in the 2019 vs. 12.89 per 100 person months in the 2020), and after the adjustment of covariates, the adjusted RR was 1.72 (95% CI: 1.10~2.34). It was higher among those who were women (RR = 2.62), aged 35−59 years old (RR = 2.72), non-farmers (RR = 2.75), had less than six years of education (RR = 2.61), had an annual household income over CNY 100,000 (USD 14,940) (RR = 2.60), and had no history of chronic diseases (RR = 2.61) (all p < 0.05). The proportion of cephalosporins consumed increased from 54.29% in 2019 to 64.92% in 2020 (p = 0.011). Among those aged 35 years and older, the proportion of antibiotics obtained from medical facilities increased, while the proportion obtained from retail pharmacies, homes, and other sources decreased (all p < 0.05). The COVID-19 outbreak changed antibiotic use patterns in this study population (Eastern China) significantly. More efforts to monitor and enhance antibiotic stewardship activities at the community level are needed in future.
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Kontoghiorghes GJ. Deferiprone: A Forty-Year-Old Multi-Targeting Drug with Possible Activity against COVID-19 and Diseases of Similar Symptomatology. Int J Mol Sci 2022; 23:ijms23126735. [PMID: 35743183 PMCID: PMC9223898 DOI: 10.3390/ijms23126735] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 02/01/2023] Open
Abstract
The need for preparing new strategies for the design of emergency drug therapies against COVID-19 and similar diseases in the future is rather urgent, considering the high rate of morbidity and especially mortality associated with COVID-19, which so far has exceeded 18 million lives. Such strategies could be conceived by targeting the causes and also the serious toxic side effects of the diseases, as well as associated biochemical and physiological pathways. Deferiprone (L1) is an EMA- and FDA-approved drug used worldwide for the treatment of iron overload and also other conditions where there are no effective treatments. The multi-potent effects and high safety record of L1 in iron loaded and non-iron loaded categories of patients suggests that L1 could be developed as a “magic bullet” drug against COVID-19 and diseases of similar symptomatology. The mode of action of L1 includes antiviral, antimicrobial, antioxidant, anti-hypoxic and anti-ferroptotic effects, iron buffering interactions with transferrin, iron mobilizing effects from ferritin, macrophages and other cells involved in the immune response and hyperinflammation, as well as many other therapeutic interventions. Similarly, several pharmacological and other characteristics of L1, including extensive tissue distribution and low cost of production, increase the prospect of worldwide availability, as well as many other therapeutic approach strategies involving drug combinations, adjuvant therapies and disease prevention.
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Affiliation(s)
- George J Kontoghiorghes
- Postgraduate Research Institute of Science, Technology, Environment and Medicine, Limassol 3021, Cyprus
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