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Addis GT, Dagnew SB, Anagaw A, Ayele TM, Tadesse TY. Evaluation of antibiotic utilization pattern in the treatment of acute diarrheal diseases at Debre Tabor comprehensive specialized hospital, Debre Tabor, Ethiopia: A retrospective cross-sectional study. Heliyon 2023; 9:e18049. [PMID: 37449097 PMCID: PMC10336787 DOI: 10.1016/j.heliyon.2023.e18049] [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: 12/22/2022] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023] Open
Abstract
Background In clinical settings all across the world, including Ethiopia, the irrational use of antibiotics to treat acute diarrhea is common. The main causes of resistance are antibiotic abuse, misuse, and underuse, and among infectious diseases, antibiotic overuse is pervasive in diarrheal infections around the world. As a result, the primary goal of this study was to evaluate antibiotic use patterns for the treatment of acute diarrheal diseases at Debre Tabor Comprehensive Specialized Hospital in North-West Ethiopia. Methodology A retrospective cross-sectional study was conducted to assess the antibiotic utilization pattern used to treat acute diarrheal illness, taken from the record cards of 243 patients who received treatment for acute diarrheal illness, employing structured questions from September 1 to September 30, 2022. The results are displayed using percentages and frequency distributions in tables along with figures. Results A total of 243 patients were involved, 134 (55.1%) of whom were male and 134 (55.1%) were under the age of five. Out of the 103 cases of acute watery diarrhea, 83 received antibiotics that were given improperly. Additionally, 88 individuals had bloody diarrhea diagnoses, but 58 of them received the currently administered antibiotics. Amoxicillin and co-trimoxazole were the most frequently prescribed medications, with 193 (79.5%) of the 243 cases of patients receiving some form of antibiotic. Conclusion The results of the study revealed that there is inappropriate antibiotic use in acute diarrheal disease at Debre Tabor Comprehensive Specialized Hospital, which might be the cause for the overall increase in antimicrobial resistance as well as the associated costs of treatment. The finding is helpful as evidence for prescribers' inappropriate use of antibiotics for the treatment of acute diarrheal sickness.
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Dereje B, Yibabie S, Keno Z, Megersa A. Antibiotic utilization pattern in treatment of acute diarrheal diseases: the case of Hiwot Fana Specialized University Hospital, Harar, Ethiopia. J Pharm Policy Pract 2023; 16:62. [PMID: 37165415 PMCID: PMC10173574 DOI: 10.1186/s40545-023-00568-7] [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: 01/11/2023] [Accepted: 05/01/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND The vast majority of acute diarrheal diseases are self-limiting and do not require treatment on a regular basis. Empirical antibiotics should only be used to treat dysenteric and invasive bacterial diarrhea. Antibiotic misuse in the treatment of acute diarrhea is widespread in clinical practice worldwide. Hence, the purpose of this study was to examine the pattern of antibiotic use for the acute diarrheal diseases at Hiwot Fana Specialized University Hospital, Harar, Ethiopia. METHODS A retrospective, institution-based cross-sectional study was conducted to investigate the antibiotic utilization pattern for the treatment of acute diarrheal diseases from September 1 to September 30, 2022. Data were obtained retrospectively from patient cards treated for diarrheal disorders from August 1, 2021 to August 31, 2022, using standardized questionnaires, and the analysis was performed using IBM SPSS Statistics version 27. RESULTS Among 332 patients in present study, 271 (81.63%) of them received nine different types of antibiotics, with the most commonly prescribed drugs were Cotrimoxazole (30.26%), Ciprofloxacin (19.19%), and Azithromycin (17.71%). Based on the presence of blood in the stools, 14.76% of the cases were invasive bacterial in nature. Antibiotics were prescribed about 2.55 times more frequently to patients under the age of 12 than to subjects 65 and older (AOR 2.55, 95% CI 1.45-3.87). Patients who received three or more medications were 2.77 times more likely to be prescribed antibiotics (AOR 2.77, 95% CI 1.84-7.56). For every unit increase in the number of drugs prescribed, the odds of prescribing antibiotics increased by 2.44 units (COR 2.44; 95% CI 2.06-4.32). CONCLUSIONS The current study found that antibiotics were overused in both adults and children with acute diarrheal diseases at Hiwot Fana Specialized University Hospital. The number of antibiotics prescribed was significantly associated with the patient's age and the number of medications prescribed. To reduce antibiotic overuse, health professionals have to follow the national standard treatment guidelines.
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Affiliation(s)
- Beyene Dereje
- Pharmacology Department, School of Medicine, College of Medicine and Health Science, Dire Dawa University, Dire Dawa, Ethiopia.
| | - Shegaye Yibabie
- Medicine Department, School of Medicine, College of Medicine and Health Science, Dire Dawa University, Dire Dawa, Ethiopia
| | - Zenebe Keno
- Pharmacy Department, Hiwot Fana Specialized University Hospital, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Alemayehu Megersa
- Pharmacology Department, School of Medicine, College of Medicine and Health Science, Dire Dawa University, Dire Dawa, Ethiopia
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Ramlal PS, Lin J, Buckley CA, Stenström TA, Amoah ID. Determinants of diarrhoeal infections among users of shared sanitation in informal settlements in Durban, South Africa. JOURNAL OF WATER AND HEALTH 2022; 20:1517-1533. [PMID: 36308496 DOI: 10.2166/wh.2022.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Diarrhoeal disease continues to be a major health problem in many parts of the world, especially in developing countries, mainly due to the lack of access to sanitation, water, and hygienic living conditions. Identifying the determinants of diarrhoeal infections continues to be a challenge in developing countries. In this study, we ascertained the factors behind diarrhoea among inhabitants of informal settlements in the city of Durban, South Africa. Prevalence of diarrhoea in the study area varied between 7-year historical clinical records and data collected during the current study (primary data), with the primary data giving the highest monthly prevalence odds ratio (POR) up to 18.1 (±1.6)%. The main factors associated with diarrhoeal infections were open defaecation (POR = 1.8; 95% confidence interval (CI): 0.9-3.12), use of shared sanitation (POR = 1.7; 95%; CI: 1.05-2.26), and exposure to faecal matter around the homes (POR = 1.69; 95% CI: 1.25-3.10). Several other factors were also determined to be associated with diarrhoeal infections, such as hygiene practices in the communities, the non-treatment of water before use, and the presence of solid waste and faecal materials around the households. This study shows that diarrhoeal disease infections in informal settlements could be multifactorial; therefore, a multifactorial approach is needed to reduce these infections. These could include improving education on hygiene practices within the home setting as well as in public places, such as the community ablution blocks.
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Affiliation(s)
- Preshod Sewnand Ramlal
- eThekwini Municipality Health Department, 9 Archie Gumede Place, Durban 4001, South Africa E-mail: ; School of Life Sciences, University of KwaZulu-Natal, KwaZulu-Natal, Durban 4001, South Africa
| | - J Lin
- School of Life Sciences, University of KwaZulu-Natal, KwaZulu-Natal, Durban 4001, South Africa
| | - C A Buckley
- WASH Research and Development Centre, University of KwaZulu-Natal, KwaZulu-Natal, Durban 4001, South Africa; We regret to state that Prof. C. A. Buckley passed away weeks before this manuscript was submitted for publication
| | - T A Stenström
- Institute for Water and Wastewater Technology, Durban University of Technology, KwaZulu-Natal, Durban 4001, South Africa
| | - I D Amoah
- Institute for Water and Wastewater Technology, Durban University of Technology, KwaZulu-Natal, Durban 4001, South Africa
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King JJC, Powell-Jackson T, Makungu C, Hargreaves J, Goodman C. How much healthcare is wasted? A cross-sectional study of outpatient overprovision in private-for-profit and faith-based health facilities in Tanzania. Health Policy Plan 2021; 36:695-706. [PMID: 33851694 DOI: 10.1093/heapol/czab039] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 02/25/2021] [Accepted: 03/25/2021] [Indexed: 12/11/2022] Open
Abstract
Overprovision-healthcare whose harm exceeds its benefit-is of increasing concern in low- and middle-income countries, where the growth of the private-for-profit sector may amplify incentives for providing unnecessary care, and achieving universal health coverage will require efficient resource use. Measurement of overprovision has conceptual and practical challenges. We present a framework to conceptualize and measure overprovision, comparing for-profit and not-for-profit private outpatient facilities across 18 of mainland Tanzania's 22 regions. We developed a novel conceptualization of three harms of overprovision: economic (waste of resources), public health (unnecessary use of antimicrobial agents risking development of resistant organisms) and clinical (high risk of harm to individual patients). Standardized patients (SPs) visited 227 health facilities (99 for-profit and 128 not-for-profit) between May 3 and June 12, 2018, completing 909 visits and presenting 4 cases: asthma, non-malarial febrile illness, tuberculosis and upper respiratory tract infection. Tests and treatments prescribed were categorized as necessary or unnecessary, and unnecessary care was classified by type of harm(s). Fifty-three percent of 1995 drugs prescribed and 43% of 891 tests ordered were unnecessary. At the patient-visit level, 81% of SPs received unnecessary care, 67% received care harmful to public health (prescription of unnecessary antibiotics or antimalarials) and 6% received clinically harmful care. Thirteen percent of SPs were prescribed an antibiotic defined by WHO as 'Watch' (high priority for antimicrobial stewardship). Although overprovision was common in all sectors and geographical regions, clinically harmful care was more likely in for-profit than faith-based facilities and less common in urban than rural areas. Overprovision was widespread in both for-profit and not-for-profit facilities, suggesting considerable waste in the private sector, not solely driven by profit. Unnecessary antibiotic or antimalarial prescriptions are of concern for the development of antimicrobial resistance. Option for policymakers to address overprovision includes the use of strategic purchasing arrangements, provider training and patient education.
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Affiliation(s)
- Jessica J C King
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Timothy Powell-Jackson
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Christina Makungu
- Health Systems Research Group, Ifakara Health Institute, Plot 463, Kiko Avenue, Mikocheni, P.O. Box 78 373, Dar es Salaam, Tanzania
| | - James Hargreaves
- Department of Public Health and Environments, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, UK
| | - Catherine Goodman
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
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5
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Alonso-Cotoner C, Abril-Gil M, Albert-Bayo M, Mall JPG, Expósito E, González-Castro AM, Lobo B, Santos J. The Role of Purported Mucoprotectants in Dealing with Irritable Bowel Syndrome, Functional Diarrhea, and Other Chronic Diarrheal Disorders in Adults. Adv Ther 2021; 38:2054-2076. [PMID: 33738725 PMCID: PMC7971407 DOI: 10.1007/s12325-021-01676-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 02/16/2021] [Indexed: 12/12/2022]
Abstract
Chronic diarrhea is a frequent presenting symptom, both in primary care medicine and in specialized gastroenterology units. It is estimated that more than 5% of the global population suffers from chronic diarrhea. and that about 40% of these subjects are older than 60 years. The clinician is frequently faced with the need to decide which is the best therapeutic approach for these patients. While the origin of chronic diarrhea is diverse, impairment of intestinal barrier function, dysbiosis. and mucosal micro-inflammation are being increasingly recognized as underlying phenomena characterizing a variety of chronic diarrheal diseases. In addition to current pharmacological therapies, there is growing interest in alternative products such as mucoprotectants, which form a mucoadhesive film over the epithelium to reduce and protect against the development of altered intestinal permeability, dysbiosis, and mucosal micro-inflammation. This manuscript focuses on chronic diarrhea in adults, and we will review recent evidence on the ability of these natural compounds to improve symptoms associated with chronic diarrhea and to exert protective effects for the intestinal barrier.
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Affiliation(s)
- Carmen Alonso-Cotoner
- Servei de Aparell Digestiu, Vall d'Hebron Hospital Universitari, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Grup de Neuro-Inmuno-Gastroenterología, Unitat de Fisiología I Fisiopatología Digestiva, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- Universitat Autònoma de Barcelona, Facultat de Medicina, Bellaterra, Barcelona, Spain
- CIBER de Enfermedades Hepaticas y Digestivas (CIBERHED), Instituto de Salud Carlos III, Madrid, Spain
| | - Mar Abril-Gil
- Grup de Neuro-Inmuno-Gastroenterología, Unitat de Fisiología I Fisiopatología Digestiva, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Mercé Albert-Bayo
- Grup de Neuro-Inmuno-Gastroenterología, Unitat de Fisiología I Fisiopatología Digestiva, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - John-P Ganda Mall
- Grup de Neuro-Inmuno-Gastroenterología, Unitat de Fisiología I Fisiopatología Digestiva, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Elba Expósito
- Grup de Neuro-Inmuno-Gastroenterología, Unitat de Fisiología I Fisiopatología Digestiva, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Ana M González-Castro
- Grup de Neuro-Inmuno-Gastroenterología, Unitat de Fisiología I Fisiopatología Digestiva, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Beatriz Lobo
- Servei de Aparell Digestiu, Vall d'Hebron Hospital Universitari, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
- Grup de Neuro-Inmuno-Gastroenterología, Unitat de Fisiología I Fisiopatología Digestiva, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.
- Universitat Autònoma de Barcelona, Facultat de Medicina, Bellaterra, Barcelona, Spain.
| | - Javier Santos
- Servei de Aparell Digestiu, Vall d'Hebron Hospital Universitari, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
- Grup de Neuro-Inmuno-Gastroenterología, Unitat de Fisiología I Fisiopatología Digestiva, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.
- Universitat Autònoma de Barcelona, Facultat de Medicina, Bellaterra, Barcelona, Spain.
- CIBER de Enfermedades Hepaticas y Digestivas (CIBERHED), Instituto de Salud Carlos III, Madrid, Spain.
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6
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Wang J, Wang M, Zhao L, Liu L, Wang X, Fan Z. Investigating the efficacy and safety of mineral smectite granules on wound healing. Exp Ther Med 2020; 21:160. [PMID: 33456527 PMCID: PMC7792489 DOI: 10.3892/etm.2020.9591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 09/08/2020] [Indexed: 11/06/2022] Open
Abstract
Mineral smectite granules have traditionally been used for diarrhea and gastrointestinal bleeding; however, the wound healing ability of mineral smectite granules has not been investigated in detail. Therefore, the present study explored the efficacy and safety of mineral smectite granules on wound healing. An excision wound rat model was established. The experimental group was treated with smectite granules, the positive control group was treated with starch and the blank control group was left untreated. Wound closure rates, wound healing times and histopathological analysis were compared among the three groups. The mechanism underlying the effects of mineral smectite granules on wound healing was assessed by performing picrosirius red staining and immunohistochemical staining and measuring hydroxyproline content. Based on wound closure rates, wound healing times and histopathological analysis, the results indicated that rats treated with smectite granules displayed increased wound healing efficacy compared with the other two groups. Investigation of the underlying mechanism suggested that mineral smectite granules could promote wound healing by inducing collagen fiber synthesis and increasing the number of neovessels. The present study indicated the efficacy and safety of mineral smectite granules on wound healing and provided a theoretical basis for its application in a clinical setting.
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Affiliation(s)
- Jiankun Wang
- Digestive Endoscopy Department and General Surgery Department, The First Affiliated Hospital with Nanjing Medical University and Jiangsu Province Hospital, Nanjing, Jiangsu 210029, P.R. China
| | - Min Wang
- Digestive Endoscopy Department and General Surgery Department, The First Affiliated Hospital with Nanjing Medical University and Jiangsu Province Hospital, Nanjing, Jiangsu 210029, P.R. China
| | - Lili Zhao
- Digestive Endoscopy Department and General Surgery Department, The First Affiliated Hospital with Nanjing Medical University and Jiangsu Province Hospital, Nanjing, Jiangsu 210029, P.R. China
| | - Li Liu
- Digestive Endoscopy Department and General Surgery Department, The First Affiliated Hospital with Nanjing Medical University and Jiangsu Province Hospital, Nanjing, Jiangsu 210029, P.R. China
| | - Xiang Wang
- Digestive Endoscopy Department and General Surgery Department, The First Affiliated Hospital with Nanjing Medical University and Jiangsu Province Hospital, Nanjing, Jiangsu 210029, P.R. China
| | - Zhining Fan
- Digestive Endoscopy Department and General Surgery Department, The First Affiliated Hospital with Nanjing Medical University and Jiangsu Province Hospital, Nanjing, Jiangsu 210029, P.R. China
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7
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Wushouer H, Zhou Y, Zhang X, Fu M, Fan D, Shi L, Guan X. Secular trend analysis of antibiotic utilisation in China's hospitals 2011-2018, a retrospective analysis of procurement data. Antimicrob Resist Infect Control 2020; 9:53. [PMID: 32295639 PMCID: PMC7160954 DOI: 10.1186/s13756-020-00709-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 03/24/2020] [Indexed: 12/23/2022] Open
Abstract
Background This study was aimed to explore the secular trends of antibiotic utilisation in China’s hospitals over an 8-year period. Methods We retrospectively analysed aggregated monthly antibiotic procurement data of 586 hospitals from 28 provinces in China from January 2011 to December 2018. Information including generic name, procurement amount, dosage form, strength, the route of administration, and geographical data were collected. Population weighted antibiotic utilisation were expressed in DDD per 1000 inhabitants per day (DID). WHO’s ‘Access, Watch, Reserve’ categorization was also adopted to analyse antibiotic utilisation. Results Between 2011 and 2018, total antibiotic utlisation in China’s hospitals increased by 39.6% (from 4.8 DID in 2010 to 6.7 DID in 2018). Antibiotic utilisation was stable or had moderately decreased in 13 provinces, while in the other 15 provinces they had substantially increased. Cephalosporins were the most consumed antibiotics, accounting for 26.9% of the total antibiotic utilisation (1.8 DID/6.7 DID). In 2018, antibiotics in the Access category comprised 19.4% of the total utilisation (1.3 DID/6.7 DID), where antibiotics in the Watch category comprised the largest proportion of 71.6% (4.8 DID/6.7 DID). Population-weighted antibiotic utlisation was greater in secondary hospitals than in tertiary hospitals (7.3 DID vs 6.6 DID). The utilisation of oral forms was almost two times the amount of parenteral forms in secondary hospitals, whereas in tertiary hospitals the amounts were about the same. Conclusions Despite efforts have been made towards restricting antibiotic use by the Chinese government, antibiotic utilisation demonstrated an upward trend after the medical reform. The increase of last-resort antibiotics raises serious concern for public health. Current patterns of antibiotic utilisation demonstrated that gaps are existed towards the global target set up by the WHO. To better facilitate proper antibiotic use, more efforts are needed to explore the appropriateness of antibiotic use at the individual level.
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Affiliation(s)
- Haishaerjiang Wushouer
- Center for Strategic Studies, Chinese Academy of Engineering, No.2 Bingjiaokou HuTong, Xicheng District, Beijing, 100088, China.,School of Medicine, Tsinghua University, No.30 Shuangqing Road, Haidian District, Beijing, 100084, China.,International Research Center for Medicinal Administration (IRCMA), Peking University, No.38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Yue Zhou
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, No.38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Xi Zhang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, No.38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Mengyuan Fu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, No.38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Daiming Fan
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Air Force Military Medical University, No. 15 Changlexi Road, Xincheng District, Xi'an, 710032, China
| | - Luwen Shi
- International Research Center for Medicinal Administration (IRCMA), Peking University, No.38 Xueyuan Road, Haidian District, Beijing, 100191, China. .,Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, No.38 Xueyuan Road, Haidian District, Beijing, 100191, China.
| | - Xiaodong Guan
- International Research Center for Medicinal Administration (IRCMA), Peking University, No.38 Xueyuan Road, Haidian District, Beijing, 100191, China. .,Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, No.38 Xueyuan Road, Haidian District, Beijing, 100191, China. .,Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, Boston, MA, 02215, USA.
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Wang S, Yang F, Li D, Qin J, Hou W, Jiang L, Kong M, Wu Y, Zhang Y, Zhao F, Fang Y, Miao Y, Xu L, Chen J, Bao Z, Olszewski MA, Zhao H, Zhang Y. Clinical application of a multiplex genetic pathogen detection system remaps the aetiology of diarrhoeal infections in Shanghai. Gut Pathog 2018; 10:37. [PMID: 30214488 PMCID: PMC6134694 DOI: 10.1186/s13099-018-0264-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 08/27/2018] [Indexed: 01/25/2023] Open
Abstract
Background Culture-based diagnostic methods cannot achieve rapid and precise diagnoses for the identification of multiple diarrhoeal pathogens (DPs). A high-throughput multiplex genetic detection system (HMGS) was adapted and evaluated for the simultaneous identification and differentiation of infectious DPs and a broad analysis of DP infection aetiology. Results DP-HMGS was highly sensitive and specific for DP detection compared with culture-based techniques and was similar to singleplex real-time PCR. The uniform level of sensitivity of DP-HMGS for all DPs allowed us to remap the aetiology of acute diarrhoeal infections in Shanghai, correcting incidences of massively underdiagnosed DP species with accuracy approaching that of sequencing-based methods. The most frequent DPs were enteropathogenic Escherichia coli, rotavirus and Campylobacter jejuni. DP-HMGS detected two additional causes of infectious diarrhoea that were previously missed by routine culture-based methods: enterohemorrhagic E. coli and Yersinia enterocolitica. We demonstrated the age dependence of specific DP distributions, especially the distributions of rotavirus, intestinal adenovirus and Clostridium difficile in paediatric patients as well as those of dominant bacterial infections in adults, with a distinct “top 3” pattern for each age group. Finally, the multiplexing capability and high sensitivity of DP-HMGS allowed the detection of infections co-induced by multiple pathogens (approximately 1/3 of the cases), with some DPs preferentially co-occurring as infectious agents. Conclusions DP-HMGS has been shown to be a rapid, specific, sensitive and appropriate method for the simultaneous screening/detection of polymicrobial DP infections in faecal specimens. Widespread use of DP-HMGS is likely to advance routine diagnostic and clinical studies on the aetiology of acute diarrhoea. Electronic supplementary material The online version of this article (10.1186/s13099-018-0264-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shiwen Wang
- 1Department of Laboratory Medicine, Huadong Hospital, Affiliated with Fudan University, Shanghai, 200040 China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, 200040 China.,3Research Center on Aging and Medicine, Fudan University, Shanghai, 200040 China
| | - Feng Yang
- 1Department of Laboratory Medicine, Huadong Hospital, Affiliated with Fudan University, Shanghai, 200040 China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, 200040 China.,3Research Center on Aging and Medicine, Fudan University, Shanghai, 200040 China
| | - Dong Li
- 4Department of Clinical Laboratory, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065 China
| | - Juanxiu Qin
- 5Department of Laboratory Medicine, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200135 China
| | - Weiwei Hou
- 4Department of Clinical Laboratory, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065 China
| | - Lian Jiang
- 4Department of Clinical Laboratory, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065 China
| | - Mimi Kong
- 6Ningbo HEALTH Gene Technologies Co., Ltd., Ningbo, China
| | - Yong Wu
- 6Ningbo HEALTH Gene Technologies Co., Ltd., Ningbo, China
| | - Yuchen Zhang
- 6Ningbo HEALTH Gene Technologies Co., Ltd., Ningbo, China
| | - Fuju Zhao
- 1Department of Laboratory Medicine, Huadong Hospital, Affiliated with Fudan University, Shanghai, 200040 China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, 200040 China.,3Research Center on Aging and Medicine, Fudan University, Shanghai, 200040 China
| | - Yi Fang
- 1Department of Laboratory Medicine, Huadong Hospital, Affiliated with Fudan University, Shanghai, 200040 China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, 200040 China.,3Research Center on Aging and Medicine, Fudan University, Shanghai, 200040 China
| | - Yingxin Miao
- 1Department of Laboratory Medicine, Huadong Hospital, Affiliated with Fudan University, Shanghai, 200040 China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, 200040 China.,3Research Center on Aging and Medicine, Fudan University, Shanghai, 200040 China
| | - Lingli Xu
- Shanghai ABSciex Analytical Instrument Trading Co., Ltd., Shanghai, China
| | - Jie Chen
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, 200040 China.,3Research Center on Aging and Medicine, Fudan University, Shanghai, 200040 China.,8Department of Gastroenterology, Gerontology Institute of Shanghai, Affiliated with Huadong Hospital, Affiliated with Fudan University, Shanghai, 200040 China
| | - Zhijun Bao
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, 200040 China.,3Research Center on Aging and Medicine, Fudan University, Shanghai, 200040 China.,8Department of Gastroenterology, Gerontology Institute of Shanghai, Affiliated with Huadong Hospital, Affiliated with Fudan University, Shanghai, 200040 China
| | - Michal A Olszewski
- 9Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System and Research Service, VA Ann Arbor Health Systems, Ann Arbor, MI USA
| | - Hu Zhao
- 1Department of Laboratory Medicine, Huadong Hospital, Affiliated with Fudan University, Shanghai, 200040 China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, 200040 China.,3Research Center on Aging and Medicine, Fudan University, Shanghai, 200040 China
| | - Yanmei Zhang
- 1Department of Laboratory Medicine, Huadong Hospital, Affiliated with Fudan University, Shanghai, 200040 China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, 200040 China.,3Research Center on Aging and Medicine, Fudan University, Shanghai, 200040 China
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9
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Abstract
BACKGROUND As mortality secondary to acute infectious diarrhoea has decreased worldwide, the focus shifts to adjuvant therapies to lessen the burden of disease. Smectite, a medicinal clay, could offer a complementary intervention to reduce the duration of diarrhoea. OBJECTIVES To assess the effects of smectite for treating acute infectious diarrhoea in children. SEARCH METHODS We searched the Cochrane Infectious Diseases Group Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Pubmed), Embase (Ovid), LILACS, reference lists from studies and previous reviews, and conference abstracts, up to 27 June 2017. SELECTION CRITERIA Randomized and quasi-randomized trials comparing smectite to a control group in children aged one month to 18 years old with acute infectious diarrhoea. DATA COLLECTION AND ANALYSIS Two review authors independently screened abstracts and the full texts for inclusion, extracted data, and assessed risk of bias. Our primary outcomes were duration of diarrhoea and clinical resolution at day 3. We summarized continuous outcomes using mean differences (MD) and dichotomous outcomes using risk ratios (RR), with 95% confidence intervals (CI). Where appropriate, we pooled data in meta-analyses and assessed heterogeneity. We explored publication bias using a funnel plot. MAIN RESULTS Eighteen trials with 2616 children met our inclusion criteria. Studies were conducted in both ambulatory and in-hospital settings, and in both high-income and low- or middle-income countries. Most studies included children with rotavirus infections, and half included breastfed children.Smectite may reduce the duration of diarrhoea by approximately a day (MD -24.38 hours, 95% CI -30.91 to -17.85; 14 studies; 2209 children; low-certainty evidence); may increase clinical resolution at day 3 (risk ratio (RR) 2.10, 95% CI 1.30 to 3.39; 5 trials; 312 children; low-certainty evidence); and may reduce stool output (MD -11.37, 95% CI -21.94 to -0.79; 3 studies; 634 children; low-certainty evidence).We are uncertain whether smectite reduces stool frequency, measured as depositions per day (MD -1.33, 95% CI -2.28 to -0.38; 3 studies; 954 children; very low-certainty evidence). There was no evidence of an effect on need for hospitalization (RR 0.93, 95% CI 0.75 to 1.15; 2 studies; 885 children; low-certainty evidence) and need for intravenous rehydration (RR 0.77, 95% CI 0.54 to 1.11; 1 study; 81 children; moderate-certainty evidence). The most frequently reported side effect was constipation, which did not differ between groups (RR 4.71, 95% CI 0.56 to 39.19; 2 studies; 128 children; low-certainty evidence). No deaths or serious adverse effects were reported. AUTHORS' CONCLUSIONS Based on low-certainty evidence, smectite used as an adjuvant to rehydration therapy may reduce the duration of diarrhoea in children with acute infectious diarrhoea by a day; may increase cure rate by day 3; and may reduce stool output, but has no effect on hospitalization rates or need for intravenous therapy.
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Affiliation(s)
- Giordano Pérez‐Gaxiola
- Hospital Pediátrico de SinaloaEvidence‐Based Medicine DepartmentBlvd. Constitución s/n, Col. Almada. 80200CuliacánMexico80200
| | - Carlos A Cuello‐García
- McMaster UniversityDepartment of Health Research Methods, Evidence, and Impact1280 Main Street West. HSC‐2CHamiltonCanadaL8S 4K1
| | - Ivan D Florez
- University of AntioquiaDepartment of PediatricsMedellinColombia
| | - Víctor M Pérez‐Pico
- Hospital Pediátrico de SinaloaBlvd. Constitución s/n, Col. Almada. 80200CuliacánMexicoC.P.80200
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10
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Assessment of Antibiotic Utilization Pattern in Treatment of Acute Diarrhoea Diseases in Bishoftu General Hospital, Oromia Ethiopia. Adv Med 2018; 2018:2376825. [PMID: 29854855 PMCID: PMC5954943 DOI: 10.1155/2018/2376825] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 02/26/2018] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Majority of acute diarrhoeal diseases are self-limiting and do not require routine treatment. Treatment with empirical antimicrobials is recommended only for dysenteric and invasive bacterial diarrhoea. Irrational use of antibiotics in treatment of acute diarrhoea is common in clinical practice worldwide. This study was carried out to assess the pattern of antibiotic use for acute diarrhoeal diseases in Bishoftu General Hospital, East Shewa Ethiopia. METHODS AND MATERIALS Institution based cross-sectional study was conducted from April 1 to April 30, 2016. Data were collected retrospectively from patients treated for diarrhoeal diseases from January 2015 to December 2015 using structured questionnaires and entered into SPSS (IBM 20) and descriptive statistics was carried out. RESULTS Among the 303 patients, 51.2% were males and 48.8% were females. Of them, 62% were children under five years. Two hundred sixty three (86.8%) patients received eight different types of antibiotics and cotrimoxazole (178 patients, 58.7%) was the most prescribed antibiotics, followed by ciprofloxacin (33, 10.9%) and amoxicillin (14, 4.6%). Based on the presence of blood in stools, 14.5% of cases were of invasive bacterial type. According to the recommendations of WHO, the rate of overuse of antibiotics was 72.3%. CONCLUSION This study revealed that there was high overuse of antibiotics for both adults and children under five with acute diarrhoea in Bishoftu General Hospital. And Cotrimoxazole was the most prescribed antibiotic.
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11
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Brownlee S, Chalkidou K, Doust J, Elshaug AG, Glasziou P, Heath I, Nagpal S, Saini V, Srivastava D, Chalmers K, Korenstein D. Evidence for overuse of medical services around the world. Lancet 2017; 390:156-168. [PMID: 28077234 PMCID: PMC5708862 DOI: 10.1016/s0140-6736(16)32585-5] [Citation(s) in RCA: 535] [Impact Index Per Article: 76.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 06/29/2016] [Accepted: 07/18/2016] [Indexed: 12/17/2022]
Abstract
Overuse, which is defined as the provision of medical services that are more likely to cause harm than good, is a pervasive problem. Direct measurement of overuse through documentation of delivery of inappropriate services is challenging given the difficulty of defining appropriate care for patients with individual preferences and needs; overuse can also be measured indirectly through examination of unwarranted geographical variations in prevalence of procedures and care intensity. Despite the challenges, the high prevalence of overuse is well documented in high-income countries across a wide range of services and is increasingly recognised in low-income countries. Overuse of unneeded services can harm patients physically and psychologically, and can harm health systems by wasting resources and deflecting investments in both public health and social spending, which is known to contribute to health. Although harms from overuse have not been well quantified and trends have not been well described, overuse is likely to be increasing worldwide.
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Affiliation(s)
- Shannon Brownlee
- Lown Institute, Brookline, MA, USA; Department of Health Policy, Harvard T.H. Chan School of Public Health, Cambridge, MA, USA.
| | - Kalipso Chalkidou
- Institute for Global Health Innovation, Imperial College, London, UK
| | - Jenny Doust
- Center for Research in Evidence-Based Practice, Bond University, Gold Coast, QLD, Australia
| | - Adam G Elshaug
- Lown Institute, Brookline, MA, USA; Menzies Centre for Health Policy, School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Paul Glasziou
- Center for Research in Evidence-Based Practice, Bond University, Gold Coast, QLD, Australia
| | - Iona Heath
- Royal College of General Practitioners, London, UK
| | | | | | - Divya Srivastava
- LSE Health, London School of Economics and Political Science, London, UK
| | - Kelsey Chalmers
- Menzies Centre for Health Policy, School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
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Evaluation of an Assay Based On Multiple Detection Temperature Technique for Simultaneous Detection of Viral Gastroenteritis-Causing Pathogens. Jundishapur J Microbiol 2017. [DOI: 10.5812/jjm.43548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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13
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Liu X, Tong X, Jin L, Ha M, Cao F, Xu F, Chi Y, Zhang D, Xu L. Prospective study on the overuse of blood test-guided antibiotics on patients with acute diarrhea in primary hospitals of China. Patient Prefer Adherence 2017; 11:537-545. [PMID: 28352160 PMCID: PMC5359135 DOI: 10.2147/ppa.s123294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Overuse with antibiotics in the treatment of infectious diseases has become a central focus of public health over the years. The aim of this study was to provide an up-to-date evaluation of the blood test-guided antibiotic use on patients with acute diarrhea in primary hospitals of China. MATERIALS AND METHODS A cross-sectional survey was conducted on 330 patients with acute diarrhea in Shanghai, People's Republic of China, from March 2013 to February 2016. These patients were treated with or without antibiotics based on the results of their blood tests, including examinations of C-reactive protein (CRP), white blood cells (WBC), and the percentage of neutrophils (Neu%). The infection types, which included bacterial, viral, and combination diarrhea, were determined by microbiological culture methods. Antibiotics used in non-bacterial diarrhea patients were considered misused and overused. RESULTS There were significant overall differences in the clinical characteristics and blood tests between patients with diarrhea with a bacterial infection and patients with other types of infections. The patients were divided into four grading groups (0-3) according to the number of the positive results from three blood testes (CRP, WBC, and Neu%). The misuse rates of antibiotics in each group (0-3) were 81.3%, 71.1%, 72.4%, and 64.9%, respectively. CONCLUSION In this prospective study, the current diagnostic criteria (CRP, WBC, and Neu%) based on blood tests are not reliable in diagnosing bacterial diarrhea or guiding antibiotics use. To limit antibiotic overuse, a rapid and accurate differentiation of bacterial diarrhea from other types of diarrhea is pivotal.
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Affiliation(s)
| | - Xueke Tong
- Department of Infectious Diseases, Shanghai Gongli Hospital, The Second Military Medical University
| | - Liyin Jin
- Department of Laboratory, Jinyang Community Health Service Center, Pudong New District
| | - Minghao Ha
- Department of Infectious Diseases and Hepatology, The Affiliated Seventh People’s Hospital of Shanghai University of Traditional Chinese Medicine
| | - Feng Cao
- Department of Preventive Care, Shanghai Gongli Hospital, The Second Military Medical University, Shanghai, People’s Republic of China
| | | | | | - Denghai Zhang
- Department of Laboratory
- Correspondence: Limin Xu; Denghai Zhang, Department of Clinical Laboratory, Shanghai Gongli Hospital, The Second Military Medical University, 219 Miaopu Rd, Pudong New Area, Shanghai 200135, People’s Republic of China, Tel +86 21 5885 8730 ext 5236; 5177, Fax +86 21 5821 9029, Email ;
| | - Limin Xu
- Department of Laboratory
- Correspondence: Limin Xu; Denghai Zhang, Department of Clinical Laboratory, Shanghai Gongli Hospital, The Second Military Medical University, 219 Miaopu Rd, Pudong New Area, Shanghai 200135, People’s Republic of China, Tel +86 21 5885 8730 ext 5236; 5177, Fax +86 21 5821 9029, Email ;
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14
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Joseph N, Suvarna P, Hariharan Bharadwaj S, Dhanush KS, Raeesa F, Mohamed Jasir KK, Joseph N, Kotian SM, Rai S. Prevalence, risk factors and treatment practices in diarrhoeal diseases in south India. Environ Health Prev Med 2016; 21:248-57. [PMID: 26943650 DOI: 10.1007/s12199-016-0521-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 02/11/2016] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVES This study was done to determine the risk factors, management practices and awareness about diarrhoea. METHODS It was a cross sectional study done in a semi urban and rural areas of South Canara district of India in February 2013. A total of 167 households (575 study population) chosen systematic randomly were visited and one adult member in each house was interviewed. The houses were also inspected to assess the living conditions. RESULTS Mean age of study population was 31.1 ± 20.2 years. The period prevalence of diarrhoea was 69 (12 %). Commonest associated symptoms in cases of diarrhoea were fever 30 (43.4 %) followed by abdominal cramps 29 (42 %). Nearly half of the cases with diarrhoea 34 (49.3 %) did not take any medications. Commonest treatment taken was allopathic medicines 26 (37.8 %) followed by home remedies 8 (22.9 %). Age ≤10 years (p < 0.001) was associated with risk of developing diarrhoea using binary logistic regression analysis. Among the 167 participants, awareness level about the disease was poor among 16 (9.6 %) and moderate among 149 (89.2 % participants). Awareness level was more among females (p = 0.001) and literate participants (p = 0.013). One hundred and sixteen (69.5 %) participants were not aware of any sign or symptom of dehydration other than loose stools. Majority of the participants 138 (82.6 %) preferred home remedies as the initial management of diarrhoea. Misconception about fluid restriction in diarrhoea was stated by 12(7.2 %) participants. CONCLUSION Public education program on proper feeding and management practices is required to address the various issues identified and for containment of diarrhoea cases in future.
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Affiliation(s)
- Nitin Joseph
- Department of Community Medicine, Kasturba Medical College, Manipal University, Light House Hill Road, Mangalore, 575001, India.
| | - Punya Suvarna
- Kasturba Medical College, Manipal University, Light House Hill Road, Mangalore, India
| | - S Hariharan Bharadwaj
- Kasturba Medical College, Manipal University, Light House Hill Road, Mangalore, India
| | - K S Dhanush
- Kasturba Medical College, Manipal University, Light House Hill Road, Mangalore, India
| | - Fathima Raeesa
- Kasturba Medical College, Manipal University, Light House Hill Road, Mangalore, India
| | - K K Mohamed Jasir
- Kasturba Medical College, Manipal University, Light House Hill Road, Mangalore, India
| | | | - Shashidhar M Kotian
- Department of Community Medicine, Kasturba Medical College, Manipal University, Light House Hill Road, Mangalore, 575001, India
| | - Sharada Rai
- Department of Pathology, Kasturba Medical College, Manipal University, Light House Hill Road, Mangalore, India
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Rocha-Castro J, Kronbauer K, Dallé J, Jimenez MF, Riche CW, Santiago JA, Antonello VS. Characteristics of bacterial acute diarrhea among women. Int J Gynaecol Obstet 2015; 132:302-4. [PMID: 26674319 DOI: 10.1016/j.ijgo.2015.07.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 07/14/2015] [Accepted: 11/17/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To describe the clinical and microbiological characteristics of women presenting with acute gastroenteritis due to infection with Salmonella spp. or Shigella spp. METHODS A cross-sectional retrospective study was conducted using data for patients with specimens positive for Shigella spp. and Salmonella spp. attending two major women's hospitals in Porto Alegre, Brazil, between January 2003 and July 2014. Women were included if they had symptoms compatible with bacterial acute diarrhea. Isolates were evaluated to determine antimicrobial susceptibility and patient clinical profile. RESULTS Among 45 eligible patients, Salmonella spp. was identified in 32 (71%) and Shigella spp. in 13 (29%). The highest antimicrobial sensitivity rates were observed for ciprofloxacin and ceftriaxone (n=44, 98% for both) whereas the greatest resistance rate was seen for ampicillin (n=20, 44%). Seven (16%) of the women were pregnant. CONCLUSION Ciprofloxacin, ceftriaxone, and sulfamethoxazole/trimethoprim are suitable choices for the treatment of bacterial acute diarrhea. However, the maternal and fetal safety profile of prescribed medications should be considered when treating pregnant patients.
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Affiliation(s)
- Juliane Rocha-Castro
- Department of Gynecology and Obstetrics, Hospital Fêmina, Porto Alegre, Brazil; Post-Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Karoline Kronbauer
- Department of Prevention and Infection Control, Hospital Fêmina, Porto Alegre, Brazil
| | - Jessica Dallé
- Department of Prevention and Infection Control, Hospital Fêmina, Porto Alegre, Brazil
| | - Mirela F Jimenez
- Department of Gynecology and Obstetrics, Hospital Fêmina, Porto Alegre, Brazil; Post-Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil; Department of Gynecology and Obstetrics, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Cezar W Riche
- Department of Prevention and Infection Control, Hospital Nossa Senhora da Conceição, Porto Alegre, Brazil
| | - Jorge A Santiago
- Department of Microbiology, Hospital Nossa Senhora da Conceição, Porto Alegre, Brazil
| | - Vicente S Antonello
- Department of Prevention and Infection Control, Hospital Fêmina, Porto Alegre, Brazil.
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16
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Pérez-Gaxiola G, Cuello-García CA, Pérez-Pico V. Smectite for acute infectious diarrhoea in children. Hippokratia 2015. [DOI: 10.1002/14651858.cd011526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Giordano Pérez-Gaxiola
- Hospital Pediátrico de Sinaloa; Evidence-Based Practice Department; Blvd. Constitución s/n, Col. Almada. 80200 Culiacán Sinaloa Mexico 80200
| | - Carlos A Cuello-García
- McMaster University Health Sciences Centre; Clinical Epidemiology and Biostatistics; 1280 Main Street West Hamilton ON Canada L8S 4K1
| | - Victor Pérez-Pico
- Medical Arbitration Committee of the State of Sinaloa; Calle Epitacio Osuna y Av. Culiacán, Sinaloa Rodolfo G. Robles no. 277, Col. Jorge Almada Culiacán Sinaloa Mexico C.P.80200
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Van Boeckel TP, Gandra S, Ashok A, Caudron Q, Grenfell BT, Levin SA, Laxminarayan R. Global antibiotic consumption 2000 to 2010: an analysis of national pharmaceutical sales data. THE LANCET. INFECTIOUS DISEASES 2014; 14:742-750. [PMID: 25022435 DOI: 10.1016/s1473-3099(14)70780-7] [Citation(s) in RCA: 1304] [Impact Index Per Article: 130.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Antibiotic drug consumption is a major driver of antibiotic resistance. Variations in antibiotic resistance across countries are attributable, in part, to different volumes and patterns for antibiotic consumption. We aimed to assess variations in consumption to assist monitoring of the rise of resistance and development of rational-use policies and to provide a baseline for future assessment. METHODS With use of sales data for retail and hospital pharmacies from the IMS Health MIDAS database, we reviewed trends for consumption of standard units of antibiotics between 2000 and 2010 for 71 countries. We used compound annual growth rates to assess temporal differences in consumption for each country and Fourier series and regression methods to assess seasonal differences in consumption in 63 of the countries. FINDINGS Between 2000 and 2010, consumption of antibiotic drugs increased by 36% (from 54 083 964 813 standard units to 73 620 748 816 standard units). Brazil, Russia, India, China, and South Africa accounted for 76% of this increase. In most countries, antibiotic consumption varied significantly with season. There was increased consumption of carbapenems (45%) and polymixins (13%), two last-resort classes of antibiotic drugs. INTERPRETATION The rise of antibiotic consumption and the increase in use of last-resort antibiotic drugs raises serious concerns for public health. Appropriate use of antibiotics in developing countries should be encouraged. However, to prevent a striking rise in resistance in low-income and middle-income countries with large populations and to preserve antibiotic efficacy worldwide, programmes that promote rational use through coordinated efforts by the international community should be a priority. FUNDING US Department of Homeland Security, Bill & Melinda Gates Foundation, US National Institutes of Health, Princeton Grand Challenges Program.
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Affiliation(s)
- Thomas P Van Boeckel
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA
| | - Sumanth Gandra
- Center for Disease Dynamics, Economics, and Policy, Washington, DC, USA
| | - Ashvin Ashok
- Center for Disease Dynamics, Economics, and Policy, Washington, DC, USA
| | - Quentin Caudron
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA
| | - Bryan T Grenfell
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA; Princeton Environmental Institute, Princeton, NJ, USA; Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | - Simon A Levin
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA; Princeton Environmental Institute, Princeton, NJ, USA; Beijer Institute of Ecological Economics, Stockholm, Sweden
| | - Ramanan Laxminarayan
- Center for Disease Dynamics, Economics, and Policy, Washington, DC, USA; Princeton Environmental Institute, Princeton, NJ, USA; Public Health Foundation of India, New Delhi, India.
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