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Ngyedu EK, Efui Acolatse JE, Akafity G, Incoom R, Rauf A, Seaton RA, Sneddon J, Cameron E, Watson M, Wanat M, Godman B, Kurdi A. Response to: 'letter to the editor: "A multifaceted strategy is needed to limit the over-the-counter sale of antimicrobials "'. Expert Rev Anti Infect Ther 2024; 22:603-605. [PMID: 38576383 DOI: 10.1080/14787210.2024.2337824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 03/18/2024] [Indexed: 04/06/2024]
Affiliation(s)
- Eric Kofi Ngyedu
- Cape Coast Teaching Hospital (CCTH), Oral and Maxillofacial Department, Cape Coast, Ghana
| | - Joseph Elikem Efui Acolatse
- Cape Coast Teaching Hospital (CCTH), Pharmacy Directorate, Cape Coast, Ghana
- Cape Coast Teaching Hospital (CCTH), Research and Development Unit, Cape Coast, Ghana
| | - George Akafity
- Cape Coast Teaching Hospital (CCTH), Research and Development Unit, Cape Coast, Ghana
| | - Robert Incoom
- Cape Coast Teaching Hospital (CCTH), Pharmacy Directorate, Cape Coast, Ghana
| | | | - R Andrew Seaton
- Infectious Unit, Queen Elizabeth University Hospital, Glasgow, UK
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | | | - Elaine Cameron
- School of Psychology, University of Stirling, Stirling, UK
| | - Margaret Watson
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK
| | - Marta Wanat
- Nuffield Department of Primary Care Health Sciences, University of Oxford Radcliffe Observatory Quarter, Oxford, UK
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK
- Centre of Medical and Bio allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Department of Clinical Pharmacy, College of Pharmacy, Hawler Medical University, Erbil, Iraq
- College of Pharmacy, Al-Kitab University, Kirkuk, Iraq
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Alvsåker LKT, Stensen MF, Mjelle AB, Hunskaar S, Rebnord IK. Outcomes of antibiotic treatment for respiratory infections in children an observational study in primary care. Scand J Prim Health Care 2024; 42:237-245. [PMID: 38265029 PMCID: PMC11003315 DOI: 10.1080/02813432.2024.2305929] [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: 07/01/2023] [Accepted: 01/04/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Antibiotic resistance is an increasing global threat, accelerated by both misuse and overuse of antibiotics. Most antibiotics to humans are prescribed in primary care, commonly for respiratory symptoms, and there is a need for research on the usage of and outcomes after antibiotic treatment to counteract antibiotic resistance. OBJECTIVE To evaluate symptom duration, treatment length, and adverse events of antibiotic treatment in children. DESIGN AND SETTING Observational study at four out-of-hours services and one paediatric emergency clinic in Norwegian emergency primary care. SUBJECTS 266 children aged 0 to 6 years with fever or respiratory symptoms. MAIN OUTCOME MEASURES Duration of symptoms and absenteeism from kindergarten/school, treatment length, and reported adverse events. RESULTS There were no differences in duration of symptoms, fever or absenteeism when comparing the groups prescribed (30.8%) and not prescribed (69.2%) antibiotics. This lack of difference remained when analysing the subgroup with otitis media.In the group prescribed antibiotics, 84.5% of parents reported giving antibiotics for 5-7 days, and 50.7% reported no difficulties. Adverse events of antibiotics were reported in 42.3% of the cases, the vast majority being gastrointestinal disturbances. CONCLUSION Children with fever or respiratory symptoms experience similar duration of symptoms and absenteeism regardless of antibiotic treatment. A substantial number of parents reported adverse events when the child received antibiotics. Several parents experienced additional difficulties with the treatment, some ending treatment within day 4. TRIAL REGISTRATION NUMBER NCT02496559; Results.
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Affiliation(s)
| | | | - Anders Batman Mjelle
- Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway
| | - Steinar Hunskaar
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Ingrid Keilegavlen Rebnord
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Ahmed N, Umar F, Saleem F, Iqbal Q, Haider S, Bashaar M. Treatment Outcomes of Severe Acute Malnutrition and Its Determinants Among Paediatric Patients in Quetta City, Pakistan. J Multidiscip Healthc 2023; 16:2809-2821. [PMID: 37753341 PMCID: PMC10518357 DOI: 10.2147/jmdh.s428873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 09/11/2023] [Indexed: 09/28/2023] Open
Abstract
Purpose Severe acute malnutrition (SAM) is the most prevalent reason for admission to a paediatric unit, and it is a leading cause of mortality in many countries, including Pakistan. This study aimed to assess treatment outcomes and associated factors among children aged 6-59 months with severe acute malnutrition. Patients and Methods A retrospective cohort study was conducted at the Outpatient Therapeutic Feeding Program Centre established at the Sheikh Khalifa bin Zayed Al Nahyan Medical Complex Quetta. Out of 225 patients' records, data from 182 (80.8%) records were analysed based on the inclusion criteria. The SAM logbook was used as a source of data. Predictors of treatment outcomes were identified by applying a regression model with p<0.05 taken as significant. Results One hundred and twenty (65.9%) of the children were diagnosed with SAM, while the remaining 34.1% had Moderate Acute Malnutrition. Ninety-five (52.2%) children were included in the marasmus, while 47.8% were included in the Kwashiorkor cohort. The recovery rate was 68.6%; 22.5% were non-responsive, 11% defaulted on the program, and 3.5% died during management. The multivariate logistic regression identified the presence of diarrhea and the use of amoxicillin as significant prognosticators of treatment outcomes. Consequently, the odds of recovery on SAM among children with diarrhea [AOR = 0.60, 95% CI: (0.35-0.75)] were lower than those without diarrhea. Likewise, children on PO amoxicillin had higher chances of recovery [AOR = 2.45, 95% CI: (2.21-4.68)]. Conclusion This study found that the recovery rate among children treated for SAM was poor based on the established Sphere Standard recommendation. In addition to community-based educational campaigns, capacity enhancement of OTP and frequent monitoring of services as well as program evaluation based on the management protocol is recommended to reduce the frequency of SAM among children.
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Affiliation(s)
- Nazir Ahmed
- Faculty of Pharmacy & Health Sciences, University of Balochistan, Quetta, Baluchistan, Pakistan
| | - Fehmida Umar
- Gynecology & Obstetrics Unit 1, Sandeman Provincial Hospital Quetta, Quetta, Baluchistan, Pakistan
| | - Fahad Saleem
- Faculty of Pharmacy & Health Sciences, University of Balochistan, Quetta, Baluchistan, Pakistan
| | - Qaiser Iqbal
- Faculty of Pharmacy & Health Sciences, University of Balochistan, Quetta, Baluchistan, Pakistan
| | - Sajjad Haider
- Faculty of Pharmacy & Health Sciences, University of Balochistan, Quetta, Baluchistan, Pakistan
| | - Mohammad Bashaar
- Research Services Division, SMART Afghan International Trainings & Consultancy, Kabul, Afghanistan
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Milani GP, Rosa C, Tuzger N, Alberti I, Ghizzi C, Zampogna S, Amigoni A, Agostoni C, Peroni D, Marchisio P, Chiappini E. Nationwide survey on the management of pediatric pharyngitis in Italian emergency units. Ital J Pediatr 2023; 49:114. [PMID: 37670391 PMCID: PMC10481466 DOI: 10.1186/s13052-023-01514-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/19/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Acute pharyngitis is a frequent reason for primary care or emergency unit visits in children. Most available data on pharyngitis management come from primary care studies that demonstrate an underuse of microbiological tests, a tendency to over-prescribe antibiotics and a risk of antimicrobial resistance increase. However, a comprehensive understanding of acute pharyngitis management in emergency units is lacking. This study aimed to investigate the frequency of rapid antigen test use to diagnose acute pharyngitis, as well as other diagnostic approaches, the therapeutic attitude, and follow-up of children with this condition in the emergency units. METHODS A multicentric national study was conducted in Italian emergency departments between April and June 2022. RESULTS A total of 107 out of 131 invited units (response rate 82%), participated in the survey. The results showed that half of the units use a scoring system to diagnose pharyngitis, with the McIsaac score being the most commonly used. Most emergency units (56%) were not provided with a rapid antigen diagnostic test by their hospital, but the test was more frequently available in units visiting more than 10,000 children yearly (57% vs 33%, respectively, p = 0.02). Almost half (47%) of the units prescribe antibiotics in children with pharyngitis despite the lack of microbiologically confirmed cases of Group A β-hemolytic streptococcus. Finally, about 25% of units prescribe amoxicillin-clavulanic acid to treat Group A β-hemolytic streptococcus pharyngitis. CONCLUSIONS The study sheds light on the approach to pharyngitis in emergency units, providing valuable information to improve the appropriate management of acute pharyngitis in this setting. The routinary provision of rapid antigen tests in the hospitals could enhance the diagnostic and therapeutic approach to pharyngitis.
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Affiliation(s)
- Gregorio P Milani
- Pediatric Unit, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Della Commenda 9, 20122, Milan, Italy.
- Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy.
| | - Claudio Rosa
- Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy
| | - Naz Tuzger
- Pediatric Unit, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Della Commenda 9, 20122, Milan, Italy
- Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy
| | - Ilaria Alberti
- Pediatric Unit, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Della Commenda 9, 20122, Milan, Italy
| | | | - Stefania Zampogna
- SOC Pediatria, Azienda Sanitaria Provinciale Di Crotone, Crotone, Italy
| | - Angela Amigoni
- Pediatric Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | - Carlo Agostoni
- Pediatric Unit, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Della Commenda 9, 20122, Milan, Italy
- Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy
| | - Diego Peroni
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy
| | - Paola Marchisio
- Pediatric Unit, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Della Commenda 9, 20122, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Elena Chiappini
- Pediatric Infectious Disease Unit, Department of Health Sciences, Meyer Children's University Hospital, University of Florence, Florence, Italy
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Tanır Basaranoğlu S, Karaaslan A, Salı E, Çiftçi E, Gayretli Aydın ZG, Aldemir Kocabaş B, Kaya C, Şen Bayturan S, Kara SS, Yılmaz Çiftdoğan D, Çay Ü, Gundogdu Aktürk H, Çelik M, Ozdemir H, Somer A, Diri T, Yazar AS, Sütçü M, Tezer H, Karadag Oncel E, Kara M, Çelebi S, Özkaya Parlakay A, Karakaşlılar S, Arısoy ES, Tanır G, Tural Kara T, Devrim İ, Erat T, Aykaç K, Kaba Ö, Güven Ş, Yeşil E, Tekin Yılmaz A, Yaşar Durmuş S, Çağlar İ, Günay F, Özen M, Dinleyici EÇ, Kara A. Antibiotic associated diarrhea in outpatient pediatric antibiotic therapy. BMC Pediatr 2023; 23:121. [PMID: 36932373 PMCID: PMC10024443 DOI: 10.1186/s12887-023-03939-w] [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: 10/01/2022] [Accepted: 03/02/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Antibiotic-associated diarrhea is one of the most frequent side effects of antimicrobial therapy. We assessed the epidemiological data of antibiotic-associated diarrhea in pediatric patients in our region. METHODS The prospective multi-center study included pediatric patients who were initiated an oral antibiotic course in outpatient clinics and followed in a well-established surveillance system. This follow-up system constituded inclusion of patient by the primary physician, supply of family follow-up charts to the family, passing the demographics and clinical information of patient to the Primary Investigator Centre, and a close telephone follow-up of patients for a period of eight weeks by the Primary Investigator Centre. RESULTS A result of 758 cases were recruited in the analysis which had a frequency of 10.4% antibiotic-associated diarrhea. Among the cases treated with amoxicillin-clavulanate 10.4%, and cephalosporins 14.4% presented with antibiotic-associated diarrhea. In the analysis of antibiotic-associated diarrhea occurrence according to different geographical regions of Turkey, antibiotic-associated diarrhea episodes differed significantly (p = 0.014), particularly higher in The Eastern Anatolia and Southeastern Anatolia. Though most commonly encountered with cephalosporin use, antibiotic-associated diarrhea is not a frequent side effect. CONCLUSION This study on pediatric antibiotic-associated diarrhea displayed epidemiological data and the differences geographically in our region.
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Affiliation(s)
- Sevgen Tanır Basaranoğlu
- Department of Pediatric Infectious Diseases, Hacettepe University Faculty of Medicine, Ankara, 06100, Turkey
| | - Ayşe Karaaslan
- Department of Pediatric Infectious Diseases, Istanbul Lutfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Enes Salı
- Department of Pediatric Infectious Diseases, Sanliurfa Training and Research Hospital, Sanliurfa, Turkey
| | - Ergin Çiftçi
- Department of Pediatric Infectious Diseases, Ankara University, Ankara, Turkey
| | | | - Bilge Aldemir Kocabaş
- Department of Pediatric Infectious Diseases, Antalya Akdeniz University, Antalya, Turkey
| | - Cemil Kaya
- Department of Pediatrics, Sanliurfa Training and Research Hospital, Sanliurfa, Turkey
| | - Semra Şen Bayturan
- Department of Pediatric Infectious Diseases, Manisa Celal Bayar University, Manisa, Turkey
| | - Soner Sertan Kara
- Department of Pediatric Infectious Diseases, Erzurum Training and Research Hospital, Erzurum, Turkey
| | - Dilek Yılmaz Çiftdoğan
- Department of Pediatric Infectious Diseases, Saglik Bilimleri University, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Ümmühan Çay
- Department of Pediatric Infectious Diseases, Trabzon Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Hacer Gundogdu Aktürk
- Department of Pediatric Infectious Diseases, Istanbul Zeynep Kamil Women and Children Training and Research Hospital, Istanbul, Turkey
| | - Melda Çelik
- Department of Pediatric Infectious Diseases, Ankara Kecioren Training and Research Hospital, Ankara, Turkey
| | - Halil Ozdemir
- Department of Pediatric Infectious Diseases, Ankara University, Ankara, Turkey
| | - Ayper Somer
- Department of Pediatric Infectious Diseases, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - Tijen Diri
- Department of Pediatrics, Istanbul Acıbadem Atakent Hospital, Istanbul, Turkey
| | - Ahmet Sami Yazar
- Department of Pediatrics, Istanbul Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Murat Sütçü
- Department of Pediatric Infectious Diseases, Konya Training and Research Hospital, Konya, Turkey
| | - Hasan Tezer
- Department of Pediatric Infectious Diseases, Ankara Gazi University, Ankara, Turkey
| | - Eda Karadag Oncel
- Department of Pediatric Infectious Diseases, Saglik Bilimleri University, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Manolya Kara
- Department of Pediatric Infectious Diseases, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - Solmaz Çelebi
- Department of Pediatric Infectious Diseases, Bursa Uludag University, Bursa, Turkey
| | - Aslınur Özkaya Parlakay
- Department of Pediatric Infectious Diseases, Ankara Yildirim Beyazit University, Ankara, Turkey
| | | | - Emin Sami Arısoy
- Department of Pediatric Infectious Diseases, Kocaeli University, Kocaeli, Turkey
| | - Gönül Tanır
- Department of Pediatric Infectious Diseases, Ankara Doktor Sami Ulus Women and Children Training and Research Hospital, Ankara, Turkey
| | - Tuğçe Tural Kara
- Department of Pediatric Infectious Diseases, Hatay State Hospital, Hatay, Turkey
| | - İlker Devrim
- Department of Pediatric Infectious Diseases, Izmir Doktor Behcet Uz Children's Hospital, İzmir, Turkey
| | - Tuğba Erat
- Department of Pediatric Infectious Diseases, Ankara University, Ankara, Turkey
| | - Kübra Aykaç
- Department of Pediatric Infectious Diseases, Hacettepe University Faculty of Medicine, Ankara, 06100, Turkey
| | - Özge Kaba
- Department of Pediatric Infectious Diseases, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - Şirin Güven
- Department of Pediatrics, Istanbul Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Edanur Yeşil
- Department of Pediatric Infectious Diseases, Bursa Uludag University, Bursa, Turkey
| | - Ayşe Tekin Yılmaz
- Department of Pediatric Infectious Diseases, Kocaeli University, Kocaeli, Turkey
| | - Sevgi Yaşar Durmuş
- Department of Pediatric Infectious Diseases, Ankara Doktor Sami Ulus Women and Children Training and Research Hospital, Ankara, Turkey
| | - İlknur Çağlar
- Department of Pediatric Infectious Diseases, Izmir Doktor Behcet Uz Children's Hospital, İzmir, Turkey
| | - Fatih Günay
- Department of Pediatrics, Ankara University, Ankara, Turkey
| | - Metehan Özen
- Department of Pediatric Infectious Diseases, Istanbul Acıbadem Atakent Hospital, Istanbul, Turkey
| | | | - Ateş Kara
- Department of Pediatric Infectious Diseases, Hacettepe University Faculty of Medicine, Ankara, 06100, Turkey.
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Gu X, Sim JX, Lee WL, Cui L, Chan YF, Chang ED, Teh YE, Zhang AN, Armas F, Chandra F, Chen H, Zhao S, Lee Z, Thompson JR, Ooi EE, Low JG, Alm EJ, Kalimuddin S. Gut Ruminococcaceae levels at baseline correlate with risk of antibiotic-associated diarrhea. iScience 2022; 25:103644. [PMID: 35005566 PMCID: PMC8718891 DOI: 10.1016/j.isci.2021.103644] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/19/2021] [Accepted: 12/13/2021] [Indexed: 12/11/2022] Open
Abstract
Antibiotic-associated diarrhea (AAD) affects a significant proportion of patients receiving antibiotics. We sought to understand if differences in the gut microbiome would influence the development of AAD. We administered a 3-day course of amoxicillin-clavulanate to 30 healthy adult volunteers, and analyzed their stool microbiome, using 16S rRNA gene sequencing, at baseline and up to 4 weeks post antibiotic administration. Lower levels of gut Ruminococcaceae were significantly and consistently observed from baseline until day 7 in participants who developed AAD. Overall, participants who developed AAD experienced a greater decrease in microbial diversity. The probability of AAD could be predicted based on qPCR-derived levels of Faecalibacterium prausnitzii at baseline. Our findings suggest that a lack of gut Ruminococcaceae influences development of AAD. Quantification of F. prausnitzii in stool prior to antibiotic administration may help identify patients at risk of AAD, and aid clinicians in devising individualized treatment regimens to minimize such adverse effects.
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Affiliation(s)
- Xiaoqiong Gu
- Antimicrobial Resistance Interdisciplinary Research Group, Singapore-MIT Alliance for Research and Technology, 1 Create Way, Singapore 138602, Singapore
- Campus for Research Excellence and Technological Enterprise (CREATE), Singapore 138602, Singapore
| | - Jean X.Y. Sim
- Department of Infectious Diseases, Singapore General Hospital, Academia Level 3, 20 College Road, Singapore 169856, Singapore
| | - Wei Lin Lee
- Antimicrobial Resistance Interdisciplinary Research Group, Singapore-MIT Alliance for Research and Technology, 1 Create Way, Singapore 138602, Singapore
- Campus for Research Excellence and Technological Enterprise (CREATE), Singapore 138602, Singapore
| | - Liang Cui
- Antimicrobial Resistance Interdisciplinary Research Group, Singapore-MIT Alliance for Research and Technology, 1 Create Way, Singapore 138602, Singapore
- Campus for Research Excellence and Technological Enterprise (CREATE), Singapore 138602, Singapore
| | - Yvonne F.Z. Chan
- Department of Infectious Diseases, Singapore General Hospital, Academia Level 3, 20 College Road, Singapore 169856, Singapore
| | - Ega Danu Chang
- Antimicrobial Resistance Interdisciplinary Research Group, Singapore-MIT Alliance for Research and Technology, 1 Create Way, Singapore 138602, Singapore
- Campus for Research Excellence and Technological Enterprise (CREATE), Singapore 138602, Singapore
| | - Yii Ean Teh
- Department of Infectious Diseases, Singapore General Hospital, Academia Level 3, 20 College Road, Singapore 169856, Singapore
| | - An-Ni Zhang
- Department of Biological Engineering, Massachusetts Institute of Technology, 21 Ames Street, Cambridge, MA 02142, USA
| | - Federica Armas
- Antimicrobial Resistance Interdisciplinary Research Group, Singapore-MIT Alliance for Research and Technology, 1 Create Way, Singapore 138602, Singapore
- Campus for Research Excellence and Technological Enterprise (CREATE), Singapore 138602, Singapore
| | - Franciscus Chandra
- Antimicrobial Resistance Interdisciplinary Research Group, Singapore-MIT Alliance for Research and Technology, 1 Create Way, Singapore 138602, Singapore
- Campus for Research Excellence and Technological Enterprise (CREATE), Singapore 138602, Singapore
| | - Hongjie Chen
- Antimicrobial Resistance Interdisciplinary Research Group, Singapore-MIT Alliance for Research and Technology, 1 Create Way, Singapore 138602, Singapore
- Campus for Research Excellence and Technological Enterprise (CREATE), Singapore 138602, Singapore
| | - Shijie Zhao
- Department of Biological Engineering, Massachusetts Institute of Technology, 21 Ames Street, Cambridge, MA 02142, USA
| | - Zhanyi Lee
- Antimicrobial Resistance Interdisciplinary Research Group, Singapore-MIT Alliance for Research and Technology, 1 Create Way, Singapore 138602, Singapore
- Campus for Research Excellence and Technological Enterprise (CREATE), Singapore 138602, Singapore
| | - Janelle R. Thompson
- Singapore Centre for Environmental Life Sciences Engineering, Nanyang Technological University, 60 Nanyang Drive, Singapore 637551, Singapore
- Asian School of the Environment, Nanyang Technological University, 62 Nanyang Drive, Singapore 637459, Singapore
| | - Eng Eong Ooi
- Program in Emerging Infectious Diseases, Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore
- Viral Research and Experimental Medicine Center, SingHealth Duke-NUS Academic Medical Centre (ViREMiCS), 20 College Road, Singapore 169856, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, Singapore 117549, Singapore
| | - Jenny G. Low
- Department of Infectious Diseases, Singapore General Hospital, Academia Level 3, 20 College Road, Singapore 169856, Singapore
- Program in Emerging Infectious Diseases, Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore
- Viral Research and Experimental Medicine Center, SingHealth Duke-NUS Academic Medical Centre (ViREMiCS), 20 College Road, Singapore 169856, Singapore
| | - Eric J. Alm
- Antimicrobial Resistance Interdisciplinary Research Group, Singapore-MIT Alliance for Research and Technology, 1 Create Way, Singapore 138602, Singapore
- Campus for Research Excellence and Technological Enterprise (CREATE), Singapore 138602, Singapore
- Department of Biological Engineering, Massachusetts Institute of Technology, 21 Ames Street, Cambridge, MA 02142, USA
- Center for Microbiome Informatics and Therapeutics, Massachusetts Institute of Technology, Building E25-321, Cambridge, MA 02139, USA
- Broad Institute of MIT and Harvard, 415 Main Street, Cambridge, MA 02142, USA
| | - Shirin Kalimuddin
- Department of Infectious Diseases, Singapore General Hospital, Academia Level 3, 20 College Road, Singapore 169856, Singapore
- Program in Emerging Infectious Diseases, Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore
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7
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Mokrzan EM, Ahearn CP, Buzzo JR, Novotny LA, Zhang Y, Goodman SD, Bakaletz LO. Nontypeable Haemophilus influenzae newly released (NRel) from biofilms by antibody-mediated dispersal versus antibody-mediated disruption are phenotypically distinct. Biofilm 2020; 2:100039. [PMID: 33447823 PMCID: PMC7798465 DOI: 10.1016/j.bioflm.2020.100039] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/02/2020] [Accepted: 11/12/2020] [Indexed: 02/08/2023] Open
Abstract
Biofilms contribute significantly to the chronicity and recurrence of bacterial diseases due to the fact that biofilm-resident bacteria are highly recalcitrant to killing by host immune effectors and antibiotics. Thus, antibody-mediated release of bacteria from biofilm residence into the surrounding milieu supports a powerful strategy to resolve otherwise difficult-to-treat biofilm-associated diseases. In our prior work, we revealed that antibodies directed against two unique determinants of nontypeable Haemophilus influenzae (NTHI) [e.g. the Type IV pilus (T4P) or a bacterial DNABII DNA-binding protein, a species-independent target that provides structural integrity to bacterial biofilms] release biofilm-resident bacteria via discrete mechanisms. Herein, we now show that the phenotype of the resultant newly released (or NRel) NTHI is dependent upon the specific mechanism of release. We used flow cytometry, proteomic profiles, and targeted transcriptomics to demonstrate that the two NRel populations were significantly different not only from planktonically grown NTHI, but importantly, from each other despite genetic identity. Moreover, each NRel population had a distinct, significantly increased susceptibility to killing by either a sulfonamide or β-lactam antibiotic compared to planktonic NTHI, an observation consistent with their individual proteomes and further supported by relative differences in targeted gene expression. The distinct phenotypes of NTHI released from biofilms by antibodies directed against specific epitopes of T4P or DNABII binding proteins provide new opportunities to develop targeted therapeutic strategies for biofilm eradication and disease resolution.
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Affiliation(s)
- Elaine M Mokrzan
- Center for Microbial Pathogenesis, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Christian P Ahearn
- Center for Microbial Pathogenesis, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - John R Buzzo
- Center for Microbial Pathogenesis, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Laura A Novotny
- Center for Microbial Pathogenesis, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Yan Zhang
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA.,The Ohio State University Comprehensive Cancer Center (OSUCCC - James), Columbus, OH, USA
| | - Steven D Goodman
- Center for Microbial Pathogenesis, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Lauren O Bakaletz
- Center for Microbial Pathogenesis, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
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8
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Mohsen S, Dickinson JA, Somayaji R. [Not Available]. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2020; 66:e228-e237. [PMID: 32933991 PMCID: PMC7491662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Objectif Rassembler l’information sur les effets indésirables des antibiotiques, que pourront utiliser les médecins prescripteurs comme référence et ressource d’apprentissage. Qualité des données Une recherche a été effectuée dans les sites web de diverses agences nationales indépendantes et dans de récentes revues de synthèse. Un tableau résume les effets indésirables de chaque groupe d’antimicrobiens et en indique les allergies, les effets nocifs à court terme et les effets nocifs graves. La fréquence de chaque effet indésirable apparaît au tableau lorsque disponible. Message principal Les antimicrobiens sont nécessaires pour traiter diverses maladies. Ils causent cependant des effets indésirables, tels que des réactions allergiques, en plus d’augmenter la résistance bactérienne. Nous sommes de plus en plus conscients du besoin de détecter et d’évaluer les effets indésirables associés aux médicaments. Des effets nocifs graves ont récemment été associés à des antibiotiques couramment utilisés. Ainsi, nous avons résumé, dans le présent article, les connaissances actuelles en matière d’effets nocifs liés aux antibiotiques oraux à action générale qui sont régulièrement utilisés en pratique familiale. Conclusion Il est difficile d’identifier et d’attribuer les probabilités exactes de la plupart des effets nocifs. Cependant, tous les antimicrobiens courants produisent des effets nocifs dont il faut tenir compte lors de la décision de prescrire. Nombreux sont les effets indésirables qui ne sont pas reconnus par les prescripteurs. Puisque les effets indésirables sont inévitables, les antimicrobiens doivent être prescrits pour la durée la plus brève possible, seulement lorsque la probabilité d’un bienfait surpasse le risque d’effets nocifs.
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Affiliation(s)
- Samiha Mohsen
- Étudiante en maîtrise au département des sciences de santé communautaire de l'Université de Calgary (Alberta)
| | - James A Dickinson
- Professeur au département de médecine familiale et au département des sciences de santé communautaire de l'Université de Calgary.
| | - Ranjani Somayaji
- Professeure adjointe au département de médecine et au département de microbiologie, d'immunologie et de maladie infectieuse à l'école de médecine Cumming de l'Université de Calgary
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Mohsen S, Dickinson JA, Somayaji R. Update on the adverse effects of antimicrobial therapies in community practice. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2020; 66:651-659. [PMID: 32933978 PMCID: PMC7491661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To gather information about antibiotic side effects to be used as a reference and learning resource for prescribing physicians. QUALITY OF EVIDENCE A search of websites of various independent national agencies and recent review articles was performed. A summary table of adverse effects for each group of antimicrobials was then created, identifying allergies, short-term harms, and serious harms. The occurrence rate of each was listed when available. MAIN MESSAGE Antimicrobials are necessary to treat various diseases. However, they cause adverse effects, such as allergic reactions, in addition to increased bacterial resistance. There is increasing awareness of the need to detect and evaluate adverse effects associated with medicines. Recently, severe and serious harms have been described for commonly used antibiotics. Therefore, current knowledge of harms from systemic oral antibiotics that are regularly used in family medicine is summarized in this article. CONCLUSION It is difficult to identify and ascribe exact probabilities of most harms. However, all common antimicrobials create harms that must be considered when choosing whether to prescribe. Many adverse effects go unrecognized by prescribers. As side effects are inevitable, antimicrobials must be prescribed for as short a course as possible, only when the probability of benefit is greater than the risk of harm.
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Affiliation(s)
- Samiha Mohsen
- Master's degree student in the Department of Community Health Sciences at the University of Calgary in Alberta
| | - James A Dickinson
- Professor in the Department of Family Medicine and the Department of Community Health Sciences at the University of Calgary.
| | - Ranjani Somayaji
- Assistant Professor in the Department of Medicine and the Department of Microbiology, Immunology and Infectious Disease in the Cumming School of Medicine at the University of Calgary
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10
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Fetensa G, Fekadu G, Tekle F, Markos J, Etafa W, Hasen T. Diarrhea and associated factors among under-5 children in Ethiopia: A secondary data analysis. SAGE Open Med 2020; 8:2050312120944201. [PMID: 32821387 PMCID: PMC7406926 DOI: 10.1177/2050312120944201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 06/25/2020] [Indexed: 11/17/2022] Open
Abstract
Objectives Diarrhea is a major contributing factor for preventable childhood morbidity and death. Despite the occurrence of diarrhea is decreasing, its effect is increasing at an alarming rate among under-5 children particularly in developing countries. The survey was aimed to assess diarrhea and associated factors among children less than 5 years (0-59 months) in Ethiopia with nationally representative data. Methods The data were extracted from the Ethiopian National Survey of 2016. A logistic regression model was undertaken to identify the contributing factors for childhood diarrhea. Variables with p < 0.05 were considered as independent predictors of childhood diarrhea. Results From a total of 10,641 under-5 children, 5483(51.5%) were males and most of the children (62.3%) were above 24 months. About 10.2% had diarrhea 14 days before data collection, and the majority (93.1%) were born to married mothers. Receiving no treatment or advice for fever/cough (adjusted odd ratio (AOR) = 0.170, 95% confidence interval (CI): 0.139-0.208, p = 0.001), being permanent residence (AOR = 0.583, 95% CI: 0.347-0.982, p = 0.043), initiating breastfeeding after 24 h of birth (AOR = 1.553, 95% CI: 1.197-2.015, p = 0.001), and lack of prenatal care (AOR = 2.142, 95% CI: 0.624-0.875, p = 0.001) were independent predictors of diarrhea among under-5 children's in Ethiopia. Conclusion The result of this survey indicated that diarrhea is a significant health challenge among under-5 children. To tackle this illness, sufficient education on child and maternal health has to be provided for mothers focusing on predictive factors.
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Affiliation(s)
- Getahun Fetensa
- School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Ginenus Fekadu
- Clinical Pharmacy Unit, Department of Pharmacy, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Firew Tekle
- Department of Public health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Jote Markos
- School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Werku Etafa
- School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Tahir Hasen
- School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
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Cheng R, Liang H, Zhang Y, Guo J, Miao Z, Shen X, Chen G, Cheng G, Li M, He F. Contributions of Lactobacillus plantarum PC170 administration on the recovery of gut microbiota after short-term ceftriaxone exposure in mice. Benef Microbes 2020; 11:489-509. [PMID: 32811176 DOI: 10.3920/bm2019.0191] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
This study aimed to determine the impact of Lactobacillus plantarum PC170 concurrent with antibiotic treatment and/or during the recovery phase after antibiotic treatment on the body weight, faecal bacterial composition, short-chain fatty acids (SCFAs) concentration, and splenic cytokine mRNA expression of mice. Orally administrated ceftriaxone quantitatively and significantly decreased body weight, faecal total bacteria, Akkermansia muciniphila, and Lactobacillus plantarum, and faecal SCFAs concentration. Ceftriaxone treatment also dramatically altered the faecal microbiota with an increased Chao1 index, decreased species diversities and Bacteroidetes, and more Firmicutes and Proteobacteria. After ceftriaxone intervention, these changes all gradually started to recover. However, faecal microbiota diversities were still totally different from control by significantly increased α- and β-diversities. Bacteroidetes all flourished and became dominant during the recovery process. However, mice treated with PC170 both in parallel with and after ceftriaxone treatment encouraged more Bacteroidetes, Verrucomicrobia, and Actinobacteria, and the diversity by which to make faecal microbiota was very much closer to control. Furthermore, the expression of splenic pro-inflammatory cytokine tumour necrosis factor-α mRNA in mice supplemented with PC170 during the recovery phase was significantly lower than natural recovery. These results indicated that antibiotics, such as ceftriaxone, even with short-term intervention, could dramatically damage the structure of gut microbiota and their abilities to produce SCFAs with loss of body weight. Although such damages could be partly recovered with the cessation of antibiotics, the implication of antibiotics to gut microbiota might remain even after antibiotic treatment. The selected strain PC170 might be a potential probiotic because of its contributions in helping the host animal to remodel or stabilise its gut microbiome and enhancing the anti-inflammatory response as protection from the side effects of antibiotic therapy when it was administered in parallel with and after antibiotic treatment.
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Affiliation(s)
- R Cheng
- Department of Nutrition, Food Hygiene and Toxicology, West China School of Public Health and West China Fourth Hospital, and Healthy Food Evaluation Research Center, Sichuan University, No. 16, 3rd section, South Renmin Road, Chengdu 610041, Sichuan, China P.R
| | - H Liang
- Department of Nutrition, Food Hygiene and Toxicology, West China School of Public Health and West China Fourth Hospital, and Healthy Food Evaluation Research Center, Sichuan University, No. 16, 3rd section, South Renmin Road, Chengdu 610041, Sichuan, China P.R
| | - Y Zhang
- Department of Nutrition, Food Hygiene and Toxicology, West China School of Public Health and West China Fourth Hospital, and Healthy Food Evaluation Research Center, Sichuan University, No. 16, 3rd section, South Renmin Road, Chengdu 610041, Sichuan, China P.R
| | - J Guo
- Department of Nutrition, Food Hygiene and Toxicology, West China School of Public Health and West China Fourth Hospital, and Healthy Food Evaluation Research Center, Sichuan University, No. 16, 3rd section, South Renmin Road, Chengdu 610041, Sichuan, China P.R
| | - Z Miao
- Department of Nutrition, Food Hygiene and Toxicology, West China School of Public Health and West China Fourth Hospital, and Healthy Food Evaluation Research Center, Sichuan University, No. 16, 3rd section, South Renmin Road, Chengdu 610041, Sichuan, China P.R
| | - X Shen
- Department of Nutrition, Food Hygiene and Toxicology, West China School of Public Health and West China Fourth Hospital, and Healthy Food Evaluation Research Center, Sichuan University, No. 16, 3rd section, South Renmin Road, Chengdu 610041, Sichuan, China P.R
| | - G Chen
- Sichuan Academy of Food and Fermentation Industries, Chengdu 610041, Sichuan, China P.R
| | - G Cheng
- Department of Nutrition, Food Hygiene and Toxicology, West China School of Public Health and West China Fourth Hospital, and Healthy Food Evaluation Research Center, Sichuan University, No. 16, 3rd section, South Renmin Road, Chengdu 610041, Sichuan, China P.R
| | - M Li
- Department of Nutrition, Food Hygiene and Toxicology, West China School of Public Health and West China Fourth Hospital, and Healthy Food Evaluation Research Center, Sichuan University, No. 16, 3rd section, South Renmin Road, Chengdu 610041, Sichuan, China P.R
| | - F He
- Department of Nutrition, Food Hygiene and Toxicology, West China School of Public Health and West China Fourth Hospital, and Healthy Food Evaluation Research Center, Sichuan University, No. 16, 3rd section, South Renmin Road, Chengdu 610041, Sichuan, China P.R
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Abstract
Penicillins are commonly prescribed to children. Recommendations in the product information may not be the most appropriate doses for children and may list clinical indications that are preferably treated with other antibiotics Reputable guidelines, for example Therapeutic Guidelines: Antibiotic, offer up-to-date advice on optimal choice, route, dosage and duration of oral penicillins in children In most instances, the child’s weight should be used to calculate the dose in mg per kg without exceeding the maximum adult dose When prescribing higher weight-based doses of amoxicillin or flucloxacillin, check the volume of oral liquid required to complete a treatment course to ensure adequate supply
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Affiliation(s)
| | | | - Greg Rowles
- Sydney Children's Hospital.,Riddells Creek, Vic.,both these authors contributed equally
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13
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Mathur S, Jackson C, Urus H, Ziarko I, Goodbun M, Hsia Y, Ellis S, Sharland M. A comparison of five paediatric dosing guidelines for antibiotics. Bull World Health Organ 2020; 98:406-412F. [PMID: 32514214 PMCID: PMC7265929 DOI: 10.2471/blt.19.234310] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 03/10/2020] [Accepted: 03/17/2020] [Indexed: 12/18/2022] Open
Abstract
Objective To compare dosing guidance in the paediatric formularies of high- and middle-income countries for 32 commonly prescribed antibiotics on the World Health Organization’s (WHO’s) 2017 Model list of essential medicines for children. Methods We identified paediatric antibiotic guidelines that were either widely used internationally or originated from countries in which antibiotic use has increased markedly in recent years (i.e. Brazil, China, India, the Russian Federation and South Africa). Findings The study analysis considered five leading antibiotic guidelines: (i) the Manual of childhood infections: the blue book; (ii) the BNF (British national formulary) for children; (iii) the Red book®: 2018–2021 report of the committee on infectious diseases; (iv) WHO’s Pocket book of hospital care for children; and (v) Indian National treatment guidelines for antimicrobial use in infectious diseases. There was marked heterogeneity in the recommended dosing (i.e. daily dose, age dosing bands and dose frequency) for most commonly used antibiotics. The rationale for dosing recommendations was generally unclear. Conclusion The pharmacokinetic, pharmacodynamic and clinical evidence supporting paediatric antibiotic dosing, particularly on total doses and on age or weight dosing bands, needs to be improved. Future research should consider whether the variations in guidance identified stem from different clinical disease patterns, varying levels of antibiotic resistance or drug availability rather than historical preferences. Interested global parties could collaborate with WHO’s Model list of essential medicines antibiotic working group to develop an evidence-based consensus and identify research priorities.
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Affiliation(s)
- Shrey Mathur
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St George's, University of London, Cranmer Terrace, London SW17 0RE, England
| | - Charlotte Jackson
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St George's, University of London, Cranmer Terrace, London SW17 0RE, England
| | - Heather Urus
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St George's, University of London, Cranmer Terrace, London SW17 0RE, England
| | - Isabelle Ziarko
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St George's, University of London, Cranmer Terrace, London SW17 0RE, England
| | - Matt Goodbun
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St George's, University of London, Cranmer Terrace, London SW17 0RE, England
| | - Yingfen Hsia
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St George's, University of London, Cranmer Terrace, London SW17 0RE, England
| | - Sally Ellis
- Global Antibiotic Research and Development Partnership, Drugs for Neglected Diseases initiative, Geneva, Switzerland
| | - Mike Sharland
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St George's, University of London, Cranmer Terrace, London SW17 0RE, England
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Immunization with a Biofilm-Disrupting Nontypeable Haemophilus influenzae Vaccine Antigen Did Not Alter the Gut Microbiome in Chinchillas, Unlike Oral Delivery of a Broad-Spectrum Antibiotic Commonly Used for Otitis Media. mSphere 2020; 5:5/2/e00296-20. [PMID: 32295873 PMCID: PMC7160684 DOI: 10.1128/msphere.00296-20] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The prevalence of chronic and recurrent diseases, combined with the overuse/abuse of antibiotics that has led to the sobering emergence of bacteria resistant to multiple antibiotics, has mandated that we develop novel approaches to better manage these diseases or, ideally, prevent them. Biofilms play a key role in the pathogenesis of chronic and recurrent bacterial diseases but are difficult, if not impossible, to eradicate with antibiotics. We developed a vaccine antigen designed to mediate biofilm disruption; however, it is also important that delivery of this vaccine does not induce collateral damage to the microbiome. The studies described here validated a vaccine approach that targets biofilms without the consequences of an altered gut microbiome. While delivery of the antibiotic most commonly given to children with ear infections did indeed alter the gut microbiome, as expected, immunization via traditional injection or by noninvasive delivery to the skin did not result in changes to the chinchilla gut microbiome. The use of broad-spectrum antibiotics to treat diseases, such as the highly prevalent pediatric disease otitis media (OM), contributes significantly to the worldwide emergence of multiple-antibiotic-resistant microbes, and gut dysbiosis with diarrhea is a common adverse sequela. Moreover, for many diseases, like OM, biofilms contribute significantly to chronicity and recurrence, yet biofilm-resident bacteria are characteristically highly resistant to antibiotics. The most cost-effective way to both prevent and resolve diseases like OM, as well as begin to address the problem of growing antibiotic resistance, would be via the development of novel approaches to eradicate bacterial biofilms. Toward this goal, we designed a vaccine antigen that induces the formation of antibodies that prevent biofilm formation and, thereby, experimental OM in the middle ears of chinchillas by the predominant Gram-negative pathogen responsible for this disease, nontypeable Haemophilus influenzae. These antibodies also significantly disrupt preexisting biofilms formed by diverse pathogens. Whereas preclinical data strongly support the continued development of this vaccine antigen, which targets an essential structural element of bacterial biofilms, a concern has been whether active immunization would also lead to unintended collateral damage in the form of an altered gut microbiome. To address this concern, we assessed changes in the microbiome of the chinchilla gut over time after the delivery of either amoxicillin-clavulanate, the standard of care for OM, or after immunization with our biofilm-targeted vaccine antigen either via a traditional subcutaneous route or via a novel noninvasive transcutaneous route. We show that differences in the abundance of specific taxa were found only in the stools of antibiotic-treated animals. IMPORTANCE The prevalence of chronic and recurrent diseases, combined with the overuse/abuse of antibiotics that has led to the sobering emergence of bacteria resistant to multiple antibiotics, has mandated that we develop novel approaches to better manage these diseases or, ideally, prevent them. Biofilms play a key role in the pathogenesis of chronic and recurrent bacterial diseases but are difficult, if not impossible, to eradicate with antibiotics. We developed a vaccine antigen designed to mediate biofilm disruption; however, it is also important that delivery of this vaccine does not induce collateral damage to the microbiome. The studies described here validated a vaccine approach that targets biofilms without the consequences of an altered gut microbiome. While delivery of the antibiotic most commonly given to children with ear infections did indeed alter the gut microbiome, as expected, immunization via traditional injection or by noninvasive delivery to the skin did not result in changes to the chinchilla gut microbiome.
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SYN-007, an Orally Administered Beta-Lactamase Enzyme, Protects the Gut Microbiome from Oral Amoxicillin/Clavulanate without Adversely Affecting Antibiotic Systemic Absorption in Dogs. Microorganisms 2020; 8:microorganisms8020152. [PMID: 31979034 PMCID: PMC7074739 DOI: 10.3390/microorganisms8020152] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 01/17/2020] [Accepted: 01/20/2020] [Indexed: 12/28/2022] Open
Abstract
Beta-lactamases, enzymes produced by bacteria to degrade beta-lactam antibiotics, have been harnessed as therapeutics to protect the gut microbiome from damage caused by antibiotics. Proof-of-concept of this approach using SYN-004 (ribaxamase), a beta-lactamase formulated for oral delivery with intravenous (IV) penicillins and cephalosporins, was demonstrated with animal models and in humans. Ribaxamase degraded ceftriaxone in the gastrointestinal tract, protected the gut microbiome, significantly reduced the incidence of Clostridioides difficile disease and attenuated emergence of antibiotic resistant organisms. SYN-007 is a delayed release formulation of ribaxamase intended for use with oral beta-lactams. In dogs treated with oral amoxicillin, SYN-007 diminished antibiotic-mediated microbiome disruption and reduced the emergence of antibiotic resistance without altering amoxicillin systemic absorption. Here, SYN-007 function in the presence of clavulanate, a beta-lactamase inhibitor, was investigated. Dogs received amoxicillin (40 mg/kg, orally (PO), three times a day (TID)) or the combined antibiotic/beta-lactamase inhibitor, amoxicillin/clavulanate (40 mg/kg amoxicillin, 5.7 mg/kg clavulanate, PO, TID) +/™ SYN-007 (10 mg, PO, TID) for five days. Serum amoxicillin levels were not significantly different +/™ SYN-007 compared to amoxicillin alone or amoxicillin/clavulanate alone as controls for both first and last doses, indicating SYN-007 did not interfere with systemic absorption of the antibiotic. Whole genome shotgun metagenomics analyses of the fecal microbiomes demonstrated both amoxicillin and amoxicillin/clavulanate significantly reduced diversity and increased the frequency of antibiotic resistance genes. Microbiome damage appeared more severe with amoxicillin/clavulanate. In contrast, with SYN-007, microbiome diversity was not significantly altered, and frequency of antibiotic resistance genes did not increase. Importantly, SYN-007 functioned in the presence of clavulanate to protect the gut microbiome indicating that SYN-007 activity was not inhibited by clavulanate in the dog gastrointestinal tract. SYN-007 has the potential to expand microbiome protection to beta-lactam/beta-lactamase inhibitor combinations delivered orally or systemically.
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16
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A Small In Vitro Fermentation Model for Screening the Gut Microbiota Effects of Different Fiber Preparations. Int J Mol Sci 2019; 20:ijms20081925. [PMID: 31003566 PMCID: PMC6514940 DOI: 10.3390/ijms20081925] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 04/09/2019] [Accepted: 04/16/2019] [Indexed: 02/06/2023] Open
Abstract
The development of prebiotic fibers requires fast high-throughput screening of their effects on the gut microbiota. We demonstrated the applicability of a mictotiter plate in the in vitro fermentation models for the screening of potentially-prebiotic dietary fibers. The effects of seven rye bran-, oat- and linseed-derived fiber preparations on the human fecal microbiota composition and short-chain fatty acid production were studied. The model was also used to study whether fibers can alleviate the harmful effects of amoxicillin-clavulanate on the microbiota. The antibiotic induced a shift in the bacterial community in the absence of fibers by decreasing the relative amounts of Bifidobacteriaceae, Bacteroidaceae, Prevotellaceae, Lachnospiraceae and Ruminococcaceae, and increasing proteobacterial Sutterilaceae levels from 1% to 11% of the total microbiota. The fermentation of rye bran, enzymatically treated rye bran, its insoluble fraction, soluble oat fiber and a mixture of rye fiber:soluble oat fiber:linseed resulted in a significant increase in butyrate production and a bifidogenic effect in the absence of the antibiotic. These fibers were also able to counteract the negative effects of the antibiotic and prevent the decrease in the relative amount of bifidobacteria. Insoluble and soluble rye bran fractions and soluble oat fiber were the best for controlling the level of proteobacteria at the level below 2%.
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17
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Wald ER, DeMuri GP. Antibiotic Recommendations for Acute Otitis Media and Acute Bacterial Sinusitis: Conundrum No More. Pediatr Infect Dis J 2018; 37:1255-1257. [PMID: 29570583 PMCID: PMC6151174 DOI: 10.1097/inf.0000000000002009] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
There has been a substantial change in the prevalence and microbiologic characteristics of cases of acute otitis media secondary to the widespread use of pneumococcal conjugate vaccines. Current trends in nasopharyngeal colonization and the microbiology of acute otitis media support a change in the recommendation for antibiotic management of acute otitis media and acute bacterial sinusitis in children.
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Affiliation(s)
- Ellen R. Wald
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health
| | - Gregory P. DeMuri
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health
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Eythorsson E, Sigurdsson S, Hrafnkelsson B, Erlendsdóttir H, Haraldsson Á, Kristinsson KG. Impact of the 10-valent pneumococcal conjugate vaccine on antimicrobial prescriptions in young children: a whole population study. BMC Infect Dis 2018; 18:505. [PMID: 30286726 PMCID: PMC6172799 DOI: 10.1186/s12879-018-3416-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 09/26/2018] [Indexed: 11/11/2022] Open
Abstract
Background Antimicrobial resistance is a public-health threat and antimicrobial consumption is the main contributor. The ten-valent pneumococcal conjugate vaccine (PHiD-CV10) was introduced into the Icelandic vaccination program in 2011. The aim was to estimate the vaccine impact of PHiD-CV10 on outpatient antimicrobial prescriptions in children. Methods Eleven Icelandic birth-cohorts (2005–2015) were followed from birth until three years of age or to the end of the study period (December 31, 2016). Birth-cohorts were grouped as vaccine non-eligible (VNEC, 2005–2010) or vaccine eligible (VEC, 2011–2015). Data on primary care visits for respiratory infections and antimicrobial prescriptions were extracted from two national registers. Using national identification numbers, prescriptions were linked to physician visits if filled within three days of the visit. Incidence rates and incidence rate ratios between VNEC and VEC were calculated. An Andersen-Gill model was used to model the individual level data, accounting for repeated events and censoring. Vaccine impact was calculated as (1 – Hazard Ratio) × 100%. Results Included were 53,510 children who contributed 151,992 person-years of follow-up and filled 231,660 antimicrobial prescriptions. The incidence rate was significantly lower in the VEC compared to the VNEC, 144.5 and 157.2 prescriptions per 100 person-years respectively (IRR 0.92, 95%CI 0.91–0.93). Children in VEC were more likely to have filled zero (IRR 1.16 (95%CI 1.10–1.23) and 1–4 (IRR 1.08 95%CI 1.06–1.11) prescriptions compared to children in VNEC. The vaccine impact of PHiD-CV10 against all-cause antimicrobial prescriptions was 5.8% (95%CI 1.6–9.8%).When only considering acute otitis media-associated prescriptions, the vaccine impact was 21.8% (95%CI 11.5–30.9%). Conclusion The introduction of PHiD-CV10 lead to reduced antimicrobial use in children, mainly by reducing acute otitis media episodes. This intervention therefore reduces both disease burden and could slow the spread of antimicrobial resistance. Electronic supplementary material The online version of this article (10.1186/s12879-018-3416-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Elias Eythorsson
- University of Iceland, Faculty of Medicine, 101, Reykjavík, Iceland
| | | | | | - Helga Erlendsdóttir
- University of Iceland, Faculty of Medicine, 101, Reykjavík, Iceland.,Department of Clinical Microbiology, Landspítali University Hospital, 101, Reykjavík, Iceland
| | - Ásgeir Haraldsson
- University of Iceland, Faculty of Medicine, 101, Reykjavík, Iceland.,Children's Hospital Iceland, Landspítali University Hospital, Reykjavík, Iceland
| | - Karl G Kristinsson
- University of Iceland, Faculty of Medicine, 101, Reykjavík, Iceland. .,Department of Clinical Microbiology, Landspítali University Hospital, 101, Reykjavík, Iceland.
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Mathur S, Fuchs A, Bielicki J, Van Den Anker J, Sharland M. Antibiotic use for community-acquired pneumonia in neonates and children: WHO evidence review. Paediatr Int Child Health 2018; 38:S66-S75. [PMID: 29790844 PMCID: PMC6176769 DOI: 10.1080/20469047.2017.1409455] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Pneumonia is the most common cause of death in children worldwide, accounting for 15% of all deaths of children under 5 years of age. This review summarises the evidence for the empirical antibiotic treatment of community-acquired pneumonia in neonates and children and puts emphasis on publications since the release of the previous WHO Evidence Summary report published in 2014. Methods A systematic search for systematic reviews and meta-analyses of antibiotic therapy for community-acquired pneumonia was conducted between 1 January 2013 and 10 November 2016. Results The optimal dosing recommendation for amoxicillin remains unclear with limited pharmacological and clinical evidence. There is limited evidence from surveillance to indicate whether amoxicillin or broader spectrum antibiotics (e.g. third-generation cephalosporins) are being used most commonly for paediatric CAP in different WHO regions. Data are lacking on clinical efficacy in the context of pneumococcal, staphylococcal and mycoplasma disease and the relative contributions of varying first-line and step-down options to the selection of such resistance. Conclusion Further pragmatic trials are required to optimise management of hospitalised children with severe and very severe pneumonia.
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Key Words
- AAD, antibiotic-associated diarrhoea
- BNFc, British National Formulary for Children
- BTS, British Thoracic Society
- CAP, community-acquired pneumonia
- CPS, Canadian Paediatric Society
- EARS-Net, European Antimicrobial Resistance Surveillance Network
- ESPID, European Society for Paediatric Infectious Diseases
- GRADE, Grading of Recommendations Assessment, Development and Evaluation
- IDSA, Infectious Diseases Society of America
- IMCI, integrated management of childhood illness
- PCV, pneumococcal conjugate vaccine
- PIDS, Pediatric Infectious Diseases Society
- Pneumonia
- RCPCH, Royal College of Paediatrics and Child Health
- WHO, World Health Organization
- antimicrobial resistance
- bacterial
- community-acquired pneumonia
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Affiliation(s)
- Shrey Mathur
- Paediatric Infectious Disease Research Group, Institute for Infection and Immunity, St George’s University of London, London, UK,Corresponding author.
| | - Aline Fuchs
- Paediatric Pharmacology and Pharmacometrics, University Children’s Hospital Basel, Basel, Switzerland
| | - Julia Bielicki
- Paediatric Infectious Disease Research Group, Institute for Infection and Immunity, St George’s University of London, London, UK,Paediatric Pharmacology and Pharmacometrics, University Children’s Hospital Basel, Basel, Switzerland
| | - Johannes Van Den Anker
- Paediatric Pharmacology and Pharmacometrics, University Children’s Hospital Basel, Basel, Switzerland,Division of Clinical Pharmacology, Children’s National Health System, Washington, DC, USA
| | - Mike Sharland
- Paediatric Infectious Disease Research Group, Institute for Infection and Immunity, St George’s University of London, London, UK
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Fuchs A, Bielicki J, Mathur S, Sharland M, Van Den Anker JN. Reviewing the WHO guidelines for antibiotic use for sepsis in neonates and children. Paediatr Int Child Health 2018; 38:S3-S15. [PMID: 29790842 PMCID: PMC6176768 DOI: 10.1080/20469047.2017.1408738] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Guidelines from 2005 for treating suspected sepsis in low- and middle-income countries (LMIC) recommended hospitalisation and prophylactic intramuscular (IM) or intravenous (IV) ampicillin and gentamicin. In 2015, recommendations when referral to hospital is not possible suggest the administration of IM gentamicin and oral amoxicillin. In an era of increasing antimicrobial resistance, an updated review of the appropriate empirical therapy for treating sepsis (taking into account susceptibility patterns, cost and risk of adverse events) in neonates and children is necessary. Methods Systematic literature review and international guidelines were used to identify published evidence regarding the treatment of (suspected) sepsis. Results Five adequately designed and powered studies comparing antibiotic treatments in a low-risk community in neonates and young infants in LMIC were identified. These addressed potential simplifications of the current WHO treatment of reference, for infants for whom admission to inpatient care was not possible. Research is lacking regarding the treatment of suspected sepsis in neonates and children with hospital-acquired sepsis, despite rising antimicrobial resistance rates worldwide. Conclusions Current WHO guidelines supporting the use of gentamicin and penicillin for hospital-based patients or gentamicin (IM) and amoxicillin (oral) when referral to a hospital is not possible are in accordance with currently available evidence and other international guidelines, and there is no strong evidence to change this. The benefit of a cephalosporin alone or in combination as a second-line therapy in regions with known high rates of non-susceptibility is not well established. Further research into hospital-acquired sepsis in neonates and children is required.
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Affiliation(s)
- Aline Fuchs
- Paediatric Pharmacology and Pharmacometrics, University Children’s Hospital Basel, Basel, Switzerland,Corresponding author.
| | - Julia Bielicki
- Paediatric Pharmacology and Pharmacometrics, University Children’s Hospital Basel, Basel, Switzerland,Paediatric Infectious Disease Research Group, Institute for Infection and Immunity, St George’s University of London, London, UK
| | - Shrey Mathur
- Paediatric Infectious Disease Research Group, Institute for Infection and Immunity, St George’s University of London, London, UK
| | - Mike Sharland
- Paediatric Infectious Disease Research Group, Institute for Infection and Immunity, St George’s University of London, London, UK
| | - Johannes N. Van Den Anker
- Paediatric Pharmacology and Pharmacometrics, University Children’s Hospital Basel, Basel, Switzerland,Division of Clinical Pharmacology, Children’s National Health System, Washington, DC, USA
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Silverman MA, Konnikova L, Gerber JS. Impact of Antibiotics on Necrotizing Enterocolitis and Antibiotic-Associated Diarrhea. Gastroenterol Clin North Am 2017; 46:61-76. [PMID: 28164853 PMCID: PMC5314436 DOI: 10.1016/j.gtc.2016.09.010] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Antibiotic treatment alters the composition and metabolic function of the intestinal microbiota. These alterations may contribute to the pathogenesis of necrotizing enterocolitis (NEC) and antibiotic-associated diarrhea (AAD). Recent studies are beginning to unravel the contribution of specific groups of microbes and their metabolic pathways to these diseases. Probiotics or other microbiota-targeted therapies may provide effect strategies to prevent and treat NEC and AAD.
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Affiliation(s)
- Michael A. Silverman
- Division of Infectious Diseases, The Children’s Hospital of Philadelphia, Philadelphia, PA 19104, and Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104
| | - Liza Konnikova
- Department of Pediatric and Newborn Medicine, Brigham and Women’s Hospital, Boston, MA 02115 and Department of Pediatrics, Harvard Medical School, Boston, MA 02115
| | - Jeffrey S. Gerber
- Center for Pediatric Clinical Effectiveness, Division of Infectious Diseases, The Children’s Hospital of Philadelphia, Philadelphia, PA, 19104 and Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104
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Mehta N, Schilder A, Fragaszy E, E R Evans H, Dukes O, Manikam L, Little P, Smith SC, Hayward A. Antibiotic prescribing in patients with self-reported sore throat. J Antimicrob Chemother 2017; 72:914-922. [PMID: 27999063 PMCID: PMC5400092 DOI: 10.1093/jac/dkw497] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 10/19/2016] [Indexed: 01/21/2023] Open
Abstract
Objectives To investigate the predictors of general practitioner (GP) consultation and antibiotic use in those developing sore throat. Methods We conducted a prospective population-based cohort study on 4461 participants in two rounds (2010-11) from 1897 households. Results Participants reported 2193 sore throat illnesses, giving a community sore throat incidence of 1.57/ person-year. 13% of sore throat illnesses led to a GP consultation and 56% of these consultations led to antibiotic use. Participants most likely to have sore throats included women and children (e.g. school compared with retirement age); adjusted incidence rate ratio (aIRR) of 1.33 and 1.52, respectively. Participants with sore throat were more likely to consult their GP if they were preschool compared with retirement age [adjusted OR (aOR) 3.22], had more days of sore throat (aOR 1.11), reported more severe pain (aOR 4.24) or reported fever (aOR 3.82). Antibiotics were more often used by chronically ill individuals (aOR 1.78), those reporting severe pain (aOR 4.14), those reporting fever (aOR 2.58) or children with earache (aOR 1.85). Among those who consulted, males and adults who reported feeling anxious were more likely to use antibiotics; aOR 1.87 and 5.36, respectively. Conclusions Only 1 in 10 people who have a sore throat see a doctor and more than half of those attending get antibiotics. Further efforts to curb antibiotic use should focus on reducing initial GP consultations through public information promoting safe self-management, targeted at groups identified above as most likely to attend with sore throats.
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Affiliation(s)
- Nishchay Mehta
- Farr Institute of Health Informatics Research, UCL, 222 Euston Road, London NW1 2DA, UK
- evidENT, Ear Institute, UCL, 330 Gray's Inn Road, London WC1X 8DA, UK
| | - Anne Schilder
- evidENT, Ear Institute, UCL, 330 Gray's Inn Road, London WC1X 8DA, UK
| | - Ellen Fragaszy
- Farr Institute of Health Informatics Research, UCL, 222 Euston Road, London NW1 2DA, UK
- London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Hannah E R Evans
- Farr Institute of Health Informatics Research, UCL, 222 Euston Road, London NW1 2DA, UK
- evidENT, Ear Institute, UCL, 330 Gray's Inn Road, London WC1X 8DA, UK
| | - Oliver Dukes
- Farr Institute of Health Informatics Research, UCL, 222 Euston Road, London NW1 2DA, UK
| | - Logan Manikam
- evidENT, Ear Institute, UCL, 330 Gray's Inn Road, London WC1X 8DA, UK
- Population, Policy and Practice, UCL Great Ormond Street, Institute of Child Health, London, UK
| | - Paul Little
- Primary Care Group, Primary Care and Population Sciences Unit, University of Southampton, Aldermoor Close, Southampton SO16 5ST, UK
| | - Sarah C Smith
- London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Andrew Hayward
- Farr Institute of Health Informatics Research, UCL, 222 Euston Road, London NW1 2DA, UK
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