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BMJ Open Quality Jul 2022Patients with self-reported antibiotic allergies have a higher cost of care, more frequent infections with resistant bacteria and worse health outcomes than patients...
BACKGROUND
Patients with self-reported antibiotic allergies have a higher cost of care, more frequent infections with resistant bacteria and worse health outcomes than patients without antibiotic allergies. Ultimately, less than 5% of patients who report a penicillin allergy have a clinically significant immune-mediated hypersensitivity reaction when tested. As 10%-30% of the population of pregnant patients are colonised for group B (GBS) and guidelines recommend penicillin as the treatment of choice for GBS, current recommendations support penicillin allergy testing in pregnant patients who report an allergy.
METHODS AND INTERVENTION
In this quality improvement project, nursing staff used an algorithm outlining inclusion and exclusion criteria to determine which patients were eligible to have penicillin allergy testing completed. Penicillin allergy testing consisted of a skin test using benzylpenicilloyl polylysine (Pre-Pen), penicillin G potassium, amoxicillin and alkaline hydrolysis mix (penicilloate) as a prick skin test, followed by intradermal skin test and finally an oral challenge with either amoxicillin or penicillin. Patient outcomes were analysed to evaluate the impact of the intervention.
RESULTS
Of the 1266 patients receiving prenatal care during the intervention, 236 (19%) reported a history of penicillin allergy, and 212 if these were eligible for testing. 150 of the eligible patients were offered penicillin allergy testing. 101 patients (67%) completed testing and 49 (33%) declined testing. Seven patients (7%) had positive penicillin allergy testing, while 94 patients (93%) had negative penicillin allergy testing and were immediately de-labelled as penicillin allergic. Seventeen of the de-labelled patients subsequently tested positive for GBS colonisation, and all received intrapartum penicillin without adverse events.
CONCLUSIONS
Pursuing penicillin allergy testing for pregnant patients with reported penicillin allergy is a safe and feasible approach, allowing for allergy de-labelling and safe, guideline-driven antimicrobial therapy during subsequent labour and delivery hospitalisations. Cost-effectiveness of the allergy testing and impact on later episodes of care should be further investigated.
Topics: Amoxicillin; Anti-Bacterial Agents; Drug Hypersensitivity; Female; Humans; Penicillins; Pregnancy; Skin Tests
PubMed: 35906008
DOI: 10.1136/bmjoq-2022-001859 -
Research in Social & Administrative... Aug 2023Antimicrobial resistance (AMR) is a global healthcare challenge that governments and health systems are tackling primarily through antimicrobial stewardship (AMS). This...
Antimicrobial resistance (AMR) is a global healthcare challenge that governments and health systems are tackling primarily through antimicrobial stewardship (AMS). This should, improve antibiotic use, avoid inappropriate prescribing, reduce prescription numbers, aligning with national/international AMS targets. In primary care in the United Kingdom (UK) antibiotics are mainly prescribed for patients with urinary and respiratory symptoms (22.7% and 46% of all antibiotic prescriptions respectively). This study aimed to capture the time-series trends (2014-2022) for commonly prescribed antibiotics for respiratory and urinary tract infections in primary care in England. Trends for Amoxicillin, Amoxicillin sodium, Trimethoprim, Clarithromycin, Erythromycin, Erythromycin ethylsuccinate, Erythromycin stearate, Doxycycline hyclate, Doxycycline monohydrate and Phenoxymethylpenicillin (Penicillin V) were determined. In doing so providing evidence regarding meeting UK antibiotic prescribing rate objectives (a 15% reduction in human antibiotic use 2019-2024). Time series trend analysis of 62,949,272 antibiotic prescriptions from 6,370 General Practices in England extracted from the National Health Service (NHS) Business Services Authority web portal were explored. With additional investigation of prescribing rate trends by quintiles of the Index of Multiple Deprivation (IMD). Overall, there is a downwards trend in antibiotic prescribing for those explored. There is an association between IMD, geographical location, and higher antibiotic prescribing levels (prescribing hot spots). England has a well-documented North-South divide of health inequalities, this is reflected in antibiotic prescribing. The corona virus pandemic (COVID-19) impacted on AMS, with a rise in doxycycline and trimethoprim prescriptions notable in higher IMD areas. Since then, prescribing appears to have returned to pre-pandemic levels in all IMDs and continued to decline. AMS efforts are being adhered to in primary care in England. This study provides further evidence of the link between locality and poorer health outcomes (reflected in higher antibiotic prescribing). Further work is required to address antibiotic use in hot spot areas.
Topics: Humans; Anti-Bacterial Agents; State Medicine; COVID-19; Amoxicillin; Doxycycline; Inappropriate Prescribing; Penicillin V; Trimethoprim; Erythromycin; Primary Health Care; Practice Patterns, Physicians'
PubMed: 37183105
DOI: 10.1016/j.sapharm.2023.05.001 -
The Journal of Allergy and Clinical... Jun 2020The positive rate and pattern of penicillin skin test (PST) has been reported to be decreasing and changing. Previous studies differ about which penicillin component is...
BACKGROUND
The positive rate and pattern of penicillin skin test (PST) has been reported to be decreasing and changing. Previous studies differ about which penicillin component is the dominant component in positive PST result.
OBJECTIVE
To characterize past and current PST patterns to determine whether different determinants in PST have changed over time.
METHODS
A retrospective review of electronic medical records (January 2001-December 2017) was performed for patients who underwent PST. Data were divided into 4 cohorts to see whether trends occurred over time. The cohorts were divided as follows: cohort 1 (2001-2005), cohort 2 (2006-2010), cohort 3 (2011-2015), and cohort 4 (2016-2017).
RESULTS
A total of 30,883 patients underwent PST with the following breakdowns per cohort: cohort 1, 6,536; cohort 2, 10,372; cohort 3, 10,640; and cohort 4, 3,335. Of these, 329 patients (1.0%) had a positive PST result with a wheal of 3 × 3 mm or greater, with 110 in cohort 1, 130 in cohort 2, 67 in cohort 3, and 22 in cohort 4, whereas 170 patients (0.5%) had a positive PST result with a wheal of 5 × 5 mm or greater, with 54 in cohort 1, 72 in cohort 2, 34 in cohort 3, and 10 in cohort 4. When the positive PST rates of cohort 2 (1.25%), cohort 3 (0.6%), and cohort 4 (0.6%) were compared with those of cohort 1 (1.7%), there was a significant decrease in positive PST rates (P = .0278; P < .0001; P < .0001, respectively). When cohort 1 positive rate to benzylpenicillin polylysine among the positive PST (wheal of 3 × 3 mm or greater) was compared with those of the other cohorts (cohorts 2-4), the percent positive of benzylpenicillin polylysine in PST was 27% compared with 21% (P = .38), 34% (P = .5), and 18% (P = .6), respectively. When the positive PST result was defined as a wheal of 5 × 5 mm or greater, the positive rate for benzylpenicillin polylysine in PST increased over time (cohort 2: 22%, P = .8; cohort 3: 32%, P = .3; cohort 4: 40%, P = .264) compared with cohort 1 (19%).
CONCLUSIONS
Positive PST rate is decreasing. We demonstrate that despite benzylpenicillin polylysine solely positive rates remaining relatively stable, the minor penicillin determinants and amoxicillin play an important role in PST and their adoption into standard protocol for routine PST should be considered.
Topics: Amoxicillin; Drug Hypersensitivity; Humans; Penicillin G; Penicillins; Retrospective Studies; Skin Tests
PubMed: 32006722
DOI: 10.1016/j.jaip.2020.01.039 -
Revista Medica de Chile Mar 2021National rates of HIV, gonorrhoeae and syphilis have increased in Chile in recent years, but it is not known if syphilis among pregnant women (PW) is also escalating.
BACKGROUND
National rates of HIV, gonorrhoeae and syphilis have increased in Chile in recent years, but it is not known if syphilis among pregnant women (PW) is also escalating.
AIM
To explore syphilis rates among PW in a southern Chilean region and to describe clinical features of mothers and offspring.
PATIENTS AND METHODS
We selected PW with positive VDRL or T. pallidum micro-he-magglutination (MHA-TP) reactive tests, referred to a high-risk obstetrical pathology center between 2011 and 2019. Clinical information of mothers and their offspring was obtained from their medical records.
RESULTS
Syphilis rates among PW increased from 0.4 to 7.2 per 1,000 live births in the reference center from 2013 to 2019, along with a national and regional increase in both sexes. Twenty-nine cases of PW with syphilis were identified with a median age of 28 years (interquartile range 23-32). Seventeen percent had a history of drug abuse, and 14% had previous sexually transmitted diseases. In seven cases (24%), the diagnosis occurred at delivery. Three percent of patients had a primary syphilis, 14% a secondary syphilis, 24% an early latent syphilis, and 59% a latent syphilis. All cases except one case were treated with benzathine penicillin G and the remaining with erythromycin due to allergy suspicion. Penicillin desensitization was required in two cases (7%). Treatment timing was inadequate in 10 cases (34.5%). Of 19 patients with available serological follow-up, 10 (53%) showed a significant decrease in VDRL titers (≥ 2 dilutions) and two cases had re-infection. Two patients (7%) had an abortion, two had congenital syphilis (7%), and six had premature births (21%), totaling 35% of adverse-pregnancy outcomes.
CONCLUSIONS
Resurgence of syphilis among pregnant women is happening in southern Chile and is associated to adverse-pregnancy outcomes.
Topics: Adult; Chile; Female; Humans; Male; Penicillin G Benzathine; Pregnancy; Pregnancy Complications, Infectious; Pregnant Women; Syphilis; Syphilis, Congenital
PubMed: 34479313
DOI: 10.4067/s0034-98872021000300348 -
Scientific Reports Jul 2020Some antibiotics have lost their efficacy over common infections and this has led to the search for new antibiotics and chemically altering existing ones for a better...
Some antibiotics have lost their efficacy over common infections and this has led to the search for new antibiotics and chemically altering existing ones for a better control of infectious diseases. In the present study, Pyrenacantha grandiflora tubers extracts were conjugated with ampicillin, penicillin, vancomycin and silver nanoparticles and their antimicrobial activity was evaluated against Escherichia coli, Staphylococcus aureus and Klebsiella Pneumoniae. The reactions were confirmed by formation of new functional groups that were identified by Fourier transmission infrared spectroscopy (FTIR). Minimum inhibitory concentrations were determined using the microdilution assay. Minimum bactericidal concentrations and the fractional inhibition concentration index were also determined. FTIR analysis indicated different functional group associated with conjugation. The activity of ampicillin was improved when conjugated with silver nanoparticles against K. pneumonia and E. coli. Vancomycin showed improvement of activity when conjugated to silver nanoparticles against K. pneumonia. Penicillin was improved by acetone extracts and vancomycin showed to be more effective when conjugated with silver nanoparticles and water extracts. The conjugation of P. grandiflora with penicillin, ampicillin and vancomycin in the presence of silver nanoparticles improved their biological activities. Therefore, the conjugates are medicinally important and can be used to improve the activity of existing antibiotics.
Topics: Ampicillin; Anti-Infective Agents; Bacterial Infections; Drug Synergism; Escherichia coli; Humans; Klebsiella pneumoniae; Magnoliopsida; Metal Nanoparticles; Microbial Sensitivity Tests; Penicillins; Silver; Staphylococcus aureus; Vancomycin
PubMed: 32665625
DOI: 10.1038/s41598-020-68290-x -
Luminescence : the Journal of... Jul 2023The penicillin derivative amoxicillin (AMX) plays an important role in treating various types of infections caused by bacteria. However, excessive use of AMX may have... (Review)
Review
The penicillin derivative amoxicillin (AMX) plays an important role in treating various types of infections caused by bacteria. However, excessive use of AMX may have negative health effects. Therefore, it is of utmost importance to detect and quantify the AMX in pharmaceutical drugs, biological fluids, and environmental samples with high sensitivity. Therefore, this review article provides valuable and up-to-date information on nanostructured material-based optical and electrochemical sensors to detect AMX in various biological and chemical samples. The role of using different nanostructured materials on the performance of important optical sensors such as colorimetric sensors, fluorescence sensors, surface-enhanced Raman scattering sensors, chemiluminescence/electroluminescence sensors, optical immunosensors, optical fibre-based sensors, and several important electrochemical sensors based on different electrode types have been discussed. Moreover, nanocomposites, polymer, and MXenes-based electrochemical sensors have also been discussed, in which such materials are being used to further enhance the sensitivity of these sensors. Furthermore, nanocomposite-based photo-electrochemical sensors and the market availability of biosensors including AMX have also been discussed briefly. Finally, the conclusion, challenges, and future perspectives of the above-mentioned sensing techniques for AMX detection are presented.
Topics: Anti-Bacterial Agents; Amoxicillin; Biosensing Techniques; Immunoassay; Nanocomposites; Electrochemical Techniques
PubMed: 36378274
DOI: 10.1002/bio.4408 -
Hospital Pediatrics Apr 2023Penicillin (PCN) allergy labels are widely recognized to be highly inaccurate. Little is known about parental perceptions of the PCN allergy evaluation and removal...
BACKGROUND
Penicillin (PCN) allergy labels are widely recognized to be highly inaccurate. Little is known about parental perceptions of the PCN allergy evaluation and removal process, especially in the hospital setting.
METHODS
Focus groups were held with parents of children and adolescents with a PCN allergy label discharged from a large academic children's hospital between January 1, 2019, and April 15, 2020. The open-ended, semistructured moderator guide included questions about PCN allergy testing and evaluation, accuracy of the PCN allergy diagnosis, amoxicillin oral challenges, delabeling process, and preferred setting for PCN allergy delabeling evaluation (outpatient clinic, hospital, etc). Study investigators coded the transcripts and identified underlying themes using inductive and deductive thematic analysis.
RESULTS
A total of 21 parents and 2 adolescents participated across 4 focus groups. We developed a theoretical framework depicting key elements of parents' and adolescents' experiences with PCN allergies, consisting of 4 major interconnected themes: (1) family context; (2) the invitation to delabel; (3) decision context; and (4) the PCN delabeling outcome. PCN allergies remained a concern for families even if their children passed an oral challenge. Some parents preferred testing to be performed in the hospital and felt this was a safer location for the procedure.
CONCLUSIONS
Parents are amenable to hospital based PCN allergy evaluation and delabeling. Further studies should incorporate parental and patient preferences to implement safe and effective PCN allergy delabeling processes in the hospital setting.
Topics: Child; Adolescent; Humans; Penicillins; Drug Hypersensitivity; Amoxicillin; Risk Assessment; Hypersensitivity; Anti-Bacterial Agents
PubMed: 36919441
DOI: 10.1542/hpeds.2022-006737 -
Journal of Microbiology, Immunology,... Jun 2022To investigate antibiotic resistance of pathogens responsible for neonatal invasive bacterial infections (IBIs) in China.
BACKGROUND
To investigate antibiotic resistance of pathogens responsible for neonatal invasive bacterial infections (IBIs) in China.
METHODS
Cross-sectional study of neonates with IBI evaluated in nine hospitals in China (January 2012-August 2019). Antibiotic resistance patterns of pathogens responsible for neonatal IBIs were analyzed.
RESULTS
Of 3770 full-term neonates who were subjected to lumbar puncture and a blood culture, IBIs were diagnosed in 460 neonates (12.2%). Escherichia coli and Group B Streptococcus (GBS) were the leading pathogens, followed by Enterococcus spp, and Staphylococcus aureus. E. coli expressed high resistance to ampicillin (72.0%) and third-generation cephalosporins (cefotaxime, 34.8%; ceftriaxone, 38.1%). The prevalence of extended spectrum beta-lactamase (ESBL)-producing E. coli was 34.1%. The proportions of E. spp resistant to penicillin and ampicillin were 60% and 54.1%. All S. aureus showed resistance to ampicillin and penicillin. The resistance rate of S. aureus to methicillin was 50%. Although all GBS were susceptible to penicillin and ampicillin, the proportions of GBS resistant to erythromycin and clindamycin were 75.9% and 77.3%. Antibiotic susceptibility appeared to improve in 2019. Susceptibility of E. coli to ampicillin, cefotaxime, and ceftriaxone improved to 42.9%, 76.9%, and 71.4% in 2019, compared with 12.5%, 37.5%, and 50% in 2012. The prevalence of ESBL-producing E. coli declined to 20% in 2019, lower than 100% in 2012. Susceptibility of GBS to erythromycin and clindamycin improved from 0% in 2012 to 28.6% and 25% in 2019.
CONCLUSIONS
The prevalence of antibiotic resistance is high in neonates in China, although there is a favorable declining trend in recent years.
Topics: Ampicillin; Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; China; Clindamycin; Cross-Sectional Studies; Drug Resistance, Bacterial; Drug Resistance, Microbial; Erythromycin; Escherichia coli; Humans; Infant, Newborn; Microbial Sensitivity Tests; Penicillins; Staphylococcus aureus; Streptococcus agalactiae
PubMed: 34059443
DOI: 10.1016/j.jmii.2021.05.004 -
Research in Veterinary Science Aug 2023Staphylococcus aureus (S. aureus) is a frequent and major etiological agent of bacterial bovine mastitis, leading to high economic losses. This pathogen readily becomes... (Meta-Analysis)
Meta-Analysis Review
Staphylococcus aureus (S. aureus) is a frequent and major etiological agent of bacterial bovine mastitis, leading to high economic losses. This pathogen readily becomes resistant to many antibiotics, resulting in persistent noncurable intramammary infection (IMI) in animals and the development of multidrug-resistant (MDR) strains. The objectives of this study were to evaluate the prevalence of antimicrobial resistance (AMR) of S. aureus strains causing bovine mastitis in Iran according to published data from 2000 to 2021. As there is still a dearth of information on the AMR of S. aureus from Iranian bovine mastitis, the primary focus and subgroup analysis of the present study was performed on Iranian isolates. A systematic review was done according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Based on the initial search, 1006 article were identified. According to inclusion and exclusion criteria and removing duplications, 55 English articles and 13 Persian articles (a total of 68 articles) were finally analyzed. The highest overall prevalence of resistance was reported against penicillin G (p-estimate = 0.568 for all isolates, and p-estimate = 0.838 for Iranian isolates), followed by ampicillin (p-estimate = 0.554, and p-estimate = 0.670 for all isolates and Iranian isolates, respectively) and amoxicillin (p-estimate = 0.391, and p-estimate = 0.695 for all isolates and Iranian isolates, respectively). Besides, the lowest prevalence of resistant isolates was related to trimethoprim-sulfamethoxazole (p-estimate = 0.108 and 0.118 for all isolates and Iranian isolates, respectively) and gentamycin (p-estimate = 0.163 and 0.190, for all isolates and Iranian isolates, respectively). Our analysis showed that the Iranian isolates were more resistant to all antibiotics than those of all isolates. This difference was significant in the case of penicillin G, ampicillin, and erythromycin at 5%. To the best of our knowledge, except for ampicillin, AMR has increased over time for all the studied antibiotics in Iranian isolates. This increased rate was significant for penicillin G, amoxicillin, and tetracycline (p < 0.1). No differences in AMR were detected regarding the mastitis types (clinical vs. subclinical mastitis) for almost evaluated antibiotics. In conclusion, the prevalence of AMR S. aureus isolated from IMI was high particularly for bovine mastitis used antibiotics like penicillin G and ampicillin. Additionally, according to the increasing rate of AMR S. aureus in recent years in Iran, control strategies should be reinforced to avoid the spread of this pathogen and drug resistance.
Topics: Animals; Cattle; Female; Anti-Bacterial Agents; Staphylococcus aureus; Iran; Mastitis, Bovine; Microbial Sensitivity Tests; Staphylococcal Infections; Ampicillin; Drug Resistance, Microbial; Amoxicillin; Cattle Diseases
PubMed: 37302281
DOI: 10.1016/j.rvsc.2023.05.016 -
Clinical Infectious Diseases : An... Dec 2023Efforts to combat antimicrobial resistance, a growing public health problem in Pakistan, have been hampered by the lack of high-quality national and provincial-level...
BACKGROUND
Efforts to combat antimicrobial resistance, a growing public health problem in Pakistan, have been hampered by the lack of high-quality national and provincial-level antimicrobial consumption data. The singular objective of this retrospective study was to measure antimicrobial consumption over 3 years between 2019 and 2021.
METHODS
The study was designed to estimate antimicrobial consumption at National and Regional levels. Antimicrobial consumption data was collected by IQVIA covering 110 districts of Pakistan in which 88% of sales are census (accurate sales collected directly from distributors), whereas 12% of sales (sales of 300 pharmacies) are projected on the national level. To determine the usage for 3 consecutive years, the consumption of antibiotics was calculated as defined daily doses (DDD) of antibiotics per 1000 inhabitants per day (DID).
RESULTS
The results of our study demonstrated a steep increase in the consumption of antimicrobials from 2019 to 2021. An increase in consumption of most classes of antibiotics was observed both nationally and Regionally. Quinolones, penicillins (co-amoxiclav), macrolides, and third-generation cephalosporins remained the most frequently used antibiotics nationally. A 40% increase in intravenous use of antimicrobials was observed between 2019 and 2021 at the national level. Moxifloxacin, Levofloxacin, Ciprofloxacin, and linezolid were the most commonly used intravenous antibiotics. Region 7 (Peshawar) demonstrated the highest consumption, followed by Region 1 (Karachi) and Region 6 (Faisalabad). Among the most commonly used antibiotics, the use of third-generation cephalosporin (cefixime), quinolones, penicillins (amoxicillin + clavulanic acid), and macrolides (azithromycin) was most noticeable in all regions, particularly in those with the higher consumption of antibiotics.
CONCLUSIONS
Although the increase in consumption of all antibiotics is concerning, the steep increase in the use of watch and reserve category antibiotics during the study period calls for immediate actions to limit and regulate their usage.
Topics: Humans; Retrospective Studies; Pakistan; COVID-19; Anti-Bacterial Agents; Anti-Infective Agents; Penicillins; Ciprofloxacin; Macrolides; Amoxicillin-Potassium Clavulanate Combination
PubMed: 38118009
DOI: 10.1093/cid/ciad647