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BMC Pulmonary Medicine Jun 2020Norwegian guideline recommendations on first-line empirical antibiotic prescribing in hospitalised patients with community-acquired pneumonia (CAP) are penicillin G/V in... (Observational Study)
Observational Study
Empirical prescribing of penicillin G/V reduces risk of readmission of hospitalized patients with community-acquired pneumonia in Norway: a retrospective observational study.
BACKGROUND
Norwegian guideline recommendations on first-line empirical antibiotic prescribing in hospitalised patients with community-acquired pneumonia (CAP) are penicillin G/V in monotherapy, or penicillin G in combination with gentamicin (or cefotaxime) in severely ill patients. The aim of this study was to explore how different empirical antibiotic treatments impact on length of hospital stay (LOS) and 30-day hospital readmission. A secondary aim was to describe median intravenous- and total treatment duration.
METHODS
We included CAP patients (≥18 years age) hospitalised in North Norway during 2010 and 2012 in a retrospective study. Patients with negative chest x-ray, malignancies or immunosuppression or frequent readmissions were excluded. We collected data on patient characteristics, empirical antibiotic prescribing, treatment duration and clinical outcomes from electronic patient records and the hospital administrative system. We used directed acyclic graphs for statistical model selection, and analysed data with mulitvariable logistic and linear regression.
RESULTS
We included 651 patients. Median age was 77 years [IQR; 64-84] and 46.5% were female. Median LOS was 4 days [IQR; 3-6], 30-day readmission rate was 14.4% and 30-day mortality rate was 6.9%. Penicillin G/V were empirically prescribed in monotherapy in 51.5% of patients, penicillin G and gentamicin in combination in 22.9% and other antibiotics in 25.6% of patients. Prescribing other antibiotics than penicillin G/V monotherapy was associated with increased risk of readmission [OR 1.9, 95% CI; 1.08-3.42]. Empirical antibiotic prescribing was not associated with LOS. Median intravenous- and total treatment duration was 3.0 [IQR; 2-5] and 11.0 [IQR; 9.8-13] days.
CONCLUSIONS
Our findings show that empirical prescribing with penicillin G/V in monotherapy in hospitalised non-severe CAP-patients, without complicating factors such as malignancy, immunosuppression and frequent readmission, is associated with lower risk of 30-day readmission compared to other antibiotic treatments. Median total treatment duration exceeds treatment recommendations.
Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Community-Acquired Infections; Female; Guideline Adherence; Humans; Length of Stay; Linear Models; Male; Middle Aged; Multivariate Analysis; Norway; Patient Readmission; Penicillin G; Penicillin V; Pneumonia; Retrospective Studies; Time Factors
PubMed: 32539706
DOI: 10.1186/s12890-020-01188-6 -
American Family Physician May 2020In 2019, regular surveillance of 110 English-language research journals identified 254 studies that met the criteria to become POEMs (patient-oriented evidence that... (Review)
Review
In 2019, regular surveillance of 110 English-language research journals identified 254 studies that met the criteria to become POEMs (patient-oriented evidence that matters). Physician members of the Canadian Medical Association rated these POEMs for their relevance to patients in their practices. This article summarizes the clinical questions and bottom-line answers from the top 20 POEMs of 2019. Taking blood pressure medications at night results in a large mortality reduction over six years compared with morning dosing. Automated devices are the best way to measure blood pressure. Nonfasting lipid profiles are preferred over fasting lipid profiles, and nonfasting and fasting lipid profiles are equally effective at predicting risk. The benefit of statins for primary prevention in people 75 years and older is uncertain at best. Aspirin has no net benefit for primary prevention of cardiovascular disease and has no effect on cancer outcomes. An Italian study found fecal immunochemical testing over five biennial screening cycles has a similar colorectal cancer yield as screening colonoscopy, whereas a meta-analysis found that taking aspirin, an anticoagulant, or a nonsteroidal anti-inflammatory drug has no impact on the positive predictive value of fecal immunochemical testing. Regarding infections, a meta-analysis showed that patients presenting with symptoms of acute respiratory tract infection are unlikely to have pneumonia if vital signs and the lung examination findings are normal. For streptococcal pharyngitis (strep throat), penicillin V at a dosage of 800 mg four times a day for five days is at least as effective as a dosage of 1,000 mg three times a day for 10 days. A primary care study in the United Kingdom reinforced that clinicians should counsel parents of children with lower respiratory tract symptoms to be patient, because these infections can take three weeks or more to fully resolve. Among direct oral anticoagulants, apixaban has the lowest bleeding risk, and cotreating with a proton pump inhibitor significantly reduces bleeding risk. Single ibuprofen doses from 400 to 800 mg significantly reduce acute pain to a similar degree. The two-dose recombinant zoster vaccine is much more effective than the single-dose live, attenuated vaccine but with a greater risk of injection site pain. Exercise helps reduce the risk of falls in older adults. Practice guidelines from 2019 on antithrombotics for atrial fibrillation, the management of type 2 diabetes mellitus, and screening for breast cancer were judged to be especially relevant.
Topics: Humans; Periodicals as Topic; Physicians, Primary Care; Primary Health Care; Research
PubMed: 32412223
DOI: No ID Found -
Cureus Mar 2020The misuse of antibiotics in dentistry is a serious concern especially in regards to the emergence of antibiotic resistance. The objective of the study was to evaluate...
The misuse of antibiotics in dentistry is a serious concern especially in regards to the emergence of antibiotic resistance. The objective of the study was to evaluate the appropriateness of antibiotics prescriptions by Lebanese dentists to patients with endodontic abscesses and their compliance with the guidelines of the American Association of Endodontists (AAE) and the European Society of Endodontology (ESE). The treating dentists recorded clinical information from 127 patients diagnosed with acute or chronic endodontic abscess. The information also included the type of antibiotic prescribed, dosage, and duration of the prescription. Prescriptions were not given to 14/20 patients with an acute endodontic abscess despite the presence of an indication to prescribe. All the prescriptions given to patients with an acute endodontic abscess were inappropriate according to the ESE and AAE guidelines. Antibiotics were also prescribed unnecessarily to 17/42 patients with a chronic endodontic abscess. This study concluded that antibiotics prescriptions by Lebanese dentists for the management of endodontic abscesses were inappropriate. Penicillin V potassium (VK) was not available in Lebanon when the study was conducted. Only broad-spectrum antibiotics were prescribed. This finding raises concerns about the emergence of antibiotic resistance.
PubMed: 32313768
DOI: 10.7759/cureus.7327 -
MSphere Mar 2020Substantial concentrations of penicillin V potassium (PVK) have been found in livestock manure, soil, and wastewater effluents, which may pose potential threats to human...
Substantial concentrations of penicillin V potassium (PVK) have been found in livestock manure, soil, and wastewater effluents, which may pose potential threats to human health and contribute to the emergence of penicillin-resistant bacterial strains. In this study, bacterial strains capable of degrading PVK were isolated from sludge and characterized. Strain X-2 was selected for biodegradation of PVK. Based on morphological observations and 16S rRNA gene sequencing, strain X-2 was identified as an strain. To enhance the PVK degradation ability of PVK, a whole-cell biodegradation process of X-2 was established and optimized. In the whole-cell biodegradation process, the optimal temperature and pH were 30°C and 7.0, respectively. Under the optimized conditions, the degradation rate using 0.5 mg/ml PVK reached 100% within 3 h. During biodegradation, two major metabolites were detected: penicilloic acid and phenolic acid. The present study provides a novel method for the biodegradation of PVK using strains, which represent promising candidates for the industrial biodegradation of PVK. Substantial concentrations of penicillin V potassium (PVK) have been found in the environment, which may pose potential threats to human health and contribute to the emergence of penicillin-resistant bacterial strains. In this study, antibiotic-degrading bacterial strains for PVK were isolated from sludge and characterized. was selected for the biodegradation of PVK with high efficiency. To enhance its PVK degradation ability, a whole-cell biodegradation process was established and optimized using The degradation rate with 0.5 mg/ml PVK reached 100% within 3 h. The potential biodegradation pathway was also investigated. To the best of our knowledge, the present study provides new insights into the biodegradation of PVK using an strain, a promising candidate strain for the industrial biodegradation of β-lactam antibiotics.
Topics: Anti-Bacterial Agents; Biodegradation, Environmental; Hydroxybenzoates; Industrial Microbiology; Ochrobactrum; Penicillanic Acid; Penicillin V; RNA, Ribosomal, 16S; Sewage; Soil Microbiology
PubMed: 32188746
DOI: 10.1128/mSphere.00058-20 -
Journal of Dentistry (Shiraz, Iran) Mar 2020Recently, new compound of 3, 5-dimethyl-1-thiocarboxamide pyrazole has been composed with excellent antibacterial property. Biocompatibility and its effects on...
STATEMENT OF THE PROBLEM
Recently, new compound of 3, 5-dimethyl-1-thiocarboxamide pyrazole has been composed with excellent antibacterial property. Biocompatibility and its effects on mechanical properties of dental composites should be considered before clinical use.
PURPOSE
The purpose of this study was to evaluate the biocompatibility of 3, 5-dimethyl-1-thiocarboxamide pyrazole as a new antibacterial compound and its effect on the mechanical properties of dental composites.
MATERIALS AND METHOD
In this experimental study, a new antibacterial compound was synthesis by reaction between Thiosemicarbazide and 2, 4-Pentandione and tested on thirty male albino Wistar rats weighting 200-250gr. Rats were randomly divided into 3 groups of 10, each rat received 3 implants of 3,5-dimethyl-1-thiocarboxamide pyrazole, penicillin v and empty polyethylene tube. A pathologist, who was unaware of types of tested materials and timing, performed the examination of specimens. The depth of cure and flexural strength of resin composite was measured using Iso4049 standard technique. Compressive strength was determined according to Iso9917 standard.
RESULTS
This compound was biocompatible and there was no significant difference in flexural strength and compressive strength of the composites containing 1% of this compound with the control group (> 0.05).
CONCLUSION
The 3, 5-dimethyl-1-thiocarboxamide pyrazole with a concentration of 1% in flowable composites can be very effective in preventing secondary caries.
PubMed: 32158785
DOI: 10.30476/DENTJODS.2019.77826.0 -
Dental Research Journal 2020Since secondary caries is one of the main problems of dental composites. The creation of an antibacterial property in these composites is essential. The objective of...
BACKGROUND
Since secondary caries is one of the main problems of dental composites. The creation of an antibacterial property in these composites is essential. The objective of this study was to synthesize 3-(2, 5-dimethylfuran-3-yl)-1H-pyrazole-5(4H)-one and check its biocompatibility and antibacterial properties in flowable dental composites.
MATERIALS AND METHODS
In this animal study, the antibacterial activity of flowable resin composites containing 0-5 wt% 3-(2,5-dimethylfuran-3-yl)-1H-pyrazole-5(4H)-one was investigated by using agar diffusion and direct contact tests on the cured resins. Statistical analysis was performed using one-way ANOVA test ( < 0.001). Thirty male albino Wistar rats were used, weighing 200-250 g. Animals were randomly divided into three groups of ten; each animal received three implants, 3-(2, 5-dimethylfuran-3-yl)-1H-pyrazole-5(4H)-one, penicillin V, and an empty polyethylene tube. A pathologist, without knowing the type of material tested and the timing of the test, examined the samples. Statistical analysis was performed using Kruskal-Wallis test ( < 0.001).
RESULTS
According to our findings, although the agar diffusion test reveals no significant difference between the groups, the direct contact test demonstrates that, by increasing the 3-(2,5-dimethylfuran-3-yl)-1H-pyrazole-5(4H)-one content, the bacterial growth was significantly diminished and the 3-(2,5-dimethylfuran-3-yl)-1H-pyrazole-5(4H)-one has a good biocompatibility ( < 0.05).
CONCLUSION
Incorporation of 3-(2,5-dimethylfuran-3-yl)-IH-pyrazole-5(4H)-one into flowable resin composites can be useful to prevent activity.
PubMed: 32055292
DOI: No ID Found -
Medicine Dec 2019Renal actinomycosis is a rare clinical infection, subacute to chronic presentation caused by the Actinomyces bacteria. Actinomyces israelii is diagnosed in the...
RATIONALE
Renal actinomycosis is a rare clinical infection, subacute to chronic presentation caused by the Actinomyces bacteria. Actinomyces israelii is diagnosed in the overpowering majority of reported cases. Abdominopelvic manifestation forms 10% to 20% of all actinomycosis, and may be misdiagnosed as either a malignancy or chronic inflammation due to the lower correct preoperative diagnostic rate (<10%).
PATIENT CONCERNS
A 38-year-old man with alcoholic liver cirrhosis experienced right flank pain, abdominal pain, and fever for 3 days. Leukocytosis, acute kidney injury, and impaired liver function were found. A computed tomographic scan demonstrated multiple renal cystic lesions, along with fluid accumulation at the right subphrenic and retroperitoneal spaces.
DIAGNOSES
Renal actinomycosis was confirmed via cultures of both the abscess and nephrectomy specimen which grew A israelii and the pathological findings of multiple renal abscesses of actinomycosis with the characteristics of sulfur granules.
INTERVENTIONS
A nephrectomy was performed for an inadequate percutaneous drainage of renal abscess.
OUTCOMES
A full course of antibiotics with intravenous penicillin G (3 million units every 4 hours) was prescribed for 2 weeks, followed by oral penicillin V given at a dose of 2 grams per day for 6 months at our out-patient facility.
LESSONS
A precise diagnosis of primary renal actinomycosis depends on any histopathological findings and/or cultures of specimens. A high dose of intravenous penicillin G is the first choice, followed by oral penicillin V, with the duration of each being dependent upon the individual condition.
Topics: Abdominal Abscess; Actinomycosis; Adult; Anti-Bacterial Agents; Humans; Kidney Diseases; Liver Cirrhosis, Alcoholic; Male; Nephrectomy; Retroperitoneal Space
PubMed: 31804331
DOI: 10.1097/MD.0000000000018167 -
BMJ (Clinical Research Ed.) Oct 2019To determine whether total exposure to penicillin V can be reduced while maintaining adequate clinical efficacy when treating pharyngotonsillitis caused by group A... (Comparative Study)
Comparative Study Randomized Controlled Trial
Penicillin V four times daily for five days versus three times daily for 10 days in patients with pharyngotonsillitis caused by group A streptococci: randomised controlled, open label, non-inferiority study.
OBJECTIVE
To determine whether total exposure to penicillin V can be reduced while maintaining adequate clinical efficacy when treating pharyngotonsillitis caused by group A streptococci.
DESIGN
Open label, randomised controlled non-inferiority study.
SETTING
17 primary healthcare centres in Sweden between September 2015 and February 2018.
PARTICIPANTS
Patients aged 6 years and over with pharyngotonsillitis caused by group A streptococci and three or four Centor criteria (fever ≥38.5°C, tender lymph nodes, coatings of the tonsils, and absence of cough).
INTERVENTIONS
Penicillin V 800 mg four times daily for five days (total 16 g) compared with the current recommended dose of 1000 mg three times daily for 10 days (total 30 g).
MAIN OUTCOME MEASURES
Primary outcome was clinical cure five to seven days after the end of antibiotic treatment. The non-inferiority margin was prespecified to 10 percentage points. Secondary outcomes were bacteriological eradication, time to relief of symptoms, frequency of relapses, complications and new tonsillitis, and patterns of adverse events.
RESULTS
Patients (n=433) were randomly allocated to the five day (n=215) or 10 day (n=218) regimen. Clinical cure in the per protocol population was 89.6% (n=181/202) in the five day group and 93.3% (n=182/195) in the 10 day group (95% confidence interval -9.7 to 2.2). Bacteriological eradication was 80.4% (n=156/194) in the five day group and 90.7% (n=165/182) in the 10 day group. Eight and seven patients had relapses, no patients and four patients had complications, and six and 13 patients had new tonsillitis in the five day and 10 day groups, respectively. Time to relief of symptoms was shorter in the five day group. Adverse events were mainly diarrhoea, nausea, and vulvovaginal disorders; the 10 day group had higher incidence and longer duration of adverse events.
CONCLUSIONS
Penicillin V four times daily for five days was non-inferior in clinical outcome to penicillin V three times daily for 10 days in patients with pharyngotonsillitis caused by group A streptococci. The number of relapses and complications did not differ between the two intervention groups. Five day treatment with penicillin V four times daily might be an alternative to the currently recommended 10 day regimen.
TRIAL REGISTRATION
EudraCT 2015-001752-30; ClinicalTrials.gov NCT02712307.
Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Child; Drug Administration Schedule; Female; Humans; Male; Middle Aged; Penicillin V; Pharyngitis; Primary Health Care; Streptococcal Infections; Streptococcus pyogenes; Tonsillitis; Treatment Outcome; Young Adult
PubMed: 31585944
DOI: 10.1136/bmj.l5337 -
Journal of Global Antimicrobial... Mar 2020Antibiotic overuse has led to the global emergence of antimicrobial-resistant bacteria, and children are among the most frequent users of antibiotics. Most studies with...
OBJECTIVES
Antibiotic overuse has led to the global emergence of antimicrobial-resistant bacteria, and children are among the most frequent users of antibiotics. Most studies with broad-spectrum antibiotics show a severe impact on resistome development in patients. Although narrow-spectrum antibiotics are believed to have fewer side effects, their impact on the microbiome and resistome is mostly unknown. The aim of this study was to investigate the impact of the narrow-spectrum antibiotic phenoxymethylpenicillin (penicillin V) on the microbiome and resistome of a child treated for acute otitis media.
METHODS
Oral and faecal samples were collected from a 1-year-old child before (Day 0) and after (Days 5 and 30) receiving penicillin V for otitis media. Metagenomic sequencing data were analysed to determine taxonomic profiling using Kraken and Bracken software, and resistance profiling using KMA in combination with the ResFinder database.
RESULTS
In the oral samples, antimicrobial resistance genes (ARGs) belonging to four classes were identified at baseline. At Day 5, the abundance of some ARGs was increased, whereas some remained unchanged and others could no longer be detected. At Day 30, most ARGs had returned to baseline levels or lower. In the faecal samples, seven ARGs were observed at baseline and five at Day 5. At Day 30, the number of ARGs had increased to 21.
CONCLUSIONS
Following penicillin V, we observed a remarkable enrichment of the aecal resistome, indicating that even narrow-spectrum antibiotics may have important consequences in selecting for a more resistant microbiome.
Topics: Anti-Bacterial Agents; Bacteria; Bacterial Proteins; Drug Resistance, Bacterial; Feces; Female; Gene Expression Regulation, Bacterial; High-Throughput Nucleotide Sequencing; Humans; Infant; Male; Metagenomics; Mouth; Otitis Media; Penicillin V; Phylogeny; Sequence Analysis, DNA
PubMed: 31415828
DOI: 10.1016/j.jgar.2019.08.004 -
International Dental Journal Dec 2019To describe antimicrobial prescribing by Belgian dentists in ambulatory care, from 2010 until 2016.
OBJECTIVES
To describe antimicrobial prescribing by Belgian dentists in ambulatory care, from 2010 until 2016.
MATERIALS AND METHODS
Reimbursement data from the Belgian National Institute for Health and Disability Insurance were analysed to evaluate antimicrobial prescribing (WHO ATC-codes J01/P01AB). Utilisation was expressed in defined daily doses (DDDs), and in DDDs and packages per 1000 inhabitants per day (DID and PID, respectively). Additionally, the number of DDD and packages per prescriber was calculated.
RESULTS
In 2016, the dentistry-related prescribing rate of 'Antibacterials for systemic use' (J01) and 'Antiprotozoals' (P01AB) was 1.607 and 0.014 DID, respectively. From 2010 to 2016, the DID rate of J01 increased by 6.3%, while the PID rate declined by 6.7%. Amoxicillin and amoxicillin with an enzyme inhibitor were the most often prescribed products, followed by clindamycin, clarithromycin, doxycycline, azithromycin and metronidazole. The proportion of amoxicillin relative to amoxicillin with an enzyme inhibitor was low. The narrow-spectrum antibiotic penicillin V was almost never prescribed.
CONCLUSIONS
Antibiotics typically classified as broad- or extended-spectrum were prescribed most often by Belgian dentists during the period 2000-2016. Although the DID rate of all 'Antibacterials for systemic use' (J01) increased over the years, the number of prescriptions per dentist decreased since 2013. The high prescription level of amoxicillin with an enzyme inhibitor is particularly worrying. It indicates that there is a need for comprehensive clinical practice guidelines for Belgian dentists.
Topics: Ambulatory Care; Anti-Bacterial Agents; Anti-Infective Agents; Belgium; Dentists; Humans
PubMed: 31376156
DOI: 10.1111/idj.12512