Antibiotics/antibacterial drug use, their marketing and promotion during the post-antibiotic golden age and their role in emergence of bacterial resistance

During the post-antibiotic golden age, it has seen a massive antibiotic/antibacterial production and an increase in irrational use of these few existing drugs in the medical and veterinary practice, food industries, tissue cultures, agriculture and commercial ethanol production globally. The irrational drug use has been further exacerbated by the increased marketing and promotion of these drugs by the pharmaceutical companies thus increasing their accessibility in the public and hence their improper use. The lack of production and introduction of the newer and effective antibiotic/antibacterial drugs in clinical practice in the post-antibiotic golden age has seen an increase in the emergence of the resistant pathogenic bacterial infections creating a significant problem in the global health of humankind. The massive productions of the antibiotic/antibacterial drugs have contributed to the poor disposal of these drugs and hence many of them are discharged in various water bodies contributing to the environmental antibiotic/antibacterial drug pollution. In the environment, these drugs exert pressure on the environmental bacteria by destroying useful bacteria that are responsible for the recycling of the organic matter and as well as promoting the selection of the resistant pathogenic bacteria that can spread in human and animal population thus causing an increase in the observed bacterial disease burden and hence a significant global public health problem. The resistant bacterial diseases lead to the high cost, increased occurrence of adverse drug reactions, prolonged hospitalization, the exposure to the second- and third-line drugs like in MDR-TB and XDR-TB that leads to toxicity and deaths as well as the increased poor production in agriculture and animal industry and commercial ethanol production.

Clinical pharmacists’ involvement in carbapenem antibiotics management at Wenzhou Integrated Hospital

BACKGROUND Carbapenem antibiotics are a pivotal solution for severe infections,particularly in hospital settings.The emergence of carbapenem-resistant bacteria owing to the irrational and extensive use of carbapenems underscores the need for meticulous management and rational use.Clinical pharmacists,with their specialized training and extensive knowledge,play a substantial role in ensuring the judicious use of carbapenem.This study aimed to elucidate the patterns of carbapenem use and shed light on the integral role played by clinical pharmacists in managing and promoting the rational use of carbapenem antibiotics at Wenzhou Integrated Traditional Chinese and Western Medicine Hospital.AIM To analyze carbapenem use patterns in our hospital and role of clinical pharmacists in managing and promoting their rational use.METHODS We performed a retrospective analysis of carbapenem use at our hospital between January 2019 and December 2021.Several key indicators,including the drug utilization index,defined daily doses(DDDs),proportion of antimicrobial drug costs to total hospitalization expenses,antibiotic utilization density,and utilization rates in different clinical departments were comprehensively analyzed.RESULTS Between 2019 and 2021,there was a consistent decline in the consumption and sales of imipenem-cilastatin sodium,meropenem(0.3 g),and meropenem(0.5 g).Conversely,the DDDs of imipenem-cilastatin sodium for injection increased in 2020 and 2021 vs 2019,with a B/A value of 0.67,indicating a relatively higher drug cost.The DDDs of meropenem for injection(0.3 g)exhibited an overall upward trend,indicating an increasing clinical preference.However,the B/A values for 2020 and 2021 were both>1,suggesting a relatively lower drug cost.The DDDs of meropenem for injection(0.5 g)demonstrated a progressive increase annually and consistently ranked first,indicating a high clinical preference with a B/A value of 1,signifying good alignment between economic and social benefits.CONCLUSION Carbapenem use in our hospital was generally reasonable with a downward trend in consumption and sales over time.Clinical pharmacists play a pivotal role in promoting appropriate use of carbapenems.

Evaluation of antibiotic use among inpatients in surgical ward at Mbarara Regional Referral Hospital,South-Western Uganda

Objective The main aim of this study was to evaluate antibiotic use among inpatients in surgical ward at South-Mbarara Regional Referral Hospital,South-Western Uganda.Methodology:A retrospective cross-sectional study was carried out on patients'follow-up forms of Mbarara Regional Referral Hospital,surgical ward from 15th November to 15th December.Data abstraction tool was employed to extracted data,entered in excel version 2010 then imported into SPSS software version 2010 where different variables were analyzed.Results:A total of 136 patient forms were studied.At least one antibiotic was prescribed in 76(56%).Majority(81.58%)of the antibiotics were prescribed for therapeutic purpose while some lacked documented and approved indications.Specific indications were not documented in 15(19.73%)of the forms.Sepsis without culture and sensitivity was the most frequent indication 14(18.42%)for antibiotics followed by prophylactic use 12(15.79%).Ceftriaxone was the most commonly(82.9%)prescribed antibiotic;followed by metronidazole for 31(40.8%)and Ampicillin/Cloxacillin for 8(10.5%)of the patients.Out of the 76 patients who used antibiotics,the overall use was found to be appropriate in only 20(26.3%).Most prescriptions had right doses 57(75.0%)followed by right frequencies 53(69.7%);whereas the duration was the least appropriate with only 46(60.5%)of the 76 patients.Conclusion:More than half of the patients had at least one antibiotic prescribed to them.Ceftriaxone and metronidazole were the most prescribed,the majority of antibiotics were used for treatment and some of the patients were on antibiotics without specific indications.Sepsis was the most common indication for the antibiotics used.Most antibiotics were inappropriately used.Duration of treatment was the most inappropriate parameter and antibiotic use varied greatly with guidelines.

Antibiotic Use in a Cohort of Extremely Low Birth Weight Neonates: Focus on Off-Label Uses and Prescription Behaviour

Aim: To analyse antibiotic prescriptions in a cohort of extremely low birth weight neonates admitted to Italian level III Neonatal intensive Care Units. Methods: An online questionnaire was used to collect detailed information for each newborn. Antibiotic prescriptions were classified about their license status and compared with British National Formulary for Children (BNFC) and with a practical guide prepared by the Italian Society of Neonatology (ISN). Results: During the study period (May-July 2014) among 93 neonates admitted to 30 Italian Neonatal intensive Care Units, 56 (60%) received at least an antibiotic (92 prescriptions in total). Ampicillin, gentamicin and vancomycin were the antibiotics most commonly used for the prevention/treatment of bacterial infections. 56/92 antibiotic prescriptions (61%) resulted off-label mainly as regards dosing frequency, while 13 prescriptions (14%) regarded antibiotics used in absence of specific indication for newborns (meropenem, imipenem, piperacillin/tazobactam, clindamycin, clarithromycin). 50/56 neonates (89.3%) received at least one off-label antibiotic prescription. Differences have been observed in dosing regimens between current study and recommendations contained in BNFC, while prescriptions adhered more frequently to ISN indications. Conclusions: Our results confirm the high prevalence of off-label antibiotic use in ELBW neonates and underline a better adherence to indications based on clinical practice.

Knowledge, Attitudes and Practices of Antibiotic Use and Antimicrobial Resistance among Medical Students in a Private University in Dominica, West Indies

Antibiotics are indispensable to maintaining human health, however, their overuse has resulted in resistant organisms which present a significantly higher burden to the low to middle income countries, due to the high incidence of communicable diseases. Insufficient antimicrobial-related training for physicians during their undergraduate education could have a negative impact on their prescribing. This study assessed the knowledge, attitudes and practices of antibiotic use and antimicrobial resistance among medical students in a private university in Dominica, a resource-limited country, in order to facilitate more effective education of these future prescribers. A cross-sectional study was undertaken with the medical students from February 2021 to April 2021 using a 36-item questionnaire. Data analysis was achieved using descriptive statistics. A total of 85 students participated in the study, majority (70%) were female, African, aged 23.8 ± 4.6 years and single. Between 64 and 99% of the respondents reported no risk factors for communicable diseases and demonstrated a low to moderate (10% - 40%) negative response to knowledge-related questions. The majority (70%) of the respondents who had used antibiotics in the past 12 months reported efficacy and limited side-effects, but confirmed lack of knowledge about the classes of antibiotics prescribed to them. Almost half of the medical students (48%) reported having abused antibiotics, while about a third (35%) of the respondents reported sharing antibiotics with friends or loved ones in the past. There was no significant association between age, gender, and the medical students’ knowledge of antibiotic resistance (p > 0.05). However, they reported that they would like more education on antimicrobial use and resistance. The medical students in this study showed knowledge of antimicrobial resistance, but lacked comprehension of components of antimicrobial stewardship, including prevention of inappropriate use and classes of antibiotics. Therefore, steps need to be taken to prepare medical students for antimicrobial resistance and stewardship initiatives effectively.

Action of Essential Oils Obtained from Baccharis coridifolia D.C.(Asteraceae-Astereae)on the Activity of Antibiotics

The aim of this study was to investigate the effects of Baccharis coridifolia essential oil on the Activity of Antibiotics. Assays were performed with ampicillin (10 μg), cephalothin (30 μg), chloramphenicol (30 μg), gentamicin (10 μg) and tetracycline (30 μg) alone and in combination with the essential oil (4% v/v) through the disk diffusion susceptibility test. The results showed the effects of essential oil on the activity of the antibiotics tested. Zones of inhibition of bacterial growth with different diameters were observed surrounding the antibiotic disks, whether or not they were impregnated with the essential oil. The occurrence of the synergistic or antagonistic effect was observed in both bacterial strains assessed—Staphylococcus aureus (ATCC-25923) and Escherichia coli (ATCC-25922). These results show that the use of products derived from plants can, in some cases, interfere with the effectiveness of antibiotics during clinical therapy.

Did the severe acute respiratory syndrome-coronavirus 2 pandemic cause an endemic Clostridium difficile infection?

BACKGROUND Clostridium difficile infection(CDI)has increased in prevalence during the last years.The coronavirus disease 2019(COVID-19)pandemic has negatively influenced patient outcomes.The majority of the severe acute respiratory syndrome-coronavirus 2(SARS-CoV-2)-infected patients received antibiotics during hospitalization.AIM To analyze the factors that influenced CDI development after SARS-CoV-2 infection.METHODS Between March 2020 to December 2020,we performed a prospective observational study including 447 patients diagnosed with CDI who were admitted to our tertiary referral university hospital.The diagnosis of CDI was based on the presence of diarrhea(≥3 watery stools within 24 h)associated with Clostridium difficile toxins A or B.We excluded patients with other etiology of acute diarrhea.RESULTS Among the total 447(12.5%)patients with CDI,most were male(54.3%)and mean age was 59.7±10.8 years.Seventy-six(17.0%)had history of COVID-19,most being elderly(COVID-19:62.6±14.6 years vs non-COVID-19:56.8±17.6 years,P=0.007),with history of alcohol consumption(43.4%vs 29.4%,P=0.017),previous hospitalizations(81.6%vs 54.9%,P<0.001)and antibiotic treatments(60.5%vs 35.5%,P<0.001),requiring higher doses of vancomycin and prone to recurrent disease(25.0%vs 13.1%,P=0.011).Age over 60 years[odds ratio(OR):2.591,95%confidence interval(CI):1.452-4.624,P=0.001],urban residence(OR:2.330,95%CI:1.286-4.221,P=0.005),previous antibiotic treatments(OR:1.909,95%CI:1.083-3.365,P=0.025),previous hospitalizations(OR:2.509,95%CI:1.263-4.986,P=0.009)and alcohol consumption(OR:2.550,95%CI:1.459-4.459,P=0.001)were risk factors of CDI in COVID-19.CONCLUSION CDI risk is unrelated to history of SARS-CoV-2 infection.However,previous COVID-19 may necessitate higher doses of vancomycin for CDI.

A controlled Intervention Study: Comparison of Intervention on the Antibiotic Prophylaxis of Three Clean Surgeries in Chinese Tertiary Hospitals

A controlled intervention study was to promote rational antibiotic prophylaxis in clean surgeries in Chinese tertiary hospitals from 2008 to 2009. The effect of the intervention was measured and compared before and after intervention (intervention group, IG, including twelve hospitals), and compared with the control group (CG, including 164 tertiary hospitals distributed in 31 provinces). There were a total of 3961 and 657 cases identified in IG & CG for the study. Comparing the changes of IG with CG following the 3rd intervention, the proportion of antibiotics use without indication decreased from 61.9% (IG) & 84.4% (CG) (χ2 test, P χ2 test, P > 0.05);the rationality scores increased from 55.4 (IG) & 57.6 (CG) (t test, P > 0.05) to 77.0 (IG) & 64.3 (CG) (t test,

The Social Context of Antibiotic Resistance

There are various socio-economic （poverty, self medication, and non-compliance to prescribed therapy） and behavior factors that affects the way of antibiotic use, which consequently brings the development of antibiotic resistance in patients. In the study, some of these social factors that might have an impact on the resistance of antibiotics in patients of regional of Vlora hospital during the period 2011-2012 were examined. The study was conducted using structured interviews on patients who were previously examined for bacterial cultures and sensitivity. The antibiotic resistance resulted really high in these patients. It is found out that the organisms with higher resistance were Streptococcus and Escherichia coli. 75% of the patients, whose cultures were positive, were resistant to at least one antibiotic and 31% to three or more antibiotics. A significant correlation between the structure of antibiotic resistance and the upper socio economic levels, the low educational level of the patients, self medication and the frequency of antibiotic use was found. These data have influence in the development of the awareness strategies in risky groups in order to clarify the concepts on the proper use of antibiotics.

Inappropriate use of empirical antibiotics in adults with acute infectious diarrhea in a large teaching hospital

Overuse of antibiotics for the treatment of acute diarrhea is very common. The aim of the current study was to investigate the inappropriate use of antibiotics in adults with acute infectious diarrhea and to evaluate the association between the use of antibiotics and clinical features. To achieve this aim, we reviewed 4891 patients＇ medical records from Apr. 2008 to Oct. 2009. Of the total 4891 cases, 30.5% had clinical features of invasive bacterial diarrhea, 48.1% were prescribed with antibiotics, and 20.3% received inappropriate antibiotic treatment. Of note, 19% involved unnecessary antibiotic prescriptions in non-indicated cases, which accounted for 39.4% of all antibiotics prescribed in the total 4891 patients. There was no significant differences between physicians and medical trainees in the inappropriate use of antibiotics （P = 1.0）. Logistic regression analysis demonstrated that except for body temperature, other clinical symptoms including abdominal pain, tenesmus, and faecal WBC count （〉10 cells/HPF） were associated with the use of antibiotics. In addition, other clinical indicators including vomiting, stool frequency of 5-10 times/d, mucous stool, and fecal WBC count of 1-10 cells/HPF, which are not normally indicators for prescribing antibiotics, were also associated with the use of antibiotics. This might suggest that these symptoms were mistaken as features of invasive bacterial diarrhea, thus leading to the overuse of antibiotics.

Occurrence, spatial distribution and ecological risks of antibiotics in soil in urban agglomeration

Antibiotics in soil environment are regarded as emerging pollutants and have introduced increasing risks to soil ecosystem and human health in rapid urbanization areas. Identifying the occurrence and spatial variability of antibiotics in soils is an urgent issue in sustaining soil security. In this study, antibiotics in soils were investigated and analyzed in BeijingTianjin-Hebei urban agglomeration. The occurrence, spatial distribution, and related affecting factors of antibiotics in soils were identified and ecological risks of antibiotics in soil environment were assessed. Results showed that(1) The mean concentration of soil antibiotics in Beijing-Tianjin-Hebei urban agglomeration was 21.79 μg/kg. Land use substantially affected the occurrence and concentration of antibiotics in soils. Concentrations of antibiotics in cropland and orchard soils were 2-3 times higher than the other land use types.(2)The concentrations of antibiotics in soils in Beijing-Tianjin-Hebei urban agglomeration presented a spatial pattern of high values in southeast, and low values in northwest. Spatial variability of antibiotics in soils was closely related to the application of organic fertilizer and wastewater irrigation as well as topographical features. Furthermore, soil properties and land management policy had substantial influences on soil antibiotics, and soil heavy metals may aggravate the accumulation of antibiotics in soils.(3) Ecological risks assessment of antibiotics in soils demonstrated that erythromycin(ERY), sulfamethoxazole(SMX), and doxycycline(DOX) may introduce high risks to soil ecosystem health, and more attention should be paid to the areas with intensive human activities that had potential high risk to soil ecosystem health. This study suggests that scientific land and soil management should be considered to prevent soil antibiotic pollution and sustain soil security in urban agglomeration.

Impact of pharmaceutical intervention on the rational use of antibiotics in primary hospital

Evidence based pharmaceutical interventions focusing on the characteristics of antibiotics use in primary hospitals were investigated to optimize the use of antibiotics. Four pharmaceutical interventions were set up in this study： 1） different levels of antibiotic management system were developed; 2） usage of antibiotics was reported in a monthly journal for the entire hospital; 3） early antibiotics warning system was started; 4） communication between pharmacists and physicians was strengthened. Use of antibiotics in 2007 （before intervention） and 2008 （after intervention） in department of respiratory medicine was analyzed. Significant differences （P〈0.01） in antibiotics use before and after intervention were observed. Use of antibiotics was changed from focusing on one category of drugs to a rotation of a wide range of agents. Evidence based, sound pharmaceutical interventions were effective means to ensure the rational use of antibiotics.

Inconsistent seasonal variation of antibiotics between surface water and groundwater in the Jianghan Plain:Risks and linkage to land uses

Antibiotics are widely used in humans and animals,but their transformation from surface water to groundwater and the impact of land uses on them remain unclear.In this study,14 antibioticswere systematically surveyed in a complex agricultural area in Central China.Results indicated that the selected antibiotic concentrations in surface waters were higher in winter(average:32.7 ng/L)than in summer(average:17.9 ng/L),while the seasonal variation in groundwaters showed an opposite trend(2.2 ng/L in dry winter vs.8.0 ng/L in summer).Macrolides were the predominant antibiotics in this area,with a detected frequency of over 90%.A significant correlation between surface water and groundwater antibiotics was only observed in winter(R^(2)=0.58).This study further confirmed the impact of land uses on these contaminants,with optimal buffer radii of 2500 m in winter and 500 m in summer.Risk assessment indicated that clarithromycin posed high risks in this area.Overall,this study identified the spatiotemporal variability of antibiotics in a typical agricultural area in Central China and revealed the impact of land uses on antibiotic pollution in aquatic environments.

3所综合医院住院抗菌药物使用合理性

目的分析上海市A区3所区属公立综合医院3个代表性病种的住院抗菌药物的使用合理性。方法通过病案评阅,分析3个代表性病种的抗菌药物使用的合理性。结果住院急性单纯性/化脓性阑尾炎(行腹腔镜阑尾切除术)、社区获得性肺炎和输尿管结石(行输尿管镜碎石取石术)的抗菌药物使用不规范且医院间存在较大的差异,有预防性抗菌用药不合理或抗菌药物用药超量的问题。结论应通过强化管理改变医疗机构及其临床医师抗菌药物的不合理使用习惯。

Clinical analysis of central venous catheter-related infections in patients in the emergency ICU

BACKGROUND:Catheter-related infection(CRI)of the central vein is a common cause of nosocomial infection.This study was undertaken to investigate the pathogen culturing and risk factors of CRI in emergency intensive care unit(EICU)in order to provide the beneficial reference.METHODS:From January 2008 to December 2010,a total of 1 363 patients were subjected to catheterization.In these patients,the peak CRI rate of the patients was determined by bacterial cultivation and blood bacterial cultivation.RESULTS:CRI happened in 147 of the 1 363 patients using the central venous catheter.The peak rate of CRI was 10.79%,with an incidence of 3.05 episodes per 1 000 catheter days.Of the147 patients,46.94%had gram-negative bacilli,40.14%had gram-positive cocci,and 12.92%had fungi.Unconditional logistic regression analysis suggests that multiple catheterization,femoral vein catheterization,the application of multicavity catheter,and the duration of catheterization were the independent risk factors for CRI.CONCLUSION:The risk factors for catheter-related infections should be controlled to prevent the occurrence of nosocomial infection.

A Royal Jelly Mixture with Berberine for Dressing Change on a Refractory Skin Ulcer:A Case Report

It has been reported that a 92-year-old female had got a bruise superficial wound on her right leg one and a half years ago,developing into refractory skin ulcer due to improper management before.A prepared cream,mixed royal jelly with berberine for dressing change,was made on the scene through the crush of berberine tablets,working with fresh royal jelly.Topical dressing change with the cream was done every 3 days,and two months later,such the ulcer became clean and was covered fully with fresh granulation tissue.This kind of cream consists of the ingredients of TCM purely,free of antibiotic,and being quite effective clinically,also helpful for proper use of antibiotic.