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Biomedical subjects

S Natsch

Publications and source records attributed to S Natsch.

At least 19 recordsLinked to original sources
PubMed2006

[Optimalisation of the antibiotic policy in The Netherlands. XI. The national electronic antibiotic guide'SWAB-ID' for use in hospitals].

The 'Stichting Werkgroep Antibioticabeleid' (Dutch Working Party on Antibiotic Policy) has developed an electronic national antibiotic guide for the antibiotic treatment and prophylaxis of common infectious diseases in hospitals. This guide also contains information on the most important characteristics of antimicrobial drugs. Advice on antibiotic treatment is based on existing national evidence-based guidelines, where available. Where no guideline is available, the advice is based on an inventory of the antibiotic policies of the 12 Dutch centres with an infectious disease or medical microbiology training programme. The national antibiotic guide can be accessed through the SWAB website (www.swab.nl) and can also be downloaded on PDA/PocketPC, free of charge. Every hospital antibiotic formulary committee in the Netherlands will be offered the opportunity to edit The national version for local use.

Anti-Bacterial Agents↗
PubMed2005

An additional measure for quantifying antibiotic use in hospitals.

OBJECTIVES: The number of defined daily doses (DDD) per 100 patient days is often used as an indicator for the selection pressure exerted by antibiotics in the hospital setting. However, this unit of measurement does not fully describe the selection pressure and is sensitive to changes in hospital resource indicators. Additional information is required to facilitate interpretation of this indicator. The number of DDD per 100 admissions could be a valuable additional tool. The aim of this study is to investigate the importance of units of measurement in quantifying antibiotic use data with regards to antibiotic resistance risks. PATIENTS AND METHODS: Trends in antibiotic use in acute care Dutch hospitals between 1997-2001 were studied. Antibiotic use was expressed in DDD per 100 patient days and in DDD per 100 admissions. RESULTS: From 1997 to 2001, total systemic antibiotic use significantly increased from 47.2 to 54.7 DDD per 100 patient days, whereas expressed in DDD per 100 admissions it remained constant. Some individual antibiotics increases in DDD per 100 patient days were not accompanied by increases in DDD per 100 admissions and vice versa. The mean number of total DDD per hospital decreased (not significantly) between 1997 and 2001. The mean number of patient days, admissions and length of stay decreased significantly. CONCLUSIONS: Knowledge of variation in resource indicators and additional expression of the data in DDD per 100 admissions is imperative for a meaningful understanding of observed trends in antibiotic use expressed in DDD per 100 patient days. Further research is needed to determine the correlation between different measures of antibiotic use and the level of antibiotic resistance.

Anti-Bacterial Agents↗
PubMed2005

Antibiotic control measures in Dutch secondary care hospitals.

Control measures for the use of antibiotics are essential because of the potential harmful consequences of side effects. Various methods have been developed to help curb undesirable antibiotic prescription. We performed a survey in Dutch secondary care hospitals (response rate 73%) to make an inventory of these measures and elucidate possible shortcomings. Almost every hospital was using an antibiotic formulary (97%), sometimes supported by extra restrictions in antibiotic choice (55%). Local practice guidelines (95%) were commonly present, but effective implementation, for example using intranet applications, could be improved (21%). National guidelines had received little attention in the composition process of local guidelines (19%). Other measures such as educational programmes for specialists (11%) and feedback on antibiotic prescription (52%) remained largely underused, although their effective implementation may optimise antibiotic prescription in hospitals.

Anti-Bacterial Agents↗
PubMed2005

Changes in antibiotic use in Dutch hospitals over a six-year period: 1997 to 2002.

OBJECTIVE: To analyse trends in antibiotic use in Dutch hospitals over the period 1997 to 2002. METHODS: Data on the use of antibiotics and hospital resource indicators were obtained by distributing a questionnaire to all Dutch hospital pharmacies. Antibiotic use was expressed as the number of defined daily doses (DDD) per 100 patient-days and as DDD per 100 admissions. RESULTS: Between 1997 and 2002, the mean length of stay decreased by 18%. The mean number of admissions remained almost constant. Total antibiotic use significantly increased by 24%, from 47.2 in 1997 to 58.5 DDD per 100 patient-days in 2002 (p<0.01), whereas expressed as DDD per admissions it remained constant. Antibiotic use varied greatly between the hospitals. Moreover, the mean number of DDD per hospital of amoxicillin with clavulanic acid, clarithromycin, cefazolin, clindamycin and ciprofloxacin increased by 16, 38, 39, 50 and 52%, respectively. Total antibiotic use was higher in university hospitals than in general hospitals. CONCLUSIONS: Between 1997 and 2002, patients hospitalised in the Netherlands did not receive more antibiotics but, since they remained in the hospital for fewer days, the number of DDD per 100 patient-days increased. For macrolides, lincosamides and fluoroquinolones increases in both DDD per 100 patient-days and in DDD per 100 admissions were observed. It is arguable whether these trends result in an increase in selection pressure towards resistance in the hospitals. Continuous surveillance of antibiotic use and resistance is warranted to maintain efficacy and safety of antibiotic treatment.

Anti-Bacterial Agents↗
PubMed2004

[Completing a course of drug therapy is necessary to combat the infection, not to discourage emergence of resistance].

For the treatment of infections, it is usually recommended to 'complete the course' so as to avoid the development of resistance. There is little evidence, however, for the exact duration of treatment. Only a few pathogenic microorganisms are able to develop resistance during exposure to effective antibiotic concentrations. Commensal flora are often destroyed during treatment, which can lead to colonisation with resistant mutants. Excretion of antibiotics in the urine will expose microorganisms in the environment, leading to resistance. Longer exposure will lead to more resistance. Only the time needed to clear up the infection should determine the duration of treatment and not the arbitrary length of an antibiotic dosage schedule.

Anti-Bacterial Agents↗
PubMed2003

Selecting outcome parameters in studies aimed at improving rational use of antibiotics - practical considerations.

When designing studies of the optimal use of antimicrobial drugs, it is important to define at an early stage, which outcome parameters to use. It must be clear to which category a parameter to be measured belongs: the structure, the process or a clinical outcome. Attention must be paid to the measurement scales as well as the statistical tests to be used. The outcome measure must be sensitive, specific and reliable. Furthermore, the timeframe chosen for the performance of a study should be validated. Whether process parameters or clinical outcomes are to be preferred depends on the settings and the intended purpose. The essential point is the appropriate choice of outcome measure for the study. Examples drawn from the field of quality of use of antimicrobial drugs are discussed.

Anti-Bacterial Agents↗
PubMed2003

The role of clinical guidelines, policies and stewardship.

The purpose of guidelines is to improve the quality of care for patients and improve clinical effectiveness by implementation of evidence-based care in daily practice. However, the potential of guidelines for resolving clinical questions should not be overstated. Ideally, policy makers use input from research data, as well as current prescribing habits, when developing guidelines. Care has to be given to the quality of guidelines, as well as their effect on outcome. Prospective validation of the content and use of guidelines must be set up. Beside the quality of guidelines, efforts are necessary for an effective implementation into daily practice. Many studies have shown that a combination of different interventions is needed. Thereby, an investigation of possible barriers should be an essential part of any strategy.

Attitude of Health Personnel↗
PubMed2001

Use of fluconazole in daily practice: still room for improvement.

One hundred courses of fluconazole treatment in a university hospital and 81 courses in a non-university teaching hospital have been analysed in a prospective audit to evaluate prescribing practices. The quality of treatments was assessed by an infectious disease specialist and a pharmacist according to standard guidelines. In the non-university hospital, prescribed dosages were lower than in the university hospital, and often below the recommended dose. Mean duration of treatment for oesophageal candidosis and disseminated infections was considerably shorter in the non-university hospital compared with the university hospital, and often judged too short. Microbiological samples were examined in 75% of the cases in both hospitals. The expert reviewers agreed with the indication to use fluconazole in 58-100% of cases in the university hospital and 42-80% in the non-university hospital, depending on the type of infection. There did not appear to be a major problem with inappropriate use of fluconazole. However, important issues for improvement could be identified, such as increasing the dosage and duration of treatment in cases of serious infections, and withholding treatment from patients with colonization rather than infection.

Adult↗
PubMed2000

[Choice of ear drops in chronic otorrhea].

In chronic otitis, the use of ear drops has certain advantages over the use of systemic antibiotics. The choice of ear drop depends on the condition of the eardrum, microbial pathogens present and the efficacy of the components of the ear drop. Ototoxicity, contact allergy and the development of bacterial resistance have to be taken into account. Ototoxicity is a rare complication of the application of ear drops, most often described when aminoglycosides were applied. Contact allergy is also most often seen in aminoglycoside-containing eardrops. Evaluation of ear swabs demonstrated a 5% resistance of Pseudomonas aeruginosa to ciprofloxacin. The appearance of resistant strains may impede systemic use of fluoroquinolones. Therefore, this class of antibiotics should be considered as reserve medication only. The first choice in local application of antiseptics in case of an open eardrum is aluminium acetotartrate 1.2% and, of a combination preparation, bacitracin-colistin-hydrocortisone. In case of a closed eardrum (external otitis) aluminium acetotartrate 12%--combination preparations with corticosteroids are advised against in these cases.

Administration, Topical↗
PubMed2000

Earlier initiation of antibiotic treatment for severe infections after interventions to improve the organization and specific guidelines in the emergency department.

OBJECTIVE: To examine whether combined interventions improve the timely administration of antibiotic therapy and acquisition of material for culture from patients admitted to the emergency department with a serious infectious disease. METHODS: Guidelines and educational programs were developed to facilitate timely antibiotic administration: guidelines on handling patients with serious infections and on ordering immediate treatment, guidelines on obtaining culture samples, lectures to medical and nursing staff, improvement of availability of antibiotics in the emergency department, and removal of financial restraints on stocking and ordering of antibiotics. Fifty consecutive patients were evaluated after this series of interventions and compared with the results in 50 patients evaluated before the interventions. The interval from presentation to the emergency department until the administration of antibiotics, number of samples taken for microbiological investigations, and number of patients receiving a first dose of antibiotic at routinely scheduled drug distribution rounds were evaluated. RESULTS: The median time to the initial dose of antibiotics administered decreased from 5.0 hours to 3.2 hours (P = .04). The number of blood cultures obtained did not change. The percentage of sputum cultures obtained increased from 28% to 50%, and the percentage of urine cultures obtained increased from 50% to 100%. The percentage of patients whose first dose of antibiotic was delayed until a routinely scheduled drug distribution round decreased from 54% to 32% (P = .03). CONCLUSIONS: Combined interventions to expedite diagnostic and therapeutic actions through directed clinical practice guidelines and organizational measures are successful. This may lead to a substantial quality improvement in the process of care.

Aged↗
PubMed2000

Anaphylactic reactions to proton-pump inhibitors.

OBJECTIVE: To report two cases of anaphylactic reactions to proton-pump inhibitors (PPIs). CASE SUMMARIES: A 54-year-old woman who had taken omeprazole in the past was treated with omeprazole 40 mg and developed periorbital edema, edema of the skin, pruritus, nausea, and vomiting about 45 minutes after taking one capsule. Five months later, she was treated with lansoprazole 30-mg capsules. Again, within 45 minutes she developed an even more serious reaction, with pruritus and urticaria on her whole body, increased sweating, facial edema, and loss of consciousness. A 61 -year-old man took one tablet of pantoprazole 40 mg one year after first being treated with the drug. Within hours after ingestion, he developed malaise, generalized pruritus and urticaria, a swollen tongue and eyes, and diffuse sweating; his blood pressure decreased to 75/50 mm Hg. DISCUSSION: Because of the acute onset of symptoms and close temporal association with exposure to the drug, as well as previous exposure to it, the reactions can be classified as anaphylactic shock to PPIs. These benzimidazole derivatives are chemically related; observations in a few patients, such as the first case above, suggest that cross-sensitivity may occur. The Uppsala Monitoring Centre (UMC) has received a total of 42 reports of anaphylactic reactions or anaphylactic shock in association with PPIs. These reports account for 0.2% of the total of reported suspected adverse drug reactions to PPIs, compared with 0.8% anaphylactic reactions in the UMC database as a whole. CONCLUSIONS: These findings suggest that the chemically related PPIs can, as a group, cause anaphylactic reactions; however, the rate is comparatively low. Since anaphylaxis is a potentially serious reaction, more precise information is needed regarding its frequency, and healthcare professionals need to be aware of this possibility when prescribing these agents.

Anaphylaxis↗
PubMed1999

The use of eardrops in an ENT department.

A survey of the pattern of usage of ototopical preparations in out-patients of the ENT department of a Dutch University Hospital has been performed. Data on clinical presentation and previous treatment of the patient, otoscopic results, prescribed current treatment and, if available, results of microbiological examination were collected. One-hundred and twenty-one evaluable patients were prospectively included. For 20% of the patients it concerned a first manifestation of the symptoms, 35% had a recurrence after a period free of symptoms and in 37% it concerned patients with persisting symptoms despite treatment. Forty-five percent of the patients' ears concerned had an intact tympanic membrane, in 25% a perforation was present and in 12% middle ear ventilation tubes were in situ. Thirty-five percent had already received previous treatment with ear drops. The species most often isolated was Staphylococcus aureus, followed by Pseudomonas aeruginosa. A wide range of products were prescribed. While previous treatment occurred with combination preparations, for current prescriptions, ofloxacin was most often used. Most patients received 2 to 3 drops 3 times a day for 7 to 10 days, which is in accordance with recommendations in the literature. Potentially ototoxic substances are regularly used in daily practice. Ofloxacin is widely used even thought it is not registered for this indication in the Netherlands and the development of resistance has to be taken into account. A new policy based on this survey is proposed, which will reduce the number of different preparations used and will eliminate ofloxacin from first the treatment.

Administration, Topical↗
PubMed1998

Application of the ATC/DDD methodology to monitor antibiotic drug use.

In order to monitor the use of antibiotics, it is essential to have comprehensive data on drug consumption. The findings of drug utilisation studies can serve to describe the pattern of drug use in a particular population, to detect areas of concern, and to evaluate the impact of interventions taken to influence the use of drugs. In the present study, the Anatomical Therapeutical Chemical Classification/Defined Daily Doses (ATC/DDD) system developed by the World Health Organisation was evaluated. The system measures the amount of drug used independent of package size and sales price, which allows comparisons not only within an institution but also within a region, a country, or even internationally. Obviously, there can be no modifications of this system. To illustrate the method, the pattern of quinolone use in the general population, in long-term care facilities, and within a single institution was analysed. These drugs were widely used in long-term care facilities in the Nijmegen region of the Netherlands, accounting for about 30% of the antibiotics used in these settings, whereas in the general population as well as in the University Hospital Nijmegen, these drugs constitute only about 6% of the total antibiotics used. These differences are large enough to warrant closer analysis of patterns of antibiotic usage in different settings to identify the reasons for the use of quinolones and to identify measures that might be taken to rationalise the prescription of these drugs.

Adolescent↗
PubMed1998

Delay in administering the first dose of antibiotics in patients admitted to hospital with serious infections.

The interval from the time of admission to the emergency room until the administration of antibiotics in patients presenting with a serious infectious disease was analysed. Fifty patients presumptively diagnosed in the emergency room as having a serious infection (respiratory tract, urinary tract, erysipelas, fever with neutropenia or bacteremia) needing immediate empirical antibiotic treatment were enrolled in the study. A median interval from time of admission to administration of antibiotics of 5 hours was determined (range 0.6-13.3 h). The interval was significantly shorter in patients admitted at night than in patients admitted during office hours (3.7 vs. 6.0 h, P< 0.05). There was no difference with respect to the presenting features, body temperature, laboratory values at presentation or number of cultures performed. In 41 of the 50 patients blood samples were taken for culture. More than 80% of the patients received an antibiotic chosen in accordance with hospital guidelines. The analysis revealed that the median delay of 5 hours before patients received their initial dose of antibiotic depended on several factors. Attempts to provide optimal antimicrobial therapy should thus concentrate not only on the correct choice and dosage of a drug but also on prompt institution of therapy.

Adult↗
PubMed1998

Use of albumin in intensive care unit patients--is continuous quality assessment necessary?

BACKGROUND: There are two main reasons for hypo-albuminaemia in severely ill patients: long-lasting malnutrition and metabolic response to stress. Hypo-albuminaemia is therefore a prognostic indicator of illness severity rather than a cause of disease. Supplementation with albumin has not yet been demonstrated to have measurable therapeutic effects. Hypovolaemia is often seen in intensive care unit (ICU) patients, either postoperatively or caused through shock. The main goal of any treatment is to maintain adequate intravascular filling. No clear benefit can be seen when using albumin instead of artificial colloids. OBJECTIVE: Based on the literature, we performed an intervention study to evaluate and improve the use of albumin. METHOD: After evaluation of the use of albumin over the last 4 years (by means of analysis of the pharmacy drug use statistics), all staff members of the ICU were invited to discuss information retrieved from recently published literature. This led to the introduction of the following new guidelines. Albumin may only be given to patients with very low serum albumin levels of less than 15 g/litre. Substitution of albumin between levels of 15-20 g/litre may take place if patients are in poor condition. The indication has to be documented in the patient's notes. RESULTS: After the introduction of the guidelines, the use of albumin dropped by more than 50% from 3178 units in 1996 to 1565 units in 1997. This led to direct cost savings of approximately US$100000. CONCLUSION: The available literature about the risks and benefits of using albumin in clinical practice is not conclusive. The use of albumin should therefore be restricted according to the guidelines.

Critical Care↗