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At least 19 recordsLinked to original sources
PubMed2004

Effect of hospitalization and antimicrobial therapy on antimicrobial resistance of colonizing Staphylococcus epidermidis.

Endogenous infections with multi-resistant S. epidermidis are among the leading causes of nosocomial infections. The effect of hospitalization and antimicrobial therapy on antimicrobial resistance of colonizing staphylococci was determined from swabs of the nose, hand, axilla and groin from 157 patients on one day. Hospitalization for >72 hours, compared with <72 hours, was associated with a higher percentage of isolates resistant to oxacillin (56% versus 19%), gentamicin (40% versus 15%), trimethoprim (36% versus 17%), clindamycin (56% versus 17%), and fusidic acid (20% versus 4%; p < 0.01 for all), but not to rifampicin (6% versus 1%) or fosfomycin (43% versus 34%, p > 0.05 for both). Concurrent antimicrobial therapy resulted in increased resistance to oxacillin (61% versus 28%), gentamicin (43% versus 20%), and clindamycin (60% versus 26%; p < 0.01 for all), but not to trimethoprim (39% versus 23%), fusidic acid (19% versus 9%), rifampicin (6% versus 3%), or fosfomycin (46% versus 38%, p > 0.05 for all). The increase in resistant isolates was not independent, since hospitalization and antimicrobial therapy were correlated (p < 0.001). After adjustment for potential risk factors such as diabetes mellitus, central venous catheters, and hemodialysis, the odds ratio for oxacillin resistance was 2.8-3.6. None of the risk factors showed statistically significant results, except for the presence of neoplastic disease, which had a significant interaction (P=0.035). The within-subgroup odds ratios for patients with and without neoplasm were 4.2 (95% CI, 2.3-5.7) and 2.1 (95% CI, 0.78-3.12), respectively. These results show that hospitalization for more than three days, with or without antimicrobial therapy, and the presence of neoplastic disease are associated with increased antimicrobial resistance in colonizing S. epidermidis.

Age Distribution↗
PubMed2003

Introduction: the goals of antimicrobial therapy.

Antimicrobial agents are generally evaluated in preclinical studies assessing in vitro activity, animal models demonstrating in vivo bacteriologic efficacy, and clinical trials primarily investigating safety and clinical efficacy. However, large sample sizes are required to detect any differences in outcomes between antimicrobials in clinical trials, and, generally, studies are powered to show only clinical equivalence. In addition, diagnosis is often based on clinical symptoms, rather than microbiological evidence of bacterial infection, and the patients most likely to have resistant pathogens are often excluded. Clinical efficacy can be achieved in some bacterial infections in which antimicrobials are suboptimal or even not prescribed. However, bacterial eradication maximizes clinical efficacy and may also reduce the development and spread of resistant organisms. The goal of antimicrobial therapy is, therefore, to eradicate bacteria at the site of infection. Bacterial eradication is not usually assessed as a primary endpoint within the limits of currently recommended clinical trial design. However, pharmacokinetic (PK) (serum concentration profiles, penetration to site of infection) and pharmacodynamic (PD) (susceptibility, concentration- versus time-dependent killing, post-antimicrobial effects) criteria can be used to predict bacteriologic efficacy. PK/PD predictions should be confirmed during all phases of antimicrobial development and throughout clinical use in response to changing patterns of resistance. A clear rationale for dose recommendations can be determined preclinically based on PK/PD parameters, and correlated with efficacy, safety and resistance endpoints in clinical trials. The duration of treatment and dose should be the shortest that will reliably eradicate the pathogen(s), and that is safe and well tolerated. Currently available agents vary significantly in their ability to achieve PK/PD parameters necessary for bacteriologic eradication. Recommendations for appropriate antimicrobial therapy should be based on PK/PD parameters, with the aim of achieving the maximum potential for eradication of both existing and emerging resistant pathogens.

Anti-Bacterial Agents↗
PubMed1999

Newer concepts in antimicrobial therapy.

Antimicrobial agents continue to play a significant role in clinical practice not only due to their active role in the treatment of bacterially induced infections. The accompanying anti-inflammatory characteristics and their antagonism against superantigens add to their importance. The practitioner must also be aware of both overt and covert unwanted effects. During the past decade, the new quinolones, advanced macrolides, and better cephalosporins have been introduced. The staid penicillins have been up-graded with the addition of a beta-lactamase inhibitor. Many antibiotics have been available for several decades but new uses for them and their derivatives permit the dermatologist to have a more versatile armamentarium. Rifamycin has been shown to be effective in the treatment of leishmaniasis. The new macrolide, clarithromycin, will reduce the lesions of acne vulgaris and acne rosacea. Although phototoxicity was well recognised in the sulfonomides, several quinolones can create similar light-induced problems. Bullous diseases are known to be instigated by the penicillins, while vasculitis may be caused by a quinolone. Even porphyria has been reported to be induced by a tetracycline. Antimicrobial therapy has been an integral part of dermatologic practice since the introduction of the sulfa drugs six decades ago. Whether skin is affronted by more pathogenic bacteria than any other organ or whether the percentage of infectious etiologies is greater for cutaneous maladies than for other organ afflictions is not germane to this presentation. The facts remain that signs and symptoms of many dermatitides are diminished or even eliminated by antimicrobials [1, 2, 3, 4].

4-Quinolones↗
PubMed1992

The essential features of microorganisms and the rationale for antimicrobial therapy.

Antimicrobial agents have had a major impact on the control of most bacterial diseases; however, viral, fungal, protozoal and helminthic diseases have generally been less amenable to drug therapy. The reason for this lies in the different structural and physiological features that each group of microorganisms have. This article will outline the basic features of the various types of microorganisms, and relate these to the mode of action of commonly used antimicrobial agents.

Animals↗
PubMed1998

General principles of antimicrobial therapy.

Antimicrobial agents are appropriate treatment for acute, severe, persistent, or progressive infectious diseases. The efficacy of treatment depends on the accuracy of the diagnosis of infection and the appropriateness of the antimicrobial agent for the causative microorganism. In this symposium, the antimicrobial agents reviewed correspond with the bacterial, fungal, viral, mycobacterial, parasitic, chlamydial, and other microorganisms that cause disease in humans. Usually, the etiologic possibilities can be limited on the basis of the history and physical examination, laboratory tests, or results of treatment trials. Many of the same findings, however, can result from noninfectious, other inflammatory, or unknown mechanisms. Manifestations such as fever and organ dysfunction are nonspecific and often not caused by an infectious process. Even when infection is clinically apparent, the causative microorganism may not be identified, and empiric treatment with broad-spectrum agents is appropriate in many cases of serious disease.

Ambulatory Care↗
PubMed1977

Rational antimicrobial therapy.

Rational antimicrobial therapy depends on the identity of the causative organisms, the location of the infection, and the condition of the host. Selection of antimicrobial therapy is often started before identification of the causative organism is complete. Certain cultural and staining procedures must be instigated prior to therapy in order to isolate the causative organism. Knowledge of the host's physiologic state is necessary to minimize toxicities and/or failures of therapy. Knowledge of synergistic and antagonistic actions of some antimicrobial agents is necessary for optimal results.

Anti-Bacterial Agents↗
PubMed2002

Cost perspectives for outpatient intravenous antimicrobial therapy.

Intravenous antimicrobial therapy often continues after a patient is discharged from the hospital or it begins in the outpatient setting. Reimbursement for this therapy varies by payer. The United States Outpatient Parenteral Antibiotic Therapy (OPAT) Outcomes Registry is a valuable resource for quantifying cost by payer, as well as for describing practice patterns and adverse events related to intravenous antimicrobial therapy. To describe the reimbursement structure and cost of intravenous vancomycin home care therapy for four different types of payers, a survey of home infusion companies was done. Also surveyed were infusion programs participating in the OPAT Outcomes Registry, representing four different types of payers, to determine the cost of outpatient intravenous therapy. A retrospective cohort study of these infusion programs was conducted to describe practice patterns and to identify adverse events that resulted from intravenous vancomycin. We found that the cost of outpatient therapy was substantial, although nonuniform, across payer types. Alternative outpatient therapies associated with lower risks for adverse events and lower costs should be considered.

Anti-Bacterial Agents↗
PubMed1999

Inhaled antimicrobial therapy.

Although antimicrobial therapy has been administered through the inhaled route for decades, it has always been controversial. There are relatively few accepted indications for this mode of administration. Well-controlled studies of aerosolized antibiotics in cystic fibrosis demonstrate that tobramycin on a cyclical basis may reduce sputum volume, bacterial counts, and improve pulmonary function. Preliminary data indicate that inhaled antibiotic therapy of ventilator-associated tracheobronchitis may reduce sputum volume, but the clinical significance of this finding remains to be determined. Inhaled pentamidine is used for prophylaxis of Pneumocystis carinii in patients with human immunodeficiency virus infection who are intolerant of oral prophylactic agents. Ribavirin has been used for 30 years to treat respiratory syncytial virus. The role, if any, of inhaled antifungal therapy with amphotericin B remains undetermined.

AIDS-Related Opportunistic Infections↗
PubMed1996

Combination antimicrobial therapy for bacterial infections. Guidelines for the clinician.

Therapy with antimicrobial combinations has been used as long as antimicrobials have been available. Combinations of antibiotics are often used to take advantage of different mechanisms of action and/or toxicity profiles. Well established indications for combination antimicrobial therapy include: (a) empirical treatment of life-threatening infections; (b) treatment of polymicrobial infections; (c) prevention of the emergence of bacterial resistance; and (d) for synergism. Disadvantages of combination therapy include: (a) increased expense; (b) increased risk of adverse effects; (c) antagonism; and (d) superinfection. Combination antimicrobial therapy should be considered for the treatment of serious Gram-negative infections caused by Enterobacter cloacae, Pseudomonas aeruginosa and Serratia marcescens, and certain Gram-positive infections caused by Enterococcus spp. and Staphylococcus spp. Selection of agents should be dependent upon local susceptibility patterns, clinical experience, site of infection, potential toxicities and cost.

Anti-Bacterial Agents↗
PubMed1998

Conventional and genetic laboratory tests used to guide antimicrobial therapy.

Detection of antimicrobial resistance is important so that clinicians can make rational decisions about optimal antimicrobial therapy for their patients. During the past decade, new types of antimicrobial resistance have emerged, some of which present new challenges for the clinical microbiology laboratory. In most cases, conventional culture-based testing methods continue to be useful. In other situations in which the organism responsible for infection grows slowly (for example, Mycobacterium tuberculosis), culture methods are technically difficult (such as for human immunodeficiency virus), or genotypes are inconsistently expressed (for instance, methicillin resistance in staphylococci), genetic susceptibility testing methods may offer special advantages. Determining serum concentrations of antimicrobial agents may be useful both to ensure adequacy of treatment and to prevent toxicity. In this review, methods are described for conventional and genetic tests used to guide antimicrobial therapy.

Anti-Bacterial Agents↗
PubMed2001

The use of outpatient parenteral antimicrobial therapy in the management of osteomyelitis: data from the Outpatient Parenteral Antimicrobial Therapy Outcomes Registries.

Because osteomyelitis requires lengthy parenteral antibiotic treatment in patients who are often otherwise healthy, it lends itself well to outpatient parenteral antibiotic therapy (OPAT). Four delivery models for OPAT are (1) self-administration at home, (2) administration by a visiting nurse in the home, (3) infusion center and (4) nursing home. Patient selection is critical to the success of any OPAT program. Clinical and microbiologic data were compiled for more than 500 osteomyelitis patients reported in a registry of OPAT cases in the United States. The most commonly isolated pathogen was Staphylococcus aureus. The antibiotics used most frequently were vancomycin and ceftriaxone. Of 255 patients assessed for bacteriologic outcome, 2 patients developed infection with a new organism and 2 failed to eliminate the causative organism by the end of OPAT therapy. Of 266 patients who were assessed for clinical outcome, 259 improved and 7 failed. Data collected by the OPAT Outcomes Registry confirms that osteomyelitis can be safely and effectively treated with intravenous antibiotics outside the hospital.

Aged↗
PubMed1999

Oral versus intravenous empirical antimicrobial therapy for fever in patients with granulocytopenia who are receiving cancer chemotherapy. International Antimicrobial Therapy Cooperative Group of the European Organization for Research and Treatment of Cancer.

BACKGROUND: Intravenously administered antimicrobial agents have been the standard choice for the empirical management of fever in patients with cancer and granulocytopenia. If orally administered empirical therapy is as effective as intravenous therapy, it would offer advantages such as improved quality of life and lower cost. METHODS: In a prospective, open-label, multicenter trial, we randomly assigned febrile patients with cancer who had granulocytopenia that was expected to resolve within 10 days to receive empirical therapy with either oral ciprofloxacin (750 mg twice daily) plus amoxicillin-clavulanate (625 mg three times daily) or standard daily doses of intravenous ceftriaxone plus amikacin. All patients were hospitalized until their fever resolved. The primary objective of the study was to determine whether there was equivalence between the regimens, defined as an absolute difference in the rates of success of 10 percent or less. RESULTS: Equivalence was demonstrated at the second interim analysis, and the trial was terminated after the enrollment of 353 patients. In the analysis of the 312 patients who were treated according to the protocol and who could be evaluated, treatment was successful in 86 percent of the patients in the oral-therapy group (95 percent confidence interval, 80 to 91 percent) and 84 percent of those in the intravenous-therapy group (95 percent confidence interval, 78 to 90 percent; P=0.02). The results were similar in the intention-to-treat analysis (80 percent and 77 percent, respectively; P=0.03), as were the duration of fever, the time to a change in the regimen, the reasons for such a change, the duration of therapy, and survival. The types of adverse events differed slightly between the groups but were similar in frequency. CONCLUSIONS: In low-risk patients with cancer who have fever and granulocytopenia, oral therapy with ciprofloxacin plus amoxicillin-clavulanate is as effective as intravenous therapy.

Administration, Oral↗
PubMed1986

Therapeutic principles of antimicrobial therapy and new antimicrobial agents.

It is important that newly developed antibiotics be used so as to increase our ability to eradicate infection, rather than to complicate the treatment of infection by spawning the creation of organisms resistant to multiple antibiotics. One must peruse the literature with a very critical eye, as most new agents are touted as tremendous advances on past antibiotics. With rising medical costs becoming of ever-greater significance, proper choice of antimicrobial agent assumes more importance as well. The proper bacterial coverage in a given clinical setting, duration of treatment, and drug pharmacokinetics and the concept of the "total cost" of administering an antibiotic (taking into account fixed and variable hospital costs) all must be considered. Although it is virtually impossible to become experienced in using all of the currently available antibiotics, it is not necessary, either. Based on the literature and discussion with infectious disease colleagues, one can choose to use one or two antimicrobials in each broad class and gain the benefits of that class for his or her patients.

Aminoglycosides↗
PubMedDate not supplied

Moxalactam therapy vs. standard antimicrobial therapy for selected serious infections.

Moxalactam was studied in a prospective randomized clinical trial in 97 hospitalized patients suspected of having infection caused by moxalactam-susceptible bacteria. Seventy-eight of the 97 patients had clinical and/or bacteriologic evidence of infection, including pneumonia, cellulitis, urinary tract infection, bacteremia, and fever in neutropenic patients. Patients in the control group received antibiotics deemed appropriate by the attending physicians, whereas the moxalactam-treated group received only the study drug. Successful treatment was defined as the resolution of illness sufficient to allow discontinuation of parenteral antibiotic therapy. No significant difference was seen in efficacy with 33 (86.8%) of 38 patients in the moxalactam-treated group and 32 (80%) of 40 in the control group treated successfully (P greater than 0.20). The mean number of febrile days was significantly less in the moxalactam-treated group than in the control group (P less than 0.05). Renal toxicity occurred more frequently in the control group (P = 0.036). Fungal superinfection developed in two patients in the control group and in one in the moxalactam-treated group. An enterococcal superinfection of the bloodstream developed in one patient treated with moxalactam. Thus moxalactam appears to be comparable in efficacy to combinations of antibiotics in the treatment of selected seriously ill patients and may have less renal toxicity.

Anti-Bacterial Agents↗
PubMed1997

Modeling the response of pneumonia to antimicrobial therapy.

The response to antimicrobial therapy in patients with pneumonia was assessed by using a previously developed pneumonia scoring system. Patients from two different clinical trials were evaluated. The first group (n = 22) was treated with cefmenoxime. For these patients, doses were adjusted to achieve an area under the plasma concentration-versus-time curve (AUC) above the MIC of 140 microg x h/ml and pneumonia response scores were evaluated retrospectively. The second group (n = 21) were treated with either ciprofloxacin (CIP) or ceftazidime (TAZ) in a randomized clinical trial. Here, doses were adjusted to achieve AUC from 0 to 24 h/MIC values that were > 250 SIT(-1) x h (estimate of the area under the curve of inverse serum inhibitory titer versus time) and pneumonia response scoring was concurrent. In both studies eradication of the pathogen was determined by serial endotracheal cultures and clinical parameters were scored daily. A decrease in total score was indicative of an improving clinical condition. The percent change in clinical daily score was determined for each day of treatment. The rate of clinical response was determined by linear regression of the percent change in daily clinical score versus time during the course of antimicrobial therapy. Factors predictive of time to eradication were explored by interval analysis. Logistic regression was used to determine the earliest time point in therapy at which treatment scores predicted outcome. Kruskal-Wallis analysis of variance was used for statistical analysis, and significance was accepted at P < 0.05. There were no differences in baseline scores at day one for the patients treated with different antibiotics (P = 0.58). For patients with pathogen eradication, a significant difference between the two studies in time to eradication was found: 4.8 days for cefmenoxime-treated patients and 1.4 days for CIP- or TAZ-treated patients (P < 0.001). For patients experiencing bacterial eradication, the rates of clinical change for cefmenoxime and CIP or TAZ treatment were similar (P = 0.77). For patients with organisms that were not eradicated, the rates of change were similar (P = 0.14). There was a significant difference in the rate of change for patients experiencing eradication compared with that for patients in which the organism persisted (P << 0.01). Both treatment group and rate were found to be predictive of days to eradication. There was a significant difference in the percent change in clinical score on day 3 of therapy for patients with bacteria that were eradicated versus those with persistent organisms (P < 0.01). The percent change was more predictive of outcome with each subsequent day. Patients who demonstrated a > or = 10% reduction in clinical score after 72 h of treatment had an 88% probability of bacterial eradication. The clinical scoring system is a useful tool for modeling the response of pneumonia to antimicrobial therapy. The ability to predict outcome relatively early in therapy, by using a scoring system of clinical parameters which can be routinely monitored, will aid in assessing the response to antimicrobial therapy in clinical as well as in research settings.

Anti-Infective Agents↗