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PubMed2000

Comparison of antibiotic beads and intravenous antibiotics in open fractures.

This study compared the efficacy of antibiotic impregnated beads with conventional intravenous antibiotics in the treatment of open fractures. A randomized prospective study was designed and conducted during a 29-month period. Sixty-seven patients with 75 open fractures were treated similarly, with the exception of the method of antibiotic administration, and were followed up for at least 1 year after injury. Infection occurred in two of 24 (8.3%) fractures treated with antibiotic beads alone and in two of 38 (5.3%) fractures treated with conventional intravenous antibiotics. In an unanticipated nonrandomized third cohort group, patients received antibiotic beads and intravenous antibiotics administered for nonorthopaedic reasons or limb threatening injury, or both. Two of 13 (15.4%) fractures in this high risk group became infected. Infection ultimately resolved in all fractures treated with antibiotic beads alone or antibiotic beads in conjunction with conventional intravenous antibiotics. This study was unable to achieve statistical significance; however, the data suggest antibiotic beads may be useful in preventing infection in open fractures. Thus, a larger multicenter randomized prospective study of isolated open fractures, eliminating other variables, is justified.

Administration, Topical↗
PubMed1999

In vitro elution of antibiotic from antibiotic-impregnated biodegradable calcium alginate wound dressing.

OBJECTIVE: The authors investigated the calcium alginate dressing as a drug-delivery system for the treatment of various surgical infections. METHODS: Cytotoxicity of the calcium alginate dressing to fibroblasts and HeLa cells was evaluated by the 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H tetrazolium bromide (MITT) colorimetric assay. The calcium alginate dressing was mixed with vancomycin, and lyophilized or not lyophilized to form two types of antibiotic dressings. The antibiotic dressings were placed in 2 mL of phosphate buffered saline (PBS) or in PBS containing 0.01% calcium ions, and incubated at 37 degrees C. The PBS was changed daily, and the removed solutions were stored at -70 degrees C until the antibiotic concentration in each sample was determined by high performance liquid chromatography assay. RESULTS: The results suggested that the antibiotic dressings present no obvious toxic risk to their use as a drug-delivery system. The concentration of vancomycin in each sample was well above the breakpoint sensitivity concentration (the antibiotic concentration at the transition point between bacterial kill. ing and resistance to the antibiotic) for more than 14 days. The release was most marked during the first 48 hours. The concentration of calcium ions in PBS and the lyophilization of the manufacture process of antibiotic dressings prolonged the antibiotic diffusion duration. The diameter of the sample inhibition zone ranged from 10 to 11 mm, and the relative activity of vancomycin ranged from 62.88% to 92.18%. CONCLUSION: All antibiotic dressings released bactericidal concentrations of the antibiotics in vitro for the period of time needed to treat surgical infections. This study offers a convenient method to meet the specific antibiotic requirement for different patients.

Alginates↗
PubMed2004

Effects of an antibiotic cycling program on antibiotic prescribing practices in an intensive care unit.

Various interventions have been proposed to combat the increase of antibiotic resistance and influence antibiotic prescribing practices. A prospective cohort study in a medical intensive care unit was conducted to determine the effect of an antibiotic cycling program on patterns of antibiotic use and to determine patient factors associated with cycling adherence. Four major classes of antibiotics for empirical therapy of suspected gram-negative bacterial infections were rotated at 3- and 4-month intervals. During the study, 1,003 patients received antibiotic therapy with at least one of the study drugs; of the 792 receiving cycle antibiotics during the cycling period, 598 (75.5%) received an on-cycle drug. Compared to the baseline, cycling recommendations increased the use of the target cycle agent: the use of cephalosporins increased during cycle 1 (56 to 64% of total antibiotic days, P < 0.001), fluoroquinolone use increased in cycle 2 (24 to 55%, P < 0.001), carbapenem use increased during cycle 3 (14 to 38%, P < 0.001), and use of extended-spectrum penicillins increased in cycle 4 (5 to 36%, P < 0.001). Overall, 48% of total cycle antibiotic days were compliant with the cycling protocol. On average, 8.8 days per patient were spent receiving on-cycle drugs (range, 1 to 109). Cycle periods that specified carbapenem and fluoroquinolone use had the highest number of off-cycle days (62 and 64%). Predictors of on-cycle antibiotic use were increased severity of illness, as measured by an acute physiology and chronic health evaluation II score, and greater length of intensive care unit stay. In conclusion, the successful implementation of this cycling protocol increased antibiotic heterogeneity over time in the study unit.

Adolescent↗
PubMedDate not supplied

Emergence of antibiotic resistant Streptococcus sanguis in dental plaque of children after frequent antibiotic therapy.

PURPOSE: In the pediatric population, several different antibiotic regimens are currently recommended for the treatment of otitis media. This study investigated whether therapy for otitis media was associated with the emergence of antibiotic-resistant oral bacteria. METHODS: Streptococcus sanguis (S. sanguis) was isolated from supragingival dental plaque of children after a recent course of antibiotic. The isolated strains were tested for resistance to penicillin, amoxicillin, trimethoprim-sulfamethoxazole, and erythromycin and compared to isolated strains from age- and sex-matched control subjects, who had received no antibiotics within two years before sampling. RESULTS: While control subjects harbored no resistant strains of S. sanguis, about 60% of children who had received antibiotics harbored S. sanguis which were resistant to at least one of the tested antibiotics. Nearly half of these strains were resistant to two or more antibiotics. Resistance to penicillin and amoxicillin decreased with the age of the child and with the length of time since exposure to the antibiotic. However, resistance to trimethoprim-sulfamethoxazole or erythromycin showed no relationship to the age of the child or the length of time since exposure to the antibiotic. CONCLUSION: The data show that children who had been treated for otitis media with common antibiotic protocols do harbor antibiotic-resistant oral streptococci which may complicate prophylactic and therapeutic regimens for bacterial endocarditis.

Amoxicillin↗
PubMed2000

Antibiotics for preventing respiratory tract infections in adults receiving intensive care.

OBJECTIVES: Pneumonia is an important cause of mortality in intensive care units. The objective of this review was to assess the effects of antibiotics for preventing respiratory tract infections and overall mortality in adults receiving intensive care. SEARCH STRATEGY: We searched MEDLINE, proceedings of scientific meetings and reference lists of articles from January 1984 to September 1997. We also contacted investigators in the field. SELECTION CRITERIA: Randomised trials of antibiotic prophylaxis for respiratory tract infections and deaths among adult intensive care unit patients. DATA COLLECTION AND ANALYSIS: Trials were assessed for quality and investigators contacted for additional information. MAIN RESULTS: Overall 33 trials involving 5727 people were included. There was variation in the antibiotics used, patient characteristics and the risk of respiratory tract infections and mortality in the control groups. In 16 trials (involving 3493 patients) of a topical and systemic antibiotic combination, the average rates of respiratory tract infections and deaths in the control group were 33% and 28% respectively. There was a significant reduction of both respiratory tract infections (odds ratio 0.36, 95% confidence interval 0.30 to 0. 43) and total mortality (odds ratio 0.80, 95% confidence interval 0. 68 to 0.93). On average five patients needed to be treated to prevent one infection and 23 treated to prevent one death. In 17 trials (involving 2366 patients) of topical antimicrobials the rates of respiratory tract infections and deaths in the control groups were 30% and 24% respectively. There was a significant reduction of respiratory tract infections (odds ratio 0.57, 95% confidence interval 0.46 to 0.69) but not in total mortality (odds ratio 1.01, 95% confidence interval 0.84 to 1.22). REVIEWER'S CONCLUSIONS: A combination of topical and systemic prophylactic antibiotics can reduce respiratory tract infections and overall mortality in adult patients receiving intensive care. [This abstract has been prepared centrally.]

Adult↗
PubMed2006

Effect of antibiotic heterogeneity on the development of infections with antibiotic-resistant gram-negative organisms in a non-intensive care unit surgical ward.

BACKGROUND: Heterogeneous antibiotic use has been suggested to limit the emergence of resistance, but determining the optimal strategy is difficult. METHODS: We developed a new strategy, termed "periodic antibiotic monitoring and supervision" (PAMS) program in a non-ICU surgical ward. The 2-year prospective study was divided into a 1-year observation period and a 1-year PAMS period. The use of four major classes of antibiotics in empirical therapy for Gram-negative rod (GNR) infections was supervised. During the PAMS program, recommended, restricted, and off-supervised classes of antibiotics were changed every 3 months according to the usage pattern of the antibiotics in the preceding term. RESULTS: Cefepime (45.5%) and imipenem/cilastatin (39.4%) were the most common antibiotics of choice during the observation period. The use of these antibiotics decreased significantly during the PAMS period, and that of fluoroquinolones and extended-spectrum penicillin/beta-lactamase inhibitor increased (4.8% vs. 21.4% and 2.4% vs. 21.4%, P<0.01 respectively). Outcome analysis demonstrated a tendency toward reduction in the incidence of resistant GNR infections (P=0.079) and that of Pseudomonas aeruginosa (P=0.053). The incidence of resistant Gram-positive core infections did not decrease. Analysis of antibiotic susceptibility to GNR revealed no significant beneficial results for any antibiotics. CONCLUSIONS: As significant changes were not observed, the PAMS program is not generally applicable and heterogeneous antibiotic use as a way of reducing infections with resistant GNR in non-ICU surgical wards was not established.

Anti-Bacterial Agents↗
PubMed2005

Prospective, randomised study on antibiotic prophylaxis in colorectal surgery. Is it really necessary to use oral antibiotics?

BACKGROUND AND AIMS: The use of prophylactic antibiotics in addition to mechanical cleansing is the current standard of care prior to colonic surgery. The question of whether the antibiotics should be administered intravenously or orally, or by both routes, remains controversial. Our aim was to compare three methods of prophylactic antibiotic administration in elective colorectal surgery. METHODS: Three hundred consecutive elective colorectal resections were studied. All patients had preoperative mechanical colon cleansing with oral sodium phosphate and intravenous antibiotic prophylaxis with cefoxitin (one dose before skin incision and two postoperative doses). Patients were randomised to one of the following three groups: group A: three doses of oral antibiotic (neomycin and metronidazole) at the time of mechanical colon cleansing; group B: one dose of oral antibiotic; group C: no oral antibiotics. All patients were followed during their hospital stay and at 7, 14 and 30 days post-surgery. RESULTS: Vomiting occurred in 31%, 11% and 9% of the studied patients (groups A, B and C, respectively) (p<0.001). Nausea was present in 44%, 18% and 13% of patients (p<0.001). Abdominal pain was recorded in 13%, 10% and 4% of patients (p: 0.077). Wound infection was present in 7%, 8% and 6% and suture dehiscence occurred in 2%, 2% and 3% of the patients in the three groups (no differences among them). Neither were differences found among the three groups in terms of urinary infections, pneumonia, postoperative ileus or intra-abdominal abscess. CONCLUSION: The addition of three doses of oral antibiotics to intravenous antibiotic prophylaxis is associated with lower patient tolerance in terms of increased nausea, vomiting and abdominal pain, and has shown no advantages in the prevention of postoperative septic complications. Therefore, we recommend that oral antibiotics should not be used prior to colorectal surgery.

Administration, Oral↗
PubMed1996

Timeliness and use of antibiotic prophylaxis in selected inpatient surgical procedures. The Antibiotic Prophylaxis Study Group.

BACKGROUND: Twenty-five percent of all nosocomial infections are wound infections. Professional guidelines support the timely use of preoperative prophylaxis for prevention of postoperative wound infections. Barriers exist in implementing this practice. IPRO, the New York State peer review organization, as part of the Health Care Financing Administration's Health Care Quality Improvement Program, sought to determine the proportion of patients receiving timely antibiotic prophylaxis for aortic grafts, hip replacements and colon resections in 44 hospitals in New York State. METHODS: IPRO conducted a retrospective medical record review of 44 hospitals through out New York State stratified for teaching, nonteaching status. A sample was drawn of 2651 patients, 2256 from Medicare and 395 from Medicaid, undergoing either abdominal aortic aneurysm repair, partial or total hip replacement or large bowel resection. The study determined the proportion of patients who had documentation of receiving antibiotics and those who received antibiotics timely, that is less than or equal to 2 hours preoperatively. RESULTS: Eighty-six percent of patients had documentation of receiving an antibiotic. Forty-six percent of aneurysm repairs and 60% of hip replacements had evidence of receiving timely antibiotic prophylaxis, that is within 2 hours prior to surgery. For colon resections, 73% of cases had either oral prophylaxis or timely parenteral therapy. An increased proportion of patients had received parenteral antibiotics prematurely as the surgical start time occurred later in the day. A total of 44 different antibiotics were recorded for prophylaxis. CONCLUSIONS: Antibiotic prophylaxis was performed in 81% to 94% of cases, however, anywhere from 27% to 54% of all cases did not receive antibiotics in a timely fashion. By delegating implementation of ordered antibiotic prophylaxis to the anesthesia team, timing may be improved and the incidence of postoperative wound infections may decrease.

Antibiotic Prophylaxis↗
PubMed2000

Antibiotics for asymptomatic bacteriuria in pregnancy.

BACKGROUND: Up to 30% of mothers develop acute pyelonephritis if asymptomatic bacteriuria is untreated. Asymptomatic bacteriuria may have a role in preterm birth, or it may be a marker for low socioeconomic status and thus, low birth weight. OBJECTIVES: The objective of this review was to assess the effect of antibiotic treatment for asymptomatic bacteriuria on persistent bacteriuria during pregnancy, the risk of preterm delivery and the development of pyelonephritis after delivery. SEARCH STRATEGY: I searched the Cochrane Pregnancy and Childbirth Group trials register. SELECTION CRITERIA: Randomised trials comparing antibiotic treatment with placebo or no treatment in pregnant women with asymptomatic bacteriuria found on antenatal screening. DATA COLLECTION AND ANALYSIS: Trial quality was assessed. MAIN RESULTS: Thirteen studies were included. Overall the study quality was not strong. Antibiotic treatment compared to placebo or no treatment was effective in clearing asymptomatic bacteriuria (odds ratio 0.07, 95% confidence interval 0.05 to 0.10). The incidence of pyelonephritis was reduced (odds ratio 0.25, 95% confidence interval 0.19 to 0.32). Antibiotic treatment was also associated with a reduction in the incidence of preterm delivery or low birth weight babies (odds ratio 0.60, 95% confidence interval 0.45 to 0.80). REVIEWER'S CONCLUSIONS: Antibiotic treatment appears to be effective in reducing the risk of pyelonephritis in pregnancy. An apparent reduction in preterm delivery is consistent with current theories about the role of infection in preterm birth, but this association should be interpreted with caution.

Anti-Bacterial Agents↗
PubMed2000

Grievances in cases using antibiotics due to orodental problems and assessment of the need for antibiotics.

OBJECTIVE: To assess the complaints of patients who were prescribed antibiotics following orodental problems and the need for antibiotics prescribed for this purpose. SETTING: Examinations were carried out in the Department of Oral Diagnosis and Radiology, Ege University, Turkey. PARTICIPANTS: A total of 203 patients (129 females and 74 males) between 8-70 years of age (mean age 37.7 +/- 13.9). INTERVENTION: Examination and report. MAIN OUTCOME MEASURES: Frequency of unnecessary antibiotic use. RESULTS: Antibiotic therapy was not necessary for 151 (74.4 per cent) cases. Antibiotics were unnecessarily prescribed in 45 cases of acute irreversible pulpitis, 10 chronic apical abscess, 6 acute apical paradontitis, 7 gingivitis, 10 periodontitis, 4 epulis, 2 TMJ (temporomandibular junction) dysfunction, 2 sharp ridge of alveolar bone, 1 burning mouth syndrome and 1 recurrent aphthous stomatitis. In 108 (53.2 per cent) of the cases, the prescribed antibiotics were found to be penicillins, 102 of which were broad-spectrum. It was also determined that only 6 (7.7 per cent) of the 78 cases diagnosed as acute apical abscess were given drainage as local therapy. CONCLUSIONS: Principles for treating dental infections suggest that an antibiotic should only be used to supplement and not substitute for conventional surgical methods. Therefore, in cases with acute apical abscess, mechanical treatment (drainage) should be the first step. Inappropriate antibiotic use is quite widespread in dentistry. Dentists should avoid inappropriate use of antibiotics. To prevent inappropriate administration, necessary precautions need to be taken against dispensing antibiotics without prescription.

Adolescent↗
PubMed2007

Comparison of CT- or ultrasound-guided drainage with concomitant intravenous antibiotics vs. intravenous antibiotics alone in the management of tubo-ovarian abscesses.

OBJECTIVE: The purpose of this study was to compare the outcome of treatment of tubo-ovarian abscesses by imaging-guided drainage and antibiotics vs. intravenous antibiotics alone. METHODS: A retrospective chart review of all patients hospitalized with a diagnosis of tubo-ovarian abscess was performed. Patients were categorized into two groups. The first group consisted of subjects treated with intravenous antibiotics alone. Patients in the second group had primary image-guided drainage with concomitant intravenous antibiotics. Treatment failures in the primary antibiotics group underwent salvage drainage when feasible. The primary outcome of interest was complete response. Secondary outcomes included need for additional treatment, duration of resolution of fever, total length of hospital stay, and complication rates. We also evaluated the effectiveness of secondary drainage in patients who failed primary antibiotic therapy alone. RESULTS: A total of 58 patients were included in the study. Fifty patients were treated primarily with intravenous antibiotics; eight patients had primary drainage, which was guided by ultrasound in all cases. Complete response was noted in 29 (58%) patients treated with antibiotics alone. All eight (100%) patients in the primary drainage group responded to treatment. Of the 21 treatment failures with primary antibiotics, two underwent surgery and 19 (90.5%) had salvage drainage with either ultrasound or computed tomographic guidance; 18 of 19 salvage drainages led to complete recovery. Subjects in the primary drainage group required shorter hospital stays and showed more rapid resolution of fever. No significant morbidity was noted as a consequence of drainage procedures. A higher failure rate for secondary drainage was noted in older patients, those with larger tubo-ovarian abscesses, and those with a history of pelvic inflammatory disease. CONCLUSION: Drainage of tubo-ovarian abscesses with concomitant intravenous antibiotics is an effective and safe treatment for the primary or secondary treatment of tubo-ovarian abscesses.

Abscess↗
PubMed2000

Parenteral antibiotic therapy in the treatment of lower respiratory tract infections. Strategies to minimize the development of antibiotic resistance.

Antibiotic use is often imputed for increases in the prevalence of infections due to antibiotic-resistant bacteria. Resistance depends on the variety of genotypes in the large bacterial population and also on the selective pressures that are produced along the antibiotic concentration gradients in the body. In effect, at certain selective concentrations the antibiotic eliminates the susceptible majority, leaving a selected remainder intact. Therefore, the choice of antibiotics for the treatment of lower respiratory tract infections should take into consideration not only their effectiveness but also the pharmacokinetics of each agent and its delivery schedule. In fact, the potential therapeutic efficacy of an antibiotic depends not only on its spectrum of action, but also on the concentration it reaches at the site of infection. Most infections occur in the tissues of the body rather than in the blood and that it is accepted that appropriate antibiotic therapy requires the maintenance of significant concentrations of antibiotics at the site of infection in the lung long enough to eliminate the invading pathogen. Thus, the development of dosing schedules for most antimicrobials has been based on the postulate that drug levels need to be above the minimal inhibitory concentration (MIC) at this site for most or all the dosing interval. The selection of antimicrobial resistance appears to be strongly associated with suboptimal antimicrobial exposure, defined as an AUIC(0-24)/MIC ratio of less than 100O125. Antimicrobial regimens that do not achieve these values cannot prevent the selective pressure that leads to overgrowth of resistant bacterial subpopulations. It has been suggested that resistance can be avoided with attention to dosing, since dosing which provides an AUIC(0-24)/MIC ratio of at least 100 appears to reduce the rate of the development of bacterial resistance. Unfortunately, very different serum or lung concentration profiles can result in the same AUIC(0-24)/MIC. High doses administered sufficiently may often completely prevent any possibility of attaining a selective concentration. Alternatively, an antibiotic which has good bactericidal potency and maintains tissue and/or serum concentrations greater than the MIC or, better, minimal bactericidal concentration (MBC) throughout the dosing interval is equally effective in minimizing the development of antibiotic resistance.

Anti-Bacterial Agents↗
PubMed2000

Antibiotic utilization at the university hospital after introducing an antibiotic policy.

OBJECTIVE: Antibiotic formulary restrictions are among the most popular methods to control antibiotic utilization in hospitals. The aim of the present survey was to investigate the influence of "reserve antibiotic" on antimicrobial utilization at the University Hospital Center (UHC) Rijeka. METHODS: At the UHC Rijeka, reserve antibiotic was implemented in July 1997. The antimicrobial drug consumption was monitored 6 months prior to and 6 months after the introduction of the method. Antimicrobial consumption was measured in defined daily doses (DDDs) among the major clinics. RESULTS: Reserve antibiotic has led to a decrease in total antibiotic consumption at the UHC Rijeka (45.9 DDDs/100 bed days vs 32.9 DDDs/100 bed days). Antibiotic utilization decreased in the second semester at most clinics: at the Clinic for Infectious Diseases 41%, at the Anesthesiology and Intensive Care Unit 30%, at the Clinic for Internal Medicine 18% and at the Surgical Clinic 12%. At the Clinic for Gynecology and Obstetrics, the antibiotic utilization remained the same, while at the Pediatric Clinic an increase of 28% in antibiotic utilization was noted. CONCLUSION: Our study indicates that restriction of usage of some antibacterial agents is a successful method to decrease antibiotic consumption and a way to bring cost savings and helps prevent emergence of resistant microorganisms in hospitals. To improve antimicrobial prescribing, additional methods such as education are required.

Academic Medical Centers↗
PubMed2004

Back-up antibiotic prescriptions could reduce unnecessary antibiotic use in rhinosinusitis.

OBJECTIVES: To examine the attitudes of patients with rhinosinusitis toward the availability of "back-up" antibiotics, and potential implications for antibiotic use rates. STUDY DESIGN AND SETTING: A survey that assessed actual and hypothetical antibiotic prescription patterns was administered to a convenience sample of patients treated for rhinosinusitis in one acute care facility between September 1 and December 1, 2001. RESULTS: Of 386 eligible patients, 114 completed the survey. Seventy-six percent of patients expected antibiotic treatment; satisfaction rates were significantly associated with receiving an antibiotic prescription (P <.05). Over two-thirds of patients (69.7%) reported preference for back-up antibiotic prescriptions in the future, with 91.1% stating they would wait at least 1 day, and 52.7% at least 7 days, to fill a backup prescription. In sensitivity analysis, back-up prescriptions significantly reduced antibiotic use over a wide range of assumptions. CONCLUSIONS: The majority of patients with rhinosinusitis in this study expected antibiotic prescriptions, and were more satisfied if they were received. Back-up antibiotics have the potential to reduce unnecessary antibiotic use, mitigate risk of nontreatment, and preserve high levels of patient satisfaction.

Acute Disease↗
PubMed1999

Relationship between usage of antibiotics in food-producing animals and the appearance of antibiotic resistant bacteria.

Many studies and meeting reports have suggested that the use of some antibiotics in food animals can compromise the treatment of some infectious diseases in humans. Although the studies and reports are timely and important, it is difficult to assess the relative value of the conclusions in relationship to the overall situation concerning antibiotic resistant foodborne bacteria because the data used in the analyses are often of disparate origin. The studies have attempted to establish a cause and effect relationship between the use ('consumption') of antibiotics in food animals and treatment failures in human disease on the basis of [1] antibiotic usage data; [2] in vitro determinations of antibiotic susceptibility of animal and human isolates, [3] results obtained from controlled animal experiments or [4] epidemiological data. Each approach has sought to associate bacterial antibiotic resistance data with it's own immediate focus area of investigation. However, a true assessment of the degree of contribution to human antibiotic resistance problems from animal use can only be facilitated by comprehensively organizing these different approaches into a concerted, coordinated effort. Concurrently, the implementation of a multinational programme aimed at monitoring antibiotic usage in food animals and resistance in specific bacteria associated with those animals should be instituted. In parallel with this endeavour is the implementation of new prudent use guidelines for antibiotic use by veterinarians. Through the use of science-based approaches like these, the development and spread of antibiotic resistant bacteria associated with food animals could be minimized and contained.

Animals↗
PubMed2006

Treatment of antibiotics and antibiotic resistant bacteria in swine wastewater with free chlorine.

Recent recognition of the occurrence of antibiotics in the environment has highlighted concerns regarding potential threats of antibiotics to humans and wildlife. Antibiotics are commonly applied to animals to prevent diseases and promote growth, making livestock agriculture a major source of antibiotic pollution. The purpose of our study was to examine chlorination technology as a method for preventing the release of antibiotics as well as antibiotic-resistant bacteria into the environment from concentrated animal feeding operations. Wastewaters from various sites of two anaerobic lagoon systems, one aerated and the other not, on a swine facility were investigated. Each system consisted of a primary treatment lagoon and a subsequent polishing lagoon. Free chlorine (or monochloramine for comparison) was applied to oxidize antibiotics and to disinfect lagoon bacteria as well. Results indicate that aeration substantially improves lagoon functionality, thereby adding both organic and ammonia removal. Ammonia present in the wastewaters plays a critical role in antibiotics decomposition and bacterial inactivation due to its rapid competition for free chlorine to form monochloramine. Generally, a chlorine dose close to breakpoint is required to achieve complete removal of antibiotics, leading to high consumption of free chlorine in most of the wastewaters examined. However, because of a low ammonia concentration in the polishing lagoon wastewater of the aerated system, a chlorine dose of 100 mg/L can effectively achieve complete removal of both antibiotics and bacteria. On the basis of our experimental findings, a possible strategy for the treatment of swine wastewater is suggested.

Ammonia↗
PubMed1984

The use of an antibiotic order form for antibiotic utilization review: influence on physicians' prescribing patterns.

An antibiotic order form was implemented for all inpatient antibiotic orders at an 800-bed hospital in April 1981 to provide an ongoing, concurrent audit of antibiotic use. The prescribing physician provided the clinical indication for the antibiotic order, and individual patient treatment courses were identified. During the 25-month study period, cephalosporins, penicillin plus ampicillin, and aminoglycosides accounted for 44%, 22%, and 17% of all treatment courses, respectively. Sixty-nine percent of first-generation cephalosporin treatment courses were for prophylaxis, whereas the remaining antibiotics were used for either empirical therapy or documented infection in 56%-79% of cases. After the introduction of the antibiotic order form, there was a significant decline in both the number of antibiotic treatment courses (P = .025) and the percentage of patients receiving any antibiotic (P = .007). We conclude that a specialized antibiotic order form is an effective method for antibiotic utilization review and can have a significant impact on a physician's prescribing patterns.

Anti-Bacterial Agents↗
PubMed2003

Laboratory antibiotic susceptibility reporting and antibiotic prescribing in general practice.

This study set out to investigate whether there was an association between antibiotic susceptibility reporting from microbiology laboratories and antibiotic prescribing for urinary tract infections in the community. Data were collected over a 3 month period using a prospective questionnaire survey of general practitioners, who submitted and received a mid-stream urine (MSU) result from selected microbiology laboratories in England and Wales. In addition, prescribing analyses and cost (PACT) data were requested from the Prescription Prescribing Authority. The study demonstrated an association between laboratory reporting of antibiotic susceptibilities and antibiotic prescribing for treatment of urinary tract infections. The reporting of susceptibilities to oral cephalosporins and nitrofurantoin from microbiology laboratories was associated with increased prescribing of each antibiotic. This association was demonstrated for the choice of empirical antibiotic therapy and the choice of antibiotic prescribed for each studied episode of urinary tract infection. PACT data demonstrated a consistently greater use of antibiotics that were reported by the servicing laboratory, although this was only statistically significant for nitrofurantoin. This study demonstrates that there is an association between antibiotic susceptibility reporting from microbiology laboratories and antibiotic prescribing for the treatment of urinary tract infections.

Anti-Bacterial Agents↗