Back-up antibiotic prescriptions for common respiratory symptoms. Patient satisfaction and fill rates.

BACKGROUND: In recent years much has been written about the overuse of antibiotics, especially for common respiratory illnesses. One approach to this issue is the use of a back-up prescription, only to be filled if a patient's condition deteriorates or fails to improve. The purpose of our study was to determine patient satisfaction, prescription fill rates, and correlates of these outcomes among patients receiving back-up antibiotic prescriptions. METHODS: In our observational study we obtained survey data from 28 physicians and 2 physician extenders in 3 family practice clinics and their patients presenting with complaints of common respiratory symptoms. We computed patient satisfaction and fill rates of back-up antibiotic prescriptions. Agreement between the perceived need of patients for antibiotics before the office visit and the subjective rating of their physicians of the clinical necessity to prescribe antibiotics for these patients was assessed using the kappa statistic. Finally, we determined correlates of satisfaction and the rate of filling back-up prescriptions. RESULTS: Of the 947 patients enrolled in the study, 46.6% received no antibiotic prescriptions, 30.2% received back-up antibiotic prescriptions, and 23.2% were given immediate-fill prescriptions for an antibiotic. Patients' self-reported satisfaction and fill rates for back-up antibiotic prescriptions were 96.1% and 50.2%, respectively. CONCLUSIONS: Our findings indicate that patients were very satisfied with a back-up antibiotic prescription. The fact that half of the patients chose not to fill these prescriptions suggests a potential health care cost savings

Treatment of acute infection of total or partial hip arthroplasty with debridement and oral chemotherapy

BACKGROUND AND OBJECTIVE: The suitable antibiotic(s) and duration of treatment for hip prosthesis acute infections (HPAIs) has not been clearly defined. PATIENTS AND METHOD: We studied 32 patients whose HPAI was diagnosed within 2 months after surgery. All patients underwent debridement and samples were taken for culture purposes. Antibiotics were started and adjusted to the antibiogram. Ambulatory follow-up controls were carried out for more than 18 months after treatment had finished. RESULTS: There were 16 cases of staphylococcal infection while it was streptococcal in 2 cases, enterococcal in 6 and due to gram-negative bacillus in 6 patients. In 2 patients, the causal microorganism could not be identified. Patients with an infection due to gram-positive cocci (other than enterococci) were administered an association of antibiotics including rifampicin for a mean 2.7 months period. Outcome was favorable in 100% valuable cases, after a mean follow-up of 20.7 months. Patients with enterococcal infections were treated with a glycopeptide or beta-lactams for a mean of 2.6 months; all them had a unfavorable outcome. Out of 6 infections due to gram-negative bacilli, 2 valuable cases had a favorable evolution. CONCLUSIONS: HPAIs due to Staphylococcus sp. or Streptococcus sp. can be successfully treated by means of surgical debridement plus an antibiotic scheme that includes rifampicin for a maximum period of 3 months. It is necessary to analyze the effectiveness of new antibiotics or antibiotic associations in cases of enterococcal infections

Detection of antimicrobial substances in individual cow and quarter milk samples using Delvotest microbial inhibitor tests.

The use of antibiotic therapy to treat and prevent udder infections of cows during the dry period is a key component of mastitis control in many countries. At the same time, the general public is becoming increasingly aware of potential hazards from antibiotic residues in foods. Consequently, Delvotest Cow Test (Royal Gist-brocades NV, Delft, The Netherlands), an on-farm version of Delvotest P, a microbial inhibitor test for antimicrobials, is being increasingly used by farmers to assess that milk from individual cows is fit for consignment to the bulk tank. Occasional reports of unexplained positive test results have led to suggestions of possible false-positive reactions in milk from individual cows. To investigate the potential causes of such positive test results, three separate investigations were undertaken. In a field survey of unexplained positive reports from farmers, 14 milk samples from six farms that tested positive were all found to contain antibiotic residues. In more formal investigations of individual quarter milk samples from an experimental herd, none of 134 milk samples from midlactation cows yielded positive reactions; for cows that had just calved, 16 of 144 milk samples were positive, and, of those, 13 had somatic cell counts > 4,000,000/ml. Natural inhibitors were responsible for 1 positive reaction, 8 positive reactions were related to incomplete milking, and 7 samples contained beta-lactam antibiotics. Positive reactions caused by antibiotic persisted in individual quarter samples for up to 7 d postcalving compared with 4 d for milk samples from the whole udder. Delvotest was sensitive to cephalonium, the active ingredient of Cepravin Dry Cow (Mallinckrodt Veterinary Ltd., Uxbridge, United Kingdom), which is the market-leading product in the United Kingdom. Test results yielded a partial purple color reaction in the presence of 8 micrograms/kg of cephalonium and a completely purple reaction at 16 micrograms/kg. These results confirm the validity of Delvotest when used to examine composite milk samples from individual cows supplying the United Kingdom dairy industry and suggest that, with proper attention to milk withdrawal periods and complete milking, there is no obvious risk of antibiotic contamination of milk

Wolbachia pipientis growth kinetics and susceptibilities to 13 antibiotics determined by immunofluorescence staining and real-time PCR.

Wolbachia spp. are strict intracellular bacteria that infect a wide range of arthropods and filarial nematodes. Filarial nematodes are important causes of human diseases. There is increasing evidence that Wolbachia spp. influence important functions in the biology of the hosts, specifically, infertility. Preliminary experiments with humans and animals have suggested that antibiotics with activity against Wolbachia may help to treat filariasis. In this study, we determined using a real-time quantitative PCR assay the growth kinetics of a strain of Wolbachia pipientis from a mosquito grown in Aa23 cells. The doubling time was estimated to be 14 h. We then determined the susceptibilities of this strain to 13 antibiotics by two methods: an immunofluorescent-antibody test and a real-time quantitative PCR assay. Both techniques gave similar results. Doxycycline and rifampin were the most effective compounds, with MICs of 0.125 and 0.06 to 0.125 micro g/ml, respectively. Fluoroquinolones were less effective, with MICs of 2 to 4 micro g/ml for ciprofloxacin, 2 micro g/ml for ofloxacin, and 1 micro g/ml for levofloxacin. beta-Lactams (penicillin G, amoxicillin, ceftriaxone) were not effective at concentrations up to 128 micro g/ml. The MIC of erythromycin was >32 micro g/ml, whereas that of telithromycin was 8 micro g/ml. Other antibiotic compounds were bacteriostatic only at high concentrations, including gentamicin, co-trimoxazole, and thiamphenicol. The real-time PCR assay was a convenient and reliable technique for determination of the antibiotic susceptibilities of WOLBACHIA: It may help in the future to simplify antibiotic susceptibility testing of strict intracellular pathogens.