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201. Antibiotic choice in UK general practice: rates and drivers of potentially inappropriate antibiotic prescribing. Full Text available with Trip Pro

Antibiotic choice in UK general practice: rates and drivers of potentially inappropriate antibiotic prescribing. To identify the rates of potentially inappropriate antibiotic choice when prescribing for common infections in UK general practices. To examine the predictors of such prescribing and the clustering effects at the practice level.The rates of potentially inappropriate antibiotic choice were estimated using 1 151 105 consultations for sinusitis, otitis media and externa, upper (...) %) and UTI in adults (2.3%) and children (0.7%). Amoxicillin was the most commonly prescribed antibiotic for all respiratory tract infections, except URTI. Amoxicillin accounted for 62.3% of prescriptions for otitis externa and 34.5% of prescriptions for URTI, despite not being recommended for these conditions. A small proportion of the variation in the probability of an inappropriate choice was attributed to the clustering effect at practice level (8% for otitis externa and 23% for sinusitis). Patients

2019 Journal of Antimicrobial Chemotherapy

202. Intervention planning for Antibiotic Review Kit (ARK): a digital and behavioural intervention to safely review and reduce antibiotic prescriptions in acute and general medicine. Full Text available with Trip Pro

Intervention planning for Antibiotic Review Kit (ARK): a digital and behavioural intervention to safely review and reduce antibiotic prescriptions in acute and general medicine. Hospital antimicrobial stewardship strategies, such as 'Start Smart, Then Focus' in the UK, balance the need for prompt, effective antibiotic treatment with the need to limit antibiotic overuse using 'review and revise'. However, only a minority of review decisions are to stop antibiotics. Research suggests (...) that this is due to both behavioural and organizational factors.To develop and optimize the Antibiotic Review Kit (ARK) intervention. ARK is a complex digital, organizational and behavioural intervention that supports implementation of 'review and revise' to help healthcare professionals safely stop unnecessary antibiotics.A theory-, evidence- and person-based approach was used to develop and optimize ARK and its implementation. This was done through iterative stakeholder consultation and in-depth qualitative

2019 Journal of Antimicrobial Chemotherapy Controlled trial quality: uncertain

203. Adaptation and implementation of the ARK (Antibiotic Review Kit) intervention to safely and substantially reduce antibiotic use in hospitals: a feasibility study. (Abstract)

Adaptation and implementation of the ARK (Antibiotic Review Kit) intervention to safely and substantially reduce antibiotic use in hospitals: a feasibility study. Antimicrobial stewardship initiatives in secondary care depend on clinicians undertaking antibiotic prescription reviews but decisions to limit antibiotic treatment at review are complex.To assess the feasibility and acceptability of implementing ARK (Antibiotic Review Kit), a behaviour change intervention made up of four components (...) (brief online tool, prescribing decision aid, regular data collection and feedback process, and patient leaflet) to support stopping antibiotic treatment when it is safe to do so among hospitalized patients; before definitive evaluation through a stepped-wedge cluster-randomized controlled trial.Acceptability of the different intervention elements was assessed for a period of 12 weeks by uptake of the online tool, adoption of the decision aid into prescribing practice, and rates of decisions to stop

2019 Journal of Hospital Infection Controlled trial quality: uncertain

204. Is A Combination of Antibiotics and Non-Steroidal Anti-Inflammatory Drugs More Beneficial Than Antibiotic Monotherapy For The Treatment of Female Acute Uncomplicated Cystitis? A Randomized Controlled Pilot Study. (Abstract)

Is A Combination of Antibiotics and Non-Steroidal Anti-Inflammatory Drugs More Beneficial Than Antibiotic Monotherapy For The Treatment of Female Acute Uncomplicated Cystitis? A Randomized Controlled Pilot Study.  Purpose: To compare the efficacy of non-steroidal anti-inflammatory drugs (NSAIDs) combination therapy to single-agent antibiotic therapy for the resolution of symptoms during two restricted activity days in patients with acute uncomplicated cystitis (AUC)Materials and Methods: We (...) (16.3%) had persistent symptoms. The follow-up numerical pain score was 0.39 ± 1.02 points. The pain score was dramatically decreased after medication. No difference was observed in the magnitude of the pain scale reduction between the two groups (P = 0.134). However, group II showed faster symptom resolution (P = 0.035) at the third administration (day 1.5).Conclusion: Combination therapy with NSAIDs and antibiotics for AUC patients can improve symptoms faster during two restricted activity days

2019 Urology journal Controlled trial quality: uncertain

205. Prevalence of antibiotic resistance in fecal flora before transrectal ultrasound-guided prostate biopsy and the clinical impact of targeted antibiotic prophylaxis. (Abstract)

Prevalence of antibiotic resistance in fecal flora before transrectal ultrasound-guided prostate biopsy and the clinical impact of targeted antibiotic prophylaxis. In this study, we aimed to evaluate ciprofloxacin resistance and the presence of extended-spectrum beta-lactamase producing organisms (ESBLs) in the population of patients with indication to undergo prostate biopsy. Our additional aim was to compare the targeted antibiotic prophylaxis and sepsis rates after transrectal ultrasound (...) guided prostate biopsy in patients who received routine ciprofloxacin prophylaxis and to evaluate the predictive factors of antibiotic resistance.Between September 2012 and January 2014, 300 patients were randomized to two groups. The first group (Group 1, n=156) received routine ciprofloxacin prophylaxis and the second group (Group 2, n=144) received a targeted prophylactic antibiotic regime that was adequate for rectal swab culture results. Rectal swab cultures were collected two weeks before

2019 Archivos Espanoles de Urologia Controlled trial quality: uncertain

206. Home self-administration of intravenous antibiotics as part of an outpatient parenteral antibiotic therapy service: a qualitative study of the perspectives of patients who do not self-administer. Full Text available with Trip Pro

Home self-administration of intravenous antibiotics as part of an outpatient parenteral antibiotic therapy service: a qualitative study of the perspectives of patients who do not self-administer. This study aimed to use a theoretical approach to understand the determinants of behaviour in patients not home self-administering intravenous antibiotics.Outpatient care: included patients were attending an outpatient clinic for intravenous antibiotic administration in the northeast (...) of Scotland.Patients were included if they had received more than 7 days of intravenous antibiotics and were aged 16 years and over. Twenty potential participants were approached, and all agreed to be interviewed. 13 were male with a mean age of 54 years (SD +17.6).Key behavioural determinants that influenced patients' behaviours relating to self-administration of intravenous antibiotics.Qualitative, semistructured in-depth interviews were undertaken with a purposive sample of patients. An interview schedule

2019 BMJ open

207. Knowledge of antibiotics and antibiotic resistance among Norwegian pharmacy customers - a cross-sectional study. Full Text available with Trip Pro

Knowledge of antibiotics and antibiotic resistance among Norwegian pharmacy customers - a cross-sectional study. Antibiotic resistance is a global health threat. Public knowledge is considered a prerequisite for appropriate use of antibiotics and limited spread of antibiotic resistance. Our aim was to examine the level of knowledge of antibiotics and antibiotic resistance among Norwegian pharmacy customers, and to assess to which degree beliefs, attitudes and sociodemographic factors (...) are associated with this knowledge.A questionnaire based, cross-sectional study was conducted among pharmacy customers in three Norwegian cities. The questionnaire covered 1) knowledge of antibiotics (13 statements) and antibiotic resistance (10 statements), 2) the general beliefs about medicines questionnaire (BMQ general) (three subdomains, four statements each), 3) attitudes toward antibiotic use (four statements), and 4) sociodemographic factors, life style and health. High knowledge level was defined

2019 BMC Public Health

208. Incorporating Antibiotics into Platelet Rich Fibrin (PRF): A Novel Antibiotics Slow Release Biological Device. (Abstract)

Incorporating Antibiotics into Platelet Rich Fibrin (PRF): A Novel Antibiotics Slow Release Biological Device. The aim of the present in vitro study was to explore the possibility of using platelet-rich fibrin (PRF) as a local sustained released device for antibiotics.Platelet-rich fibrin was prepared with the addition of antibiotics (5 mg/ml metronidazole; 150 mg/ml clindamycin; 1 mU/ml penicillin) or saline prior to centrifugation, while collagen sponges served as control. PRFs anti-bacterial (...) properties were examined in an anti-biogram assay with Staphylococcus aureus or Fusobacterium nucleatum at different time intervals after PRF preparation.The addition of antibiotic solutions at volumes of 2 or 1 ml led to significant changes in PRF's physical properties, while the addition of 0.5 ml solution did not. PRF with saline showed minor anti-bacterial activity, while all PRFs with antibiotics showed significant anti-bacterial activity (p < 0.05). No differences were observed between raw (clot

2019 Journal of Clinical Periodontology

209. Prospective randomized clinical trial of uncomplicated right-sided colonic diverticulitis: antibiotics versus no antibiotics. (Abstract)

Prospective randomized clinical trial of uncomplicated right-sided colonic diverticulitis: antibiotics versus no antibiotics. Antibiotics are widely used in the treatment of uncomplicated left-sided colonic diverticulitis. In Asian countries, however, right-sided colonic diverticulitis is more common than left-sided colonic diverticulitis. The aim of the present study was to evaluate the need for antibiotics in the treatment of uncomplicated right-sided colonic diverticulitis in an Asian (...) population.Patients were randomized to two management strategies: antibiotics and no antibiotics. At 4-6 weeks after discharge, the patients in both groups underwent computed tomography or were contacted by phone to confirm the effectiveness of the treatment. The primary end point was the treatment failure rate of the initial treatment, and secondary end points were the length of hospital stay and total admission costs.Patients were randomized to treatment with (61 patients) or without (64 patients) antibiotics

2019 International journal of colorectal disease Controlled trial quality: uncertain

210. Antibacterial and Antibiotic Modifying Potential of Crude Extracts, Fractions, and Compounds from <i>Acacia polyacantha</i> Willd. against MDR Gram-Negative Bacteria. Full Text available with Trip Pro

Antibacterial and Antibiotic Modifying Potential of Crude Extracts, Fractions, and Compounds from Acacia polyacantha Willd. against MDR Gram-Negative Bacteria. The present study aimed to assess the in vitro antibacterial and antibiotic modifying activities of methanol extracts prepared from the leaf (APL) and bark (APB) of Acacia polyacantha, fractions (APLa-d) and compounds isolated from APL against a panel of multidrug resistant (MDR) Gram-negative bacteria. Leaf extract was subjected (...) to column chromatography for compounds isolation; antibacterial assays were performed on samples alone and with an efflux pump inhibitor (EPI), respectively, and several antibiotics on the tested bacteria. The phytochemical investigation of APL led to the isolation of stigmasterol (1), β-amyrin (2), 3-O-β-D-glucopyranosylstigmasterol (3), 3-O-methyl-D-chiro-inositol (4), epicatechin (5), quercetin-3-O-glucoside (6), 3-O-[β-D-xylopyranosyl-(1→4)-β-D-galactopyranosyl]-oleanolic acid (7), and 3-O-[β

2019 Evidence-based Complementary and Alternative Medicine (eCAM)

211. Detection of antibiotic resistance genes from blood cultures: performance assessment and potential impact on antibiotic therapy management. (Abstract)

Detection of antibiotic resistance genes from blood cultures: performance assessment and potential impact on antibiotic therapy management. Molecular assays may constitute a valid method for timely prediction of antimicrobial resistance and optimization of empirical antibiotic therapies. This study assessed ELITe MGB assays of blood cultures to detect the main carbapenemase and extended-spectrum beta-lactamase (ESBL) genes, Staphylococcus aureus and mec genes in less than 3 h. Excellent

2019 Journal of Hospital Infection

212. Trends and patterns of outpatient and inpatient antibiotic use in China's hospitals: data from the Center for Antibacterial Surveillance, 2012-16. (Abstract)

Trends and patterns of outpatient and inpatient antibiotic use in China's hospitals: data from the Center for Antibacterial Surveillance, 2012-16. Data surveillance and policy interventions can optimize antibiotic use, but few studies have focused on the changes in antibiotic use after a strict antibiotic stewardship policy was implemented in China in 2012.Based on the Center for Antibacterial Surveillance, data were collected from general hospitals in two provinces of China. Using indicators (...) (e.g. percentage of antibiotic use and proportion of antibiotic costs) recommended by the WHO, this study aimed to identify trends and patterns of systemic antibiotic (Anatomical Therapeutic Chemical code J01) use in hospitals in 2012-16 and to explore inappropriate antibiotic use.This study obtained 282 479 outpatient prescriptions and 86 070 inpatient records from 52 hospitals. The percentage of antibiotic use in outpatients and non-surgical and surgical inpatients significantly declined from

2019 Journal of Antimicrobial Chemotherapy

213. Changes in outpatient antibiotic utilization, 2000-2016: More people are receiving fewer antibiotics. (Abstract)

Changes in outpatient antibiotic utilization, 2000-2016: More people are receiving fewer antibiotics. We examined annual outpatient antibiotic dispensings within a health insurance plan covering ∼970,000 members per year during 2000-2016. The proportion of members with antibiotic dispensings decreased from 33.3% in 2000 to 25.9% in 2016. This trend was consistent in all stratifications of age, race/ethnicity, sex, and comorbidities.

2019 Infection control and hospital epidemiology

214. Consecutive antibiotic use in the outpatient setting: an extensive, longitudinal descriptive analysis of antibiotic dispensing data in the Netherlands. Full Text available with Trip Pro

Consecutive antibiotic use in the outpatient setting: an extensive, longitudinal descriptive analysis of antibiotic dispensing data in the Netherlands. Taking consecutive antibiotic use into account is of importance to obtain insight in treatment within disease episodes, use of 2nd- and 3rd-choice antibiotics, therapy failure and/or side effects. Nevertheless, studies dealing with consecutive antibiotic use are scarce. We aimed at evaluating switch patterns in antibiotic use in the outpatient (...) setting in the Netherlands.Outpatient antibiotic dispensing data was processed to antibiotic treatment episodes consisting of single prescriptions or consecutive prescriptions (2006 to 2014). Consecutive prescriptions were categorised into prolongations and switches. Switches were further analysed to obtain antibiotic switch percentages and trends over time. Outcomes were compared with recommendations of Dutch guidelines.A total of 43,179,867 antibiotic prescriptions were included in the analysis

2019 BMC Infectious Diseases

215. Investing in antibiotics to alleviate future catastrophic outcomes: What is the value of having an effective antibiotic to mitigate pandemic influenza? Full Text available with Trip Pro

Investing in antibiotics to alleviate future catastrophic outcomes: What is the value of having an effective antibiotic to mitigate pandemic influenza? Over 95% of post-mortem samples from the 1918 pandemic, which caused 50 to 100 million deaths, showed bacterial infection complications. The introduction of antibiotics in the 1940s has since reduced the risk of bacterial infections, but growing resistance to antibiotics could increase the toll from future influenza pandemics if secondary (...) bacterial infections are as serious as in 1918, or even if they are less severe. We develop a valuation model of the option to withhold wide use of an antibiotic until significant outbreaks such as pandemic influenza or foodborne diseases are identified. Using real options theory, we derive conditions under which withholding wide use is beneficial, and calculate the option value for influenza pandemic scenarios that lead to secondary infections with a resistant Staphylococcus aureus strain. We find

2019 Health economics

216. General practitioners' accounts of negotiating antibiotic prescribing decisions with patients: a qualitative study on what influences antibiotic prescribing in low, medium and high prescribing practices. Full Text available with Trip Pro

General practitioners' accounts of negotiating antibiotic prescribing decisions with patients: a qualitative study on what influences antibiotic prescribing in low, medium and high prescribing practices. Antimicrobial resistance (AMR) is high on the UK public health policy agenda, and poses challenges to patient safety and the provision of health services. Widespread prescribing of antibiotics is thought to increase AMR, and mostly takes place in primary medical care. However, prescribing rates (...) vary substantially between general practices. The aim of this study was to understand contextual factors related to general practitioners' (GPs) antibiotic prescribing behaviour in low, high, and around the mean (medium) prescribing primary care practices.Qualitative semi-structured interviews were conducted with 41 GPs working in North-West England. Participants were purposively sampled from practices with low, medium, and high antibiotic prescribing rates adjusted for the number

2019 BMC Family Practice

217. Antibiotic treatment for Burkholderia cepacia complex in people with cystic fibrosis experiencing a pulmonary exacerbation. (Abstract)

Antibiotic treatment for Burkholderia cepacia complex in people with cystic fibrosis experiencing a pulmonary exacerbation. Chronic pulmonary infection is a hallmark of lung disease in cystic fibrosis. Infections dominated by organisms of the Burkholderia cepacia complex, a group of at least 18 closely-related species of gram-negative bacteria, are particularly difficult to treat. These infections may be associated with a fulminant necrotising pneumonia. Burkholderia cepacia complex bacteria (...) are resistant to many common antibiotics and able to acquire resistance against many more. Following patient segregation in cystic fibrosis medical care, the more virulent epidemic strains are not as frequent, and new infections are more likely to be with less virulent environmentally-acquired strains. Although evidence-based guidelines exist for treating respiratory exacerbations involving Pseudomonas aeruginosa, these cannot be extended to Burkholderia cepacia complex infections. This review, which

2016 Cochrane

218. Antibiotic use for irreversible pulpitis. (Abstract)

Antibiotic use for irreversible pulpitis. Irreversible pulpitis, which is characterised by acute and intense pain, is one of the most frequent reasons that patients attend for emergency dental care. Apart from removal of the tooth, the customary way of relieving the pain of irreversible pulpitis is by drilling into the tooth, removing the inflamed pulp (nerve) and cleaning the root canal. However, a significant number of dentists continue to prescribe antibiotics to stop the pain (...) of irreversible pulpitis.This review updates the previous version published in 2013.To assess the effects of systemic antibiotics for irreversible pulpitis.We searched the Cochrane Oral Health Group's Trials Register (to 27 January 2016); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2015, Issue 12); MEDLINE via Ovid (1946 to 27 January 2016); EMBASE via Ovid (1980 to 27 January 2016), ClinicalTrials.gov (to 27 January 2016) and the WHO International Clinical Trials

2016 Cochrane

219. Antibiotics for treating community-acquired pneumonia in people with sickle cell disease. Full Text available with Trip Pro

Antibiotics for treating community-acquired pneumonia in people with sickle cell disease. As a consequence of their condition, people with sickle cell disease are at high risk of developing an acute infection of the pulmonary parenchyma called community-acquired pneumonia. Many different bacteria can cause this infection and antibiotic treatment is generally needed to resolve it. There is no standardized approach to antibiotic therapy and treatment is likely to vary from country to country (...) . Thus, there is a need to identify the efficacy and safety of different antibiotic treatment approaches for people with sickle cell disease suffering from community-acquired pneumonia. This is an update of a previously published Cochrane Review.To determine the efficacy and safety of the antibiotic treatment approaches (monotherapy or combined) for people with sickle cell disease suffering from community-acquired pneumonia.We searched The Group's Haemoglobinopathies Trials Register (01 September

2016 Cochrane

220. Antibiotics for treating osteomyelitis in people with sickle cell disease. Full Text available with Trip Pro

Antibiotics for treating osteomyelitis in people with sickle cell disease. Osteomyelitis (both acute and chronic) is one of the most common infectious complications in people with sickle cell disease. There is no standardized approach to antibiotic therapy and treatment is likely to vary from country to country. Thus, there is a need to identify the efficacy and safety of different antibiotic treatment approaches for people with sickle cell disease suffering from osteomyelitis (...) . This is an update of a previously published Cochrane Review.To determine whether an empirical antibiotic treatment approach (monotherapy or combination therapy) is effective and safe as compared to pathogen-directed antibiotic treatment and whether this effectiveness and safety is dependent on different treatment regimens, age or setting.We searched The Group's Haemoglobinopathies Trials Register, which comprises references identified from comprehensive electronic database searches and handsearching of relevant

2016 Cochrane

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