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Latest & greatest articles for antibiotics
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Antibiotics also referred to as antibacterial are a type of medicine that prevents the growth of bacteria. As such they are used to treat infections caused by bacteria. They kill or prevents bacteria from spreading.
Antibiotics are vital in modern day medicine; they are among the most frequently prescribed drug. There are over a 100 types of antibiotics, the main types and most commonly prescribed are penicillin, cephalosporin, macrolides, fluoroquinolone and tetracycline. They tend to be classified by mechanism of action. So, those that target the bacterial cell wall (penicillins and cephalosporins) or the cell membrane (polymyxins), or interfere with essential bacterial enzymes (rifamycins, lipiarmycins, quinolones, and sulfonamides) have bactericidal activities. Antibiotics such as macrolides, lincosamides and tetracyclines inhibit protein synthesis.
Antibiotics can all be defined by their specificity. “Narrow-spectrum” antibiotics target specific types of bacteria, for instance gram-negative (-ve) or gram-positive (+ve), whereas broad-spectrum antibiotics affect a wide range of bacteria.
Antibiotics are increasingly suffering from antibiotic resistance caused by bacterial mutations meaning the bacteria evolves to not be sensitive to the specific antibiotics being used.
Clinical trials are important to the development and understanding of antibiotics and their side effects. Although they are deemed safe, over use of the drug can kill good bacteria and lead to antibiotic resistance. This halts the ability of bacteria and microorganisms to resist the effects of the antibiotic. Clinical trials and research allow scientists and medical professionals to study the effects and develop new antibiotics.
A Randomized Trial of Prophylactic Antibiotics for Miscarriage Surgery. Surgical intervention is needed in some cases of spontaneous abortion to remove retained products of conception. Antibiotic prophylaxis may reduce the risk of pelvic infection, which is an important complication of this surgery, particularly in low-resource countries.We conducted a double-blind, placebo-controlled, randomized trial investigating whether antibiotic prophylaxis before surgery to complete a spontaneous (...) of these features and the clinically identified need to administer antibiotics. The definition of pelvic infection was changed before the unblinding of the data; the original strict definition was two or more of the clinical features, without reference to the administration of antibiotics.We enrolled 3412 patients in Malawi, Pakistan, Tanzania, and Uganda. A total of 1705 patients were assigned to receive antibiotics and 1707 to receive placebo. The risk of pelvic infection was 4.1% (68 of 1676 pregnancies
Antibiotic management of urinary tract infection in elderly patients in primary care and its association with bloodstream infections and all cause mortality: population based cohort study. To evaluate the association between antibiotic treatment for urinary tract infection (UTI) and severe adverse outcomes in elderly patients in primary care.Retrospective population based cohort study.Clinical Practice Research Datalink (2007-15) primary care records linked to hospital episode statistics (...) and death records in England.157 264 adults aged 65 years or older presenting to a general practitioner with at least one diagnosis of suspected or confirmed lower UTI from November 2007 to May 2015.Bloodstream infection, hospital admission, and all cause mortality within 60 days after the index UTI diagnosis.Among 312 896 UTI episodes (157 264 unique patients), 7.2% (n=22 534) did not have a record of antibiotics being prescribed and 6.2% (n=19 292) showed a delay in antibiotic prescribing. 1539
Duration of antibiotic treatment for common infections in English primary care: cross sectional analysis and comparison with guidelines. To evaluate the duration of prescriptions for antibiotic treatment for common infections in English primary care and to compare this with guideline recommendations.Cross sectional study.General practices contributing to The Health Improvement Network database, 2013-15.931 015 consultations that resulted in an antibiotic prescription for one of several (...) indications: acute sinusitis, acute sore throat, acute cough and bronchitis, pneumonia, acute exacerbation of chronic obstructive pulmonary disease (COPD), acute otitis media, acute cystitis, acute prostatitis, pyelonephritis, cellulitis, impetigo, scarlet fever, and gastroenteritis.The main outcomes were the percentage of antibiotic prescriptions with a duration exceeding the guideline recommendation and the total number of days beyond the recommended duration for each indication.The most common reasons
Antibiotic treatment for newborns with congenital syphilis. Congenital syphilis continues to be a substantial public health problem in many parts of the world. Since the first use of penicillin for the treatment of syphilis in 1943, which was a notable early success, it has remained the preferred and standard treatment including for congenital syphilis. However, the treatment of congenital syphilis is largely based on clinical experience and there is extremely limited evidence on the optimal (...) dose or duration of administration of penicillin or the use of other antibiotics.To assess the effectiveness and safety of antibiotic treatment for newborns with confirmed, highly probable and possible congenital syphilis.We searched the Cochrane STI Group Specialized Register, CENTRAL, MEDLINE, Embase, LILACS, WHO ICTRP, ClinicalTrials.gov and Web of Science to 23 May 2018. We also handsearched conference proceedings, contacted trial authors and reviewed the reference lists of retrieved
Effectiveness and safety of electronically delivered prescribing feedback and decision support on antibiotic use for respiratory illness in primary care: REDUCE cluster randomised trial. To evaluate the effectiveness and safety at population scale of electronically delivered prescribing feedback and decision support interventions at reducing antibiotic prescribing for self limiting respiratory tract infections.Open label, two arm, cluster randomised controlled trial.UK general practices (...) in the Clinical Practice Research Datalink, randomised between 11 November 2015 and 9 August 2016, with final follow-up on 9 August 2017.79 general practices (582 675 patient years) randomised (1:1) to antimicrobial stewardship (AMS) intervention or usual care.AMS intervention comprised a brief training webinar, automated monthly feedback reports of antibiotic prescribing, and electronic decision support tools to inform appropriate prescribing over 12 months. Intervention components were delivered
Antibiotics for induction and maintenance of remission in Crohn's disease. Several antibiotics have been evaluated in Crohn's disease (CD), however randomised controlled trials (RCTs) have produced conflicting results.To assess the efficacy and safety of antibiotics for induction and maintenance of remission in CD.We searched MEDLINE, Embase, CENTRAL, the Cochrane IBD Group Specialized Register and Clinicaltrials.gov database from inception to 28 February 2018. We also searched reference lists (...) and conference proceedings.RCTs comparing antibiotics to placebo or an active comparator in adult (> 15 years) CD patients were considered for inclusion.Two authors screened search results and extracted data. Bias was evaluated using the Cochrane risk of bias tool. The primary outcomes were failure to achieve clinical remission and relapse. Secondary outcomes included clinical response, endoscopic response, endoscopic remission, endoscopic relapse, histologic response, histologic remission, adverse events
There?s Pus About, So Are Antibiotics In or Out? Adding antibiotics for abscess management Tools for Practice is proudly sponsored by the Alberta College of Family Physicians (ACFP). ACFP is a provincial, professional voluntary organization, representing more than 5,000 family physicians, family medicine residents, and medical students in Alberta. Established over sixty years ago, the ACFP strives for excellence in family practice through advocacy, continuing medical education and primary care (...) research. www.acfp.ca January 21, 2019 There’s Pus About, So Are Antibiotics In or Out? Adding antibiotics for abscess management Clinical Question: Does the addition of antibiotics to incision and drainage improve cure rates in single, uncomplicated skin abscesses? Bottom Line: Adding antibiotics that cover MRSA during incision and drainage for a small abscess increases the cure rate from 85% to 92%, meaning an additional one in 15 patients will be cured compared to placebo at one month. Approximately
Antibiotic-Loaded Collagen Sponges in Clinical Treatment of Chronic Osteomyelitis: A Systematic Review Chronic osteomyelitis is caused by bacterial infection of the bone and is a major problem in orthopaedic surgery. Treatment of chronic osteomyelitis requires surgical debridement accompanied by local and systemic administration of antibiotics. A widely established biodegradable local antibiotic carrier is antibiotic-loaded collagen sponges (fleeces). These sponges are commonly used (...) in the treatment of chronic osteomyelitis, but a systematic review of their clinical efficacy and assessment of the quality of evidence have not been conducted, to our knowledge.This systematic review, performed according to the PRISMA statement, examined the clinical efficacy of and quality of evidence regarding different antibiotic-loaded collagen sponges in the clinical treatment of chronic osteomyelitis. Clinical efficacy was defined as eradication of infection with bone and wound-healing. In addition
A strategy of 'delayed antibiotic prescribing' for respiratory infections may reduce antibiotic use A strategy of 'delayed antibiotic prescribing' for respiratory infections may reduce antibiotic use Discover Portal Discover Portal A strategy of 'delayed antibiotic prescribing' for respiratory infections may reduce antibiotic use Published on 19 December 2017 doi: Delaying antibiotic prescribing made little difference to most symptoms of respiratory infection. It reduced antibiotic use and did (...) not affect patient satisfaction compared with immediate prescribing of antibiotics. Increasing antibiotic resistance is a global health concern. Many people don’t realise that viruses cause most respiratory infections and that antibiotics won’t help. The strategy allows some time for symptoms to improve naturally. This review of the latest evidence on delayed prescribing for self-limiting respiratory infections is in line with current guidance. On the whole delaying antibiotics made little difference
Blood test could shorten antibiotic treatment in newborns with suspected sepsis Blood test could shorten antibiotic treatment in newborns with suspected sepsis Discover Portal Discover Portal Blood test could shorten antibiotic treatment in newborns with suspected sepsis Published on 28 November 2017 doi: Measuring procalcitonin levels in newborns with suspected sepsis in the first days of life reduced antibiotic duration by 10 hours compared with standard care. There was no increase (...) in the risk of re-infection or death. Systemic infection can be rapidly life-threatening in newborn babies, so those with risk factors are often treated pre-emptively with intravenous antibiotics. If sepsis is not confirmed by blood culture the decision whether to discontinue antibiotics needs to be made, but results of the blood culture takes time. Procalcitonin is released into the blood in response to inflammation, and low levels may give an earlier indication that there is no serious infection
Blood test reduces mortality and shortens antibiotic use among adults with chest infection Blood test reduces mortality and shortens antibiotic use among adults with chest infection Discover Portal Discover Portal Blood test reduces mortality and shortens antibiotic use among adults with chest infection Published on 16 January 2018 doi: It may be feasible to use procalcitonin blood levels to guide antibiotic treatment for adults in hospital with a suspected chest infection. By measuring (...) procalcitonin, an indicator of bacterial infection, clinicians could review their diagnosis earlier. This reduced antibiotic exposure by 2.5 days with fewer adverse effects and also less mortality. About 14 extra people in every 1,000 who had their management guided by the blood test would be expected to survive the first month, compared with those receiving standard care without this test. Antibiotics are commonly prescribed pre-emptively for a suspected respiratory infection and may be continued longer
Carefully managed antibiotic use could halve antibiotic-resistant infections Carefully managed antibiotic use could halve antibiotic-resistant infections Discover Portal Discover Portal Carefully managed antibiotic use could halve antibiotic-resistant infections Published on 17 October 2017 doi: Antibiotic stewardship programmes could halve the number of infections due to antibiotic-resistant bacteria compared with unguided prescribing. Combining these programmes with hand hygiene (...) , such as washing hands with soap and water and using alcohol-based hand-rubs, could reduce antibiotic resistance further. Bacterial resistance to existing antibiotics is increasing, and for some conditions, there aren’t enough new antibiotics available to treat infections caused by resistant bacteria. Antibiotic stewardship involves promoting the appropriate use of antibiotics according to local resistance patterns and aims to give patients the right antibiotics for the right length of time and at the correct
Long-term antibiotics likely to reduce risk of recurrent cellulitis Long-term antibiotics likely to reduce risk of recurrent cellulitis Discover Portal Discover Portal Long-term antibiotics likely to reduce risk of recurrent cellulitis Published on 17 October 2017 doi: Antibiotics may reduce the risk of leg cellulitis by about two thirds, in adults who have had at least two previous episodes, but only while they take the antibiotics. There is limited evidence measuring the efficacy of other (...) forms of prevention. A review of five studies showed that the risk of developing repeated cellulitis was reduced in participants who were taking long-term (more than six months) penicillin or erythromycin, compared with a control group. Once the antibiotic course had finished, participants’ risk of recurrent cellulitis was no different from the control group. Cellulitis is a bacterial skin infection that spreads and worsens quickly. Risk of recurrence is high in people with a predisposing condition
Computerised decision support can improve antibiotic prescribing in hospitals Computerised decision support can improve antibiotic prescribing in hospitals Discover Portal Discover Portal Computerised decision support can improve antibiotic prescribing in hospitals Published on 28 November 2017 doi: Using a computerised decision support tool (software used by hospital prescribers) improved the adequacy of antibiotic coverage and adherence to guidelines, and may have reduced the risk of people (...) dying. Only four studies reported on resistance to antibiotics, so no conclusions can be drawn about the impact of this tool on resistance. Antibiotic stewardship programmes aim to get prescribers to think before they decide to prescribe antibiotics, then consider the type and dose of antibiotic. Computerised decision support aims to support this practice by embedding these principles into everyday practice. This review suggests that computerised decision support tools may be a useful component
Intravenous antibiotics, administered over 3 hours, are linked to lower death rates in sepsis Intravenous antibiotics, administered over 3 hours, are linked to lower death rates in sepsis Discover Portal Discover Portal Intravenous antibiotics, administered over 3 hours, are linked to lower death rates in sepsis Published on 31 January 2018 doi: The risk of death in adults with sepsis was 30% lower when each dose of antibiotic was given intravenously over three hours compared to a bolus or less (...) than 60 minutes. This systematic review included adults on intensive care units with a range of ages, severity of sepsis and other symptoms. A variety of antibiotics of the anti-pseudomonal beta-lactam class were used in the trials. These included carbapenems, penicillins and cephalosporins. In the UK, current guidance for intravenous use of these drugs is to give them over a period of up to 30 minutes. This review provides high-quality evidence that suggests that all patients should be given
Nitrofurantoin is as effective as other long-term antibiotics for preventing recurrent urinary tract infections Nitrofurantoin is as effective as other long-term antibiotics for preventing recurrent urinary tract infections Discover Portal Discover Portal Nitrofurantoin is as effective as other long-term antibiotics for preventing recurrent urinary tract infections Published on 19 December 2016 doi: The antibiotic nitrofurantoin works as well as other long-term antibiotics for preventing (...) recurrent urinary tract infections in women. However gastrointestinal side effects were more common in people on nitrofurantoin. The potential for inducing less antibiotic resistance compared to trimethoprim is a potential advantage of nitrofurantoin but this wasn’t a specified outcome for this review. This review of 12 trials, with 1,063 women, compared nitrofurantoin with other antibiotics such as trimethoprim, or oestrogen cream. It was hoped that this older antibiotic could be a first-line strategy
Study shows no benefit of an antibiotic for acute asthma Study shows no benefit of an antibiotic for acute asthma Discover Portal Discover Portal Study shows no benefit of an antibiotic for acute asthma Published on 21 December 2016 doi: The antibiotic azithromycin did not reduce symptoms or change other outcomes in adults seeking emergency care for an acute asthma attack. However people not already taking antibiotics were hard to find and the trial failed to enrol enough people to answer (...) the research question. In this UK-based trial, people with asthma who received azithromycin on top of standard treatment with corticosteroids had no better symptoms ten days later than people who received corticosteroids alone. Almost half of almost 4,600 potential participants had already been given antibiotics. This study shows that many people are being prescribed antibiotics to treat an asthma attack despite British guidance stating that antibiotics should not be routinely used. This raises questions
Giving immediate antibiotics reduces deaths from sepsis Giving immediate antibiotics reduces deaths from sepsis Discover Portal Discover Portal Giving immediate antibiotics reduces deaths from sepsis Published on 18 April 2017 doi: Giving immediate antibiotics (defined as within one hour) when people present to emergency departments with suspected sepsis reduces their risk of dying by a third compared with later administration. This meta-analysis of observational data from 23,596 people (...) in emergency department settings confirmed that giving antibiotics within one hour was linked to a lower risk of in-hospital mortality compared with giving antibiotics later. This adds weight to recommendations from NICE and other organisations that antibiotics should be administered straight away in people with suspected sepsis. However, in practice up to a third of people in the UK do not receive antibiotics within the hour. NHS England and the UK Sepsis Trust have recently launched a campaign
Antibiotics by injection into the eye can prevent severe infection following cataract surgery Antibiotics by injection into the eye can prevent severe infection following cataract surgery Discover Portal Discover Portal Antibiotics by injection into the eye can prevent severe infection following cataract surgery Published on 11 April 2017 doi: Injecting the antibiotics vancomycin or moxifloxacin into the eyeball after eye surgery can reduce the risk of developing severe infection inside the eye (...) (endophthalmitis) compared to other routes. Cefuroxime is currently the antibiotic of choice for this in the UK, but researchers wanted to see if drugs with lower rates of resistance might also be effective. A of 34 studies, mostly observational studies with nine randomised controlled trials (RCTs), explored the effects of different types of antibiotic regimens on the risk of endophthalmitis in people who had received eye surgery. There were no randomised trials of vancomycin or moxifloxacin injections
Adding the extra antibiotic rifampicin did not improve cure rates after sepsis Adding the extra antibiotic rifampicin did not improve cure rates after sepsis Discover Portal Discover Portal Adding the extra antibiotic rifampicin did not improve cure rates after sepsis Published on 17 April 2018 doi: Adding the antibiotic rifampicin did not improve cure rates or reduce deaths for people with bacterial blood infections caused by Staphylococcus aureus . It increased the risk of adverse reactions (...) requiring a change in treatment and the chances of drug interactions. This NIHR-funded trial is the largest to date on adding rifampicin to standard antibiotic therapy. The study included 770 people in 29 UK hospitals. Half were assigned to 14 days of treatment with rifampicin on top of their existing antibiotic regime. Rifampicin could be either oral or intravenous. Share your views on the research. Why was this study needed? Blood stream infections with S. aureus are life-threatening and one