Antibiotics Over-Prescribed By GPs

GPs are unnecessarily giving patients antibiotics for respiratory tract (RT) infections which would clear up on their own. Doctors tend to over-emphasise symptoms such as white spots in the throat, rather than looking at factors such as old age and co-morbidity, which would affect a patient's recovery, according to an article published in the online open access journal, BMC Family Practice.Huug J. van Duijn and his team at the Julius Center for Health Sciences and Primary Care from the University Medical Center Utrecht, The Netherlands, looked at the practice records of 163 GPs from 85 Dutch practices over a 12 month period, and carried out a survey of the doctors' attitudes to prescribing antibiotics for RT infections. Diagnostic labelling (the tendency to encode RT episodes as infections rather than as symptoms) seemed to be an arbitrary process, often used to justify antibiotic prescribing. GPs may give out antibiotics unnecessarily to defend themselves against unforeseen complications, even if these are unlikely to materialize.Although Dutch GPs prescribe relatively small antibiotic volumes and international colleagues often envy the quality assurance system in Dutch primary care with guidelines and peer review groups, Van Duijn suggests that the results of his study should be used to update quality assurance programs and postgraduate courses, to emphasise the use of evidence-based prognostic criteria (e.g. chronic respiratory co-morbidity and old age) as an indication to prescribe antibiotics instead of single signs of inflammation or diagnostic labels. "Even in the Netherlands there is an over-prescribing of antibiotics; about 50% of the antibiotic prescriptions for acute RT episodes are not in accordance with Dutch national guidelines," says van Duijn. "Considering costs, side-effects and the growing resistance to pathogens, it is important to rationalise antibiotic prescribing as much as possible."

Alternative To Antibiotics May Be More Effective And Less Harmful

Photodynamic therapy (PDT) may be an effective way to treat the bacteria associated with periodontal diseases, and could provide a better option than antibiotics or other mechanical methods for treating periodontal diseases, according to a new study published in the March issue of theJournal of Periodontology. Researchers at São Paulo State University found that using PDT was an effective method to minimize destruction of periodontal tissue which can accompany treatment for periodontal diseases. In a rat population, PDT did minimal damage to periodontal tissues, in comparison to other techniques including scaling and root planing and antibiotic therapy. "We found that PDT is significantly less invasive than other treatments for periodontal diseases," said study author Dr. Valdir Gouveia Garcia, from the Department of Periodontology at São Paulo State University. "It can provide improved dentin hypersensitivity, reduced inflammation of the tissues surrounding the teeth, and allows tissues to repair faster." PDT may be an alternative to antibiotic treatment, which is becoming increasingly important as antibiotic resistance increases. PDT involves two stages; first, a light-sensitive drug is applied to the area. Second, a light or laser is shone on that area. When the light is combined with the drug, phototoxic reactions induce the destruction of bacterial cells. PDT was first approved by the Food and Drug Administration in 1999 to treat pre-cancerous skin lesions of the face or scalp. "This is an exciting finding," said Preston D. Miller, Jr., DDS and President of the American Academy of Periodontology. "PDT may be an effective therapy for the treatment of periodontal diseases. While patients have many options for treating their periodontal diseases, PDT could prove to be a preferable alternative to antibiotic therapy. Unfortunately, long term antibiotic therapy not only decreases the drug's effectiveness, but also may lead to the development of drug resistant organisms. Our Academy supports future research to further define the application of PDT as a means to treat periodontal disease."

Research May Lead To New Classes Of Antibiotics

Scientists have what could be some very bad news for disease-causing bacteria. All three major classes of antibiotics that kill infectious bacteria do so in part by ramping up the production of harmful free radicals, researchers report in Cell a publication of Cell Press. Because those different types of antibiotics each initially hit different targets, it had been believed they worked by independent means. The findings could point the way to new classes of antibiotics and to a common method by which existing antibiotics could be made to stamp out bacteria even better, according to the Boston University researchers. Such advances are particularly critical at a time when, according to the Centers for Disease Control and Prevention, nearly all significant bacterial infections in the world are becoming resistant to the most commonly prescribed antibiotic treatments. "Hydroxyl radicals damage DNA, which turns on the S.O.S. repair response," said James Collins. "Therefore, our findings suggest that if you could shut off the bacteria's repair response, you might make all bactericidal antibiotics more effective and effective at lower doses. You could in essence create a super-Cipro, super-mycins, and so on." Current antimicrobial therapies fall into two general categories: (1) bactericidal drugs, which kill bacteria with almost complete efficiency, and (2) bacteriostatic drugs, which inhibit their growth, allowing the immune system to clear the infection, Collins's group explained. The targets of bactericidal antibiotics are well studied and predominantly fall into three classes: (1) those that hit DNA, (2) those that hit proteins, and (3) those that hit the bacterial cell wall. In contrast, most bacteriostatic drugs work by blocking the function of ribosomes, which are the sites of protein synthesis. While antibiotics' ability to kill bacteria had been attributed solely to those class-specific drug-target interactions, "our understanding of many of the bacterial responses that occur as a consequence of the primary drug-target interaction remains incomplete," the researchers said. Collins and his colleagues recently uncovered some evidence that at least some antibiotics might have some other deadly tricks. They showed that one type of antibiotics, including quinolones, which block DNA's replication and transcription into messenger RNA, also causes a breakdown that leads to the production of free radicals. Moreover, they found that those highly reactive chemicals help finish the bacteria off. In the new study, the researchers wanted to know whether other antibiotics also drive the toxic brew. Indeed, they show, drugs that kill bacteria all do cause a rise in free radicals, and all in the same manner. This is not so for drugs that only stunt bacteria's growth, they report. "The ever-increasing prevalence of antibiotic-resistant strains has made it critical that we develop novel, more effective means of killing bacteria," the researchers concluded. "Our results indicate that targeting bacterial systems that remediate hydroxyl radical damage, including proteins involved in triggering the DNA damage response… is a viable means of potentiating all three major classes of bactericidal drugs. Moreover, pathway analyses and systems biology approaches may uncover druggable targets for stimulating hydroxyl radical formation, which could result in new classes of bactericidal antibiotics."

APhA Calls For Appropriate Use Of Antibiotics - Pharmacists And Other Healthcare Professionals Can Educate The Public

The American Pharmacists Association (APhA), the national professional society of pharmacists, encourages patients to talk to their pharmacist and healthcare professional about proper antibiotic use, prevention of antibiotic resistance, and appropriate infection control. Tens of thousands of deaths and an estimated 1 million hospital infections are blamed on antibiotic resistant bacteria each year. According to an article in the October 17, 2007 issue of the Journal of the American Medical Association (JAMA), inappropriate and overuse of antibiotics is a major contributing factor to the development of antibiotic resistant bacteria. "Pharmacists, as the medication use specialists, have the knowledge and skills to assist with the selection and appropriate use of antibiotics," according to John Gans, APhA Executive Vice President. "The battle against drug-resistant infections requires a commitment by healthcare providers and patients to protect the public's health." Drug-resistant bacteria include methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci, and resistant strains of Streptococcus pneumonia. Infections caused by MRSA appear to be more prevalent than previously believed and are being found more often outside of health care settings, according to the JAMA study. MRSA has become the most frequent cause of skin and soft tissue infections among patients presenting to emergency departments in the United States, and can also cause severe, sometimes fatal invasive disease. APhA, in accordance with the Centers for Disease Control and Prevention, recommends the following antibiotic use and infection prevention tips: Appropriate Antibiotic Use- Know how to take your medication. Complete prescribed courses of treatment (don't skip doses) even if you are feeling better. - Do not demand antibiotics when a health care provider has determined they are not needed. - Do not take antibiotics prescribed for someone else. The antibiotic may not be appropriate for your illness. Taking the wrong medicine may delay correct treatment and allow bacteria to multiply. - Do not save any antibiotics for the next time you get sick. Appropriately discard any leftover medication once you have completed your prescribed course of treatment. - Do not take an antibiotic for a viral infection like a cold, a cough or the flu. - Ask your pharmacist if you have questions about your medication therapy. Prevention of Infection- Be up-to-date on your immunizations. - Watch for signs of infection (unexpected pain, chills, or fever or drainage or increased inflammation from wounds), especially if recently discharged from hospitals. - See a physician promptly if you have a suspicious skin sore or boil. - Wash hands thoroughly and often with soap and water. - Ask health care workers to wash their hands before examinations. - Keep cuts and abrasions clean and covered with a bandage until healed. - Avoid contact with other people's wounds or material contaminated by wounds. - Do not share items such as razors, soap, ointments and balms, towels or wash cloths, clothing or uniforms. - If participating in contact sports, cover cuts, scrapes and other wounds with a bandage. - Shower with soap immediately after each practice or game. Wipe down all nonwashable equipment (mats, head protectors, gymnastics equipment, etc.) with alcohol or antibiotic solution after each person uses it. - If caring for someone with an infection at home, wash hands with soap after each physical contact and before going outside. Only use towels for drying hands once. Change and launder linens frequently, right away if they are soiled.

Too Many Antibiotics Prescribed For Sinus Infections

US scientists researching treatments for sinus infections suggest that antibiotics are overprescribed to treat the condition. And they are concerned this could be increasing the drug resistance and virulence of infectious bacteria.The study is published in the March issue of Archives of Otolaryngology-Head & Neck Surgery.According to the study, by Hadley J. Sharp and colleagues at the University of Nebraska Medical Center, Omaha, US, antibiotics were prescribed for 82 per cent of acute sinus infections and nearly 70 per cent of chronic sinus infections.This is surprising because most sinus infections are caused by viruses, and antibiotics only kill bacteria. The scientists used national data from 1999 and 2002 to find out which drugs were being prescribed for sinus infections by general practitioners, outpatient and emergency departments. The data was representative of the US population and came from two national surveys collected by the National Center for Health Statistics.Rhinosinusitis, commonly known as sinus infection or sinusitis, is an inflammation of the sinus cavities that connect with the nasal passage. According to the study, it is a common and expensive medical condition in the US.Acute sinusitis occurs for up to 4 weeks and is thought to be caused mostly by infectious agents. Chronic sinusitis is thought to be affected mostly by allergies, hormone changes and facial anatomy and symptoms persist for 12 or more weeks.In 2002, of all the antibiotic prescriptions that year in the US, 21 per cent were for adults with sinus infections and 9 per cent was for children.According to the survey data, over 14 million visits are paid to health care facilities in the US every year are for chronic sinusitis, while over 3 million are for acute sinusitis. As a proportion of all ambulatory care in the US per year, chronic sinusitis represents 1.39 per cent of visits and acute sinusitis 0.30 per cent.In 69.95 percent of visits for chronic sinusitis at least one antibiotic was prescribed. For acute sinusitis this figure was 82.74 per cent.Sharp and colleagues assessed that "The most frequently recommended medications for treatment of both acute and chronic rhinosinusitis are antibiotic agents, followed by antihistamines; nasal decongestants; corticosteroids; and antitussive, expectorant and mucolytic agents, respectively".The most commonly used antibiotics for both chronic and acute bacterial infections were penicillins (mainly amoxicillin and amoxicillin-clavulanate potassium, brand name Augmentin). These were prescribed appropriately, they said, with 30.35 per cent of chronic and 27.18 per cent of acute infection visits mentioning penicillin prescriptions.However, the researchers questioned the use of the stronger antibiotics such as erythromycins, lincosamides, and macrolides, amongst others. These were mentioned in 24.32 per cent of acute sinusitis visits, which, in order, makes them more frequently prescribed than cephalosporins, sulfonamides and trimethprim, and tetracyclines.The authors assessed the relative proportions of the causes of sinusitis from other studies. Comparing these proportions with the relative proportions of what is actually being prescribed to treat sinusitis they found major discrepancies.They concluded that "Prescription antibiotic drugs are being used far more than bacterial causes studies would indicate." Sharp and colleagues also assessed that "Nasal and inhaled corticosteroids are prescribed more frequently to treat acute rhinosinusitis than published studies imply is necessary". However, they estimated that where antihistamines were prescribed, this was roughly in proportion with estimated prevalence of allergic sinusitis.In trying to fathom why the use of antibiotics is so high, the authors suggest that some doctors could be trying to treat secondary infections. On the other hand, it could be because doctors think antibiotics are working because patients get better while taking them, whereas they could be getting better anyway.They express concern about the problems that overuse of antibiotics bring, including drug resistance and increased virulence of bacteria.They conclude, "When two-thirds of patients with sinus symptoms expect or receive an antibiotic and as many as one-fifth of antibiotic prescriptions for adults are written for a drug to treat rhinosinusitis, these disorders hold special pertinence on the topic."

Hearing Loss Due To Antibiotics May Be Prevented By Genetically Screening Patients Beforehand

Some patients have a genetic mutation which means they are more at risk of hearing loss after taking antibiotics called aminoglycosides. Experts, writing in the British Medical Journal (BMJ) believe that screening patients for this genetic mutation may prevent this. The writers, Maria Bitner-Glindzicz and Shamima Rahman, the Institute of Child health, London, England, explain that aminoglycosides are valuable antibiotics for such serious infections as complicated urinary tract infections, tuberculosis and septicemia. They are known to potentially cause damage to the ear (otoxicity). However, what isn't well known is that there are people who have an inherited predisposition that makes them extremely sensitive to the effects - they can end up with severe and permanent hearing loss. Approximately 5% of deafness in children in the UK is caused by this mutation, known as m.1555A-G. About 1 in 40,000 people in the UK have this mutation. Studies in other countries have indicated much higher incidences, in New Zealand it is thought to occur in 1 in 206 cases of newborns, and 1 in 1,161 in the USA (also newborns). Families carrying this mutation, even if they never take aminoglycosides, may develop some degree of deafness later in life. A study carried out in Spain found that 27% of families which included two deaf people were positive for this mutation. It was also found that everybody who had this mutation in Spain and took aminoglycosides suffered from hearing loss. A person who had taken aminoglycosides had a 96.5% of becoming deaf by the age of 30 if he/she had been exposed to aminoglycosides, while 38.9% of those who had never taken it became deaf. The authors write that aminoglycosides are a major environmental modifier of the m.1555A-G mutation. The writers ask whether it is cost effective to screen for this mutation before deciding whether to prescribe aminoglycosides. A test in the UK costs approximated £35 ($70). This cost would probably go down considerably if they were carried out in much larger numbers. It costs the NHS £61,000 ($122,000) for every child who becomes deaf (over his/her lifetime), plus about £18,000 ($36,000) in educational costs. US estimates have placed the lifetime cost to society for a child who loses his/her hearing before acquiring language at one million dollars. It is possible to prevent deafness brought on by aminoglycosides in individuals who have this genetic mutation, explain the authors. Doctors who have patients who are deaf are well aware of this mutation. Many doctors, however, do not know about this susceptibility, and many others do not know that mutation testing is available. The authors propose that the true prevalence of this mutation be ascertained for the UK, so that the cost-effectiveness of screening everyone who is prescribed aminoglycosides can be determined. Until this is done, people who are likely to be receiving multiple courses of aminoglycosides should be screened, such as leukemia patients and infants admitted to special care baby units. They conclude that test results should be produced rapidly, and until they appear the patient should be given some other type of antibiotic.

Antibiotic Resistance In Humans Researched Using Pig Model

Pigs could be the key to understanding how antibiotic resistant bacteria persist in Intensive Care Units in hospitals. NSW Department of Primary Industries (NSW DPI) Immunology & Molecular Diagnostic Research Unit Team Leader, Dr James Chin, says it is commonly believed that each time an antibiotic is used only pathogens or disease-causing bacteria will be killed. "Antibiotic use in hospitals is often perceived to be solely directed against only bad bacteria. "In reality, antibiotics also act against entire microbial communities, including the good bacteria which can protect patients from pathogenic bacteria. "Antibiotics do not just eliminate bad bacteria", Dr Chin said. "They also maintain a pool of antibiotic resistance genes within the microbial community of patients treated with antibiotics." Using pigs as a model, Dr Chin and Dr Toni Chapman at NSW DPI's Elizabeth Macarthur Agricultural Institute have examined how E.coli bacteria -- a common cause of diarrhoea in pigs and humans -- respond to treatment by antibiotics. Dr Chin told the 2007 Australian Society for Microbiology's annual conference in Adelaide in July that: "The current theory of antibiotic resistance is that the 'fittest' bacteria, that is, those carrying genes for resistance, are the most likely to survive. "Because antibiotic treatment will never kill all bacteria, bad or good, there will always be a pool of antibiotic resistance bacteria that can potentially transfer resistance to incoming pathogens. "It is important to identify the antimicrobial resistant gene pool in entire microbial communities before antibiotic treatment. Dr Chin said this has been tested with E. coli in pigs. "Our research shows clearly that use of one antibiotic to treat E. coli not only increases resistance against that antibiotic but also increases the carriage of resistance genes against other classes of antibiotics. "This creates a real problem because subsequent therapy with a second antibiotic may be ineffective because resistance against the second antibiotic had already been increased by the first antibiotic." In the United States an estimated 10 percent of patients get sick because of infections acquired whilst being treated in hospital. More careful use of antibiotics is regarded as vital. Dr Chin said the use of antibiotics for disease prevention is critical in patients admitted to intensive care. However there is currently a major bottleneck when it comes to deciding which antibiotics to use. "Current protocols require pathogens to be cultured, leading to delays of some days before the bacteria to be targeted can be accurately identified. Dr Chin said for this reason it is important to develop a molecular detection method that can identify antibiotic resistance signatures of entire microbial communities. "Our hope is that this kind of information will equip clinicians to better manage prescribing of antibiotics." This latest research is being planned in collaboration with clinical microbiologists and intensive care specialists at Westmead Hospital.