Research

11 pages, 379 KiB

Open AccessArticle

Evaluating the Counseling Standards and Ability of Pharmacy Staff to Detect Antibiotic-Drugs Interactions: A Simulated Client Study from Pakistan

by Muhammad Majid Aziz, Muhammad Fawad Rasool, Muteb Alanazi, Tareq Nafea Alharby, Jowaher Alanazi and Bader Huwaimel

Antibiotics 2023, 12(5), 931; https://doi.org/10.3390/antibiotics12050931 - 19 May 2023

Cited by 3 | Viewed by 1409

Abstract

Effective and safe medication use can be maximized by providing medication counseling, which aims to optimize therapeutic results. This approach improves the effectiveness of antibacterial treatment, reduces treatment expenses, and mitigates the emergence of antimicrobial resistance. No research from Pakistan has been previously [...] Read more.

Effective and safe medication use can be maximized by providing medication counseling, which aims to optimize therapeutic results. This approach improves the effectiveness of antibacterial treatment, reduces treatment expenses, and mitigates the emergence of antimicrobial resistance. No research from Pakistan has been previously documented. The purpose of this research was to evaluate both the quality of antibiotic counseling provided and the level of understanding exhibited by pharmacy employees with regard to interactions involving antibiotic medications. Using a simulated client method, two scenarios were used to assess 562 pharmacies that were systematically selected. Scenario 1 focused the counseling for use of prescribed medicines with non-prescribed antibiotics. Scenario2 indicated counseling provision for prescribed antibiotics that have possible antibiotic–drug interactions. The evaluation of counseling skills was also conducted. The analysis involved the use of descriptive statistics and chi-square tests. Only 34.1% of simulated clients received medication counseling directly; 45% received it on request. About 31.2% of clients were referred to a physician without counseling. The most frequently provided information was therapy dose (81.6%) and duration (57.4%). More than half (54.0%) of clients were asked about disease duration, but drug storage was ignored. Insufficient information was provided about side effects (1.1%) and antibiotic–drug interactions (1.4%). Most (54.3%) clients were instructed about dietary or lifestyle modifications. Only 1.9% of clients received information about drug administration route. No information was provided about other medication during therapy, effect of medicine withdrawal, and compliance to medication. The current level of antibiotic counseling within Pakistani community pharmacies is inadequate and requires the attention of medical authorities. Professional training of staff could improve counseling. Full article

(This article belongs to the Special Issue Antibiotics in Health and Diseases)

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15 pages, 1814 KiB

Open AccessArticle

Early Life Antimicrobial Exposure: Impact on Clostridioides difficile Colonization in Infants

by Chinwe Vivien Obiakor, Jaclyn Parks, Tim K. Takaro, Hein M. Tun, Nadia Morales-Lizcano, Meghan B. Azad, Piushkumar J. Mandhane, Theo J. Moraes, Elinor Simons, Stuart E. Turvey, Padmaja Subbarao, James A. Scott and Anita L. Kozyrskyj

Antibiotics 2022, 11(7), 981; https://doi.org/10.3390/antibiotics11070981 - 21 Jul 2022

Cited by 2 | Viewed by 2027

Abstract

The relationship between antibiotic use and Clostridioides difficile (C. difficile) has been well established in adults and older children but remains unclear and is yet to be fully examined in infant populations. This study aimed to determine the separate and cumulative [...] Read more.

The relationship between antibiotic use and Clostridioides difficile (C. difficile) has been well established in adults and older children but remains unclear and is yet to be fully examined in infant populations. This study aimed to determine the separate and cumulative impact from antibiotics and household cleaning products on C. difficile colonization in infants. This study included 1429 infants at 3–4 months of age and 1728 infants at 12 months of age from the Canadian Healthy Infant Longitudinal Development (CHILD) birth cohort. The levels of infant antimicrobial exposure were obtained from hospital birth charts and standardized questionnaires. Infant gut microbiota was characterized by Illumina 16S ribosomal ribonucleic acid (rRNA) gene sequencing. Analysis of C. difficile was performed using a quantitative polymerase chain reaction (qPCR). Overall, C. difficile colonized 31% and 46% of infants at 3–4 months and 12 months, respectively. At 3–4 months, C. difficile colonization was significantly higher in infants exposed to both antibiotics and higher (above average) usage of household cleaning products (adjusted odds ratio (aOR) 1.50, 95% CI 1.03–2.17; p = 0.032) than in infants who had the least antimicrobial exposure. This higher colonization persisted up to 12 months of age. Our study suggests that cumulative exposure to systemic antibiotics and higher usage of household cleaning products facilitates C. difficile colonization in infants. Further research is needed to understand the future health impacts. Full article

(This article belongs to the Special Issue Antibiotics in Health and Diseases)

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11 pages, 685 KiB

Open AccessArticle

Impact of Pharmacist-Led Implementation of a Community Hospital-Based Outpatient Parenteral Antimicrobial Therapy on Clinical Outcomes in Thailand

by Teeranuch Thomnoi, Virunya Komenkul, Abhisit Prawang and Wichai Santimaleeworagun

Antibiotics 2022, 11(6), 760; https://doi.org/10.3390/antibiotics11060760 - 02 Jun 2022

Cited by 1 | Viewed by 1601

Abstract

Few studies have analyzed community hospital-based parenteral anti-infective therapy (CohPAT). We aimed to assess the clinical impact of a pharmacist-led implementation of a clinical practice guideline (CPG) for CohPAT, and to determine the pharmacist’s role in CohPAT medication management. The prospective-period patients (post-implementation [...] Read more.

Few studies have analyzed community hospital-based parenteral anti-infective therapy (CohPAT). We aimed to assess the clinical impact of a pharmacist-led implementation of a clinical practice guideline (CPG) for CohPAT, and to determine the pharmacist’s role in CohPAT medication management. The prospective-period patients (post-implementation group) were compared with the historical control-period patients (pre-implementation group) for receiving a continuous antimicrobial parenteral injection. A CPG was used for laboratory testing for efficacy and safety, the monitoring of adverse drug events during admission, microbiology results coordination, and dosage adjustment. For any antimicrobial drug-related problems, the pharmacist consulted with the clinicians. Over 14 months, 50 participants were included in each group. In the pre-implementation period, 7 (14%) and 4 (8%) out of 50 patients received an inappropriate dosage and nonlaboratory monitoring for dose adjustment, respectively. The patients received the proper dosage of antimicrobial agents, which increased significantly from 78% pre- to 100% post-implementation (p = 0.000). The pharmacist’s interventions during the prospective-period were completely accepted by the clinicians, and significantly greater laboratory monitoring complying with CPG was given to the postimplementation group than the pre-implementation group (100% vs. 60%; p = 0.000). Significantly less patients with unfavorable outcomes (failure or in-hospital mortality) were observed in the post-implementation than in the pre-implementation (6% vs. 26%; p = 0.006) group. For the logistic regression analysis, lower respiratory infection (adjusted OR, aOR 3.68; 95%CI 1.13–12.06) and the post-implementation period (aOR 0.21; 95%CI 0.06–0.83) were significant risk factors that were associated with unfavorable outcomes. Given the better clinical outcomes and the improved quality of septic patient care observed after implementation, pharmacist-led implementation should be adopted in healthcare settings. Full article

(This article belongs to the Special Issue Antibiotics in Health and Diseases)

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10 pages, 648 KiB

Open AccessArticle

Direct Urine Resistance Detection Using VITEK 2

by Eva Torres-Sangiao, Brais Lamas Rodriguez, María Cea Pájaro, Raquel Carracedo Montero, Noelia Parajó Pazos and Carlos García-Riestra

Antibiotics 2022, 11(5), 663; https://doi.org/10.3390/antibiotics11050663 - 15 May 2022

Cited by 2 | Viewed by 3014

Abstract

Urinary tract infections (UTIs) are the most common infectious diseases in both communities and hospitals. With non-anatomical or functional abnormalities, UTIs are usually self-limiting, though women suffer more reinfections throughout their lives. Certainly, antibiotic treatment leads to a more rapid resolution of symptoms, [...] Read more.

Urinary tract infections (UTIs) are the most common infectious diseases in both communities and hospitals. With non-anatomical or functional abnormalities, UTIs are usually self-limiting, though women suffer more reinfections throughout their lives. Certainly, antibiotic treatment leads to a more rapid resolution of symptoms, but also it selects resistant uropathogens and adversely affects the gut and vaginal microbiota. As uropathogens are increasingly becoming resistant to currently available antibiotics, it could be time to explore alternative strategies for managing UTIs. Rapid identification and antimicrobial susceptibility testing (AST) allow fast and precise treatment. The objective of this study was to shorten the time of diagnosis of UTIs by combining pathogen screening through flow cytometry, microbial identification by matrix-assisted laser desorption ionisation time-of-flight mass spectrometry (MALDI-TOF MS), and the VITEK 2 system for the direct analysis of urine samples. First, we selected positive urine samples by flow cytometry using UF5000, establishing the cut-off for positive at 150 bacteria/mL. After confirming the identification using MALDI-TOF MS and filtering the urine samples for Escherichia coli, we directly tested the AST N388 card using VITEK 2. We tested a total of 211 E. coli from urine samples. Cefoxitin, ertapenem, imipenem, gentamicin, nalidixic acid, ciprofloxacin, fosfomycin, and nitrofurantoin had no major important errors (MIE), and ampicillin, cefuroxime, and tobramycin showed higher MIEs. Cefepime, imipenem, and tobramycin had no major errors (ME). Fosfomycin was the antibiotic with the most MEs. The antibiotic with the most minor errors (mE) was ceftazidime. The total categorical agreement (CA) was 97.4% with a 95% CI of (96.8–97.9)_95%. The direct AST from the urine samples proposed here was shorter by one day, without significant loss of sensibility regarding the standard diagnosis. Therefore, we hypothesize that this method is more realistic and better suited to human antibiotic concentrations. Full article

(This article belongs to the Special Issue Antibiotics in Health and Diseases)

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22 pages, 3303 KiB

Open AccessArticle

Antimicrobial Prescribing Confidence and Knowledge Regarding Drug Resistance: Perception of Medical Students in Malaysia and the Implications

by Mainul Haque, Tasim Ara, Md. Ahsanul Haq, Halyna Lugova, Siddhartha Dutta, Nandeeta Samad, Abdullahi Rabiu Abubakar, Sharifah Shasha Binti Syed Mohdhar, Md. Mahabubur Rahman, Salequl Islam, Nihad Adnan, Rahnuma Ahmad, Shahidah Leong Binti Abdullah, Mohd Hafizi Bin Ismail and Brian Godman

Antibiotics 2022, 11(5), 540; https://doi.org/10.3390/antibiotics11050540 - 19 Apr 2022

Cited by 5 | Viewed by 2519

Abstract

Background: Worldwide, microbes are becoming more challenging by acquiring virulent skills to adapt and develop antimicrobial resistance (AMR). This is a concern as AMR increases morbidity, mortality, and costs. Consequently, physicians need to be trained on appropriate antimicrobial prescribing, starting as medical students. [...] Read more.

Background: Worldwide, microbes are becoming more challenging by acquiring virulent skills to adapt and develop antimicrobial resistance (AMR). This is a concern as AMR increases morbidity, mortality, and costs. Consequently, physicians need to be trained on appropriate antimicrobial prescribing, starting as medical students. Objective: To evaluate medical students’ confidence in antimicrobial prescribing and AMR. Methods: Cross-sectional study assessing medical students’ knowledge, perception, and confidence in prescribing antimicrobials and AMR in a Malaysian University. A universal sampling method was used. Results: Most responding students believed that educational input regarding overall prescribing was sufficient. Regarding the principle of appropriate and accurate prescriptions, female medical students had less knowledge (odds ratio (OR) = 0.51; 95% confidence interval (CI) 0.25–0.99; p = 0.050). Year-IV and Year-V medical students had more excellent knowledge than Year-III students regarding confidence in potential antibiotic prescribing once qualified. Year-V students also showed an appreciably higher confidence in the broad principles of prescribing, including antibiotics for infectious diseases, compared to those in other years. Conclusion: Overall, medical students gain more knowledge and confidence regarding the potential prescribing of antimicrobials as their academic careers progress. This is important given concerns with the current excessive use of antimicrobials in Malaysia. Full article

(This article belongs to the Special Issue Antibiotics in Health and Diseases)

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12 pages, 2516 KiB

Open AccessArticle

Effectiveness and Safety of Ceftriaxone Compared to Standard of Care for Treatment of Bloodstream Infections Due to Methicillin-Susceptible Staphylococcus aureus: A Systematic Review and Meta-Analysis

by Yazed Saleh Alsowaida, Gregorio Benitez, Khalid Bin Saleh, Thamer A. Almangour, Fadi Shehadeh and Eleftherios Mylonakis

Antibiotics 2022, 11(3), 375; https://doi.org/10.3390/antibiotics11030375 - 10 Mar 2022

Cited by 10 | Viewed by 6797

Abstract

(1) Background: Ceftriaxone is a potential alternative for the treatment of methicillin-susceptible Staphylococcus aureus (MSSA) bloodstream infections (BSIs) in acute care and outpatient parenteral antimicrobial therapy (OPAT) settings. We evaluated the effectiveness and safety of ceftriaxone for the treatment of MSSA BSIs. (2) [...] Read more.

(1) Background: Ceftriaxone is a potential alternative for the treatment of methicillin-susceptible Staphylococcus aureus (MSSA) bloodstream infections (BSIs) in acute care and outpatient parenteral antimicrobial therapy (OPAT) settings. We evaluated the effectiveness and safety of ceftriaxone for the treatment of MSSA BSIs. (2) Method: We searched PubMed, Embase, and Cochrane Library from their inception to October 30th 2021. Our outcomes included clinical cure, microbiological cure, 30- and 90-day mortality, 90-day hospital readmission, and adverse drug reactions (ADRs). We compared ceftriaxone against standard of care (SOC) therapy. We used the random-effects model for the meta-analysis, and our estimated effects were reported as odds ratios (ORs) with 95% confidence intervals (CI). (3) Results: Twelve retrospective cohort studies were included, comprising 1037 patients in the ceftriaxone arms and 2088 patients in the SOC arms. The clinical cure rate of the ceftriaxone regimen was not statistically different from SOC: OR 0.65 (95% CI: 0.29–1.45). Ceftriaxone was also not statistically different from SOC in microbiological cure: OR 1.48 (95% CI: 0.29–7.51); 30-day mortality: OR 0.79 (95% CI: 0.14–4.65); 90-day mortality: OR 0.82 (95% CI: 0.38–1.80); 90-day hospital readmission: OR 1.20 (95% CI: 0.92–1.56); and ADRs: OR 0.92 (95% CI: 0.39–2.18). (4) Conclusion: Ceftriaxone could provide an alternative for the treatment of MSSA BSIs in acute care and OPAT settings (except in patients whose BSIs were due to infective endocarditis). Full article

(This article belongs to the Special Issue Antibiotics in Health and Diseases)

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Review

Jump to: Research, Other

22 pages, 1316 KiB

Open AccessReview

About Functional Foods: The Probiotics and Prebiotics State of Art

by Andrea Ballini, Ioannis Alexandros Charitos, Stefania Cantore, Skender Topi, Lucrezia Bottalico and Luigi Santacroce

Antibiotics 2023, 12(4), 635; https://doi.org/10.3390/antibiotics12040635 - 23 Mar 2023

Cited by 26 | Viewed by 4380

Abstract

Poor diet, obesity and a sedentary lifestyle have a significant impact on natural microbiota disorders; specifically, the intestinal one. This in turn can lead to a multitude of organ dysfunctions. The gut microbiota contains more than 500 species of bacteria and constitutes 95% [...] Read more.

Poor diet, obesity and a sedentary lifestyle have a significant impact on natural microbiota disorders; specifically, the intestinal one. This in turn can lead to a multitude of organ dysfunctions. The gut microbiota contains more than 500 species of bacteria and constitutes 95% of the total number of cells in the human body, thus contributing significantly to the host’s resistance to infectious diseases. Nowadays, consumers have turned to purchased foods, especially those containing probiotic bacteria or prebiotics, that constitute some of the functional food market, which is constantly expanding. Indeed, there are many products available that incorporate probiotics, such as yogurt, cheese, juices, jams, cookies, salami sausages, mayonnaise, nutritional supplements, etc. The probiotics are microorganisms that, when taken in sufficient amounts, contribute positively to the health of the host and are the focus of interest for both scientific studies and commercial companies. Thus, in the last decade, the introduction of DNA sequencing technologies with subsequent bioinformatics processing contributes to the in-depth characterization of the vast biodiversity of the gut microbiota, their composition, their connection with the physiological function—known as homeostasis—of the human organism, and their involvement in several diseases. Therefore, in this study, we highlighted the extensive investigation of current scientific research for the association of those types of functional foods containing probiotics and prebiotics in the diet and the composition of the intestinal microbiota. As a result, this study can form the foundation for a new research path based on reliable data from the literature, acting a guide in the continuous effort to monitor the rapid developments in this field. Full article

(This article belongs to the Special Issue Antibiotics in Health and Diseases)

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15 pages, 1613 KiB

Open AccessReview

Antibiotic Resistance to Mycobacterium tuberculosis and Potential Use of Natural and Biological Products as Alternative Anti-Mycobacterial Agents

by Roberto Arrigoni, Andrea Ballini, Skender Topi, Lucrezia Bottalico, Emilio Jirillo and Luigi Santacroce

Antibiotics 2022, 11(10), 1431; https://doi.org/10.3390/antibiotics11101431 - 18 Oct 2022

Cited by 8 | Viewed by 3267

Abstract

Background: Tuberculosis (TB) is an infectious disease caused by the bacillus Mycobacterium tuberculosis (Mtb). TB treatment is based on the administration of three major antibiotics: isoniazid, rifampicin, and pyrazinamide. However, multi-drug resistant (MDR) Mtb strains are increasing around the world, thus, [...] Read more.

Background: Tuberculosis (TB) is an infectious disease caused by the bacillus Mycobacterium tuberculosis (Mtb). TB treatment is based on the administration of three major antibiotics: isoniazid, rifampicin, and pyrazinamide. However, multi-drug resistant (MDR) Mtb strains are increasing around the world, thus, allowing TB to spread around the world. The stringent response is demonstrated by Mtb strains in order to survive under hostile circumstances, even including exposure to antibiotics. The stringent response is mediated by alarmones, which regulate bacterial replication, transcription and translation. Moreover, the Mtb cell wall contributes to the mechanism of antibiotic resistance along with efflux pump activation and biofilm formation. Immunity over the course of TB is managed by M1-macrophages and M2-macrophages, which regulate the immune response against Mtb infection, with the former exerting inflammatory reactions and the latter promoting an anti-inflammatory profile. T helper 1 cells via secretion of interferon (IFN)-gamma, play a protective role in the course of TB, while T regulatory cells secreting interleukin 10, are anti-inflammatory. Alternative therapeutic options against TB require further discussion. In view of the increasing number of MDR Mtb strains, attempts to replace antibiotics with natural and biological products have been object of intensive investigation. Therefore, in this review the anti-Mtb effects exerted by probiotics, polyphenols, antimicrobial peptides and IFN-gamma will be discussed. All the above cited compounds are endowed either with direct antibacterial activity or with anti-inflammatory and immunomodulating characteristics. Full article

(This article belongs to the Special Issue Antibiotics in Health and Diseases)

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10 pages, 1447 KiB

Open AccessReview

Elevated Mortality Risk from CRKp Associated with Comorbidities: Systematic Review and Meta-Analysis

by Lucas Candido Gonçalves Barbosa, José Arthur Silva e Sousa, Graziela Picciola Bordoni, Gabriel de Oliveira Barbosa and Lilian Carla Carneiro

Antibiotics 2022, 11(7), 874; https://doi.org/10.3390/antibiotics11070874 - 29 Jun 2022

Cited by 10 | Viewed by 1891

Abstract

Carbapenem-resistant Klebsiella pneumoniae has become a public health problem with therapeutic limitations and high mortality associated with comorbidities. Methods: This is a systematic review and meta-analysis with a search in PubMed, SciELO, and Lilacs. Ten articles were selected, considering cohort, case-control, and cross-sectional [...] Read more.

Carbapenem-resistant Klebsiella pneumoniae has become a public health problem with therapeutic limitations and high mortality associated with comorbidities. Methods: This is a systematic review and meta-analysis with a search in PubMed, SciELO, and Lilacs. Ten articles were selected, considering cohort, case-control, and cross-sectional studies. Tests for proportions and relative risk of mortality were performed, considering a 5% threshold for significance. Statistical analyses were performe dusing Rstudio^® software, version 4.0.2 of Ross Ihaka and Robert Genleman in Auckland, New Zealand. Results: Klebsiella pneumoniae, associated with chronic kidney disease, was responsible for 26%/258 deaths, chronic lung disease 28%/169, diabetes 31%/185, liver disease 15%/262, and heart disease 51%/262 deaths. Carbapenem-resistant Klebsiella pneumoniae associated with chronic kidney disease was responsible for 49%/83 deaths, with diabetes 29%/73, and with liver disease 33%/73 deaths. The risk of death from carbapenem-resistant Klebsiella pneumoniae was twice as high as the number of deaths associated with carbapenem-sensitive Klebsiella pneumoniae, RR = 2.07 (p < 0.00001). Conclusions: The present study showed an increase in mortality from carbapenem-resistant Klebsiella pneumoniae when associated with comorbidities. Full article

(This article belongs to the Special Issue Antibiotics in Health and Diseases)

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Other

Jump to: Research, Review

8 pages, 455 KiB

Open AccessViewpoint

Effects of Vitamin D on the Renin–Angiotensin System and Acute Childhood Pneumonia

by Andrea Zovi, Francesco Ferrara, Roberta Pasquinucci, Livia Nava, Antonio Vitiello, Roberto Arrigoni, Andrea Ballini, Stefania Cantore, Raffele Palmirotta, Marina Di Domenico, Luigi Santacroce and Mariarosaria Boccellino

Antibiotics 2022, 11(11), 1545; https://doi.org/10.3390/antibiotics11111545 - 03 Nov 2022

Cited by 2 | Viewed by 1406

Abstract

Vitamin D promotes kidney calcium reabsorption and regulates calcium and phosphate metabolism, as well as the intestinal absorption of calcium and phosphorus and bone mineralization events. Vitamin D is also known for its immunomodulatory properties. It has been shown in the literature that [...] Read more.

Vitamin D promotes kidney calcium reabsorption and regulates calcium and phosphate metabolism, as well as the intestinal absorption of calcium and phosphorus and bone mineralization events. Vitamin D is also known for its immunomodulatory properties. It has been shown in the literature that the active form of vitamin D, 1,25-dihydroxyvitamin D, performs multiple functions in the adaptive and innate immune system, as well as acting on the endothelial membrane. Recent evidence shows that vitamin D is a negative endocrine modulator of the renin–angiotensin system (RAS), with protection from diseases leading to lung damage, such as pneumonia caused by various pathogens. Vitamin D support associated with the use of antibiotics could be crucial to counteract these infectious diseases. Full article

(This article belongs to the Special Issue Antibiotics in Health and Diseases)

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