Latest & greatest articles for antibiotics

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Antibiotics

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.

Trip has extensive coverage of the evidence base on antibiotics allowing users to easily find trusted answers. Coverage include guidelines, systematic reviews, controlled trials and evidence-based synopses.

Top results for antibiotics

41. Pneumonia (hospital-acquired): antimicrobial prescribing

of 23Contents Contents Overview 4 Who is it for? 4 Recommendations 5 1.1 Managing hospital-acquired pneumonia 5 1.2 Choice of antibiotic 6 T erms used in the guideline 13 Hospital-acquired pneumonia 13 Summary of the evidence 14 Antibiotic prescribing strategies 14 Choice of antibiotics 15 Antibiotic course length, dosage and route of administration 22 Other considerations 23 Medicines adherence 23 Resource implications 23 Pneumonia (hospital-acquired): antimicrobial prescribing (NG139) © NICE 2019. All (...) rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 3 of 23Ov Overview erview This guideline sets out an antimicrobial prescribing strategy for adults, young people, children and babies aged 72 hours and over with a confirmed diagnosis of hospital-acquired pneumonia. It does not cover ventilator-associated pneumonia. It aims to optimise antibiotic use and reduce antibiotic resistance. See a 3-page visual summary of the recommendations

2019 National Institute for Health and Clinical Excellence - Clinical Guidelines

42. Pneumonia (community-acquired): antimicrobial prescribing

37 Resource implications 37 Pneumonia (community-acquired): antimicrobial prescribing (NG138) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 3 of 37Ov Overview erview This guideline sets out an antimicrobial prescribing strategy for adults, young people, children and babies aged 72 hours and over with a confirmed diagnosis of community-acquired pneumonia. It aims to optimise antibiotic use and reduce antibiotic (...) disease or immunosuppression local antimicrobial resistance and surveillance data (such as flu and Mycoplasma pneumoniae infection rates) recent antibiotic use recent microbiological results, including colonisation with multidrug-resistant bacteria. 1.1.2 Start antibiotic treatment as soon as possible after establishing a diagnosis of community-acquired pneumonia, and certainly within 4 hours (within 1 hour if the person has suspected sepsis and meets any of the high risk criteria for this – see

2019 National Institute for Health and Clinical Excellence - Clinical Guidelines

43. Cellulitis and erysipelas: antimicrobial prescribing

. It aims to optimise antibiotic use and reduce antibiotic resistance. See a 3-page visual summary of the recommendations, including tables to support prescribing decisions. For managing other skin conditions, see our web page on skin conditions. NICE has also produced a guideline on antimicrobial stewardship: systems and processes for effective antimicrobial medicine use. Who is it for? Healthcare professionals People with cellulitis and erysipelas, their families and carers Cellulitis and erysipelas (...) Staphylococcus aureus (MRSA) status if known. 1.1.5 Give oral antibiotics first line if the person can take oral medicines, and the severity of their condition does not require intravenous antibiotics. Cellulitis and erysipelas: antimicrobial prescribing (NG141) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 5 of 361.1.6 If intravenous antibiotics are given, review by 48 hours and consider switching to oral antibiotics

2019 National Institute for Health and Clinical Excellence - Clinical Guidelines

44. Antibiotic awareness: important messages on antibiotic use

Antibiotic awareness: important messages on antibiotic use Antibiotic awareness: important messages on antibiotic use - GOV.UK GOV.UK uses cookies which are essential for the site to work. We also use non-essential cookies to help us improve government digital services. Any data collected is anonymised. By continuing to use this site, you agree to our use of cookies. Accept cookies You’ve accepted all cookies. You can at any time. Hide Search Guidance Antibiotic awareness: important messages (...) on antibiotic use This document explains how to use antibiotics responsibly for patients, animal keepers, pet owners and prescribers. Published 23 September 2014 Last updated 7 October 2019 — From: Documents Ref: PHE publication gateway reference: GW-779 If you use assistive technology (such as a screen reader) and need a version of this document in a more accessible format, please email . Please tell us what format you need. It will help us if you say what assistive technology you use. Details PHE has

2019 Public Health England

45. Effect of Bismuth Subsalicylate vs Placebo on Use of Antibiotics Among Adult Outpatients With Diarrhea in Pakistan: A Randomized Clinical Trial Full Text available with Trip Pro

Effect of Bismuth Subsalicylate vs Placebo on Use of Antibiotics Among Adult Outpatients With Diarrhea in Pakistan: A Randomized Clinical Trial Many of the 4.5 billion annual episodes of diarrhea are treated unnecessarily with antibiotics; prevalence of antibiotic resistance among diarrheal pathogens is increasing. Knowledge-based antibiotic stewardship interventions typically yield little change in antibiotic use.To compare antibiotic use among adult outpatients with diarrhea given bismuth (...) assigned (1:1) to receive BSS or placebo for 48 hours or less.Use of systemic antibiotics within 5 days of enrollment. Secondary outcomes included measures of duration and severity of illness.Among eligible patients, 39 declined to participate, 440 enrolled, and 1 enrolled participant was lost to follow-up, for a total of 439 patients included in the analysis. Median (interquartile range) participant age was 32 (23-45) years and 187 (43%) were male. Two hundred twenty patients were randomized to BSS

2019 EvidenceUpdates

46. Prophylactic antibiotics to prevent surgical site infection after breast cancer surgery. (Abstract)

Prophylactic antibiotics to prevent surgical site infection after breast cancer surgery. Surgery has been used as part of breast cancer treatment for centuries; however any surgical procedure has the potential risk of infection. Infection rates for surgical treatment of breast cancer are documented at between 3% and 15%, higher than average for a clean surgical procedure. Pre- and perioperative antibiotics have been found to be useful in lowering infection rates in other surgical groups, yet (...) there is no consensus on the use of prophylactic antibiotics for breast cancer surgery. This is an update of a Cochrane Review first published in 2005 and last updated in 2014.To determine the effects of prophylactic (pre- or perioperative) antibiotics on the incidence of surgical site infection (SSI) after breast cancer surgery.For this fourth update, in August 2018 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process

2019 Cochrane

47. Antibiotics for trachoma. (Abstract)

, and it was difficult to judge risk of bias.There was low-certainty evidence of little or no difference in effect between oral and topical antibiotics on active trachoma at three months (RR 0.97, 95% CI 0.81 to 1.16; 953 people; 6 RCTs; I2 = 63%) and 12 months (RR 0.93, 95% CI 0.75 to 1.15; 886 people; 5 RCTs; I2 = 56%). There was very low-certainty evidence for ocular infection at three or 12 months. Antimicrobial resistance was not assessed. In those studies that reported adverse effects, no serious adverse (...) Antibiotics for trachoma. Trachoma is the world's leading infectious cause of blindness. In 1996, WHO launched the Alliance for the Global Elimination of Trachoma by the year 2020, based on the 'SAFE' strategy (surgery, antibiotics, facial cleanliness, and environmental improvement).To assess the evidence supporting the antibiotic arm of the SAFE strategy by assessing the effects of antibiotics on both active trachoma (primary objective), Chlamydia trachomatis infection of the conjunctiva

2019 Cochrane

48. Antibiotics for treating acute chest syndrome in people with sickle cell disease. (Abstract)

Antibiotics for treating acute chest syndrome in people with sickle cell disease. The clinical presentation of acute chest syndrome is similar whether due to infectious or non-infectious causes, thus antibiotics are usually prescribed to treat all episodes. Many different pathogens, including bacteria, have been implicated as causative agents of acute chest syndrome. 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 acute chest syndrome. This is an update of a Cochrane Review first published in 2007, and most recently updated in 2015.To determine whether an empirical antibiotic treatment approach (used alone or in combination):1. is effective for acute chest syndrome compared to placebo or standard treatment;2. is safe for acute chest syndrome compared to placebo or standard

2019 Cochrane

49. Blood Culture Results Before and After Antimicrobial Administration in Patients With Severe Manifestations of Sepsis: A Diagnostic Study. (Abstract)

Blood Culture Results Before and After Antimicrobial Administration in Patients With Severe Manifestations of Sepsis: A Diagnostic Study. Administering antimicrobial agents before obtaining blood cultures could potentially decrease time to treatment and improve outcomes, but it is unclear how this strategy affects diagnostic sensitivity.To determine the sensitivity of blood cultures obtained shortly after initiation of antimicrobial therapy in patients with severe manifestations (...) of sepsis.Patient-level, single-group, diagnostic study. (ClinicalTrials.gov: NCT01867905).7 emergency departments in North America.Adults with severe manifestations of sepsis, including systolic blood pressure less than 90 mm Hg or a serum lactate level of 4 mmol/L or more.Blood cultures were obtained before and within 120 minutes after initiation of antimicrobial treatment.Sensitivity of blood cultures obtained after initiation of antimicrobial therapy.Of 3164 participants screened, 325 were included

2019 Annals of Internal Medicine

50. Antibiotic or silver versus standard ventriculoperitoneal shunts (BASICS): a multicentre, single-blinded, randomised trial and economic evaluation. Full Text available with Trip Pro

Antibiotic or silver versus standard ventriculoperitoneal shunts (BASICS): a multicentre, single-blinded, randomised trial and economic evaluation. Insertion of a ventriculoperitoneal shunt for hydrocephalus is one of the commonest neurosurgical procedures worldwide. Infection of the implanted shunt affects up to 15% of these patients, resulting in prolonged hospital treatment, multiple surgeries, and reduced cognition and quality of life. Our aim was to determine the clinical and cost (...) -effectiveness of antibiotic (rifampicin and clindamycin) or silver shunts compared with standard shunts at reducing infection.In this parallel, multicentre, single-blind, randomised controlled trial, we included patients with hydrocephalus of any aetiology undergoing insertion of their first ventriculoperitoneal shunt irrespective of age at 21 regional adult and paediatric neurosurgery centres in the UK and Ireland. Patients were randomly assigned (1:1:1 in random permuted blocks of three or six) to receive

2019 Lancet

51. Mechanical and oral antibiotic bowel preparation versus no bowel preparation for elective colectomy (MOBILE): a multicentre, randomised, parallel, single-blinded trial. (Abstract)

Mechanical and oral antibiotic bowel preparation versus no bowel preparation for elective colectomy (MOBILE): a multicentre, randomised, parallel, single-blinded trial. Decreased surgical site infections (SSIs) and morbidity have been reported with mechanical and oral antibiotic bowel preparation (MOABP) compared with no bowel preparation (NBP) in colonic surgery. Several societies have recommended routine use of MOABP in patients undergoing colon resection on the basis of these data. Our aim

2019 Lancet Controlled trial quality: predicted high

52. Duration of intravenous antibiotic therapy in people with cystic fibrosis. (Abstract)

Duration of intravenous antibiotic therapy in people with cystic fibrosis. Progressive lung damage from recurrent exacerbations is the major cause of mortality and morbidity in cystic fibrosis. Life expectancy of people with cystic fibrosis has increased dramatically in the last 40 years. One of the major reasons for this increase is the mounting use of antibiotics to treat chest exacerbations caused by bacterial infections. The optimal duration of intravenous antibiotic therapy is not clearly (...) defined. Individuals usually receive intravenous antibiotics for 14 days, but treatment may range from 10 to 21 days. A shorter duration of antibiotic treatment risks inadequate clearance of infection which could lead to further lung damage. Prolonged courses of intravenous antibiotics are expensive and inconvenient. The risk of systemic side effects such as allergic reactions to antibiotics also increases with prolonged courses and the use of aminoglycosides requires frequent monitoring to minimise

2019 Cochrane

53. Respiratory tract infections (self-limiting) – reducing antibiotic prescribing

in the event of a significant clinical deterioration. Sore throat/pharyngitis/tonsillitis has been excluded from the contextualised guideline for two reasons: (i) in contrast to the UK, New Zealand has a relatively high incidence of rheumatic fever and therefore the risks of not prescribing an antibiotic treatment for many patients with sore throat are very much greater; and (ii) in New Zealand there are widely used guidelines that recommend antimicrobial treatment for patients with sore throat who (...) Otitis Media. Diagnosis and Management of Acute Otitis Media. Pediatrics, 2004 113(5), 1451-65. 2. McGregor A, Dovey S, Tilyard M. Antibiotic use in upper respiratory tract infections in New Zealand. Family Practice 1995;12:166-70. 3. Thomas MG, Smith AJ, Tilyard M. Rising antimicrobial resistance: a strong reason to reduce antimicrobial consumption in New Zealand. NZ Med J 2014;127:1394:72-84. 4. Heart Foundation of New Zealand: Guidelines for Group A Streptococcal Sore Throat Management Guideline

2019 Best Practice Advocacy Centre New Zealand

54. Long-term follow-up of the AVOD randomized trial of antibiotic avoidance in uncomplicated diverticulitis (Abstract)

Long-term follow-up of the AVOD randomized trial of antibiotic avoidance in uncomplicated diverticulitis The aim of this study was to assess the long-term results in patients with uncomplicated diverticulitis who had participated in the Antibiotics in Acute Uncomplicated Diverticulitis (AVOD) RCT, which randomized patients with CT-verified left-sided acute uncomplicated diverticulitis to management without or with antibiotics.The medical records of patients who had participated in the AVOD (...) trial were reviewed for long-term results such as recurrences, complications and surgery. Quality-of-life questionnaires (EQ-5D™) were sent to patients, who were also contacted by telephone. Descriptive statistics were used for the analysis of clinical outcomes.A total of 556 of the 623 patients (89·2 per cent) were followed up for a median of 11 years. There were no differences between the no-antibiotic and antibiotic group in recurrences (both 31·3 per cent; P = 0·986), complications (4·4 versus 5

2019 EvidenceUpdates

55. Excess Antibiotic Treatment Duration and Adverse Events in Patients Hospitalized With Pneumonia: A Multihospital Cohort Study. (Abstract)

Excess Antibiotic Treatment Duration and Adverse Events in Patients Hospitalized With Pneumonia: A Multihospital Cohort Study. Randomized trials demonstrate no benefit from antibiotic treatment exceeding the shortest effective duration.To examine predictors and outcomes associated with excess duration of antibiotic treatment.Retrospective cohort study.43 hospitals in the Michigan Hospital Medicine Safety Consortium.6481 general care medical patients with pneumonia.The primary outcome (...) was the rate of excess antibiotic treatment duration (excess days per 30-day period). Excess days were calculated by subtracting each patient's shortest effective (expected) treatment duration (based on time to clinical stability, pathogen, and pneumonia classification [community-acquired vs. health care-associated]) from the actual duration. Negative binomial generalized estimating equations (GEEs) were used to calculate rate ratios to assess predictors of 30-day rates of excess duration. Patient outcomes

2019 Annals of Internal Medicine

56. Use of Antibiotics Without a Prescription in the U.S. Population: A Scoping Review. (Abstract)

Use of Antibiotics Without a Prescription in the U.S. Population: A Scoping Review. Use of antibiotics without a prescription may increase unnecessary and inappropriate drug use or doses as well as global risk for antimicrobial resistance.To perform a scoping review of research on the prevalence of nonprescription antibiotic use in the United States and to examine the factors that influence it.Searches of PubMed, EMBASE, CINAHL, Scopus, and relevant Web sites without language restrictions from (...) January 2000 to March 2019.Studies reporting nonprescription use of antibiotics, storage of antibiotics, intention to use antibiotics without a prescription, and factors influencing nonprescription use.Two reviewers independently screened citations and full texts and performed data abstraction.Of 17 422 screened articles, 31 met inclusion criteria. Depending on population characteristics, prevalence of nonprescription antibiotic use varied from 1% to 66%, storage of antibiotics for future use varied

2019 Annals of Internal Medicine

57. C-Reactive Protein Testing to Guide Antibiotic Prescribing for COPD Exacerbations. Full Text available with Trip Pro

C-Reactive Protein Testing to Guide Antibiotic Prescribing for COPD Exacerbations. Point-of-care testing of C-reactive protein (CRP) may be a way to reduce unnecessary use of antibiotics without harming patients who have acute exacerbations of chronic obstructive pulmonary disease (COPD).We performed a multicenter, open-label, randomized, controlled trial involving patients with a diagnosis of COPD in their primary care clinical record who consulted a clinician at 1 of 86 general medical (...) practices in England and Wales for an acute exacerbation of COPD. The patients were assigned to receive usual care guided by CRP point-of-care testing (CRP-guided group) or usual care alone (usual-care group). The primary outcomes were patient-reported use of antibiotics for acute exacerbations of COPD within 4 weeks after randomization (to show superiority) and COPD-related health status at 2 weeks after randomization, as measured by the Clinical COPD Questionnaire, a 10-item scale with scores ranging

2019 NEJM Controlled trial quality: predicted high

58. Prophylactic antibiotics in the prevention of infection after operative vaginal delivery (ANODE): a multicentre randomised controlled trial. Full Text available with Trip Pro

Prophylactic antibiotics in the prevention of infection after operative vaginal delivery (ANODE): a multicentre randomised controlled trial. Risk factors for maternal infection are clearly recognised, including caesarean section and operative vaginal birth. Antibiotic prophylaxis at caesarean section is widely recommended because there is clear systematic review evidence that it reduces incidence of maternal infection. Current WHO guidelines do not recommend routine antibiotic prophylaxis (...) for women undergoing operative vaginal birth because of insufficient evidence of effectiveness. We aimed to investigate whether antibiotic prophylaxis prevented maternal infection after operative vaginal birth.In a blinded, randomised controlled trial done at 27 UK obstetric units, women (aged ≥16 years) were allocated to receive a single dose of intravenous amoxicillin and clavulanic acid or placebo (saline) following operative vaginal birth at 36 weeks gestation or later. The primary outcome

2019 Lancet Controlled trial quality: predicted high

59. Antibiotic therapy for chronic infection with Burkholderia cepacia complex in people with cystic fibrosis. (Abstract)

Antibiotic therapy for chronic infection with Burkholderia cepacia complex in people with cystic fibrosis. Cystic fibrosis (CF) a life-limiting inherited disease affecting a number of organs, but classically associated with chronic lung infection and progressive loss of lung function. Chronic infection by Burkholderia cepacia complex (BCC) is associated with increased morbidity and mortality and therefore represents a significant challenge to clinicians treating people with CF. This review (...) examines the current evidence for long-term antibiotic therapy in people with CF and chronic BCC infection.The objective of this review is to assess the effects of long-term oral and inhaled antibiotic therapy targeted against chronic BCC lung infections in people with CF. The primary objective is to assess the efficacy of treatments in terms of improvements in lung function and reductions in exacerbation rate. Secondary objectives include quantifying adverse events, mortality and changes in quality

2019 Cochrane

60. Guideline-Based Clinical Assessment Versus Procalcitonin-Guided Antibiotic Use in Pneumonia: A Pragmatic Randomized Trial (Abstract)

Guideline-Based Clinical Assessment Versus Procalcitonin-Guided Antibiotic Use in Pneumonia: A Pragmatic Randomized Trial Efforts to reduce unnecessary and unnecessarily long antibiotic treatment for community-acquired pneumonia have been attempted through use of procalcitonin and through guidelines based on serial clinical assessment. Our aim is to compare guideline-based clinical assessment- and procalcitonin algorithm-guided antibiotic use among patients with community-acquired pneumonia.We (...) performed a pragmatic, randomized, multicenter trial from November 2012 to April 2015 at 12 French hospitals. We included emergency department (ED) patients older than 18 years with community-acquired pneumonia. Patients were randomly assigned to either the procalcitonin-guided or clinical assessment group. In accordance with past studies, we hypothesized that serial clinical assessment would be superior to procalcitonin-guided care. The primary outcome was antibiotic duration, and secondary outcomes

2019 EvidenceUpdates