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Youngster I, Gelernter R, Klainer H, Paz H, Kozer E, Goldman M. Electronically Monitored Adherence to Short-Term Antibiotic Therapy in Children. Pediatrics 2022; 150:189810. [PMID: 36317476 DOI: 10.1542/peds.2022-058281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Nonadherence to short-term antibiotic treatment in children can lead to treatment failure and the development of drug-resistant microorganisms. We aimed to provide reliable adherence estimates in this population. METHODS A prospective, blinded, electronically monitored, observational study between January 2018 and October 2021. Patients aged 2 months to 5 years diagnosed with an acute bacterial infection requiring short-term (5-10 days) oral antibiotic monotherapy, were provided with an electronically monitored medication bottle, recording every manipulation of the cap. Primary outcomes were overall adherence, predefined as administration of >75% of doses relative to the number of doses prescribed, and timing adherence, defined as the administration of >75% of prescribed doses taken within ±20% of the prescribed interval. RESULTS One hundred infants (49 boys, mean [range] age 1.87 years [0.2-5.1]) were included in the final analysis. Only 11 participants received all the recommended doses. Overall adherence was 62%, whereas timing adherence was 21%. After applying a logistic regression model, the only factor significantly associated with nonadherence was being a single parent (odds ratio = 5.7; 95% confidence interval [1.07-30.3]). Prescribers overestimated adherence, defining 49 of 62 (77.7%) participants as likely adherent. Patients predicted to be adherent were not more likely to be adherent than those predicted to be nonadherent (31/47 actual adherence among those predicted to be adherent vs 6/16, P = .77). CONCLUSIONS Adherence of children to the short-term antimicrobial treatment of an acute infection is suboptimal. Providers were unable to predict the adherence of their patients. These data are important when considering recommended treatment durations and developing interventional programs to increase adherence.
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Affiliation(s)
- Ilan Youngster
- Pediatric Infectious Diseases Unit.,The Center for Microbiome Research.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Renana Gelernter
- Pediatric Emergency Unit.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Hadas Paz
- Pediatric Division, Shamir Medical Center, Zerifin, Israel
| | - Eran Kozer
- Pediatric Emergency Unit.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Goldman
- Pediatric Division, Shamir Medical Center, Zerifin, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Kardas P, Dabrowa M, Witkowski K. Adherence to treatment in paediatric patients - results of the nationwide survey in Poland. BMC Pediatr 2021; 21:16. [PMID: 33407266 PMCID: PMC7786916 DOI: 10.1186/s12887-020-02477-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 12/16/2020] [Indexed: 11/24/2022] Open
Abstract
Background Due to high prevalence, non-adherence to prescribed treatment seriously undermines the effectiveness of evidence-based therapies in paediatric patients. In order to change this negative scenario, physicians need to be aware of adherence problem, as well as of possible solutions. Unfortunately, full potential of adherence-targeting interventions is still underused in Poland. Therefore, the aim of this study was to assess the knowledge, attitudes and behaviours toward non-adherence in Polish paediatricians. Methods An anonymous cross-sectional nationwide survey was conducted in the convenience sample of Polish doctors providing care to paediatric patients. The survey focused on the prevalence of non-adherence, its causes, and interventions employed. Primary studied parameter was perceived prevalence of non-adherence in paediatric patients. Reporting of this study adheres to STROBE guidelines. Results One thousand and thirty-three responses were eligible for analysis. Vast majority of respondents were female (85.9%), most of them worked in primary care (90.6%). The respondents represented all 16 Polish Voivodeships, with the biggest number coming from the Mazowieckie Voivodeship (n = 144, 13.9%). Survey participants believed that on average 28.9% of paediatric patients were non-adherent to medication. More than half of the respondents (n = 548, 53.0%) were convinced that their own patients were more adherent than average. Duration of the professional practice strongly correlated with a lower perceived prevalence of non-adherence. Professionals with more than 40 years of practice believed that the percentage of non-adherent patients was <=20% particularly often (OR = 3.82 (95% CI 2.11–6.93) versus those up to 10 years in practice). Out of all respondents, they were also most often convinced that their own patients were more adherent than the general population (P < 0.01). Consequently, they underestimated the need for training in this area. Conclusions Physicians taking care of Polish paediatric patients underestimated the prevalence of medication non-adherence and believed that this was a problem of other doctors. This optimistic bias was particularly pronounced in older doctors. These results identify important barriers toward improving patient adherence that are worth addressing in the pre- and post-graduate education of Polish physicians. They also put some light over the challenges that educational activities in this area may face.
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Affiliation(s)
- Przemyslaw Kardas
- Department of Family Medicine, Medical University of Lodz, 60, Narutowicza St., 90-136, Lodz, Poland.
| | - Marek Dabrowa
- Department of Biopharmacy, Medical University of Lodz, Lodz, Poland
| | - Konrad Witkowski
- Department of Family Medicine, Medical University of Lodz, 60, Narutowicza St., 90-136, Lodz, Poland
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Füri J, Widmer A, Bornand D, Berger C, Huttner B, Bielicki JA. The potential negative impact of antibiotic pack on antibiotic stewardship in primary care in Switzerland: a modelling study. Antimicrob Resist Infect Control 2020; 9:60. [PMID: 32384939 PMCID: PMC7206713 DOI: 10.1186/s13756-020-00724-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/28/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND In Switzerland, oral antibiotics are dispensed in packs rather than by exact pill-count. We investigated whether available packs support compliance with recommended primary care treatment regimens for common infections in children and adults. METHODS Hospital-based guidelines for oral community -based treatment of acute otitis media, sinusitis, tonsillopharyngitis, community-acquired pneumonia and afebrile urinary tract infection were identified in 2017 in an iterative process by contacting hospital pharmacists and infectious diseases specialists. Furthermore, newly available national guidelines published in 2019 were reviewed. Available pack sizes for recommended solid, dispersible and liquid antibiotic formulations were retrieved from the Swiss pharmaceutical register and compared with recommended regimens to determine optimal (no leftovers) and adequate (optimal +/- one dose) matches. RESULTS A large variety of recommended regimens were identified. For adults, optimal and adequate packs were available for 25/70 (36%) and 8/70 (11%) regimens, respectively. Pack-regimen matching was better for WHO Watch (optimal: 15/24, 63%) than Access antibiotics (optimal: 7/39, 18%). For the four paediatric weight-examples and 42 regimens involving child-appropriate formulations, optimal and adequate packs were available for only 14/168 (8%) and 27/168 (16%), respectively. Matching was better for older children with higher body and for longer treatment courses > 7 days. CONCLUSIONS Fixed antibiotic packs often do not match recommended treatment regimens, especially for children, potentially resulting in longer than necessary treatments and leftover doses in the community. As part of national stewardship, a move to an exact pill-count system, including for child-appropriate solid formulations, should be considered.
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Affiliation(s)
- Julia Füri
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Paediatric Pharmacology Group, University of Basel Children's Hospital, Basel, Switzerland
| | - Andreas Widmer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- SwissNoso, National Centre for Infection Prevention, Bern, Switzerland
| | - Delia Bornand
- Hospital Pharmacy, University Hospital Basel, Basel, Switzerland
| | - Christoph Berger
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Benedikt Huttner
- Infection Control Program and Division of Infectious Diseases, World Health Organization Collaborating Centre on Patient Safety, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Julia Anna Bielicki
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
- Paediatric Pharmacology Group, University of Basel Children's Hospital, Basel, Switzerland.
- SwissNoso, National Centre for Infection Prevention, Bern, Switzerland.
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Raupach-Rosin H, Rübsamen N, Schütte G, Raschpichler G, Chaw PS, Mikolajczyk R. Knowledge on Antibiotic Use, Self-Reported Adherence to Antibiotic Intake, and Knowledge on Multi-Drug Resistant Pathogens - Results of a Population-Based Survey in Lower Saxony, Germany. Front Microbiol 2019; 10:776. [PMID: 31031737 PMCID: PMC6473076 DOI: 10.3389/fmicb.2019.00776] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 03/26/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction Assessment of public awareness on antibiotic use and resistance can identify key issues for campaigns addressing these problems. Our aim was to assess the knowledge, attitudes, and practice (KAP) related to antibiotic use and multi-drug resistant (MDR) pathogens in a general population in Germany. Methods We conducted a KAP survey on antibiotics and on MDR pathogens using an online panel recruited from the general population, which was established using stratified random sampling from the population registry in four districts in Lower Saxony, Germany. Results In the 12 months preceding the survey, 32.3% of the participants had received at least one prescription for antibiotics, 95.7% reported to follow the recommendations of prescribers, and 10.3% reported to stop taking antibiotics as soon as they feel better. Up to 94.9% of the participants had heard of MDR pathogens, 42.7% reported to know somebody who had been tested positive for it, 0.8% had an infection with it, and 37.2% were worried of contracting it. In case of contact with a carrier of MDR pathogens, over 90% would increase hand hygiene and 0.8% would avoid the carrier completely. Participants considered health care workers (75.1%) and everybody in society (87.8%) to be responsible for combating the spread of MDR pathogens. Conclusion There is a high reported exposure to antibiotics and awareness of the problem of MDR pathogens. Despite personal worries, most of the participants indicated a reasonable, non-stigmatizing behavior toward carriers of MDR pathogens, and that every individual was responsible to avoid their spread.
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Affiliation(s)
- Heike Raupach-Rosin
- Research Group Epidemiological and Statistical Methods, Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Nicole Rübsamen
- Research Group Epidemiological and Statistical Methods, Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany.,PhD Programme "Epidemiology", Braunschweig-Hannover, Germany
| | - Gesa Schütte
- Research Group Epidemiological and Statistical Methods, Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Gabriele Raschpichler
- Research Group Epidemiological and Statistical Methods, Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Pa Saidou Chaw
- Research Group Epidemiological and Statistical Methods, Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany.,PhD Programme "Epidemiology", Braunschweig-Hannover, Germany
| | - Rafael Mikolajczyk
- Research Group Epidemiological and Statistical Methods, Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany.,Institute of Medical Epidemiology, Biometry and Informatics, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle, Germany
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5
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Petkova V, Lambov N, Dimitrov M. Antibiotic treatment among children – appropriateness and compliance. Int J Pharm 2018. [DOI: 10.1016/j.ijpharm.2017.08.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Lajoinie A, Janiaud P, Henin E, Gleize JC, Berlion C, Nguyen KA, Nony P, Gueyffier F, Maucort-Boulch D, Kassaï Koupaï B. Assessing the effects of solid versus liquid dosage forms of oral medications on adherence and acceptability in children. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2017. [DOI: 10.1002/14651858.cd012783] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Audrey Lajoinie
- Clinical Investigation Centre CIC-INSERM 1407, EPICIME, Department of Pharmacotoxicology / Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Evolutive UMR5558; Hospices Civils de Lyon/University of Lyon 1; Lyon France
| | - Perrine Janiaud
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research; University Hospital Basel, University of Basel; Basel Switzerland
| | - Emilie Henin
- Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Evolutive UMR5558; University of Lyon 1; Lyon France
| | - Jean-Cédric Gleize
- Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Evolutive UMR5558; University of Lyon 1; Lyon France
| | - Clémentine Berlion
- Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Evolutive UMR5558; University of Lyon 1; Lyon France
| | - Kim An Nguyen
- Clinical Investigation Centre CIC-INSERM 1407, EPICIME, Department of Pharmacotoxicology / Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Evolutive UMR5558; Hospices Civils de Lyon/University of Lyon 1; Lyon France
| | | | - Francois Gueyffier
- UMR5558, CNRS et Université Claude Bernard - Service de Pharmacologie & Toxicologie; Hopital Cardio-Vasculaire et Pneumologique Louis Pradel; Lyon France
| | - Delphine Maucort-Boulch
- Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Evolutive UMR5558; University of Lyon 1; Lyon France
| | - Behrouz Kassaï Koupaï
- Clinical Investigation Centre CIC-INSERM 1407, EPICIME, Department of Pharmacotoxicology / Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Evolutive UMR5558; Hospices Civils de Lyon/University of Lyon 1; Lyon France
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[Treatment and progression of acute communautary osteoarticular infections in healthy children: A retrospective monocentric study of 64 patients]. Arch Pediatr 2016; 23:1124-1134. [PMID: 27745829 DOI: 10.1016/j.arcped.2016.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 08/21/2016] [Accepted: 08/22/2016] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The prognosis of osteoarticular infections has improved over the past 20 years but it still remains potentially severe. The treatment of these infections has been simplified and shortened. In 2008, the Pediatric Infectious Disease Group (GPIP) established new therapeutic guidelines in order to standardize treatment in France. The aim of this study is to analyze practices in a Parisian hospital and assess the efficacy of this treatment in short and medium terms. MATERIALS AND METHODS This retrospective study focused on patients older than 3 months, without comorbidities, who were hospitalized for an acute osteoarticular infection in 2012 at Trousseau Hospital (Paris), with a follow-up of at least 4 weeks. The patients were selected from the hospital register. RESULTS The study included 64 patients of 156, who were admitted for examination with a diagnosis of acute osteoarticular infection, bacteriologically confirmed (29/64) or presumed on the basis of bacteriological evidence (35/64). The median age of the patients was 22 months. Of the patients, 78 % were febrile; 35 patients had arthritis (54.7 %), 21 osteomyelitis (32.8 %), seven osteoarthritis (10.9 %), and one spondylitis. Preferential localizations were the knees and hips; 61 % of arthritis cases were diagnosed with ultrasound, 54 % of osteomyelitis cases with scintigraphy. The two main microorganisms found were Kingella kingae (62.1 %) and Staphylococcus aureus (24.1 %). In 98 % of cases, patients were treated by cefamandole, with or without gentamicine, for a median duration of 3 days (1-10) intravenously, with oral relay by amoxicillin-clavulanic acid, for a total duration of 6 weeks, but in association with rifampicin in 40 % of cases without explanation. The median follow-up was 13 weeks, with a treatment success rate of 86 %. CONCLUSION The study of local practices showed us that the GPIP guidelines are not followed, with the duration of oral treatment being too long. The trend in therapy is toward short treatments of 10-20 days, with a shorter intravenous phase.
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te Molder M, de Hoog MLA, Uiterwaal CSPM, van der Ent CK, Smit HA, Schilder AGM, Damoiseaux RAMJ, Venekamp RP. Antibiotic Treatment for First Episode of Acute Otitis Media Is Not Associated with Future Recurrences. PLoS One 2016; 11:e0160560. [PMID: 27632355 PMCID: PMC5025241 DOI: 10.1371/journal.pone.0160560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 07/21/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Antibiotic treatment of acute otitis media (AOM) has been suggested to increase the risk of future AOM episodes by causing unfavorable shifts in microbial flora. Because current evidence on this topic is inconclusive and long-term follow-up data are scarce, we wanted to estimate the effect of antibiotic treatment for a first AOM episode occurring during infancy on AOM recurrences and AOM-related health care utilization later in life. METHODS We obtained demographic information and risk factors from data of the Wheezing Illnesses Study Leidsche Rijn, a prospective birth cohort study in which all healthy newborns born in Leidsche Rijn (between 2001 and 2012), The Netherlands, were enrolled. These data were linked to children's primary care electronic health records up to the age of four. Children with at least one family physician-diagnosed AOM episode before the age of two were included in analyses. The exposure of interest was the prescription of oral antibiotics (yes vs no) for a child's first AOM episode before the age of two years. RESULTS 848 children were included in analyses and 512 (60%) children were prescribed antibiotics for their first AOM episode. Antibiotic treatment was not associated with an increased risk of total AOM recurrences (adjusted rate ratio: 0.94, 95% CI: 0.78-1.13), recurrent AOM (≥3 episodes in 6 months or ≥4 in one year; adjusted risk ratio: 0.79, 95% CI: 0.57-1.11), or with increased AOM-related health care utilization during children's first four years of life. CONCLUSIONS Oral antibiotic treatment of a first AOM episode occurring during infancy does not affect the number of AOM recurrences and AOM-related health care utilization later in life. This information can be used when weighing the pros and cons of various AOM treatment options.
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Affiliation(s)
- Marthe te Molder
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marieke L. A. de Hoog
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- * E-mail:
| | - Cuno S. P. M. Uiterwaal
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cornelis K. van der Ent
- Department of Pediatric Pulmonology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Henriette A. Smit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anne G. M. Schilder
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Otorhinolaryngology, University Medical Center Utrecht, Utrecht, The Netherlands
- Ear Institute, University College London, London, United Kingdom
| | - Roger A. M. J. Damoiseaux
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Roderick P. Venekamp
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Otorhinolaryngology, University Medical Center Utrecht, Utrecht, The Netherlands
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Bast DJ, Dresser L, Duncan CL, Walker SE, Mandell LA, Low DE, de Azavedo JCS. Short-Course Therapy of Gemifloxacin Effective Against Pneumococcal Pneumonia in Mice. J Chemother 2013; 18:634-40. [PMID: 17267342 DOI: 10.1179/joc.2006.18.6.634] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Standard 7-14 day (d) courses of antimicrobial therapy for community-acquired pneumonia (CAP) are thought to have contributed to the emergence of resistant pneumoccoci. Consequently, short-course fluoroquinolone regimens have been proposed to minimize resistance. To test this, we examined 2-day versus 5-day regimens of gemifloxacin and levofloxacin for treatment of pneumonia in a murine model. In doing so, we also investigated whether the enhanced potency of gemifloxacin would influence outcomes. CD1 Swiss mice were infected intratracheally with 10(5)-CFU of a virulent Streptococcus pneumoniae strain. Drugs were administered every 8 h for 2 d and 5 d, starting at 24 h postinfection. Temperature was used to assess disease progression. Gemifloxacin remained effective for 2 d and 5 d, with survival rates of 100%-83% compared with 40%-58% for levofloxacin. Eighty-nine to 100% of gemifloxacin-treated mice were clear of pulmonary bacteria compared with only 0%-20% for levofloxacin. For levofloxacin-treated mice, 2 of 7 (29%) isolates with a levofloxacin minimum inhibitory concentration (MIC) 4 times that of the infecting parent strain had ParC mutations. By contrast, no isolates recovered from gemifloxacin-treated mice were reduced in susceptibility. Gemifloxacin could be effective in shortening duration of therapy for CAP treatment as well as minimize resistance development.
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Affiliation(s)
- D J Bast
- Department of Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada
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Fossum GH, Lindbæk M, Gjelstad S, Dalen I, Kværner KJ. Are children carrying the burden of broad-spectrum antibiotics in general practice? Prescription pattern for paediatric outpatients with respiratory tract infections in Norway. BMJ Open 2013; 3:bmjopen-2012-002285. [PMID: 23299114 PMCID: PMC3549229 DOI: 10.1136/bmjopen-2012-002285] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To investigate the antibiotic prescription pattern and factors that influence the physicians' choice of antibiotic. DESIGN Observational study. SETTING Primary healthcare in Norway, December 2004 through November 2005. PARTICIPANTS 426 general practitioners, GPs, in Norway, giving 24 888 respiratory tract infection episodes with 19 938 children aged 0-6 years. OUTCOME MEASURES Assess antibiotic prescription details and patient and GP characteristics associated with broad-spectrum and narrow-spectrum antibiotic use. RESULTS Of the 24 888 episodes in the study, 26.2% (95% CI 25.7% to 26.8%) included an antibiotic prescription. Penicillin V accounted for 42% and macrolide antibiotics for 30%. The prescription rate varied among the physicians, with a mean of 25.5% (95% CI 24.2% to 26.7%). Acute tonsillitis gave the highest odds for a prescription, OR 33.6 (95% CI 25.7% to 43.9%), compared to 'acute respiratory tract infections and symptoms' as a reference group. GPs with a prescription rate of 33.3% or higher had the larger probability for broad-spectrum antibiotic prescriptions, OR 3.33 (95% CI 2.01% to 5.54%). Antibiotic prescriptions increased with increasing patient age. CONCLUSIONS We found a low antibiotic prescription rate for childhood respiratory tract infections. However, our figures indicate an overuse of macrolide antibiotics and penicillins with extended spectrum, more so than in the corresponding study including the adult population. Palatability of antibiotic suspensions and other administrative challenges affect medication compliance in children. To help combat antibiotic resistance, guidelines need to be followed, in particular for our youngest patients. TRIAL REGISTRATION NUMBER (CLINICALTRIALS.ORG): NCT00272155.
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Affiliation(s)
- Guro Haugen Fossum
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
- Division of Surgery and Clinical Neuroscience, Department for Otorhinolaryngology, Head and Neck Surgery, Oslo University Hospital, Oslo, Norway
| | - Morten Lindbæk
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Svein Gjelstad
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Ingvild Dalen
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Kari J Kværner
- Research, Innovation and Education Unit, Oslo University Hospital, Oslo, Norway
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
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11
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Francis NA, Gillespie D, Nuttall J, Hood K, Little P, Verheij T, Coenen S, Cals JW, Goossens H, Butler CC. Antibiotics for acute cough: an international observational study of patient adherence in primary care. Br J Gen Pract 2012; 62:e429-37. [PMID: 22687236 PMCID: PMC3361123 DOI: 10.3399/bjgp12x649124] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 11/09/2011] [Accepted: 01/09/2012] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Non-adherence to acute antibiotic prescriptions is poorly described and may impact on clinical outcomes, healthcare costs, and interpretation of research. It also results in leftover antibiotics that could be used inappropriately. AIM To describe adherence to antibiotics prescribed for adults presenting with acute cough in primary care, factors associated with non-adherence, and associated recovery. DESIGN AND SETTING Prospective observational cohort study in general practices in 14 European primary care networks. METHOD GPs recorded patient characteristics and prescribing decisions for adults with acute cough or clinical presentation suggestive of lower respiratory tract infection. Patients recorded antibiotic consumption and daily symptoms over 28 days. Rates of adherence to prescribed antibiotics were assessed, and factors associated with non-adherence were identified using logistic regression. Recovery was compared using a Cox proportional hazards model. RESULTS Of 2520 patients prescribed immediate or no antibiotics at the index consultation, 282 (11.2%) took an antibiotic during the follow-up period that was not prescribed for them at the index consultation. Of these, 38.1% had no reconsultations during this period. Prior duration of symptoms, antibiotic treatment duration, antibiotic choice, and primary care network were all associated with adherence. There was no difference in time to recovery between those who were prescribed antibiotics at the index consultation and were fully adherent, partially adherent, and non-adherent. CONCLUSION Non-adherence to antibiotics for acute cough or lower respiratory tract infection is common. Duration of treatment, choice of antibiotic, and setting were associated with adherence but adherence to treatment was not associated with differences in recovery.
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Affiliation(s)
- Nick A Francis
- Cochrane Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK.
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12
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Hov I, Bjartnes M, Slørdal L, Spigset O. [Are drugs taken as prescribed?]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2012; 132:418-22. [PMID: 22353834 DOI: 10.4045/tidsskr.11.0225] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND The term "adherence" is used to describe whether drugs are taken as prescribed. This article outlines what is known about adherence for several central drug classes, which factors modify adherence, the consequences of low adherence and how adherence can be improved. METHODS We reviewed a selection of studies of adherence for the following seven drug classes: antidiabetics, antiepileptics, antihypertensives, statins, psychotropic drugs, antibiotics and analgesics. RESULTS For antidiabetics, the proportion of patients with high adherence varied between 31 % and 80 % in the different studies. The corresponding figures for the other drug classes were: antiepileptics, 61-74 %; antihypertensives, 23-73 %; statins, 25-44 %; psychotropic drugs, 21-80 %; antibiotics, 41-70 % and analgesics, 41-53 %. As a general rule, adherence declined with time. For serious diseases, a decline in adherence led to a worsening of symptoms and an increased risk of hospitalisation and death. Dosing once daily proved to result in higher adherence than multiple daily dosing. Complex therapy regimes, depression, impaired cognitive function, side effects and inadequate follow-up reduce adherence. INTERPRETATION It is important to achieve high adherence, not least for serious diseases. In order to improve adherence it is necessary to identify patients who have low adherence, understand why the patient does not take the drugs and whether there are any practical problems related to intake. Good communication between patient and doctor is a key factor.
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Affiliation(s)
- Ingrid Hov
- Institutt for laboratoriemedisin barne- og kvinnesykdommer, Norges teknisk-naturvitenskapelige universitet, og Avdeling for klinisk farmakologi, St. Olavs hospital, Norway
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Chappuy H, Tréluyer JM, Faesch S, Giraud C, Chéron G. Length of the treatment and number of doses per day as major determinants of child adherence to acute treatment. Acta Paediatr 2010; 99:433-7. [PMID: 19912146 DOI: 10.1111/j.1651-2227.2009.01601.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the rate of aftercare adherence to prescriptions from a paediatric emergency department and to identify predictors for nonadherence. METHODS Patients discharged from a French paediatric emergency department with at least one oral drug prescription were included. A telephone interview questionnaire was used to determine whether the child had received the treatments according to the prescription. Adherence was assessed according to three items: frequency of drug administration, length of treatment and drug administering method. Complete adherence was defined as adherence to the three items mentioned above, and nonadherent as nonadherent to at least one of the items. Influence of age, sex, pathology, language spoken at home, type of medical insurance, type of medication prescribed, diagnosis, dissatisfaction with the explanation of the medical problem, number of prescribed medications, length of the treatment and number of doses per day was assessed. RESULTS One hundred and five telephone interviews were exploited. The children were 60 boys (57%) and 45 girls (43%). The ages of these 105 children were between 0.2 and 12 years. The most common diagnoses were asthma and pulmonary infection. Complete adherence with the prescription was 36.2%. Three factors were significantly associated with nonadherence (p < 0.05): length of treatment, number of doses per day and male sex. CONCLUSION This study suggests that simplifying treatment schedules is an effective strategy for improving compliance in paediatric emergency departments.
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Affiliation(s)
- H Chappuy
- Service d'Urgences Pédiatriques, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France.
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Kairuz T, Svirskis D, Sheridan J. Children's prescription medicines: parents' perceptions on dosing intervals, dosing devices and prescription advice. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2010. [DOI: 10.1211/ijpp.15.1.0003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Abstract
Objective To gather information on devices used to administer liquid medicines, dosing intervals for antibiotic administration, and parents' perceptions of the advice received from pharmacists about prescription medicines, for children up to the age of six years.
Setting Six schools from different socio-economic areas were selected within the Auckland area of New Zealand. To facilitate distribution and collection of questionnaires, the headmaster or a teacher was known to the researchers.
Method An anonymous questionnaire was distributed to year 1 and 2 students (aged five and six years) to take home for completion by a parent or primary caregiver. Respondents were asked to refer to their youngest child and/or to the last time they had given medicines or received a prescription for a child.
Key findings A total of 299 completed questionnaires were received (48.2%); 60 questionnaires had not been distributed by school teachers in error, and the overall return rate was thus adjusted to 53.4%. The device used most frequently to administer medicines to younger children up to the age of three years was an oral medicine syringe, while nearly one-third of children aged three to six years received medicine in a ‘teaspoon’. Almost half the respondents (48.8%) indicated they would be most likely to forget the midday dose of antibiotics, and dosing deviated from recommended intervals. Most respondents had received advice from a pharmacist on how to take the medicine, and had understood instructions and had the opportunity to ask questions.
Conclusion This study highlights areas that pharmacists can include when advising parents and guardians about children's medicines, such as ideal dosing intervals of antibiotics and the use of accurate dosing devices.
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Affiliation(s)
- Therése Kairuz
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Darren Svirskis
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Janie Sheridan
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
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Dimopoulos G, Matthaiou DK, Karageorgopoulos DE, Grammatikos AP, Athanassa Z, Falagas ME. Short- versus long-course antibacterial therapy for community-acquired pneumonia : a meta-analysis. Drugs 2009; 68:1841-54. [PMID: 18729535 DOI: 10.2165/00003495-200868130-00004] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND The evidence for traditionally recommended 7- to 14-day duration of antibacterial therapy for community-acquired pneumonia (CAP) is not well established. OBJECTIVES We endeavoured to assess the effectiveness and safety of shorter than traditionally recommended antibacterial therapy for CAP. METHODS We performed a meta-analysis of randomized controlled trials (RCTs) comparing short- (< or = 7 days) versus long- (> or = 2 days difference) course therapy for CAP with the same antibacterial regimens, in the same daily dosages. RESULTS Five RCTs involving adults (including outpatients and inpatients who did not require intensive care) and two RCTs involving children (aged 2-59 months, residing in developing countries) were included. All RCTs were double-blind and assessed patients with CAP of mild to moderate severity. No differences were found between short- (adults 3-7 days; children 3 days) and long- (adults 7-10 days; children 5 days) course regimens (adults - amoxicillin, cefuroxime, ceftriaxone, telithromycin and gemifloxacin; children - amoxicillin) regarding clinical success at end-of-therapy (six RCTs; 5107 patients [1095 adults, 4012 children]; fixed-effect model [FEM]; odds ratio [OR] = 0.89; 95% CI 0.74, 1.07), clinical success at late follow-up, microbiological success, relapses, mortality (seven RCTs; 5438 patients; FEM; OR = 0.57; 95% CI 0.23, 1.43), adverse events (five RCTs; 3214 patients; FEM; OR = 0. 90; 95% CI 0.72, 1.13) or withdrawals as a result of adverse events. No differences were found in subset analyses of adults or children, and of patients treated with no more than 5-day short-course regimens versus at least 7-day long-course regimens. CONCLUSION No difference was found in the effectiveness and safety of short- versus long-course antimicrobial treatment of adult and paediatric patients with CAP of mild to moderate severity.
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Affiliation(s)
- George Dimopoulos
- Alfa Institute of Biomedical Sciences (AIBS), Athens, GreeceDepartment of Critical Care, Attikon University Hospital, University of Athens, Athens, Greece
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Ishizaka T, Okada S, Takemoto E, Tokuyama E, Tsuji E, Mukai J, Uchida T. The Suppression of Enhanced Bitterness Intensity of Macrolide Dry Syrup Mixed with an Acidic Powder. Chem Pharm Bull (Tokyo) 2007; 55:1452-7. [DOI: 10.1248/cpb.55.1452] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Toshihiko Ishizaka
- School of Pharmaceutical Sciences, Mukogawa Women's University
- Department of Pharmacy, Izumi Municipal Hospital
| | - Sachie Okada
- School of Pharmaceutical Sciences, Mukogawa Women's University
| | - Eri Takemoto
- School of Pharmaceutical Sciences, Mukogawa Women's University
| | - Emi Tokuyama
- School of Pharmaceutical Sciences, Mukogawa Women's University
| | - Eriko Tsuji
- School of Pharmaceutical Sciences, Mukogawa Women's University
| | - Junji Mukai
- School of Pharmaceutical Sciences, Mukogawa Women's University
- Department of Pharmacy, Izumi Municipal Hospital
| | - Takahiro Uchida
- School of Pharmaceutical Sciences, Mukogawa Women's University
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Tsuji E, Uchida T, Fukui A, Fujii R, Sunada H. Evaluation of Bitterness Suppression of Macrolide Dry Syrups by Jellies. Chem Pharm Bull (Tokyo) 2006; 54:310-4. [PMID: 16508183 DOI: 10.1248/cpb.54.310] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The purpose of this study was to evaluate the bitterness-suppressing effect of three jellies, all commercially available on the Japanese market as swallowing aids, on two dry syrups containing the macrolides clarithromycin (CAM) or azithromycin (AZM). The bitterness intensities of mixtures of the dry syrups and acidic jellies were significantly greater than those of water suspensions of the dry syrups in human gustatory sensation tests. On the other hand, the mixture with a chocolate jelly, which has a neutral pH, was less bitter than water suspensions of the dry syrups. The bitterness intensities predicted by the taste sensor output values correlated well with the observed bitterness intensities in human gustatory sensation tests. When the concentrations of CAM and AZM in solutions extracted from physical mixtures of dry syrup and jelly were determined by HPLC, concentrations in the solutions extracted from mixtures with acidic jellies were higher than those from mixtures with a neutral jelly (almost 90 times higher for CAM, and almost 7-10 times higher for AZM). Thus, bitterness suppression is correlated with the pH of the jelly. Finally, a drug dissolution test for dry syrup with and without jelly was performed using the paddle method. There was no significance difference in dissolution profile. It was concluded the appropriate choice of jelly with the right pH is essential for taste masking. Suitable jellies might be used to improve patient compliance, especially in children. The taste sensor may be used to predict the bitterness-suppressing effect of the jelly.
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Affiliation(s)
- Eriko Tsuji
- School of Pharmaceutical Sciences, Mukogawa Women's University, Nishinomiya, Hyogo, Japan
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Kardas P, Devine S, Golembesky A, Roberts C. A systematic review and meta-analysis of misuse of antibiotic therapies in the community. Int J Antimicrob Agents 2005; 26:106-13. [PMID: 16009535 DOI: 10.1016/j.ijantimicag.2005.04.017] [Citation(s) in RCA: 165] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2005] [Accepted: 04/26/2005] [Indexed: 11/22/2022]
Abstract
Misuse of antibiotic therapy can have a profound negative impact both on individuals and on the community. The objective of this meta-analysis was to estimate the prevalence of antibiotic misuse in terms of non-compliance with therapy or reuse of leftover antibiotics in the community. Of 2848 screened articles, 46 contained the required information on the number of participants, the number compliant/using leftovers and the measurement technique. Mean compliance with antibiotics was 62.2% (95% confidence interval (CI), 56.4-68.0%) and mean use of leftover antibiotics was 28.6% (95% CI, 21.8-35.4%). Although variation in the methods resulted in substantial heterogeneity in the estimates, results were generally consistent by region and measurement technique. Patient education and simpler antibiotic regimens should be encouraged to promote responsible use of antibiotic therapy.
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Affiliation(s)
- Przemyslaw Kardas
- Department of Family Medicine, Medical University of Lodz, 96 Narutowicza Str., 90-141 Lodz, Poland
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Affiliation(s)
- H Chappuy
- Département des urgences pédiatriques, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75743 Paris cedex 15, AP-HP, Université Paris-V, France.
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Abstract
Compliance, or adherence, as it relates to health care is the extent to which a person's behavior coincides with medical or health advice. Medication compliance is critical for all aspects of pediatrics, specifically in successful treatment, disease prevention, and health promotion. Compliance depends on the patient's and physician's committing to the same objectives. It is unfortunate that numerous studies and physician accounts reveal difficulties in achieving compliance with pediatric medication therapy. Medication compliance in pediatric patients ranges from 11% to 93%. At least one third of all patients fail to complete relatively short-term treatment regimens. Poor compliance places children at risk for problems such as continued disease, complicates the physician-patient relationship, and prevents accurate assessment of the quality of care provided. This article presents the issue in the context of its incidence of and barriers to compliance and provides general principles to improve compliance in pediatrics by improving communication and characteristics of the practice setting. A one-on-one relationship between physician and patient is needed for communication and improved compliance.
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Adams VJ, Campbell JR, Waldner CL, Dowling PM, Shmon CL. Evaluation of client compliance with short-term administration of antimicrobials to dogs. J Am Vet Med Assoc 2005; 226:567-74. [PMID: 15742698 DOI: 10.2460/javma.2005.226.567] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe the degree of and variability in the level of client compliance and identify determinants of client compliance with short-term administration of antimicrobial medications to dogs. DESIGN Prospective study. SAMPLE POPULATION 90 owners of dogs prescribed antimicrobials. PROCEDURE Eligible clients were invited to participate when antimicrobial medications were dispensed. Data were collected during a follow-up appointment by use of a client questionnaire, residual pill count, and return of an electronic medication monitoring device. Attending veterinarians also completed a questionnaire that asked them to predict client compliance. Methods of assessing compliance were compared with nonparametric tests. Generalized estimating equations were used to investigate potential determinants of compliance. RESULTS Median compliance rates of 97% of prescribed container openings, 91% of days when the correct number of doses were given, and 64% of doses given on time as assessed by the electronic medication monitoring devices were significantly lower than the median compliance rates of 100% for client self-report of missing doses and pill count. Veterinarians were unable to predict client compliance. The dosage regimen significantly determined compliance. Clients giving antimicrobials once or twice daily were 9 times more likely to be 100% compliant, compared with 3 times daily dosing. CONCLUSIONS AND CLINICAL RELEVANCE The combination of reported missed doses and pill counts was a significant predictor of compliance as measured by electronic monitoring. Electronic monitoring caps provided useful information only when they were used appropriately. Asking clients about missed doses and performing pill counts are the most practical assessments of compliance in practice.
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Affiliation(s)
- Vicki J Adams
- Department of Large Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK S7N 5B4, Canada
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22
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Gueylard Chenevier D, LeLorier J. A willingness-to-pay assessment of parents' preference for shorter duration treatment of acute otitis media in children. PHARMACOECONOMICS 2005; 23:1243-55. [PMID: 16336018 DOI: 10.2165/00019053-200523120-00008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVE To assess parental willingness to pay (WTP) for a shorter course of antibacterial treatment versus conventional antibacterial therapy for acute otitis media (AOM). METHODS The study population consisted of 562 parents of children who had been seen and treated by a paediatrician for an episode of AOM between February and November 2002 in Montreal, Quebec, Canada. At the end of the AOM treatment, a questionnaire that included demographic information about the parents and child, details of the child's AOM history, a global wellbeing (i.e. quality of life) assessment, an evaluation of treatment compliance and a scripted WTP question was administered over the telephone. Descriptive analyses were performed in addition to a multivariate analysis to estimate possible predictors of parental WTP. RESULTS The children with AOM were representative of the AOM patient population, with 46% being <2 years of age and the majority attending day-care or school. Parents were willing to pay a median of 31.66 Can dollars (2002 values) for a mono-dose (one dose, on 1 day) and 26.63 Can dollars for a tri-dose (one dose daily, for 3 days) antibacterial treatment. Regression analyses demonstrated that the amount parents were willing to pay was positively associated with increasing household income, increasing number of AOM episodes during the previous year and experiencing adverse effects of treatment. CONCLUSION Parents of children with AOM were willing to pay more for their child to benefit from a shorter duration of antibacterial treatment than for a standard course. Short duration of treatment appears to be associated with better compliance and parents' perception of better general wellbeing for their child.
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Pechère JC. Le médecin, le malade et les antibiotiques. BULLETIN DE L'ACADÉMIE NATIONALE DE MÉDECINE 2004. [DOI: 10.1016/s0001-4079(19)33650-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Improving adherence with antimicrobial therapy for respiratory tract infections: a discussion of directly observed therapy (DOT) and short-course therapies. Am J Ther 2004; 11 Suppl 1:S18-21. [PMID: 23570158 DOI: 10.1097/01.mjt.0000129050.13889.73] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although some of the variables associated with adherence (eg, patient age, place of residence) cannot be influenced, others are very amenable to modifications. Levels of adherence correlate with the convenience of dosage regimens, as shown in a number of clinical trials. Therefore, antimicrobial agents that are well accepted by patients should be considered whenever feasible. Such agents include those that enable shortterm therapy with the fewest daily doses and shortest effective treatment regimens. DOT, a cost-effective and clinically effective approach for certain chronic conditions, may also have practical implications for the treatment of acute infectious diseases, such as CAP, AECB, and otitis media. Although there are a number of challenges to the implementation of DOT for these conditions, such an approach may be beneficial, particularly when short-course antibiotic therapy is indicated and appropriate candidates are identified for treatment.
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25
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Dhaon NA. Amoxicillin tablets for oral suspension in the treatment of acute otitis media: a new formulation with improved convenience. Adv Ther 2004; 21:87-95. [PMID: 15310082 DOI: 10.1007/bf02850336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Acute otitis media (AOM) is the most common cause of pediatric office visits in the United States and the most frequent bacterial infection in children. Antimicrobials are often prescribed and amoxicillin continues to be the first-line treatment for AOM. Recently, amoxicillin tablets that disperse in water to form an oral suspension have become available in the United States for the treatment of AOM. This formulation retains the efficacy, safety, and tolerability features of conventional amoxicillin formulations while providing the additional potential benefits of improved portability, patient convenience and compliance, and dosing accuracy.
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Affiliation(s)
- Nitin A Dhaon
- Marion Internal Medicine Associates, Ocala, Florida, USA
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26
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Perez-Gorricho B, Ripoll M. Does short-course antibiotic therapy better meet patient expectations? Int J Antimicrob Agents 2003; 21:222-8. [PMID: 12636982 DOI: 10.1016/s0924-8579(02)00360-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A pan-European market research study of 3254 patients designed to determine patient attitudes, expectations and behaviour to antibiotic management of mild-moderate RTIs, identified three key drivers of perceived antibiotic efficacy: length of antibiotic course, time to onset of symptom relief and time to complete resolution of symptoms. Azithromycin was selected as "drug therapy of shortest dosage schedule" for common outpatient infections. The results demonstrate that once-daily, short-course treatment is perceived to be significantly more effective than longer antibiotic courses and thus, better meets patient expectations of therapy. This perception of efficacy with short-course therapy also correlates with overall satisfaction with management by the physician and compliance with therapy. These findings have important implications for the way physicians manage patients with mild-moderate RTIs.
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Affiliation(s)
- B Perez-Gorricho
- Division of Infectious Diseases, Children's Hospital Niño Jesus, Universidad Autónoma de Madrid, Menéndez Pelayo 65, 28009 Madrid, Spain.
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Raghavan U, Jones NS. Combating bacterial resistance in otorhinolaryngology. CLINICAL OTOLARYNGOLOGY AND ALLIED SCIENCES 2002; 27:446-52. [PMID: 12472510 DOI: 10.1046/j.1365-2273.2002.00624.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Bacterial resistance appears to be an ever-increasing problem and is threatening to spiral out of control. The scare caused by the rapid spread of methicillin-resistant Staphylococcus aureus among hospitals in the UK is the most recent. Otorhinolaryngology is deeply involved in this problem, as one of the reasons often cited for increasing bacterial resistance is the use of antibiotics in suspected bacterial infections in ear, nose and throat by primary care physicians. This speciality is also involved in the development of guidelines for antimicrobial use by primary and secondary care. This review attempts to discuss the reason for the development of antimicrobial resistance especially in relation to otorhinolaryngology, what can be done to contain this menace and the surveillance system developed to monitor the trend in the development of bacterial resistance.
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Affiliation(s)
- U Raghavan
- Department of Otorhinolaryngology, University Hospital, Nottingham, UK
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Harbarth S, Albrich W, Goldmann DA, Huebner J. Control of multiply resistant cocci: do international comparisons help? THE LANCET. INFECTIOUS DISEASES 2001; 1:251-61. [PMID: 11871512 DOI: 10.1016/s1473-3099(01)00120-7] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Antibiotic resistance has become a worldwide problem. However, the reasons for the uneven geographic distribution of antibiotic-resistant microorganisms are not fully understood. For instance, there are striking differences in the epidemiology of multiresistant gram-positive cocci between the USA and Germany. According to recent reports, the prevalence of high-level penicillin-resistant pneumococci (PRP), meticillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant enterococci (VRE) in clinically relevant isolates of hospitalised patients in the USA and Germany are: PRP, 14% versus less than 1%; MRSA, 36% versus 15%; and VRE, 15% versus 1%. These disparities may be explained by several determinants: (1) diagnostic practice and laboratory recognition (all three pathogens); (2) clonal differences and pathogen transmissibility (VRE); (3) antibiotic prescribing practices (all three pathogens); (4) population characteristics, including extensive daycare exposure in the USA (PRP); (5) cultural factors (all three pathogens); (6) factors related to the health-care and legal system (all three pathogens); and (7) infection-control practices (MRSA and VRE). Understanding these determinants is important for preventing further spread of multiresistant cocci within the USA. A rational approach to national surveillance is urgently needed in Germany to preserve the favourable situation and decrease MRSA transmission. Finally, we suggest that a macro-level perspective on antibiotic resistance can broaden the understanding of this worldwide calamity, and help prevent further dissemination of multiply resistant microorganisms.
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Affiliation(s)
- S Harbarth
- Children's Hospital, and Harvard Medical School, Boston, USA.
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Abstract
To better evaluate patient contribution in antibiotic use, we questioned 5379 subjects from 9 countries. Antibiotics are perceived as strong, efficient drugs, but they are believed to undermine immunity. Interviewees believe that most respiratory infections, except the common cold, require antibiotic therapy, and 11% of them had to exaggerate their symptoms to get an antibiotic prescription from their physician. About 1 patient in 4 saved part of the antibiotic course for future use. Sixty-nine percent of the patients claimed to have taken the course until the end (United Kingdom, 90%; Thailand, 53%), and 75% claimed that they actually took all the daily doses. In all countries, it was possible to get antibiotics from a pharmacist without a medical prescription. This study shows that patients exert pressure on their doctors to get antibiotics and should allow a design for precise educational action aimed at the public for better control of antibiotic use in the community.
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Affiliation(s)
- J C Pechère
- Department of Genetics and Microbiology, University of Geneva, Geneva, Switzerland.
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30
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Affiliation(s)
- D Rodríguez
- Fundació Institut Català de Farmacologia, Servei de Farmacologia Clínica, Hospital Universitari Vall d'Hebron, Barcelona
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