DOCSLIB.ORG

Bacterial Challenges and Evolving Antibacterial Drug Strategy B

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Bacterial Challenges and Evolving Antibacterial Drug Strategy B Postgrad Med J: first published as 10.1136/pgmj.68.795.6 on 1 January 1992. Downloaded from Postgrad Med J (1992) 68, 6 - 21 i) The Fellowship of Postgraduate Medicine, 1992 Reviews in Medicine Bacterial challenges and evolving antibacterial drug strategy B. Watt and J.G. Collee Bacteriology Laboratory, City Hospital, Edinburgh EH10 SSB andDepartment ofMedical Microbiology, University Medical School, Edinburgh EH8 9AG, UK Introduction In this paper, we attempt to summarize bacterial infections obliges us to consider a variety developments ofimportance for practising hospital of new challenges, especially mycobacterial infec- clinicians and for primary care doctors who must tions. be aware of the ever-widening spectrum of recog- Our relative lack of success in dealing with some nized pathogens. This article is restricted to con- aggressive infections, such as those caused by the siderations ofpathogenic bacteria and antibacterial meningococcus or Haemophilus influenzae, has drugs that have obliged us to change our strategies called for a review of our prophylactic strategies, or policies in the last decade or so. There have been and this has been highlighted in the case of many confusing developments. Whilst basically pneumococcal challenges in compromised (as- new antibacterial drugs are rare, variations on plenic) patients. The common occurrence of previously successful models have been very polymicrobial or mixed bacterial infections has copyright. numerous and some significant progress has been been acknowledged, and the neglected concept of made. pathogenic synergy has been revived. The problems Over the decade, several new infective challenges of antibiotic-associated diarrhoea have necessitated have posed problems for clinicians and micro- scrutiny of precipitating antibiotics and studies of biologists. It is recognized that community- the most effective therapy. Meanwhile, the general acquired infections differ from hospital-acquired acceptance of the principle of peroperative anti- infections in the range and nature and antibiotic microbial prophylaxis and its application to resistance profiles of the causative organisms. The specific areas of operative surgery has had a major http://pmj.bmj.com/ inexorable progress ofbacterial drug resistance has impact. obliged us to reconsider first-choice therapy for some infections. Beta-lactamase production by various bacteria Changes in first-line choices has restricted our therapeutic options or has obliged us to use new preparations. For example, The sulphonamides have been largely superseded our recognition of the pathogenic potential of by newer drugs in the last decade, though they are on September 30, 2021 by guest. Protected Moraxella (Branhamella) catarrhalis has required still used, often in conjunction with trimethoprim modification of previous approaches to the (as cotrimoxazole), in the treatment of uncompli- antibiotic therapy of respiratory tract infections, cated urinary tract infections. Resistance to sul- and beta-lactamase-producing strains of Haemo- phonamides is common and it is arguable that the philus influenzae have created further problems. use of the combination is now often irrational. Worrying outbreaks of a range of infections from Thus, trimethoprim has emerged as a single drug in legionellosis to salmonellosis have extended us to its own right, but its use too has often been determine or define appropriate therapy. Our evol- overtaken by the development of resistance. ving awareness of human immunodeficiency virus Nalidixic acid has been superseded by the develop- (HIV) disease and associated opportunistic ment of the more potent 4-quinolones, and nitro- furantoin is not favoured by many clinicians. Some ofthese drugs have special roles that maintain them in our formularies for the 1990s although they are not now in general daily use. The lincosamides, notably clindamycin, had Correspondence: B. Watt. M.D., F.R.C.Path. special virtues that endeared them to orthopaedic Postgrad Med J: first published as 10.1136/pgmj.68.795.6 on 1 January 1992. Downloaded from BACTERIAL CHALLENGES AND ANTIBACTERIAL DRUGS 7 surgeons and others who valued their efficacy beta-lactamases. These include: (1) ampicillin and against gram-positive cocci and anaerobes and amoxycillin (the amino penicillins); (2) carbenicil- their good penetration into bone. Clindamycin is lin and other carboxypenicillin analogues; (3) acyl still highly regarded as an alternative to penicillin ureido penicillins such as mezlocillin, azlocillin and when such an option is sought. Unfortunately, the piperacillin; and (4) amidino penicillins such as association with pseudomembranous colitis mecillinan. It is most important to note in practice (PMC) has understandably inhibited the general that none ofthe Group III penicillins is completely use of clindamycin. It should be noted that the stable to the beta-lactamases. volume of use of ampicillin ensures that ampicillin Group IV holds the only true penicillin that is features prominently in the PMC league table; our beta-lactamase stable, temocillin, but the activity experience in the last decade shows that no of this drug does not extend beyond the aerobic antibiotic is exempt. Nevertheless, the association Gram-negative bacteria. with the lincosamides is especially clear and is a justifiable (though not absolute) restraint. Beta-lactamase inhibitors As bacterial resistance The staphylococcus has sequentially challenged to beta-lactam antibiotics is largely attributable to all of the antibacterial drugs as they have been potent bacterial beta-lactamases, pharmaceutical developed and widely used, and has obliged us to companies sought to develop beta-lactam drugs keep our therapeutic options open. Thus, fusidic that are resistant to these enzymes (q.v.). Another acid (usually in combination with another drug) is strategy is to develop preparations in which a still useful. Strains of methicillin resistant sensitive beta-lactam drug is protected by a beta- Staphylococcus aureus (MRSA) have posed special lactamase inhibitor such as clavulanic acid or problems. Vancomycin retains a remarkable place sulbactam or tazobactam. in our attempts to control coagulase-negative These inhibitors have some antibacterial activity staphylococcal infections and MRSA infections in their own right, but their role in the combination (and pseudomembranous colitis caused by Clost- is to shield the more active drug. This has extended ridium difficile). It is worrying that our options in the usefulness ofdrugs such as amoxycillin against these difficult situations are so limited and that we beta-lactamase-producing staphylococci, coliform copyright. are so dependent on such a restricted number of organisms and anaerobes including Bacteroides active agents. fragilis. However, Pseudomonas aeruginosa has innate resistance to amoxycillin and this still holds. The combination of amoxycillin with clavulanic The basic armament acid (co-amoxiclav) is marketed in Britain as Augmentin; ticarcillin with clavulanic acid is Many antibacterial drugs have stood the test of Timentin; and ampicillin with sulbactam is sul- time, despite our abuse of them over the years. tamicillin.3 Tazobactam in combination with http://pmj.bmj.com/ Accordingly, the list of those regarded as first-line piperacillin is a useful development of this theme.4 choices for the 1990s does not differ significantly Meanwhile, the pharmaceutical industry was from the 1980 list. We now consider developments developing the cephalosporins as an alternative in antibacterial drug strategy and practice in the answer to the threat of the penicillinases. last decade in relation to changing aspects of infection. The following account reviews The cephalosporins and related drugs developments in the use of our main-line anti- bacterial drugs and draws attention to important These drugs can be classified into 4 groups that on September 30, 2021 by guest. Protected new applications. reflect an extending clinical requirement for a range of activity or specific efficacy.' The penicillins Group I drugs (examples cephaloridine, cepha- zolin) are highly active against Gram-negative Williams' recognized the following 4 groups of bacteria, notably staphylococci and streptococci. penicillins. Group lcephalosporins (examples cefamandole, Group I contains benzyl penicillin (penicillin G), cefuroxime) are effective against Gram-positive the original and still probably the best,2 and cocci and (Gram-negative) coliform organisms, but analogues such as the orally active phenoxymethyl not pseudomonas. penicillin (penicillin V). Group III drugs (examples cefotaxime, ceftazi- Group II contains the anti-staphylococcal dime) are active against Pseudomonas and related methicillin and the clinically useful orally active species, in addition to their activity against cloxacillin series. enterobacteria. Cefotaxime is less active than cef- Group III contains penicillins with activity tazidime against Pseudomonas aeruginosa. Cef- against Gram-negative bacilli (coliform organisms sulodin was developed specifically as an anti- and Haemophilus species etc.), but susceptible to pseudomonal cephalosporin. Postgrad Med J: first published as 10.1136/pgmj.68.795.6 on 1 January 1992. Downloaded from 8 B. WATT & J.G. COLLEE Group IV contains the cephamycins (examples ant in the laboratory investigation ofa patient with cefoxitin, latamoxef, cefotetan) with broad- an undiagnosed infection that might be myco- spectrum efficacy that includes activity against bacterial,
Load more

Recommended publications
  • WO 2015/179249 Al 26 November 2015 (26.11.2015) P O P C T
    (12) INTERNATIONAL APPLICATION PUBLISHED UNDER THE PATENT COOPERATION TREATY (PCT) (19) World Intellectual Property Organization International Bureau (10) International Publication Number (43) International Publication Date WO 2015/179249 Al 26 November 2015 (26.11.2015) P O P C T (51) International Patent Classification: (81) Designated States (unless otherwise indicated, for every C12N 15/11 (2006.01) A61K 38/08 (2006.01) kind of national protection available): AE, AG, AL, AM, C12N 15/00 (2006.01) AO, AT, AU, AZ, BA, BB, BG, BH, BN, BR, BW, BY, BZ, CA, CH, CL, CN, CO, CR, CU, CZ, DE, DK, DM, (21) Number: International Application DO, DZ, EC, EE, EG, ES, FI, GB, GD, GE, GH, GM, GT, PCT/US2015/031213 HN, HR, HU, ID, IL, IN, IR, IS, JP, KE, KG, KN, KP, KR, (22) International Filing Date: KZ, LA, LC, LK, LR, LS, LU, LY, MA, MD, ME, MG, 15 May 2015 (15.05.2015) MK, MN, MW, MX, MY, MZ, NA, NG, NI, NO, NZ, OM, PA, PE, PG, PH, PL, PT, QA, RO, RS, RU, RW, SA, SC, (25) Filing Language: English SD, SE, SG, SK, SL, SM, ST, SV, SY, TH, TJ, TM, TN, (26) Publication Language: English TR, TT, TZ, UA, UG, US, UZ, VC, VN, ZA, ZM, ZW. (30) Priority Data: (84) Designated States (unless otherwise indicated, for every 62/000,43 1 19 May 2014 (19.05.2014) US kind of regional protection available): ARIPO (BW, GH, 62/129,746 6 March 2015 (06.03.2015) US GM, KE, LR, LS, MW, MZ, NA, RW, SD, SL, ST, SZ, TZ, UG, ZM, ZW), Eurasian (AM, AZ, BY, KG, KZ, RU, (72) Inventors; and TJ, TM), European (AL, AT, BE, BG, CH, CY, CZ, DE, (71) Applicants : GELLER, Bruce, L.
    [Show full text]
  • CLINICAL USE of RIFABUTIN, a RIFAMYCIN-CLASS ANTIBIOTIC, for the TREATMENT of TUBERCULOSIS (A Supplement to the 2008 Revision Of“ Standards for Tuberculosis Care”)
    Kekkaku Vol. 86, No. 1: 43, 2011 43 CLINICAL USE OF RIFABUTIN, A RIFAMYCIN-CLASS ANTIBIOTIC, FOR THE TREATMENT OF TUBERCULOSIS (A supplement to the 2008 revision of“ Standards for tuberculosis care”) August, 2008 The Treatment Committee of the Japanese Society for Tuberculosis The Treatment Committee of the Japanese Society for [Dosage and administration of rifabutin] Tuberculosis published statements on the“ Standards for Rifabutin, 5 mg/kg in body weight/day, maximum 300 mg/ tuberculosis care” in April 2008. Therein we referred to day, once daily. rifampicin as follows“; Use of rifampicin requires attention The dosage of rifabutin can be increased up to the maximum because of the interactions with a number of other drugs. daily dose of 450 mg in cases where decreased rifabutin serum Particularly for HIV-infected patients who need antiviral levels are expected due to anti-HIV drugs such as efavirenz, drugs, the replacement of rifampicin by rifabutin should be and in other cases if necessary. considered”. Rifabutin, belonging to rifamycin-class antibiotics In non-HIV-infected patients, rifabutin can be used for like rifampicin, causes less significant drug-drug interactions intermittent treatment with a regimen of twice or three times a than rifampicin, and can be used in combination with antiviral week, with the same dosage as daily administration. drugs mentioned above. In July 2008, rifabutin was approved as antituberculous drug, and is expected to be added to the drug [Important points for use of rifabutin] price listing in the near future*. Therefore, to the published (1) Rifabutin causes drug interactions due to induction of opinions, we add new statements concerning the use of rifabutin hepatic enzyme though less significantly than rifampicin.
    [Show full text]
  • National Antibiotic Consumption for Human Use in Sierra Leone (2017–2019): a Cross-Sectional Study
    Tropical Medicine and Infectious Disease Article National Antibiotic Consumption for Human Use in Sierra Leone (2017–2019): A Cross-Sectional Study Joseph Sam Kanu 1,2,* , Mohammed Khogali 3, Katrina Hann 4 , Wenjing Tao 5, Shuwary Barlatt 6,7, James Komeh 6, Joy Johnson 6, Mohamed Sesay 6, Mohamed Alex Vandi 8, Hannock Tweya 9, Collins Timire 10, Onome Thomas Abiri 6,11 , Fawzi Thomas 6, Ahmed Sankoh-Hughes 12, Bailah Molleh 4, Anna Maruta 13 and Anthony D. Harries 10,14 1 National Disease Surveillance Programme, Sierra Leone National Public Health Emergency Operations Centre, Ministry of Health and Sanitation, Cockerill, Wilkinson Road, Freetown, Sierra Leone 2 Department of Community Health, Faculty of Clinical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone 3 Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, 1211 Geneva, Switzerland; [email protected] 4 Sustainable Health Systems, Freetown, Sierra Leone; [email protected] (K.H.); [email protected] (B.M.) 5 Unit for Antibiotics and Infection Control, Public Health Agency of Sweden, Folkhalsomyndigheten, SE-171 82 Stockholm, Sweden; [email protected] 6 Pharmacy Board of Sierra Leone, Central Medical Stores, New England Ville, Freetown, Sierra Leone; [email protected] (S.B.); [email protected] (J.K.); [email protected] (J.J.); [email protected] (M.S.); [email protected] (O.T.A.); [email protected] (F.T.) Citation: Kanu, J.S.; Khogali, M.; 7 Department of Pharmaceutics and Clinical Pharmacy & Therapeutics, Faculty of Pharmaceutical Sciences, Hann, K.; Tao, W.; Barlatt, S.; Komeh, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 0000, Sierra Leone 8 J.; Johnson, J.; Sesay, M.; Vandi, M.A.; Directorate of Health Security & Emergencies, Ministry of Health and Sanitation, Sierra Leone National Tweya, H.; et al.
    [Show full text]
  • RIFAMPICIN Productinformation Sigma Prod
    RIFAMPICIN ProductInformation Sigma Prod. No. R3501 CH3 CH3 CAS NUMBER: 13292-46-1 HO SYNONYMS: Tubocin; Sinerdol; Rimactan; L-5103; Dione-21 Acetate; Archidyn; Arficin; 3-(4- CH3 O O OH O Methylpiperazinyliminomethyl)-rifamycin SV; NSC 113926; C OH OH CH 1 2 3 H C Rifampin ; Rifaldazine; Rifamycin AMP H3C 3 O NH H3C PHYSICAL PROPERTIES: CH3 N CH N Appearance: Orange-brown to red-brown powder.3 O OH N Molecular formula: C43H58N4O12 O Molecular weight: 823.0 O CH3 CH3 EmM (max absorbance, phosphate buffer, pH 7.38): 33.20 (237 nm); 32.10 (255 nm); 27.00 (334 nm); 15.40 (475 nm)2,4 pKa (in water):1.7 (4-hydroxyl group), 7.9 (4-piperazine nitrogen); in methylcellosolve-water (4:1): 3.6 (4- hydroxyl group), 6.7 (3-piperazine nitrogen)4 pI (in water): 4.84 25° 4 Optical rotation: [α]D =+10.6° (c=0.5% in CDCl3) Melting point: 183-188°C (dec.)2,4 METHOD OF PREPARATION: Methods of preparation have been reported.4,5 The NMR, UV, IR, Mass spectra, Thin-Layer chromatography and HPLC methods of detection have been reported.4,5,6 A colorimetric test for identification was reported.4 STABILITY / STORAGE: Rifampicin (Rif) should be stable for at least two years when stored desiccated at -20°C and protected from light.3 Rif is stable as a solid at temperatures up to 70EC.4 SOLUBILITY / SOLUTION STABILITY: Rif is soluble in dimethylsulfoxide (~100mg/mL), dimethylformamide, methanol (16 mg/ml, 25EC), chloroform (349 mg/ml, 25°C), ethyl acetate (108 mg/ml, 25°C), and acetone (14 mg/ml, 25°C).4,6,7,8,9 Rif is slightly soluble in water at 25°C: 2.5 mg/ml, pH 7.3; 1.3 mg/ml, pH 4.3; and in 95% ethanol (∼10 mg/mL).4 Rif is soluble at 37°C: in 0.1 N HCl, 200 mg/ml and in phosphate buffer pH 7.4, 9.9 mg/ml.4 R3501 Page 1 of 4 03/28/97 - ARO RIFAMPICIN Sigma Prod.
    [Show full text]
  • Compositions and Formulations Based on Swellable Matrices for Sustained Release of Poorly Soluble Drugs Such As Clarithromycin
    (19) & (11) EP 2 283 824 A1 (12) EUROPEAN PATENT APPLICATION (43) Date of publication: (51) Int Cl.: 16.02.2011 Bulletin 2011/07 A61K 9/20 (2006.01) A61K 31/00 (2006.01) (21) Application number: 09166824.4 (22) Date of filing: 30.07.2009 (84) Designated Contracting States: (72) Inventors: AT BE BG CH CY CZ DE DK EE ES FI FR GB GR • Camponeschi, Claudio HR HU IE IS IT LI LT LU LV MC MK MT NL NO PL 00040, Pomezia (IT) PT RO SE SI SK SM TR • Colombo, Paolo Designated Extension States: 43100, Parma (IT) AL BA RS (74) Representative: Palladino, Saverio Massimo et al (71) Applicants: Notarbartolo & Gervasi S.p.A. • Special Products Line S.p.A. Corso di Porta Vittoria, 9 00040 Pomezia (IT) 20122 Milano (IT) • So. Se. Pharm S.r.l. 00040 Pomezia (IT) (54) Compositions and formulations based on swellable matrices for sustained release of poorly soluble drugs such as clarithromycin (57) The present invention concerns the discovery uct, capable to provide a quasi-constant prolonged re- of a new formulation for oral drug sustained release prod- lease of poorly soluble drugs whose solubility depends on the pH. EP 2 283 824 A1 Printed by Jouve, 75001 PARIS (FR) EP 2 283 824 A1 Description FIELD OF THE INVENTION 5 [0001] The present invention concerns the discovery of new compositions and formulations for oral drug modified release products, capable to provide a sustained release of poorly soluble drugs whose solubility depends on the pH. BACKGROUND OF THE INVENTION 10 [0002] New drug dosage forms facilitating the human therapeutic practice are needed for making efficient the treatment of several diseases.
    [Show full text]
  • Infant Antibiotic Exposure Search EMBASE 1. Exp Antibiotic Agent/ 2
    Infant Antibiotic Exposure Search EMBASE 1. exp antibiotic agent/ 2. (Acedapsone or Alamethicin or Amdinocillin or Amdinocillin Pivoxil or Amikacin or Aminosalicylic Acid or Amoxicillin or Amoxicillin-Potassium Clavulanate Combination or Amphotericin B or Ampicillin or Anisomycin or Antimycin A or Arsphenamine or Aurodox or Azithromycin or Azlocillin or Aztreonam or Bacitracin or Bacteriocins or Bambermycins or beta-Lactams or Bongkrekic Acid or Brefeldin A or Butirosin Sulfate or Calcimycin or Candicidin or Capreomycin or Carbenicillin or Carfecillin or Cefaclor or Cefadroxil or Cefamandole or Cefatrizine or Cefazolin or Cefixime or Cefmenoxime or Cefmetazole or Cefonicid or Cefoperazone or Cefotaxime or Cefotetan or Cefotiam or Cefoxitin or Cefsulodin or Ceftazidime or Ceftizoxime or Ceftriaxone or Cefuroxime or Cephacetrile or Cephalexin or Cephaloglycin or Cephaloridine or Cephalosporins or Cephalothin or Cephamycins or Cephapirin or Cephradine or Chloramphenicol or Chlortetracycline or Ciprofloxacin or Citrinin or Clarithromycin or Clavulanic Acid or Clavulanic Acids or clindamycin or Clofazimine or Cloxacillin or Colistin or Cyclacillin or Cycloserine or Dactinomycin or Dapsone or Daptomycin or Demeclocycline or Diarylquinolines or Dibekacin or Dicloxacillin or Dihydrostreptomycin Sulfate or Diketopiperazines or Distamycins or Doxycycline or Echinomycin or Edeine or Enoxacin or Enviomycin or Erythromycin or Erythromycin Estolate or Erythromycin Ethylsuccinate or Ethambutol or Ethionamide or Filipin or Floxacillin or Fluoroquinolones
    [Show full text]
  • Identification of Leishmania Donovani Inhibitors from Pathogen Box Compounds of Medicine for Malaria Venture
    bioRxiv preprint doi: https://doi.org/10.1101/716134; this version posted July 26, 2019. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under aCC-BY 4.0 International license. Identification of Leishmania donovani inhibitors from pathogen box compounds of Medicine for Malaria Venture Markos Tadele1¶, Solomon M. Abay2¶*, Eyasu Makonnen2,4, Asrat Hailu3 1 Ethiopian institute of agricultural research, Animal health research program, Holetta, Ethiopia 2Department of Pharmacology and clinical pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia 3Department of Microbiology, Immunology and Parasitology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia 4Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT Africa), College of Health Sciences, Addis Ababa University * Corresponding author Email: [email protected], [email protected] ¶ These authors contributed equally to this work. Author Contributions Conceptualization and design the experiment: MT, SMA, EM, AH Investigation: MT, SMA, AH Data analysis: MT, SMA Funding acquisition and reagents contribution: SMA, AH Supervision: SMA, EM, AH Writing – original draft: MT Writing – review & editing: MT, SMA, EM, AH 1 | P a g e bioRxiv preprint doi: https://doi.org/10.1101/716134; this version posted July 26, 2019. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under aCC-BY 4.0 International license.
    [Show full text]
  • Rifabutin (Mycobutin) Reference Number: HIM.PA.12 Effective Date: 09.04.18 Last Review Date: 11.19 Revision Log Line of Business: HIM
    Clinical Policy: Rifabutin (Mycobutin) Reference Number: HIM.PA.12 Effective Date: 09.04.18 Last Review Date: 11.19 Revision Log Line of Business: HIM See Important Reminder at the end of this policy for important regulatory and legal information. Description Rifabutin (Mycobutin®) is a derivative of rifamycin, an antimycobacterial agent. FDA Approved Indication(s) Mycobutin is indicated for the prevention of disseminated Mycobacterium avium complex (MAC) disease in patients with advanced HIV infection. Policy/Criteria Provider must submit documentation (such as office chart notes, lab results or other clinical information) supporting that member has met all approval criteria. It is the policy of health plans affiliated with Centene Corporation® that Mycobutin is medically necessary when the following criteria are met: I. Initial Approval Criteria A. Mycobacterium avium Complex Prophylaxis (must meet all): 1. Prescribed by or in consultation with an HIV or infectious disease specialist; 2. Age ≥ 18 years; 3. Failure of azithromycin or clarithromycin, unless contraindicated or clinically significant adverse effects are experienced; 4. Dose does not exceed 300 mg per day. Approval duration: 12 months B. Tuberculosis (must meet all): 1. Diagnosis of tuberculosis infection; 2. Prescribed by or in consultation with an HIV or infectious disease specialist; 3. Documentation of current treatment with protease inhibitors or non-nucleoside reverse transcriptase inhibitors (NNRTIs) for the treatment of HIV infection; 4. Age ≥ 18 years; 5. Dose does not exceed 5 mg/kg per day. Approval duration: 12 months C. Other diagnoses/indications 1. Refer to the off-label use policy for the relevant line of business if diagnosis is NOT specifically listed under section III (Diagnoses/Indications for which coverage is NOT authorized): HIM.PHAR.21 for health insurance marketplace.
    [Show full text]
  • AMEG Categorisation of Antibiotics
    12 December 2019 EMA/CVMP/CHMP/682198/2017 Committee for Medicinal Products for Veterinary use (CVMP) Committee for Medicinal Products for Human Use (CHMP) Categorisation of antibiotics in the European Union Answer to the request from the European Commission for updating the scientific advice on the impact on public health and animal health of the use of antibiotics in animals Agreed by the Antimicrobial Advice ad hoc Expert Group (AMEG) 29 October 2018 Adopted by the CVMP for release for consultation 24 January 2019 Adopted by the CHMP for release for consultation 31 January 2019 Start of public consultation 5 February 2019 End of consultation (deadline for comments) 30 April 2019 Agreed by the Antimicrobial Advice ad hoc Expert Group (AMEG) 19 November 2019 Adopted by the CVMP 5 December 2019 Adopted by the CHMP 12 December 2019 Official address Domenico Scarlattilaan 6 ● 1083 HS Amsterdam ● The Netherlands Address for visits and deliveries Refer to www.ema.europa.eu/how-to-find-us Send us a question Go to www.ema.europa.eu/contact Telephone +31 (0)88 781 6000 An agency of the European Union © European Medicines Agency, 2020. Reproduction is authorised provided the source is acknowledged. Categorisation of antibiotics in the European Union Table of Contents 1. Summary assessment and recommendations .......................................... 3 2. Introduction ............................................................................................ 7 2.1. Background ........................................................................................................
    [Show full text]
  • Antibiotic Dispensation Without a Prescription Worldwide: a Systematic Review
    antibiotics Review Antibiotic Dispensation without a Prescription Worldwide: A Systematic Review Ana Daniela Batista 1, Daniela A. Rodrigues 2 , Adolfo Figueiras 3,4,5 , Maruxa Zapata-Cachafeiro 3,4 ,Fátima Roque 2,6 and Maria Teresa Herdeiro 7,* 1 Department of Medical Sciences, University of Aveiro, 3810-193 Aveiro, Portugal; [email protected] 2 Research Unit for Inland Development, Polytechnic Institute of Guarda (UDI/IPG), 6300-559 Guarda, Portugal; [email protected] (D.A.R.); [email protected] (F.R.) 3 Department of Preventive Medicine and Public Health, University of Santiago de Compostela, 15702 Santiago de Compostela, Spain; adolfo.fi[email protected] (A.F.); [email protected] (M.Z.-C.) 4 Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiology and Public Health-CIBERESP), 28001 Madrid, Spain 5 Health Research Institute of Santiago de Compostela (IDIS), 15702 Santiago de Compostela, Spain 6 Health Sciences Research Centre, University of Beira Interior (CICS-UBI), 6200-506 Covilhã, Portugal 7 Institute of Biomedicine (iBiMED), Department of Medical Sciences, University of Aveiro, 3810-193 Aveiro, Portugal * Correspondence: [email protected] Received: 7 October 2020; Accepted: 6 November 2020; Published: 7 November 2020 Abstract: Antibiotic resistance still remains a major global public health problem and the dispensing of antibiotics without a prescription at community pharmacies is an important driver of this. MEDLINE, Pubmed and EMBASE databases were used to search and identify studies reporting the dispensing of non-prescribed antibiotics in community pharmacies or drugstores that sell drugs for human use, by applying pharmacy interviews/questionnaires methods and/or simulated patient methods.
    [Show full text]
  • RIFABUTIN Rifabutin Must Be Taken Regularly to Higher Risk of Bacterial Infection), Or Be Effective and to Prevent the Anemia (A Reduced Number of Red
    RIFABUTIN Rifabutin must be taken regularly to higher risk of bacterial infection), or be effective and to prevent the anemia (a reduced number of red development of resistance. Take all blood cells that can make you feel Other NAMES: Mycobutin of your doses even if you begin to tired and short of breath). In rare feel better. cases it can also cause WHY is this drug prescribed? thrombocytopenia (a reduced What should you do if you number of platelets so that you bleed Rifabutin is an antibacterial drug used to FORGET a dose? or bruise more easily), or changes in prevent or treat Mycobacterium avium liver function . Blood tests will be complex (MAC) infection. When used If you miss a dose of rifabutin, take it done regularly to check for any to treat MAC, it is usually used in as soon as possible. However, if it is changes in these values. Inform combination with other agents. time for your next dose, do not your doctor or pharmacist if you have double the dose, just carry on with symptoms such as fever, chills, Rifabutin may also be used to treat other your regular schedule. shortness of breath, racing types of infections, including heartbeat, fatigue, bleeding or tuberculosis. What ADVERSE EFFECTS can this bruising. drug cause? What should you do HOW should this drug be taken? about them? Rifabutin may cause uveitis (an inflammation of the eye causing When used to prevent or treat MAC, the Most adverse effects of rifabutin are pain, redness and loss of vision). It usual dose is 300mg once daily.
    [Show full text]
  • The Nitroimidazole Family of Drugs
    Br J Vener Dis: first published as 10.1136/sti.54.2.69 on 1 April 1978. Downloaded from British Journal of Venereal Diseases, 1978, 54, 69-71 Editorial The nitroimidazole family of drugs In 1955 an antibiotic complex isolated from a operative infection caused by susceptible anaerobes, strain of Streptomyces on the island of Reunion particularly in gynaecological surgery, appendi- was found by research workers of Rhone-Poulenc in cectomy, and colonic surgery. Paris to contain a trichomonacidal antibiotic- Real innovations in chemotherapy, such as azomycin. It had previously been isolated in Japan metronidazole, always attract attention from other (Maeda et al., 1953) and identified as 2-nitroimi- research groups. Although interest was slow to dazole (Ia see Table) (Nakamura, 1955). At the develop, research workers have sought analogous, time, and for some years after, this remarkably structurally-modified compounds which might afford simple compound defied synthesis, but it stimulated some advantage in clinical use-for example, the workers at Rhone-Poulenc to prepare and test greater potency, better tolerance and freedom from the activity of the more readily accessible isomeric side effects, a broader spectrum of action, a longer 5-nitroimidazoles (II). It was their good fortune in duration of action, or in some other characteristic. 1957 to find that these isomers were more active This effort has been concerned with important antiprotozoal agents than the natural product veterinary uses of 5-nitroimidazoles as well as the (Cosar and Julou, 1959). In a series of 150 related applications in human medicine. compounds, the one with a P-hydroxyethyl group Metronidazole has been a difficult target to in the 1-position gave the best compromise between improve upon, but several other drugs of this activity and toxicity and this brand of metroni- chemical family have been introduced to clinical dazole was introduced as Flagyl.
    [Show full text]