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Home , Ceftibuten, Cefuroxime

VOL.07 NO. 01 FEBRUARY 2019

Synergistic Effect of Pattern of Antimicrobial & Resistance to Combination was Far More than Prevention of Surgical Site among the Cefuroxime Alone against E. Coli Infections: Current Recommen- Patients in Bangladesh dations and Guidelines β-lactamase mediated resistance is the most common mechanism which renders the β-lactam Azithromycin is a reliable Urinary tract infection (UTI) is one of the most common ineffective against bacteria including Escherichia coli. antibiotic in URTI infectious diseases in the community practice with approxi- The development of resistance has led to the wide- mately 150 million people affected in the world each year spread empirical use of higher generation cephalospor- was Effective and accounting for nearly 25% of all infections. Among all the ins, and it is likely that the third generation cephalo- Well Tolerated in Critically Ill causative organisms Escherichia coli is the most common, sporins are also losing Infants but antimicrobial resistance becomes an alarming issue for their efficacy by the same UTI management now a days. An observational study was mechanism. A study was is as effective as conducted from February 2017 to January 2018 in the The zones of conducted to evaluate the /clavulanate in the district of Jashore, inhibition antimicrobial effect of treatment of acute exacerbations Bangladesh to assess the surrounding the Escherichia coli is cefuroxime with and of chronic pattern of antimicrobial disks containing without a β-lactamase the most common resistance to E coli among both cefuroxime inhibitor named clavulan- causative organ- the UTI patients. A total ic acid, against E. coli. of 696 eligible patients of and clavulanic ism in UTI but Clavulanic acid is both sexes whose urine acid were larger antimicrobial naturally occurring potent culture grown E coli were than those resistance inhibitor of β-lactamase included in the study. containing cefuro- obtained by, fermentation becomes an Patients with UTI caused xime alone. from streptomyces alarming issue by other than E coli, clavuligerus. It is a female during menstrua- “suicidal inhibitor” of tion, , history of β-lactamases produced by a wide range of Gram taking antibiotics within last 21 days, catheterization within positive and Gram negative micro-organisms. An 1 month and pelvic organ & genito urinary tract surgery institution based analytic observational study was within 6 months were excluded from the study. Evaluation carried out at Department of Microbiology, Khyber of antimicrobial resistance was done according to the Medical College, Peshawar. β-lactamase producing standard bacteriological methods. Mean age of the study Escherichia. coli were identified and cultured in cases was 41.46±17.21 years with the range from 15 to 91 Mueller Hinton medium in petri dishes. The antibiotic years. More than 85% participants were female with a sex disks containing cefuroxime alone and in combination ratio of 8:1.5. Reproductive age group ranged from 21 to 50 ....see ROLL page 2 ....see ROLL page 2 Azithromycin is a reliable antibiotic treatment in upper respiratory tract infections Page-4 diagnosis before treatment (at the inclusion), at the 4th day (end of the therapy) and at the 12th (end of the study). In this study azithromycin led to the relief of symptoms after three days in 93.6 % of patients. Antibiotics were prescribed within one year before inclusion in 56.6 % of patients and 20.5 % were previously treated with macrolides. Clinical effectiveness in study population was Azithromycin is a reliable antibiotic treatment in upper 95.6 %. Overall, 38 (9.1 %) patients reported 48 adverse events. The respiratory tract infections, giving fast resolution of symptoms most common were: abdominal pain in 14 patients (1.1 %) , in with little adverse events in patients with presumed bacterial 12 (0.9 %), nausea in 5 (0.4 %), vomiting in 5 (0.4 %). The results of infections. this study show that azithromycin in the treatment of upper respiratory tract infections has a high clinical effectiveness and small number of adverse events. So, based on the study, Azithromycin is a reliable antibiotic treatment in upper respiratory tract infections, giving fast resolution of symptoms with little adverse events in patients with presumed bacterial infections.

Meropenem was Effective Pattern of Antimicrobial Cefuroxime And Clavulanic and Well Tolerated in Resistance to Escherichia Acid Combination Was More Critically Ill Infants Coli than Cefuroxime Alone

From Page-4 From Page-1 From Page-1 in the study, 99 (50%) experienced an adverse event, years was affected most commonly which constituted with clavulanic acid were placed in the same petri and 34 (17%) had serious adverse events; but no approximately two-thirds of the study population.The dishes about 24-30 mm apart. The zones of inhibition adverse events were probably or definitely related to study revealed that the maximum antimicrobial were measured according to NCCLs (National meropenem. The most commonly reported adverse resistance to E coli was Cotrimoxazole (95.0%), Committee for Clinical Laboratory standards) events were (6%), seizures (5%), elevated followed by (75.7%), Gentamicin Standards) zone diameter criteria using disk diffusion conjugated bilirubin (5%), and hypokalemia (5%). (70.3%), Amikacin (69.0%), Imipenam (58.9 %,), method. A total of 40 β-lactamase producing bacteria Only 2 of the serious adverse events were deter- (58.0%), Ciprofloxacin (57.3%), Azithro- were isolated. The zones of inhibition surrounding the mined to be possibly related to meropenem (isolated mycin (56.0%), Cefuroxime (46.6%), disks containing both cefuroxime and clavulanic acid ileal perforation and an episode of fungal sepsis). (37.4%), (35.2%), Meropenem (32.2%), were larger than those containing cefuroxime alone. Effectiveness was evaluable in 192 (96%) subjects, and Nitrofurantion (4.7%). So, high magnitude of So, in this study it was found that the synergistic and overall treatment success was 84%. So, this antimicrobial resistance against Escherichia coli was antibacterial effect of the combination of cefuroxime study found that, meropenem was well tolerated in observed among the UTI patients in Bangladesh even and clavulanic acid was far more than the cefuroxime critically ill infants, and the majority of infants with extended generation of , Carbap- alone against Escherichia coli. treated with meropenem met the definition of enems, Ciprofloxacin, Cotrimoxazole, Azithromycin therapeutic success. and Aminoglycosides. Antibiotics resistance depends on the genetic mutation and locality. So, geographical variation may be a determinant of difference magni- tude of antimicrobial resistance pattern. Prevention of Surgical Site Infections: Current Recommendations and Guidelines

Postoperative/Posthospital CriteriaWHO ACS CDC Surgical SAP administration after comple- No evidence that prophylactic antibiot- Additional prophylactic antibiotic tion of the operation is not recom- ic administration after incision closure antimicrobial agent doses prophylaxis mended the purpose of preventing decreases SSI risk should not be administered (SAP) prolon- SSI Prophylactic antibiotics should be after the surgical incision is closed in the operating room, gation Perioperative SAP should not be discontinued at time of incision closure even in the presence of a drain continued in the presence of a (exceptions include implant-based breast wound drain solely for the reconstruction, joint arthroplasty, and purpose of preventing SSI cardiac precedures where optimal duration of antibiotic therapy remains unknown)

Wound Do not use advanced dressings Mupirocin topical antibiotic applica- Do not apply antimicrobial Care over a standard dressing on tion can decrease SSI compared with a agents (i.e., ointmints, primarily closed surgical standard dressing. solutions, or powders) to the wounds for the purpose of Topical antibiotics can reduce SSI for surgical incision for the preventing SSI specific cases, including spine surgery, prevention of SSI total joint arthroplasty, and cataract surgery, but there is insufficient evidence to recommend routine use at this time

Postoperative No recommendations/not Early showering (12 hours postopera- No recommendations/not Showering addressed tively) does not increase the risk of addressed SSI

Postoperative Prevention of Surgical Site Infections According to NICE Guideline Changing dressings Use an aseptic non-touch technique for changing or removing surgical wound dressings.

Postoperative cleansing Use sterile saline for wound cleansing up to 48 hours after surgery. Advise patients that they may shower safely 48 hours after surgery. Use tap water for wound cleansing after 48 hours if the surgical wound has separated or has been surgically opened to drain pus.

Topical antimicrobial agents for wound healing by primary intention Do not use topical antimicrobial agents for surgical wounds that are healing by primary intention to reduce the risk of surgical site infection.

Dressings for wound healing by secondary intention Do not use Eusol and gauze, or moist cotton gauze or mercuric antiseptic solutions to manage surgical wounds that are healing by secondary intention. Use an appropriate interactive dressing to manage surgical wounds that arehealing by secondary intention. Refer to a tissue viability nurse (or another healthcare professional with tissue viability expertise) for advice on appropriate dressings for the management of surgical wounds that are healing by secondary intention.

Antibiotic treatment of surgical site infection and treatment failure When surgical site infection is suspected (i.e. cellulitis), either de novo or because of treatment failure, give the patient an antibiotic that covers the likely causative organisms. Consider local resistance patterns and the results of microbiological tests in choosing an antibiotic.

Debridement Do not use Eusol and gauze, or dextranomer or enzymatic treatments for debridement in the management of surgical site infection.

ACS, American College of Surgeons; CDC, Centers for Disease Control and Prevention; WHO, World Health Organization; SSI, surgical site infection; N.B. Preoperative and Intraoperative recommendations for prevention of surgical site infections were published in the previous issues Ceftibuten is as Effective as Amoxicillin/Clavulanate in the Treatment of Acute Exacerbations of Chronic Bronchitis Azithromycin is a reliable Meropenem was Effective Chronic bronchitis is a common condition which is antibiotic in the treatment and Well Tolerated in Criti- characterized by secondary bacterial infection which of upper respiratory tract may require hospitalization. The acute exacerbation cally Ill Infants of chronic bronchitis (AECB) is an important infections complication requiring early and effective interven- tion. The pathogens most commonly isolated from Upper-respiratory tract infections such as acute the sputum of patients with AECB are Haemophilus Intra-abdominal infections in young infants (<91 pharyngitis/tonsillitis (AP), acute sinusitis (AS) influenzae, pneumoniae and Moraxella days of age) lead to substantial morbidity and and acute (AOM) are common in catarrhalis. The increasing prevalence of β-lactamase mortality. Approximately 20% of infants with children and adults. These infections are usually producing strains of H. influenzae and M. catarrhalis necrotizing enterocolitis die, and survivors suffer mild, allowing treatment on outpatient basis. has focused attention on the need for new and from severe neurodevelopmental impairment. Although viruses account for most of these effective antimicrobial Broad-spectrum or combination antimicrobial infections, bacterial primary infection or super Clinical response agents to overcome agents are often prescribed for these infections infection may require antibiotic treatment. them. Ceftibuten has given their polymicrobial nature. Meropenem is was equivalent, Azithromycin is a macrolide antibiotic structur- known activity against a a broad-spectrum antimicrobial agent with with cure or ally modified from erythromycin with an broad range of bacteria, excellent activity expanded spectrum of activity and improved improvement in and has been shown to against pathogens tissue pharmacokinetic characteristics relative 92.4% ceftib- be effective clinically Majority of associated with to erythromycin. It is particularly active against uten-treated against a variety of intra-abdominal Gram-negative pathogens, such as H. influenza infants treated respiratory tract infections. An patients and and M. catarrhalis. Azithromycin is also active with meropenem infections associated open-label, 92.7% of AMX/CA against atypical pathogens such as Mycoplasma with H. influenzae, M. met the definition prospective study pneumoniae and Chlamydophila pneumoniae, treated patients. catarrhalis and Pneu- of therapeutic was conducted to which can also be a cause of acute . mococci. Ceftibuten has success. determine the A study was conducted in centers of Croatia, greater stability to the action of most plasmid-mediat- safety and Bosnia and Herzegovina to describe clinical ed β-lactamases than commonly used cephalosporins. effectiveness of effectiveness of azithromycin in the manage- The efficacy and safety of short course ceftibuten meropenem in ment of upper respiratory tract infections, to (400 mg once daily for 5 days) were compared with young infants with suspected or complicated examine the duration of symptoms after that of amoxicillin/clavulanate (AMX/CA) (250/125 intra-abdominal infections. Preterm and term beginning of therapy and to mark possible mg thrice daily for 10 days) in a multicentre, infants <91 days of age with suspected or adverse events of azithromycin treatment. The single-blind, parallel-group trial in 335 adults with confirmed intra-abdominal infections hospital- study population included 422 patients: 184 AECB. Clinical response was equivalent, with cure ized in 24 neonatal intensive care units were with diagnosis of acute pharyngitis (AP), 156 or improvement in 92.4% ceftibuten-treated patients included in the study. Adverse events and serious with acute sinusitis (AS) and 82 with acute and 92.7% of AMX/CA treated patients. The overall adverse events were collected through 3 and 30 otitis media (AOM). Clinical effectiveness was eradication rates were similar (ceftibuten 88.3%; days following the last meropenem dose, based on the results of clinical improvement AMX/CA 87.5%) and also the incidence of adverse respectively. Effectiveness was assessed by 3 and cure after three days treatment with events which occurred in 14.7% ceftibuten-treated criteria: death, bacterial cultures, and presump- azithromycin, calculating the clinical score for and 15.5% AMX/CA treated patients. So, the study tive clinical cure score. Of 200 subjects enrolled each found that, ceftibuten 400 mg once daily for 5 days is as effective and well tolerated as AMX/CA 250 mg thrice daily for 10 days in the treatment of AECB. ....see ROLL page 2 ....see ROLL page 2

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