The Journal of antimicrobial chemotherapy
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J. Antimicrob. Chemother. · Nov 2010
ReviewOptimizing antibiotic prescribing in primary care settings in the UK: findings of a BSAC multi-disciplinary workshop 2009.
Several UK resources, including the National Institute for Health and Clinical Excellence (NICE), Clinical Knowledge Summaries, the Infection Specialist Library, the HPA Management of Infection Guide, the Map of Medicine and the Royal College of General Practitioners (RCGP) web site, produce primary care antibiotic prescribing guidance. A BSAC 2009 workshop aimed to discuss how guidance could be best translated into practice using public and professional educational programmes. Workshop participants were asked to consider approaches within the context of a behaviour change model, in which readiness to change is recognized as a product of the individual's perception of the importance of change (the 'why' of change; 'Why should I change my antibiotic prescribing') and their confidence that they can achieve a change (the 'how' of change). ⋯ Videos are a useful tool for demonstrating good and poor communication skills and approaches to eliciting and addressing patient concerns and expectations. Well-designed patient information can facilitate consultations. Feedback and audit on antibiotic use to clinicians is essential; this can be facilitated by incentive schemes, especially if clinical records link diagnosis with prescriptions.
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Inappropriate antibiotic use and antibiotic resistance are now major global issues. Antimicrobial stewardship programmes are increasingly being used to optimize antibiotic prescribing in acute care. The central tenet of these programmes tends to be policy and guidelines aimed at prescribers. ⋯ Best practice needs to be positively reinforced by an environment that facilitates and supports optimal prescribing choices, i.e. a 'choice architecture' that makes prudent antibiotic prescribing the path of least resistance. To make prudent antibiotic management an integral part of the behaviour of all healthcare professionals and to bring about quality improvement it is necessary to adopt a whole-system approach. To do this it is necessary first to understand the factors that influence antibiotic management and prescribing.
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J. Antimicrob. Chemother. · Nov 2010
Comparative StudyEfficacy of doripenem in the treatment of Pseudomonas aeruginosa experimental pneumonia versus imipenem and meropenem.
The aim of this study was to compare doripenem with imipenem and meropenem in an experimental rabbit model of Pseudomonas aeruginosa pneumonia and then to compare different doripenem doses and methods of intravenous administration. ⋯ In this model of P. aeruginosa pneumonia, doripenem had an efficacy equivalent to that of meropenem and imipenem at a high dose of 1 g three times a day and lower efficacy at a standard dose (0.5 g three times daily) than the other two agents in terms of bacteria cultivated from spleens. Doripenem is a new drug that offers new therapeutic options, especially for difficult-to-treat infections such as pneumonia due to non-fermenting Gram-negative bacteria.
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To develop a population pharmacokinetic model of meropenem in burn patients and to explore the appropriateness of current dosage regimens. ⋯ The population clearance and volume of distribution in our burn patients were significantly greater than those reported in non-burn patients. The simulation of 1000 virtual patients' plasma meropenem concentration treated with 1000 mg (30 min infusion) every 8 h based upon the model predicted the probability of achieving the time above MIC >40% of the dosing interval as 58.9% for Pseudomonas aeruginosa isolated from three university hospitals in Korea.