International journal of antimicrobial agents
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The pharmacodynamic (PD) parameters most often used in studies of antibiotic effect include the following relationships between the antibiotic concentration curve in serum as a surrogate marker for the antibiotic concentration at the infection site, the peak/minimal inhibitory concentration (MIC) ratio, the area under the curve (AUC)/MIC ratio and the duration of time the concentration exceeds the MIC (T(>MIC)). The MIC plays an important role also as a PD marker, and its precision in this respect is discussed. The predictive role of T(>MIC) is important for drugs showing minimal concentration dependent effect such as the beta-lactam antibiotics, the macrolides and others. ⋯ This is the case for aminoglycosides and fluoroquinolones, and for both classes a peak/MIC ratio of at least 10 within the first 24 h of treatment has been shown to result in around 90% bacteriological as well as clinical cure. One consequence of clinical dosing has been the once-a-day (OD) dosing for aminoglycosides, which is the standard mode of therapy in many countries. Clinical studies in the field of antibacterial PD are still relatively scarce, and much information is needed to enable relevant dosing strategies for all types of antibiotics against all common infections and micro-organisms.
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Int. J. Antimicrob. Agents · Feb 2002
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialPiperacillin 2 g/tazobactam 0.5 g is as effective as imipenem 0.5 g/cilastatin 0.5 g for the treatment of acute uncomplicated pyelonephritis and complicated urinary tract infections.
This randomised, double-blind, multicentre trial compared piperacillin/tazobactam (2 g/0.5 g/q8h) and imipenem/cilastatin (0.5 g/0.5 g/q8h) as monotherapy in patients with acute pyelonephritis or complicated urinary tract infections. In total, 237 patients were randomised to receive either piperacillin/tazobactam (n=161) or imipenem/cilastatin (n=166). At the early follow-up (=test-of-cure-visit) 5-9 days after antibiotic therapy, clinical success was noted in 122/147 (83.0%) piperacillin/tazobactam recipients compared with 123/154 (79.9%) imipenem/cilastatin recipients, thus proving that both treatments were equally effective. ⋯ Microbiological success at the early follow-up was 78/135 (57.8%) for piperacillin/tazobactam and 70/144 (48.6%) for imipenem/cilastatin. These results were confirmed by equivalent success rates on the last therapy day. Both drugs were generally well tolerated.
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Int. J. Antimicrob. Agents · Nov 2001
Randomized Controlled Trial Comparative Study Clinical TrialTolerability of 3-day, once-daily azithromycin suspension versus standard treatments for community-acquired paediatric infectious diseases.
Tolerability of azithromycin oral suspension, 10 mg/kg once daily for 3 days, was assessed in paediatric patients (< or = 18 years) with respiratory or skin and soft-tissue infections. Of 2425 patients evaluated, 1213 received azithromycin and 1212 received standard regimens of amoxycillin/clavulanic acid, cefaclor, cefixime, ceftriaxone, clarithromycin, erythromycin, or penicillin V. ⋯ Significantly fewer gastrointestinal events were recorded for azithromycin than comparators (6.5 vs. 9.9%, P=0.002), and their duration was significantly shorter (mean 2.3 vs. 5.0 days, P=0.0001). Azithromycin paediatric oral suspension is well tolerated and associated with significantly fewer adverse events than comparators.
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Prudent antimicrobial prescribing in the community may help to prevent the relentless increase in resistance, highlighted worldwide by numerous parliamentary documents. Antibiotic guidance, developed by primary care professionals and disseminated locally with outreach workshops, helps to reduce the use of broad-spectrum antimicrobials. ⋯ Primary care physicians need to consider how much pharmaceutical representatives and free samples influence their prescribing. This multi-faceted approach needs to be backed up with a research programme developing the evidence base for management guidance of antimicrobial use in primary care.
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Int. J. Antimicrob. Agents · May 2001
Increasing resistance of M. tuberculosis to anti-TB drugs in Saudi Arabia.
The incidence of drug resistance in Mycobacterium tuberculosis (MTB) isolated from our hospital between April 1996 and March 1998 was compared with an earlier study (1993-1995). Thirty (29.7%) of 101 MTB isolates were resistant to one or more anti-TB drugs and 21 (20%) of 101 were multi-drug resistant M. tuberculosis (MDR-TB). ⋯ Resistance to pyrazinamide and ethambutol was 7.9 and 6.9%, respectively. There was a three-fold increase in resistance compared with the earlier study.