Antibiotics for the treatment of hepatic encephalopathy.

Feb 2013

Patidar KR, Bajaj JS.

Source

Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, 1201 Broad Rock Boulevard, Richmond, VA, USA.

Abstract

The treatment of hepatic encephalopathy (HE) is complex and therapeutic regimens vary according to the acuity of presentation and the goals of therapy. Most treatments for HE rely on manipulating the intestinal milieu and therefore antibiotics that act on the gut form a key treatment strategy. Prominent antibiotics studied in HE are neomycin, metronidazole, vancomycin and rifaximin. For the management of the acute episode, all antibiotics have been tested. However the limited numbers studied, adverse effects (neomycin oto- and nephrotoxicity, metronidazole neurotoxicity) and potential for resistance emergence (vancomycin-resistant enterococcus) has limited the use of most antibiotics, apart from rifaximin which has the greatest evidence base. Rifaximin has also demonstrated, in conjunction with lactulose, to prevent overt HE recurrence in a multi-center, randomized trial. Despite its cost in the US, rifaximin may prove cost-saving by preventing hospitalizations for overt HE. In minimal/covert HE, rifaximin is the only systematically studied antibiotic. Rifaximin showed improvement in cognition, inflammation, quality-of-life and driving simulator performance but cost-analysis does not favor its use at the current time. Antibiotics, especially rifaximin, have a definite role in the management across the spectrum of HE.

PubMed

Factors Affecting the Prescribing Patterns of Antibiotics and Injections

2012

Kyung-Hyun Choi, Sang-Min Park, Ju-Hyun Lee,  Soonman Kwon¹

Author information ► Article notes ► Copyright and License information ►

ABSTRACT

There are serious problems concerning the inadequate prescription of antibiotics and overuse of injections in primary care. However, the determinants of prescription patterns in Korea are not well-documented. To examine the area characteristics affecting the prescription of antibiotics and injections in primary care practices in the treatment of respiratory tract infections (RTIs), a nationwide cross-sectional study was performed in all 250 administrative districts of Korea. The outcome was modeled as a binary variable: over-prescription or not compared with the nation-wide average. Over-prescription of antibiotics was associated with the ratio of specialists to general physicians and over-prescription in previous years in the area (adjusted odds ratio [aOR], 4.8; 95% confidence interval [CI] 1.5-14.8; and aOR, 12.0; 95% CI 5.5-25.9, respectively). Over-use of injections was associated with younger population, urban living and the number of hospital beds in the area (aOR, 0.2; 95% CI 0.1-0.4; aOR, 0.3; 95% CI 0.1-0.8; and aOR, 0.4, 95% CI 0.2-0.9; respectively). There were differences in the prescribing patterns in different districts; prescription patterns were affected more by supply factors than by demand factors. Highly competitive medical environment associated with supply factors is a significant determinant of prescription patterns in Korea.

Read the full text article

NIH - Journal of Korean Medical Science

Distribution of anaerobes in periodontal abscess and its resistance to antibiotics.

Dec 2012

[Article in Chinese]

He JL, Yu LY, Chen JZ.

Source

Department of Stomatology, Huashan Hospital, Fudan University, Shanghai 200040, China. Email: wuyu1984@hotmail.com.

Abstract

OBJECTIVE:

To isolate and culture the predominant anaerobes from the periodontal abscesses, and to test the antibiotic susceptibility and drug resistant genes of the strains.

METHODS:

The isolated strains were identified by both API20A biochemical method and polymerase chain reaction (PCR) method. The antibiotic susceptibility test was performed by agar dilution method. The resistant genes of the drug-resistant strains obtained were screened by PCR.

RESULTS:

The anaerobes were detected in 48% (28/58) of the samples and Prevotella melaninogenica (Pm) was mostly identified in 43% (12/28). API20A biochemical method had 82% (23/28) agreement with the 16SrRNA method in identification rate. Anaerobes were resistant to metronidazole, clindamycin and cefmetazole. The erythromycin-resistant methylase genes F (ermF) gene was detected in three of eight clindamycin resistant strains. None of them was found coded on bacterial plasmids. However, no metronidazole resistant gene was detected on drug resistant strains.

CONCLUSIONS:

Pm was the predominant species dectected in the periodontal abscess of the patients. The antibiotic agents should be used based on the genotypes and general condition of the patients.

PubMed

Mutational and transcriptomic changes involved in the development of macrolide resistance in Campylobacter jejuni.

Dec 2012

Hao H, Yuan Z, Shen Z, Han J, Sahin O, Liu P, Zhang Q.

Source

National Reference Laboratory of Veterinary Drug Residues(HZAU)/MOA Key Laboratory of Food Safety Evaluation, Huazhong Agricultural University, Wuhan 430070, P. R. China.

Abstract

Macrolide antibiotics are important for clinical treatment of infections caused by Campylobacter jejuni. Development of resistance to this class of  antibiotics in Campylobacter is a complex process and the dynamic molecular changes involved in this process remain poorly defined. Multiple lineages of macrolide-resistant mutants were selected by stepwise exposure of C. jejuni to escalating doses of erythromycin or tylosin. Mutations in target genes were determined by DNA sequencing and the dynamic changes in the expression of antibiotic efflux transporters and the transcriptome of C. jejuni were examined by real-time RT-PCR, immunoblotting, and DNA microarray. Multiple types of mutations in ribosomal proteins L4 and L22 occurred in the early stepwise selection. On the contrary, the mutations in 23S rRNA gene, mediating highly resistant to macrolides, were only observed in the late-stage mutants. Upregulation of antibiotic efflux genes was observed in the intermediate-level resistant mutants, and the magnitude of upregulation declined as the occurrence of mutations in the 23S rRNA. DNA microarray analysis revealed differential expression of 265 genes, most of which occurred in the intermediate mutant, including upregulation of genes encoding ribosomal proteins and downregulation of genes involved in energy metabolism and motility. These results indicate 1) that mutations in L4 and L22 along with temporal overexpression of antibiotic efflux genes precede and may facilitate the development of high-level macrolide resistance and 2) that the development of macrolide resistance affects the pathways important for physiology and metabolism in C. jejuni, providing an explanation for the reduced fitness of macrolide-resistant Campylobacter.

PubMed

Antibiotics' effect on chest infections queried

Antibiotics' effect on chest infections queried

Posted: Thu 27/12/2012 by Deborah Condon www.irishhealth.com

Chest infections are very common at this time of year. However, a new study has found that an antibiotic commonly prescribed for some of these infections does not work, even in older patients.

The study focused on common lower respiratory tract infections (LRTI), such as bronchitis and the effect of the antibiotic, amoxicillin.

According to UK scientists, LRTIs are one of the most common acute illnesses seen by GPs. While most of these infections are thought to be caused by viruses - which antibiotics have no effect on - the use of the drugs in treating them is a topic of major debate. To date, research results have been conflicting.

The team from the University of Southampton looked at over 2,000 adults with acute, uncomplicated LRTIs from 12 European countries, including England, Wales, Germany, Sweden Spain and Poland.

The participants were randomly assigned to receive either amoxicillin or a placebo three times a day for seven days. They were monitored throughout.

The study found that there was little difference in the duration or severity of the symptoms between the two groups. This was true even for patients over the age of 60.

While more patients in the placebo group reported new or worsening symptoms, just two from that group, along with one from the antibiotic group, needed to be hospitalised because of the LRTI.

Furthermore, patients in the antibiotic group reported more side-effects, such as diarrhoea, nausea and rash, than those in the placebo group.

"Our results show that most people get better on their own. But, given that a small number of patients will benefit from antibiotics, the challenge remains to identify these individuals," commented Prof Paul Little of the University of Southampton.

He added that using amoxicillin to treat respiratory infections in patients not suspected of having pneumonia ‘is not likely to help and could be harmful', particularly if it leads to antibiotic resistance.

Details of these findings are published in the journal, The Lancet Infectious Diseases.

Irish Health

Bad Mix: Haldi impedes effect of antibiotics

Bad Mix: Haldi impedes effect of antibiotics

Turmeric has been an integral part of Indian kitchen for ages. But now, researchers from the Indian Institute of Science (IISc) suggest that people on antibiotics should avoid turmeric for fast recovery.

A study conducted by the Centre for Infectious Disease Research and Biosafety Laboratories, IISc, Bengaluru, reveals that curcumin, an active chemical substance found in turmeric, interferes with the efficacy of antibiotics like ciprofloxacin. Thus, antibiotics lose their ability to fight harmful bacteria. The IISc team tested ciprofloxacin against typhoid bacteria in the presence of curcumin.

Ciprofloxacin is the first line drug to treat typhoid.

Turmeric has gained importance in treating diseases, as a food additive and preservative. Many consume turmeric tablets as a daily dietary supplement. Some even have the spice to benefit from the curative properties of curcumin. Moreover, haldi is added in Indian dishes.

The IISc team demonstrated that curcumin inhibited the action of ciprofloxacin by not preventing the ciprofloxacin-induced cleavage of DNA.

The study was published in the latest issue of the Journal of Antimicrobial Chemotherapy.

Curcumin is a major dietary molecule among Indians and on an average, a person takes 0.03 to 0.12 gm per day.

**Editor's note: More research is needed to confirm what this article reports.  It should be noted there is some criticism of it and the basis of the researchers conclusions.**

Deccan Chronicle

Bacteriocins - a viable alternative to antibiotics?

Dec 24, 2912

Cotter PD, Ross RP, Hill C.

Source

1] Teagasc Food Research Centre, Moorepark, Fermoy, Cork, Ireland. [2] Alimentary Pharmabiotic Centre, Cork, Ireland.

Abstract

Solutions are urgently required for the growing number of infections caused by antibiotic-resistant bacteria. Bacteriocins, which are antimicrobial peptides produced by certain bacteria, might warrant serious consideration as alternatives to traditional antibiotics. These molecules exhibit significant potency against other bacteria (including antibiotic-resistant strains), are stable and can have narrow or broad activity spectra. Bacteriocins can even be produced in situ in the gut by probiotic bacteria to combat intestinal infections. Although the application of specific bacteriocins might be curtailed by the development of resistance, an understanding of the mechanisms by which such resistance could emerge will enable researchers to develop strategies to minimize this potential problem.

PubMed

Look For More Regulation On Antibiotics

Dec. 19, 2012

Burt Rutherford

If you want to sum up the debate over antibiotics in food animals, try this – the more we expose organisms to antibiotics in animals, the more opportunity there is for them to develop resistance to those antibiotics and, ultimately, to affect human health.

That linear thinking has been the source of decades of debate about whether or not, or to what extent, antibiotics should be used in animals. At the center of the debate is the use of low-level antibiotics for growth promotion and feed efficiency.

Here’s the rub: “While it’s plausible, there is simply no hard evidence that connects human cases of infection with a resistant bacteria and the use of antimicrobials in animals,” says Ron DeHaven, American Veterinary Medical Association (AVMA) executive vice president. “Further, there is little evidence at this point to suggest that eliminating or greatly reducing the use of antimicrobials in food animals improves human health or results in less antimicrobial resistance in humans.”

He points to Denmark as an example. That country banned the use of antibiotics for growth promotion and feed efficiency in pigs in 2000. Following the ban, Danish hog produces reported significant animal health problems, particularly in the early stages. As a result, veterinarians had to resort to greater use of therapeutic doses of antibiotics to maintain animal health and welfare.

“That ban has been in place for quite some time and yet there has been no improvement in terms of the increased frequency of antimicrobial resistance seen in humans,” DeHaven says. “Indeed, some evidence suggests there’s been an increasing prevalence of antimicrobial-resistant infections in people since the ban.”

A Closer Look: Is Solving The Antibiotic Resistance Dilemma Possible?

That suggests a number of things, he says, not the least of which is that there may be a therapeutic response to subtherapeutic use of antibiotics.

Nonetheless, U.S. politicians and regulators are forging ahead, seeking to limit the use of antibiotics in food animal production.

DeHaven says the FDA Center for Veterinary Medicine, the regulatory body over antibiotic use, recognizes and supports the importance of antibiotics in animals for control and prevention of disease. “Long term, they would like to see a phase in of greater veterinary oversight and a phase out of growth promotion and feed efficiency use,” he says. “In the meantime, we need data to see if, in fact, the benefit we’re seeing in terms of growth promotion and feed efficiency is because we’re seeing a therapeutic benefit from the use of antibiotics given in low doses to large numbers of animals.”

So what’s ahead? Likely, it’s more veterinary oversight on all antibiotic use and an eventual reduction in flexibility, if not an outright ban, of low-level antibiotics in feed and water. While AVMA supports more veterinary oversight of antibiotic use, DeHaven says the group does have some workforce concerns.

Another Perspective: Overcoming Antibiotic Resistance Is A Tough Task

Those concerns revolve largely around limitations in the number of rural veterinarians to carry out the needs of greater veterinary oversight. If you have to wait on your veterinarian to write a prescription for an antibiotic before you head to the feed store, the delay could result in greater animal suffering and increased disease incidence as the bugs spread through your herd.

DeHaven says FDA will likely use the existing Veterinary Feed Directive as the vehicle to impose more regulations on antibiotic use in food animals. The directive essentially calls for a veterinarian’s prescription to use antibiotics in feed and water. “We do have workforce concerns, hence the need for more flexibility in how we apply the Veterinary Feed Directive,” he says.

Beef Magazine

Pharmacotherapy for pneumococcal infections: an update.

Dec 2012

Esposito S, Principi N.

Source

Pediatric Clinic 1, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Via Commenda 9, 20122 Milano , Italy +39 02 55032498 ; +39 02 50320206 ; susanna.esposito@unimi.it.

Abstract

Introduction: 

The management of pneumococcal diseases still places a significant burden on medical and economic resources. The subjects at greatest risk of pneumococcal infections are children. Areas covered: The aim of this review is to analyse the best current therapeutic approach to pneumococcal resistance, taking into account the level of susceptibility of Streptococcus pneumoniae, and the pharmacokinetics and pharmacodynamics of different antibiotics in the various pneumococcal diseases. Expert opinion: Antibiotic treatment of a number of pneumococcal diseases remains difficult or impossible due to the presence of strains resistant to commonly used antibiotics. In children the problem is significantly more important than in adults due to the reduced number of licenced drugs for subjects in the first years of life. The new conjugate pneumococcal vaccines containing 10 (PCV10) and 13 serotypes (PCV13), which include most of the recently emerging strains, might reduce the incidence of pneumococcal infections and the circulation of resistant pathogens. However, it is likely that optimal results will only be reached after the development of effective vaccines based on conserved proteins that are capable of preventing all pneumococcal infections, regardless of the serotype of the causative organism.

PubMed

Analysis of pollution levels of 16 antibiotics in the river water of Daliao River water system

2012

[Article in Chinese]

Yang C, Wang L, Hou X, Chen J.

Source

Shenyang Pharmaceutical University, Shenyang 110016, China.

Abstract

The detection of the pollution level of antibiotics in Daliao River system is a meaningful work. Sixteen antibiotics (6 sulfonamides, 5 fluoroquinolones, 3 tetracyclines and 2 chloramphenicols) were simultaneously quantified with solid-phase extraction (SPE) and liquid chromatography-tandem mass spectrometry (LC-MS/MS). In the SPE procedure, methanol and 2% (v/v) ammonia/methanol were used as the elution solvents in sequence to reduce the elution volume and improve the recovery. The results showed that this method have good sensitivity and enrichment effect for the target antibiotics in aqueous water, the recoveries ranged from 69.5% to 122.6%, the detection limits ranged from 0.05 ng/L to 0.32 ng/L. Thirteen antibiotics were found in the river water of Daliao River water system. Sulfa antibiotics were widely distributed, in which sulfamethoxazole was detected in all the sampling sites. The concentration of fluoroquinolones was relatively high in some sampling sites. The highest detection concentration of enoxacin was 41.3 ng/L. The frequencies and concentrations of tetracyclines and chloramphenicols were lower. In the upper reaches of the river, the concentrations of the 4 types ofantibiotics appeared lower, but around the large cities such as Shenyang City, Benxi City, Liaoyang City, the concentrations showed higher levels. The study indicated that the Daliao River water system suffered from the pollution of antibiotics to a certain extent.

PubMed

Chronic scrotal pain syndrome (CSPS): the widespread use of antibiotics is not justified.

Jan 2013

Strebel RT, Schmidt C, Beatrice J, Sulser T.

Source

Department of Urology, Kantonsspital Graubünden, Chur, Switzerland.

Abstract

Data supporting the widespread use of antibiotics in patients with chronic scrotal pain syndrome (CSPS) are not available. Therefore, the aim of this study was to investigate the presence of bacteria in the genitourinary tract in patients presenting with CSPS. From July 2005 to July 2007 we prospectively enrolled patients presenting with CSPS in our outpatient clinic. The evaluation consisted of a detailed patient's history, physical examination and ultrasound examination of the scrotum. A blood and urinalysis, a Meares-Stamey four-glass test for bacterial cultures and PCR testing for Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma hominis and Neisseria gonorrhoeae as well as a semen culture were performed. We assessed the symptom severity with the chronic epididymitis symptom index (CESI) score according to Nickel et al. (J Urol 2002, 167:1701; based on the NIH-CPSI). A total of 55 eligible men (median age 34 years) with CSPS were enrolled in the study. The median CESI score was 17 (range 4-26). The majority of patients (n = 39; 71%) were seen by a general practitioner or an urologist before. Of these, 25 patients (64%) were treated with antibiotics and 26 (67%) with non-steroidal anti-inflammatory drugs, respectively. A significant bacterial colony count in at least one specimen was detected in 21 of 55 patients (38%). The predominantly detected microorganisms were an Alpha-haemolytic Streptococcus (11 patients) and coagulase-negative staphylococci (10 patients). Thus, only in 12 of 55 (22%) patients isolated bacteria were considered to be of clinical relevance. No factor or condition predictive for a bacterial aetiology for CSPS could be identified. In our microbiological assessment of patients presenting with CSPS we found no evidence for the widely held belief that CSPS is predominantly the result of a chronic bacterial infection. We therefore conclude that the widespread use of antibiotic agents in the treatment of patients with CSPS is not justified.

PubMed

Dynamic Duo: Antibiotics and Probiotics

Post on Dec 10, 2012 by Jennifer Huber from QUEST Northern California

Antibiotics work by killing bacteria or by stopping bacteria from multiplying. Each type of antibiotics affects different bacteria in different ways, although broad-spectrum antibiotics are used to treat a wide range of infections. Antibiotics quickly make you feel better because the drug kills the majority of the targeted bacteria very quickly.

However antibiotics also kill beneficial bacteria and induce negative side effects — most commonly diarrhea, upset stomach, and vaginal yeast infection. For instance, antibiotics cause about one out of three people to get diarrhea by disrupting the balance of the intestinal flora, a collection of bacteria and other microorganisms in the digestive tract. This can result in an overgrowth of the Clostridium difficile bacteria that causes diarrhea. Similarly, antibiotics can disrupt the vaginal flora and cause an overgrowth of Candidayeasts to cause a yeast infection.

Probiotics are live bacteria, yeasts and other microbes intended to maintain or restore the supply of beneficial bacteria in the body, particularly the stomach and intestines. Probiotics are found naturally in certain foods, including yogurt, aged cheeses, kefir, miso, tempeh, and fermented cabbage. Dietary supplements are another common source of probiotics.

Although probiotics have been widely promoted as a way to keep your body in balance, scientific evidence for these claims have been weakened by the small size of most research studies. However, the use of probiotics to reduce antibiotic-induced side effects is now becoming more widely accepted by the medical profession.

In a recent study  published in the Journal of the American Medical Association supports taking probiotics with antibiotics. A team of researchers from southern California combined and analyzed the results of 63 randomized controlled trials of probiotics for the prevention or treatment of antibiotic-associated diarrhea. The 11811 men and women included in this large combined study took a placebo or probiotics supplement along with their antibiotics. The people who took the probiotics were 42% less likely to develop diarrhea than those taking the placebo. This pooled evidence strongly suggests that probiotics can help populations of beneficial bacteria recover and more quickly restore balance in the intestines.

However, further research is needed to determine which probiotics are the most effective at preventing and treating antibiotic-associated side effects, as well as determine the optimal dose of the probiotics. Research is also needed to identify which antibiotics are most likely to induce adverse effects. Hopefully these further studies are underway.

Of course it is also important to limit your use of antibiotics, using them only for bacterial infections when necessary. Common cold and flu viruses don’t respond to antibiotics anyway.

Science

Soil Bacteria May “Eat” Antibiotics

Soil Bacteria May “Eat” Antibiotics

By Dan Cossins | December 10, 2012

Long-term exposure to antibiotics from agricultural run off may encourage the evolution of soil bacteria that break down and consume the antibacterial agents.

Soil microbes exposed to antibiotics over a long period evolve the ability to detoxify the compounds, and may even derive nutritional benefit in the process, according to a report out last week (December 6) in the Journal of Environmental Quality.

Antibiotics administered to promote the growth and health of livestock find their way into agricultural soils through the manure of the treated animals, which is used as fertilizer. To see how long-term exposure to these medicines affect bacteria in the soil, researchers set up an experiment more than a decade ago in which plots of land were dosed every year with a mixture of three common veterinary antibiotics—sulfamethazine, tylosin, and chlortetracycline.

Ten years on, the team found that sulfamethazine and tylosin were degraded much more rapidly in soils with a history of antibiotic exposure than in untreated soils, suggesting that antibiotic-degrading microbes are selected for over time. They also found that residues of sulfamethazine were quickly mineralized to carbon dioxide in exposed soils, but not in controls, and subsequently isolated from the treated soil a new strain of Microbacterium, a microbe that uses sulfamethazine as source of carbon and nitrogen.

The findings led the team to propose that under the selective pressure of long-term exposure to antibiotics, microbes may evolve to not only break down the compounds, but also to use them to fuel its own growth. “I think it’s kind of a game changer in terms of how we think about our environment and antibiotic resistance,” lead study author Edward Topp of Agriculture and Agri-Food Canada in London, Ontario, said in a press release.

And although the evolution of antibiotic-eating bacteria means that drugs from agricultural wastes will not linger in the soil for long, the researchers warn that the trait could be transferred to a pathogenic microbe. “A reservoir of antibiotic resistance genes in the environment that is made larger through contamination with agricultural wastes may represent an enhanced threat to human health,” the authors wrote.

The Scientist

Fast determination of antibiotics in whole blood.

Oct 2012

Chen Q, Andersson A, Mecklenburg M, Xie B.

Source

Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Medical School of Xi'an Jiaotong University, Xi'an, China.

Abstract

There is a need for analytical methods capable of monitoring blood antibiotic levels in real time. Here we present a method for quantifying antibiotic levels in whole blood that does not require any sample pretreatment. The tests employ the enzyme penicillinase to assay for penicillin G, penicillin V and ampicillin using a flow-injected biosensor, the Enzyme Thermistor. Optimal flow rates, sample volumes and pH were determined to be 0.5 mL/min, 100 μL and 7.0, respectively. Analysis of the antibiotics diluted in buffer gave a linear range of 0.17-5.0 mM. Calibration curves prepared using blood spiked with the antibiotics gave a linear range of 0.17-2.0 mM. Linear regression values for all of the calibration curves were 0.998 or higher. Assay cycle time was 5 min. The relative standard deviation value for 100 determinations of a mock blood sample spiked with penicillin G was 6.71%. Despite the elimination of sample pretreatment, no detectable clogging or signal drift was observed. The assay provides a fast, simple, reliable analytical method for determining antibiotic concentrations in blood without the need for any sample pretreatment. This is an important first step towards developing a device capable of real-time monitoring of antibiotic levels in whole blood. The technology has the potential to significantly improve the outcomes of patients undergoing critical care.

PubMed

Role of antibiotics in generalized aggressive periodontitis: A review of clinical trials in humans.

2012

Ahuja A, Baiju CS, Ahuja V.

Source

Department of Periodontics, Sudha Rustagi College of Dental Sciences and Research, Faridabad, India.

Abstract

BACKGROUND:

It is well-recognized fact that periodontal diseases are caused by multifactorial etiologies, in which microorganisms play an important role. An essential component of therapy is to eliminate or manage these pathogens. This has been traditionally accomplished through mechanical means by scaling and root planning which is ineffective in some of the aggressive periodontal diseases. These aggressive diseases involve particular groups of microorganisms which are not eliminated by mechanical means; and they require anti-infective therapy, which includes local and systemic antimicrobials. This approach of therapy is of interest to periodontist due to the aforementioned shortcomings of conventional methods.

MATERIALS AND METHODS:

A manual and electronic search was made for human studies up to March 2011 that presented clinical and microbiological data for the efficacy of a systemic antibiotics in generalized aggressive periodontitis along with scaling and root planning. A systematic approach was followed by two independent reviewers and included eligibility criteria for study inclusion, quality assessment, and determination of outcome measures, data extraction, data synthesis, and drawing of conclusion.

RESULTS:

 Only three randomized controlled human trials qualified, and they concluded that both scaling and root planing (SRP) mono-therapy and SRP with antibiotics proves beneficial in improving clinical and microbiological parameters in aggressive periodontitis. Better results were seen in SRP with antibiotic groups as compared with SRP alone.

CONCLUSION:

 Because of the insufficient quantity and heterogenecity of studies, no adequate evidence could be gathered to use the beneficial effects of these antibiotics along with SRP in aggressive periodontitis compared with SRP alone.

PubMed

Early Antibiotics Improve Survival Following Out-Of Hospital Cardiac Arrest.

Nov 2012

Davies KJ, Walters JH, Kerslake ID, Greenwood R, Thomas MJ.

Source

Speciality Registrar and Consultant, Intensive Care Unit; Senior Statistician, Bristol Royal Infirmary, UK. Electronic address: drkjdavies@gmail.com.

Abstract

INTRODUCTION:

Therapeutic hypothermia (TH) has become standard management following out of hospital cardiac arrest (OHCA). Recent evidence suggests TH increases the incidence of pneumonia. We retrospectively assessed infective indicators after OHCA and evaluated the effect of antibiotics on survival.

METHOD:

We identified all patients admitted to the ICU of a regional primary angioplasty hospital following OHCA from May 2007 to December 2010. We collected demographic and outcome data, evidence of infection and the use of antimicrobial therapy 

RESULTS: 138 patients were admitted to ICU following OHCA. The mortality rate was 68.1% with mean ICNARC predicted mortality of 77.5%. Of 138 patients, 135 (97.8%) had at least one positive marker of infection within 72hours. 53 of 138 patients (38.4%) received antibiotics during the first 7 days of their ICU stay. The hospital mortality rate for these patients was significantly less than those not receiving antibiotics (56.6% vs. 75.3%; p=0.025) with NNT of 5. Multivariate analysis demonstrated that antibiotic use was an independent predictor of survival.

CONCLUSION:

The post-arrest management of OHCA is commonly complicated by infections, the accurate diagnosis of which is impaired by the associated increase in inflammatory markers, body temperature control, delay in the processing of samples and poor quality chest radiography. We have shown a significant reduction in mortality in patients who received antibiotics compared with patients who did not. This suggests that a formal clinical trial is warranted.

PubMed