Tetracycline (TC) is a well-known broad spectrum antibiotic, which is effective against many Gram positive and Gram negative bacteria. Controlled release nanoparticle formulations of TC have been reported, and could be beneficial for application in the treatment of periodontitis and dental bone infections. Furthermore, TC-controlled transcriptional regulation systems (Tet-on and Tet-off) are useful for controlling transgene expression in vitro and in vivo for biomedical research purposes; controlled TC release systems could be useful here, as well. Mesoporous silica nanomaterials (MSNs) are widely studied for drug delivery applications; Mobile crystalline material 41 (MCM-41), a type of MSN, has a mesoporous structure with pores forming channels in a hexagonal fashion. We prepared 41˘4 and 406˘55 nm MCM-41 mesoporous silica nanoparticles with loaded TC for controlled drug release; TC content in the TC-MCM-41 nanoparticles was 18.7% and 17.7% w/w, respectively. Release of TC from TC-MCM-41 nanoparticles was then measured in phosphate-buffered saline (PBS), pH 7.2, at 37˝C over a period of 5 h. Most antibiotic was released from both over this observation period; however, the majority of TC was released over the first hour. Efficacy of the TC-MCM-41 nanoparticles was then shown to be superior to free TC against Escherichia coli (E. coli) in culture over a 24 h period, while blank nanoparticles had no effect.

Nonbacterial acute bronchitis leads to many outpatient clinic visits in the US that result in an antibiotic prescription. Understanding antibiotic prescribing patterns and their clinical consequences will help improve antimicrobial stewardship efforts. A retrospective chart review was conducted to identify any correlations between patient and provider characteristics with antibiotic use in adult acute bronchitis (AAB) and to compare the clinical outcomes and rates of health care utilization between those who did and did not receive antibiotics. Study participants included adults with uncomplicated AAB seen by family medicine or internal medicine, specialty, and mid-level practitioners in a Baylor Scott & White Health outpatient facility. Phase 1 investigated whether prescribing rates varied by provider-or patient-level characteristics. Phase 2 compared clinical outcomes and health care utilization between patients who received an antibiotic versus those who did not receive an antibiotic for AAB. Among 35,383 visits for AAB, 81.4% resulted in a prescription for an antibiotic. Physicians >35 years of age and internal and family medicine physicians were more likely to prescribe antibiotics. Health care utilization rates did not differ between cohorts. The number of Clostridium difficile events was negligible. KEYWORDS Acute bronchitis; community-acquired Clostridium difficile; health care utilization; outpatient antibiotics; upper respiratory tract infection A cute respiratory tract infections are the leading drivers in outpatient visits in the US. 1 Nearly 68 million outpatient visits for this diagnosis per year result in an antibiotic prescription, and 50% of those antibiotics may be unnecessary. 2 Uncomplicated adult acute bronchitis (AAB) is diagnosed after ruling out risk factors such as asthma, chronic obstructive pulmonary disease, heart failure, and pneumonia in patients with productive or nonproductive cough lasting up to 6 weeks. 3 Evidence from 40 years of studies has shown the lack of efficacy of antibiotics in AAB, 4,5 as bacteria are detected in only 1% to 10% of AAB cases. 3 Thus, professional societies and medical organizations strongly recommended against antibiotic use in uncomplicated AAB. 2,3 6-9 Despite this, antibiotics were still prescribed in about 70% of AAB visits from 1996 to 2010,

Background The increase in deaths due to diabetes records a trend in growth and the OSMED National Report of 2011 highlights a prescription shift towards the high-cost innovative drugs for the treatment of type II diabetes mellitus (DMII). This is subject to intensive monitoring by the health ministry. In the management of diabetic patients, the guidelines suggest an early intensive therapeutic intervention and the pursuit of a personal glycaemic target for avoiding hypoglycaemic episodes, which are possibly responsible for the increased risk of developing cardiovascular episodes. Purpose To analyse the population, consumption and type of innovative diabetic drugs used in the Piedmont region; this is to put a value on the type of treatment used for DMII, because the advantages of innovative therapy must be valued too. Materials and MethodsIn the first step the incidence of DMII in Piedmont was valued by analysing data from the regional diabetic database during the period 2007–2012. Dipeptidyl peptidase 4 inhibitors (sitagliptin and vildagliptin alone or in association with metformin and saxagliptin), thiazolidinediones (pioglitazone alone or in association with metformin), glucagon-like peptide 1 (exenatide, liraglutide), insulin glargine and detemir were considered innovative drugs. Consumption and type of drugs were analysed in terms of the defined daily dose/1000 inhabitants/day (DDD) over a six-month period in 2012 using regional databases of prescriptions which enabled us to access population data. 2012 data were compared with 2011. Results The first striking finding is the increase in the incidence of DMII, 1.70% in five years, which corresponds to 80,327 patients. Focusing on the population treated with innovative drugs revealed that 21% (61,679/294,590) of diabetic patients are 65 years old and far more males than females are affected (respectively 53.87% vs. 46.13%). The drug most used is insulin glargine with 43.84% of total consumption, another 25.08% use DPP4 inhibitors alone or in association, 20.05% use pioglitazone alone or in association, 9.02% use glucagon-like peptide 1 and 2.01% use insulin detemir. The comparison with the same period of 2011 highlights the increased consumption of innovative drugs in Piedmont, 23% (8.97 DDD in 2012 vs. 6.91 DDD in 2011) while Italian data record an increase of 5% (15.69 DDD vs. 14.87 in 2011). Conclusions Increased consumption of these drugs suggests that medical prescriptions could maybe move on innovative therapeutic molecules. It is important that clinicians discuss and compare the data analysis shown above with medical management guidelines, with the aim of estimating the genuine advantages of innovative drugs in terms of compliance, reduction in adverse reactions and increased quality of life. No conflict of interest.

Background The European Centre for Disease Prevention and Control promoted the HALT project (Healthcare-Associated Infections in Long-Term Care Facilities) to support the control of healthcare-associated infections (HAI) and antimicrobial use in European Long-Term Care Facilities (LTCF). Purpose To study the prevalence of HAI, antibiotic use and available infection control resources in Asti (Italy). A point prevalence survey (PPS) was performed in May–June 2013 by the multidisciplinary team of Local Health Unit of Asti. Materials and methods An institutional questionnaire collected denominator data regarding risk factors and aggregated data on residents’ characteristics (care load). A resident questionnaire was filled in for each resident with an antibiotic treatment and/or signs and symptoms of infection on the day of the survey. Results A total of 7 LTCF participated in the PPS: 452 eligible residents (25% male, 56% >85 years). Incontinence, disorientation and impaired mobility were reported in 67%, 64% and 62% of the cases, respectively. On the PPS day, 5.9% of the residents presented antibiotic treatment and/or signs and symptoms of infection (prevalence in Italy 5.9%; in Europe 4.1%). The most frequently reported infection site concerned the respiratory tract (98%) followed by the skin (1%), the gastrointestinal tract (1%). Antimicrobials were prescribed in 2% of the residents: 82% treatment; 18% prophylaxis. Third-generation cephalosporins (45%) were most commonly prescribed, followed by combinations of penicillins including beta-lactamase inhibitors (18%), macrolides (9%), imidazole derivatives (9%). The most frequently reported tasks were: development of an infection prevention policy and antibiotic policy; non-available training of nursing staff and care protocols. Conclusions The development of an antibiotics policy is an important element for having good antimicrobial stewardship; local LTCF teams need additional and specific training in order to improve assessment of infection and antibiotic use in this setting. No conflict of interest.