Application of the Formula for Rational Antimicrobial Therapy (FRAT) to Community-Acquired Pneumonia

Abstract

Community-acquired pneumonia (CAP) remains a common condition for which patients seek medical advice in the outpatient setting and where antimicrobial agents are prescribed empirically-often based on therapeutic guideline recommendations. Antimicrobial resistance impacts on therapeutic choices as resistance is associated with clinical failure which in turn may impact morbidity and mortality. The Formal for Rational Antimicrobial Therapy (FRAT) considers etiology and antimicrobial susceptibility to generate a factor to predict the likely activity of an antimicrobial agent in CAP or any other infection for which etiology and susceptibility data can be considered. In considering the FRAT formula in CAP, amoxicillin and macrolides offer a predictability of 52.6-78.3% whereas for trimethoprim/sulfamethoxazole the predictability was 45.2% as compared to 90.1% for tetracyclines/doxycycline and 98.2% for levofloxacin (and moxifloxacin). The FRAT formula clearly differentiates antimicrobial agents based on spectrum of activity and impact of antimicrobial resistance and provides yet another factor for consideration in the selection of an antimicrobial agent for treatment of CAP.

Can surgical site infections be controlled through microbiological surveillance? A three-year laboratory-based surveillance at an orthopaedic unit, retrospective observatory study

“…An elevated number of deep incisional infections had been expected, as already described by other authors [8, 13]. A Swiss research, however, points to a lower share of deep incisional infections: 28.4% for hip replacements and 44.8% for knee replacements, morbidity amounting to 1.4% and 0.9% respectively [31].…”

“…The cumulative antibiogram reports have been prepared using the Formula for Rational Empiric Antimicrobial Therapy (FRAT) [13]. The latter had been calculated as the microorganism prevalence multiplied by the drug sensitivity rate—both figures based only on the microorganisms detected and antibiotic groups applied in the studied SSI cases.…”

Treatment of Community-Acquired Pneumonia: A Case Report and Current Treatment Dilemmas

“…Along with local resistance rates, antibiotic selection should consider the patient's risk factors for possible infection with DRSP [ 5 , 16 , 20 ], including the following: Recent antibiotic use (within 3 months) Age greater than 65 years Immunosuppressive illness Multiple medical comorbidities Exposure to a child attending a daycare center Alcohol abuse Asthma/COPD Diabetes mellitus Recent travel [ 5 ] In the first decade of this millennium, DRSP risk factors were present in approximately half of outpatient CAP cases treated in the acute care setting. Despite this fact, physician adherence to guideline-concordant antibiotic therapy remained infrequent as clinicians continued to use macrolides, especially azithromycin, as CAP monotherapy [ 18 ].…”

“…In the USA, S. pneumoniae resistance rates are increasing across antibiotic class [ 25 ], with S. pneumoniae even being fully resistant to one or more antibiotics in 30% of severe pneumonia cases [ 26 ]. High-level macrolide resistance to S. pneumoniae is increasing [ 26 , 27 ], with many US states showing overall resistant rates greater than 40% ( Figure 3 ) [ 16 , 26 ].…”

Antimicrobial Resistance & ‘Man's best Friend’: What they give to us we might be giving Right Back

“…A recent report commenting on antimicrobial use and antimicrobial resistance in various geographical regions in the USA (as determined by the CDC) found the highest usage of antimicrobial agents occurred in geographical regions with the highest incidence of heart disease, diabetes and smoking [1]. Antimicrobial resistance was also highest in this region for Streptococcus pneumoniae and macrolides.…”