Considerations of antibiotic therapy duration in community- and hospital-acquired bacterial infections

Esposito, Silvano; Esposito, Isabella; Leone, Sebastiano

doi:10.1093/jac/dks277

Cited by 29 publications

(19 citation statements)

References 57 publications

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“…Patients receive specific oral or intravenous antibiotic therapy, or both, targeted toward bacteria isolated during the first-stage surgery [11]. Although the ideal duration for antibiotic therapy is not defined, most of the recent literature recommends a 6-to 12-week course [12][13][14][15]. Once the infection is eradicated, and CRP and ESR levels return to normal, the second surgery is performed to remove the spacer and implant the revision prosthesis.…”

Section: This Article Is Part Of the Topical Collection On Revision Kmentioning

confidence: 99%

The use of spacers (static and mobile) in infection knee arthroplasty

Mazzucchelli

Rosso

Marmotti

et al. 2015

Curr Rev Musculoskelet Med

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Revision total knee arthroplasty (TKA) is the treatment of choice in patients with periprosthetic joint infection. It may be performed in either a single stage or two stages. In the latter option, between stages, an antibiotic-loaded spacer may be used to maintain a certain amount of joint stability and mobility after the infected implant is removed, adding an intra-articular concentration of antibiotics. There are two types of antibiotic-loaded cement spacers: static and dynamic. Static spacers basically create a temporary arthrodesis with antibiotic-loaded cement and usually are handmade within the surgical field. Dynamic spacers can be created intraoperatively by using different tools or may be prepackaged by the manufacturer; they allow range of motion between stages. In this article, the authors review the indications, surgical techniques, and results for static and dynamic spacers in two-stage revision TKA.

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Section: This Article Is Part Of the Topical Collection On Revision Kmentioning

confidence: 99%

The use of spacers (static and mobile) in infection knee arthroplasty

Mazzucchelli

Rosso

Marmotti

et al. 2015

Curr Rev Musculoskelet Med

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“…Many studies proved the equal efficacy of second and third generation cephalosporins and azithromycin in bacterial eradication with a short course of 3-5 days. 9 Clinical studies and in-vitro models demonstrated longer the course of antibiotics administered, higher are the rates of resistance developed. 9 Misclassifying viral infections as "antibiotic appropriate" scale gives a wrong message on a broader public health perspective.…”

Section: Discussionmentioning

confidence: 99%

“…9 Clinical studies and in-vitro models demonstrated longer the course of antibiotics administered, higher are the rates of resistance developed. 9 Misclassifying viral infections as "antibiotic appropriate" scale gives a wrong message on a broader public health perspective. 10 When a particular antibiotic is prescribed, the susceptible bacteria have less survival advantage than the resistant bacteria.…”

Section: Discussionmentioning

confidence: 99%

Role of usage of antibiotics in pharyngitis: a prospective study

Deepthi

Narsimloo

2017

Int J Otorhinolaryngol Head Neck Surg

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Background: Antibiotic resistance is emerging as a global public health problem and is growing day by day in both developed and developing countries. This study aims at scientific investigation into the need for the use of antibiotics in cases of pharyngitis. Methods: A prospective study of 2000 patients complaining of sore throat, randomly selected from outpatient department during 1 year period from August 2015 – 2016 .They were studied clinically and investigated for infectious etiology and the role of usage of antibiotics was analysed. Results: Among 2000 patients, 1840 patients were relieved of sorethroat with only symptomatic treatment. Antibiotics were given only in 160 patients (8%) as throat swab demonstrated bacterial growth. Most common organisms were Group A beta haemolytic Streptococci and E coli. Allergic pharyngitis and laryngo pharyngeal reflux disease constituted the important causes of sore throat among middle age groups (20-40 years) and elderly age groups (50-60 years) respectively. Conclusions: Antibiotics should not be given to patients unless there is documentary evidence of bacterial infection. Most of the patients (92%) did not require antibiotic prescription, the illness was self-limiting in acute cases and patients who demonstrated allergic and laryngo-pharyngeal reflux etiology required symptomatic medication. Inadvertent use of antibiotics will lead to spread of resistance in the community; this will limit the usage of higher antibiotics for complicated cases and ICU patients. This highlights opportunity to enhance physician‘s awareness for reducing inadvertent use of antibiotics among adult pharyngitis patients and optimizing Antibiotic therapy usage.

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“…Thus, unnecessarily long therapy could be harmful to patients. In studies of antibiotics used to treat other bacterial infections, it has been suggested that better outcomes occur with shorter rather than longer duration therapy [53]. However, this is a matter of ongoing debate.…”

Section: Discussionmentioning

confidence: 99%

Therapy duration and long-term outcomes in extra-pulmonary tuberculosis

et al. 2014

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BackgroundTuberculosis is classified as either pulmonary or extra-pulmonary (EPTB). While much focus has been paid to pulmonary tuberculosis, EPTB has received scant attention. Moreover, EPTB is viewed as one wastebasket diagnosis, as “the other” which is not pulmonary.MethodsThis is a retrospective cohort study of all patients treated for EPTB in the state of Texas between January 2000 and December 2005, who had no pulmonary disease. Clinical and epidemiological factors were abstracted from electronic records of the Report of Verified Case of Tuberculosis. The long-term outcome, which is death by December 2011, was established using the Social Security Administration Death Master File database. Survival in EPTB patients was compared to those with latent tuberculosis, as well as between different types of EPTB, using Cox proportional hazard models. A hybrid of the machine learning method of classification and regression tree analyses and standard regression models was used to identify high-order interactions and clinical factors predictive of long-term all-cause mortality.ResultsFour hundred and thirty eight patients met study criteria; the median study follow-up period for the cohort was 7.8 (inter-quartile range 6.0-10.1) years. The overall all-cause mortality rate was 0.025 (95% confidence interval [CI]: 0.021-0.030) per 100 person-year of follow-up. The significant predictors of poor long-term outcome were age (hazard ratio [HR] for each year of age-at-diagnosis was 1.05 [CI: 1.04-1.06], treatment duration, type of EPTB and HIV-infection (HR = 2.16; CI: 1.22, 3.83). Mortality in genitourinary tuberculosis was no different from latent tuberculosis, while meningitis had the poorest long-term outcome of 46.2%. Compared to meningitis the HR for death was 0.50 (CI: 0.27-0.91) for lymphatic disease, 0.42 (CI: 0.21-0.81) for bone/joint disease, and 0.59 (CI: 0.27-1.31) for peritonitis. The relationship between mortality and therapy duration for each type of EPTB was a unique “V” shaped curve, with the lowest mortality observed at different therapy durations for each, beyond which mortality increased.ConclusionsEPTB is comprised of several different diseases with different outcomes and durations of therapy. The “V” shaped relationship between therapy duration and outcome leads to the hypothesis that longer duration of therapy may lead to higher patient mortality.

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Considerations of antibiotic therapy duration in community- and hospital-acquired bacterial infections

Cited by 29 publications

References 57 publications

The use of spacers (static and mobile) in infection knee arthroplasty

The use of spacers (static and mobile) in infection knee arthroplasty

Role of usage of antibiotics in pharyngitis: a prospective study

Therapy duration and long-term outcomes in extra-pulmonary tuberculosis

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