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Barbara A. Santevecchi Tiffeny T. Smith Shawn H. MacVane 《International journal of antimicrobial agents》2018,51(4):629-635
Background
Ceftazidime/avibactam is a newly approved β-lactam/β-lactamase inhibitor combination with activity against antibiotic-resistant Gram-negative organisms, including many carbapenem-resistant strains. Although this agent may offer a promising treatment option for serious infections with limited alternatives available, clinical experience with ceftazidime/avibactam in treatment of infections caused by multidrug-resistant Gram-negative organisms other than Klebsiella pneumoniae is limited.Methods
A retrospective case series was performed to evaluate patients treated with ceftazidime/avibactam for infections caused by organisms other than K. pneumoniae at our institution over a 1-year period. Patients aged at least 18 years who received at least one dose of ceftazidime/avibactam were eligible for inclusion. Clinical and microbiological data were collected, and investigators assessed adverse effects, microbiological cure, clinical success, and 30-day in-hospital mortality following completion of ceftazidime/avibactam therapy.Results
Ten patients were included. The most common index infection was pneumonia (n?=?6/13, 46%) and the most frequently isolated organism was Pseudomonas aeruginosa (n?=?8/21, 38%). Fifty percent of patients received ceftazidime/avibactam as monotherapy. Microbiological cure was achieved in 67% (n?=?6/9) of patients and 70% (n?=?7/10) of patients met criteria for clinical success. The 30-day in-hospital mortality rate was 30%. No patients experienced adverse events because of ceftazidime/avibactam therapy.Conclusions
For infections caused by antibiotic-resistant Gram-negative organisms other than K. pneumoniae, clinical and microbiological success rates for patients treated with ceftazidime/avibactam were similar to those that have been reported for K. pneumoniae. Ceftazidime/avibactam appears to be a promising treatment option for infections caused by a variety of resistant Gram-negative organisms when limited alternatives exist. 相似文献3.
Michele Bartoletti Sara Tedeschi Renato Pascale Luigi Raumer Alberto Enrico Maraolo Giulia Palmiero Fabio Tumietto Francesco Cristini Simone Ambretti Maddalena Giannella Russell Edward Lewis Pierluigi Viale 《International journal of antimicrobial agents》2018,51(3):516-521
Objectives
We hypothesised that treatment with a tigecycline-based antimicrobial regimen for intra–abdominal infection (IAI) could be associated with lower rates of subsequent carbapenem-resistant Enterobacteriaceae (CRE) colonisation or Clostridium difficile infection (CDI) compared with a meropenem-based regimen.Methods
We performed a retrospective, single-centre, matched (1:1) cohort analysis of all patients who received at least 5 days of empirical or targeted tigecycline (TIG)- or meropenem (MER)-based treatment regimens for IAI over a 50-month period. Patients with previous CRE colonisation and CDI were excluded. Risk factors for CRE and CDI were assessed with a Cox regression model that included treatment duration as a time-dependent variable. Thirty-day mortality was assessed with Kaplan-Meier curves.Results
We identified 168 TIG-treated and 168 MER-treated patients. The cumulative incidence rate ratio of CDI was 10-fold lower in TIG-treated vs. MER-treated patients (incidence rate ratio [IRR] 0.10/1000 patient-days, 95%CI 0.002–0.72, P?=?0.007), but similar incidence rates were found for CRE colonisation (IRR 1.39/1000 patient-days, 95%CI 0.68–2.78, P?=?0.36). In a multivariate Cox regression model, the receipt of a TIG- vs. MER-based regimen was associated with significantly lower rates of CDI (HR 0.07, 95%CI 0.03–0.71, P?=?0.02), but not CRE (HR 1.12, 95% CI 0.45–2.83, P?=?0.80). All-cause 30-day mortality was similar in the two groups (P?=?0.46).Conclusion
TIG-based regimens for IAI were associated with a 10-fold lower incidence of CDI compared with MER-based regimens, but there was no difference in the incidence of CRE colonisation. 相似文献4.
Ahmad Al-Azayzih Sara Gharaibeh Anan S. Jarab Tareq L. Mukattash 《Saudi Pharmaceutical Journal》2018,26(8):1146-1154
Background
Torsade de Pointes (TdP) is an abnormal cardiac rhythm associated with a prolongation of QT interval. Although in most cases it spontaneously returns to the normal rhythm, TdP can lead to sudden cardiac death. Medications are the main cause of QT-prolongation and subsequent TdP flare, even though the exact mechanism of why some people evoke TdP but others do not is still unknown. It is evident that elderly patients are more susceptible to experience drug's side effects especially with chronically used medications.Objectives
To describe the pattern of prescribing drugs with risk of Torsade’s de Pointes among elderly patients who were visiting different outpatient clinics in North Jordan Hospitals.Methods
All patients who were aged ≥65?years old and were visiting outpatient clinics in King Abdullah University Hospital (KAUH) and Princess Basma Hospital (PBH) through December 2016 were included in the study. A total of 5319 patients’ dispending records were collected and analyzed for the prevalence of drug-induced TdP using both Microsoft Excel and the SPSS statistical software.Results
A total of 5319 patients were included in the study, more than half (58.5%, n?=?3114) of patients were consuming drugs with risk of TdP. Almost half (49.4%, n?=?1539) of these patients were women. The majority of patients (62.3%, n?=?1939) were using only one drug with TdP risk. However, other patients were found to take five or six different TdP-inducing drugs. Excluding age and gender, 94.3% (n?=?2937) of patients who were using TdP-inducing drugs had at least one additional risk factor of inducing TdP.Conclusion
High usage of TdP-inducing drugs among geriatric patients in North Jordan demonstrated the urgent need for increasing awareness of TdP’s risk induced by commonly prescribed medications. 相似文献5.
Aim
Anti-tumor necrosis factor-alpha (Anti-TNF-α) therapy has achieved an important position, are widely used for ankylosing spondylitis (AS) patients. TNF-α inhibition improves clinical outcomes and has differential effects on haematopoiesis. Information about effects on eosinophils is limited. The aim of our study is to determine the relationship between blood eosinophil counts in AS patients treated with TNF-α inhibitors.Methods
Seventy-five patients diagnosed with AS according to modified New York criteria were enrolled in this study. Disease activity was assessed by BASDAI, and erythrocyte sedimentation rate, C-reactive protein of patients were evaluated. All data were analyzed with Spearman’s correlation and Friedman's Two-Way by using SPSS version 19.0 statistical software, and p?<?0.05 was considered as statistically significant.Results
Seventy-five AS (F/M: 27/48, the mean age of 41?±?10?years) patients were evaluated. On the 3rd month of treatment, there was a correlation between BASDAI and CRP (r?=?0.32, p?=?0.005), but no correlation between BASDAI and ESR (r?=?0.21, p?=?0.06). Blood eosinophil count was not correlated with BASDAI, ESR and CRP on pre-, post-therapy (p?>?0.05). It counts lower before anti-TNF-α therapy compare with post-treatment (130/mm3, 140/mm3 and 190/mm3, respectively). There was no statistically significant difference between pre- and 3rd month (p?>?0.05), while correlation was found between pre- and 6th month, and also 3rd month and 6th month (p?<?0.001, p?=?0.002, respectively) for blood eosinophil count.Conclusion
To the best of our knowledge, our study is the first to evaluate blood eosinophil counts and disease activity with anti-TNF-α therapy. Blood eosinophil count may be affected by TNF-α inhibition in patients with AS. 相似文献6.
M. Cordina K. Hämeen-Anttila J. Lauri S. Tabone H. Enlund 《Research in social & administrative pharmacy》2018,14(9):817-823
Background
Health and medication literacy may be important factors in the outcomes of medical treatment. Similarly, shared decision making or lack of it may influence patient's behavior and adherence to medications.Objectives
To describe health and medication literacy as well as factors associated with poor medication literacy in two different populations and secondly, to describe desire to participate in decisions concerning medications; and to assess the role of poor medication literacy in decision making.Methods
A general population based survey in Finland (n?=?8003) and in Malta (n?=?2000). Health and medication literacy and the desire to participate in decision making was each measured with three statements based on the literature. Medication literacy was operationalized as understanding the instructions on package insert and ability to follow instructions on pharmacy label.Results
Fifteen percent of the Finnish respondents and 16% of Maltese reported always or often having problems understanding package inserts, i.e., poor medication literacy. Males (p?=?0.004) and respondents in the age group 65–79 years (p?<?0.001) were more prone to report such poor medication literacy. Respondents in Finland (59%) and Malta (65%) reported wanting to discuss different treatment options with the doctor. The respective percentages (42% Finland, 57% Malta) were lower for discussing about the choice of medicine and for deciding about the medicine (36% and 43%, respectively). The desire to participate in deciding about the medicines was higher among females (p?<?0.001) and Maltese respondents (p?<?0.001). Also those with poor medication literacy more often (p?<?0.001) expressed a desire to participate in deciding in the choice of medicine.Conclusions
Medication literacy was rather low, while desire to participate in pharmacotherapy decision making was high, especially in Malta. Overall, women tended to be more willing to participate in decision making. The desire to participate in decisions was higher among persons with low medication literacy. 相似文献7.
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Iman A. Basheti Nathir M. Obeidat Helen K. Reddel 《Saudi Pharmaceutical Journal》2018,26(8):1127-1136
Objectives
To investigate the effect of inhaler technique education delivered by a clinical pharmacist to patients hospitalised for asthma, on inhaler technique scores and asthma control at three months post-discharge.Methods
This pre-post interventional study in Jordan enrolled patients who had been admitted for asthma and were using controller medication by Accuhaler [Diskus] (ACC), Turbuhaler (TH) or Pressurized metered dose inhalers (pMDI). Inhaler technique was assessed using published checklists (score 0–9). Asthma symptom control was assessed by Asthma Control Test (ACT, range 5–25). Patients were assessed on admission (baseline), pre-discharge, and 3?months later. All patients received a ‘Show-and-Tell’ inhaler technique counseling service prior to discharge.Results
Baseline data were available for 140 patients, 71% females, mean age 52.7 (SD 16.64) years, mean ACT score 10.0 (SD 4.8). Mean inhaler score was 7.5 (SD 1.52) with no significant difference between the inhaler groups (p?=?0.174). After pre-discharge training, all patients had correct technique (score 9/9). After 3?months, mean inhaler scores were significantly higher than at baseline (8.14 (SD 0.87, p?<?0.001), with mean change significantly higher for TH 1.21 (SD 2.25) and ACC 0.85 (SD 0.97) than pMDI (0.16; SD 0.72), p?=?0.001. Symptom control improved significantly for all patients, with a mean increase in ACT score of 7.54 (SD 8.18), with no significant difference between the inhaler device groups (p?=?0.326).Conclusions
Patients hospitalized for asthma achieved correct inhaler technique after training by a pharmacist, and maintained better technique at 3?months than on admission. Significant improvements in ACT scores were documented for all inhaler groups. 相似文献9.
Olayinka O. Shiyanbola Elizabeth Unni Yen-Ming Huang Cameron Lanier 《Research in social & administrative pharmacy》2018,14(9):824-830
Background
Beliefs in medications and illness perceptions is associated with medication adherence among individuals with diabetes and several adherence interventions focus on patients' beliefs in medicines and illnesses. Though health literacy is important in medication adherence, the relationship between health literacy and medication adherence remains inconclusive; thus raising the question as to whether health literacy has an amplifying or reducing effect on the relationship between beliefs and adherence.Objective
The study examined (1) the association between health literacy, beliefs in medicines, illness perceptions, and medication adherence in individuals with type 2 diabetes and (2) the moderating effects of health literacy (including numeracy and document literacy) on the relationship between illness perceptions, beliefs in medicines, and medication adherence.Methods
Adults ≥20 years taking oral diabetes medicines at two family medicine clinics, completed a cross-sectional survey. Participants were assessed on beliefs in medicines, illness perceptions, health literacy, self-efficacy, and medication adherence. Multiple linear regressions examined the effect of health literacy, beliefs and self-efficacy, and the moderator effect of health literacy in the relationship between beliefs and adherence.Results
Of the 174 participants, more than half were women (57.5%) and white (67.8%). There was a significant positive association between self-efficacy and adherence (β?=?0.486, p?<?.001), and a negative association between threatening illness perceptions and adherence (β?=??0.292, p?<?.001). Health literacy had a significant moderator effect on the relationship between adherence and concerns beliefs (β?=??0.156, p?=?.014) and threatening illness perceptions (β?=?0.196, p?=?.002). The concern beliefs - adherence association was only significant at marginal and adequate literacy levels. When health literacy was separated into numeracy and document literacy, only numeracy moderated the illness perceptions - adherence relationship (β?=?0.149, p?=?.038).Conclusions
Health literacy, especially numeracy, needs to be initially addressed before diabetes adherence interventions that address individual concerns about medicines and threatening illness perceptions can work. 相似文献10.
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Mohammad H. Aljawadi Abdullah T. Khoja Abdullah M. Alhammad Azzam D. AlOtaibi Sulaiman A. Al-Shammari Tawfik A. Khoja 《Saudi Pharmaceutical Journal》2018,26(8):1112-1119
Purpose
First, to determine benzodiazepines prevalence (BDZs) among Saudi older adults (SOA); Second, to quantify the association between BDZs use and falls among SOA. Third, to determine falls effect on all-cause mortality among SOA.Methods
This is a cross-sectional study that used the Saudi National Survey for Elderly Health; a nationally-representative, population-based survey. Participants were asked about BDZs use and falls history during the 12?months prior to the interview. Demographics, medications, comorbidities and housing conditions were used as covariates. Multiple imputation was used to impute missing data. Modified poisson multivariable regression was used to study the association between BDZs and falls. Cox- proportional hazard regression was used to determine falls effect on mortality over nine years period.Results
Among 2946 SOA, BDZs prevalence was 4%. Around 13% reported falls. In the multivariable regression, relative risk (RR) of falls was 2 comparing BDZs users to non-users (95CI%: 1.02–3.99). Antidepressants (RR?=?1.72; 95%CI: 1.10–2.74), laxatives (RR?=?1.38; 95%CI: 1.11–1.7), low body mass index (RR?=?1.94; 95%CI: 1.33–2.84), mild cognitive impairment (RR?=?1.56; 95%CI: 1.21–2.03), high door steps (RR?=?1.54; 95%CI: 1.23–1.93) and insufficient illumination (RR?=?1.38; 95%CI: 1.11–1.71) increased falls risk. Lastly, the hazard ratio of falls on death was 1.48 (95%CI: 1.17, 1.89) over nine years.Conclusion
Despite the recommendation against BDZs use among older adults, still there were subjects who were prescribed these drugs. falls are common among SOA. Preventive strategies such medication therapy management, nutrition improvement, elderly-friendly housing structures can reduce the prevalence of falls and consequent increase in mortality among SOA. 相似文献12.
Fatema Suliman Alatawi Uzma A. Faridi Mohsen Suliaman Alatawi 《Saudi Pharmaceutical Journal》2018,26(8):1208-1213
Background
In diabetes mellitus, uncontrolled hyperglycemia has been reported to induce oxidative stress, which may lead to health complications. Vitamin D, however, acts as a non-enzymatic antioxidant to protect cells against oxidative stress and damage.Objective
To investigate the antioxidative effect of vitamin D combined with calcium in streptozotocin (STZ)-induced diabetic rats.Methods
Rats were divided into four groups (ten rats in each group). The first group (control) received a normal diet and water. The second group, including STZ-induced diabetic rats (diabetic controls), received a normal diet and water. The third group, also including STZ-induced diabetic rats, received vitamin D (2000?IU/day) with calcium (500?mg/kg/day) orally for 28 consecutive days. The fourth group consisted of STZ-induced diabetic rats that received insulin treatment for 28 consecutive days. Activities of superoxide dismutase (SOD), glutathione peroxidase (GPO) and catalase were measured in the liver tissues. The level of malonaldehyde (MDA) was measured in the plasma.Results
Diabetic rats showed a significant decrease in the activities of SOD, GPO and catalase compared to normal rats. Oral administration of vitamin D with calcium to diabetic rats caused a significant increase in the activities of SOD, GPO and catalase compared with the untreated group. Furthermore, the plasma level of MDA was significantly elevated in diabetic rats compared to normal rats. Diabetic rats treated with vitamin D and calcium had a significantly reduced level of MDA, suggesting that vitamin D with calcium played a vital role in the protection of tissues from damage by free radicals.Conclusion
Oral supplementation with vitamin D and calcium may be a useful treatment for diabetic patients to reduce/prevent the pathological complications of diabetes. 相似文献13.
Eyal Kleinhendler Matan J. Cohen Allon E. Moses Ora Paltiel Jacob Strahilevitz Amos Cahan 《International journal of antimicrobial agents》2018,51(1):71-76
Background
There are several empiric antibiotic treatment options for febrile neutropenia, yet there is no universally-accepted initial protocol. We aimed to assess the performance of a protocol (piperacillin, gentamicin and cefazolin) introduced over 40 years ago and compare its coverage against bacteria isolated from blood of neutropenic patients with that of various commonly used antibiotic treatment protocols.Methods
Adults with neutropenia admitted between 2003 and 2012 to the hemato-oncologic departments and in whom blood cultures were taken on admission were included. Appropriateness of several common antibiotic protocols was assessed based on the susceptibility of the blood isolates. Crude mortality rates were computed by the susceptibility of bacteria isolated from patients' blood to the actual treatment given.Results
In total, 180 admissions of neutropenic patients (95 in patients who had fever above 38?°C) with positive blood cultures were analyzed. The actual antibiotic regimen prescribed was deemed appropriate in 82% of bacteremia episodes. The recommended institutional protocol was used in 62% of bacteremia episodes in neutropenic patients. This protocol would have been appropriate in 85% of all neutropenic bacteremia episodes and 89% of episodes in febrile neutropenia patients compared with piperacillin/tazobactam (79%, P?=?0.13 and 76%, P?=?0.002, respectively) and imipenem (93%, P?=?0.004 and 92%, P?=?0.74, respectively). Isolation of bacteria resistant to the actual antibiotic treatment given was associated with higher mortality at one week and at 30 days.Conclusion
Common current antibiotic regimens provide similar coverage among febrile neutropenic patients, whereas broad spectrum antibiotic combinations maximize coverage among neutropenic patients. 相似文献14.
Background
During the undergraduate years, laboratory practical classes using experimental animals are important in pharmacy schools. Limitations for experimental use of animals exist, including the procurement of animals, the difficulty in performing animal experiments, ethical considerations, and more often students' preferences.Objective
To evaluate pharmacy students’ perceptions, barriers, and confidence regarding animal use in the pharmacology laboratory course, and the effect of animal handling on their confidence.Methods
This observational pre- and post-course parallel group design study was conducted during the Pharmacology laboratory involving 3rd-year pharmacology students from one school of pharmacy in Jordan. A questionnaire was designed and validated to collect students’ demographic characteristics, perceived barriers and perceptions regarding animal handling during the lab, and the level of confidence pre- and post-course, assessing differences between those who handled and those who did not handle animals.Results
All Pharmacology lab students (n?=?212) with a mean age of 21.11 (SD 1.32) and the majority being females (77.0%) were enrolled. Students who refused to handle animals (n?=?105, 49.5%) stated phobia as the main barrier. Students who accepted to handle animals agreed more with the importance of seeing and practicing animal handling, with animal handling being essential to understand the effect of drugs on animals and in its importance to gain skills, than those who refused. More than half of students (55.9%) reported feeling confident/somewhat confident in animal handling and in giving animals injections (50.8%) at baseline. At the end of the course, students who accepted animal handling reported significantly higher confidence.Conclusion
This study revealed important students’ barriers and perspectives to animal handling. Those who handled the animals reported better confidence in certain areas at the end of the course than those who refused. Engaging students when making decisions regarding educational practices paves the way for change to the current traditional paradigm in the education of future scholars. 相似文献15.
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Marjan Wouthuyzen-Bakker Eduard Tornero Laura Morata Prashant V. Nannan Panday Paul C. Jutte Guillem Bori Greetje A. Kampinga Alex Soriano 《International journal of antimicrobial agents》2018,51(1):38-42
Objectives
The combination of a fluoroquinolone with rifampin is one of the cornerstones in the treatment of prosthetic joint infections (PJI) caused by staphylococci. Moxifloxacin is highly active against methicillin–susceptible Staphylococcus aureus (MSSA) and, therefore, is an attractive agent to use. However, several studies reported a lowering in serum moxifloxacin levels when combined with rifampin. The clinical relevance remains unclear. We determined the outcome of patients with early acute PJI caused by MSSA treated with either moxifloxacin/rifampin or levofloxacin/rifampin.Methods
Medical files of patients treated with moxifloxacin/rifampin (University Medical Centre Groningen) or levofloxacin/rifampin (Hospital Clinic Barcelona) were retrospectively reviewed (2005–2015). Treatment failure was defined as the need for revision surgery and/or suppressive therapy, death by infection or a relapse of infection during follow-up.Results
Differences in baseline characteristics between the two cohorts were observed, but prognostic parameters for failure, as defined by the KLIC-score (Kidney failure, Liver cirrhosis, Index surgery, C–reactive protein and Cemented prosthesis), were similar in the two groups (2.9 [1.5 SD] for the moxifloxacin group vs. 2.2 [1.2 SD] for the levofloxacin group [P?=?0.16]). With a mean follow-up of 50 months (36 SD) in the moxifloxacin group, and 67 months (50 SD) in the levofloxacin group (P?=?0.36), treatment was successful in 89% vs. 87.5%, respectively (P?=?0.89). None of the failures in the moxifloxacin group were due to rifampin– or moxifloxacin–resistant S. aureus strains.Conclusion
Our data indicate that moxifloxacin combined with rifampin is as clinically effective as levofloxacin/rifampin for early acute PJI caused by MSSA. 相似文献18.
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