anti-bacterial agents

Observations Acute bacterial prostatitis consists of a urinary tract infection (UTI) that includes infection of the prostate, typically associated with fever or chills and caused by gram-negative bacteria, such as Escherichia coli, Klebsiella, or Pseudomonas, in 80% to 97% of cases. First-line therapy for acute prostatitis is broad-spectrum intravenous or oral antibiotics, such as intravenous piperacillin-tazobactam, ceftriaxone, or oral ciprofloxacin, which has a 92% to 97% success rate when prescribed for 2 to 4 weeks for people with febrile UTI and acute prostatitis. Chronic bacterial prostatitis is defined as a persistent bacterial infection of the prostate, typically presenting as recurrent UTIs from the same strain. Up to 74% of chronic bacterial prostatitis diagnoses are due to gram-negative organisms, such as E coli. First-line therapy for chronic bacterial prostatitis is a minimum 4-week course of levofloxacin or ciprofloxacin. Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) presents as pelvic pain or discomfort for at least 3 months and is associated with urinary symptoms, such as urinary frequency. CP/CPPS is diagnosed when evaluation, including history and physical examination, urine culture, and postvoid residual measurement, does not identify other causes for the symptoms, such as infection, cancer, urinary obstruction, or urinary retention. The National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) measures symptom severity (scale of 0-43), with a 6-point change considered clinically meaningful. First-line oral therapy for CP/CPPS with urinary symptoms is α-blockers (eg, tamsulosin, alfuzosin; ΔNIH-CPSI score difference vs placebo = −10.8 to −4.8). Other oral therapies are associated with modest changes in NIH-CPSI score compared with placebo, including anti-inflammatory drugs (eg, ibuprofen; ΔNIH-CPSI score difference = −2.5 to −1.7), pregabalin (ΔNIH-CPSI score difference = −2.4), and pollen extract (ΔNIH-CPSI score difference = −2.49).

Conclusions and Relevance Prostatitis includes acute bacterial prostatitis, chronic bacterial prostatitis, and CP/CPPS, each of which is diagnosed and treated differently. First-line treatments are broad-spectrum antibiotics for acute bacterial prostatitis (such as piperacillin-tazobactam, ceftriaxone, or ciprofloxacin), at least 4 weeks of fluoroquinolones for chronic bacterial prostatitis, and α-blockers for CP/CPPS with urinary symptoms.

Author/s:

Benjamin J Borgert, Eric M Wallen, Minh N Pham

Antibiotics for acute diverticulitis

Erin Blanchette — Wed, 02 Apr 2025 21:42:20 +0000

Date Added:

April 2, 2025

Journal/Publication:

Canadian Family Physician

Publisher:

College of Family Physicians of Canada

Publication Date:

March 1, 2025

Issue:

Volume:

Pages:

184

URL:

Antibiotics for acute diverticulitis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.46747/cfp.7103184

Keywords

PMID (1):

40102007

MeSH

Diverticulitis

anti-bacterial agents

Frail Elderly

Colorectal Neoplasms

A concise summary of the evidence regarding treatment of acute diverticulitis with antibiotics. James W. Mold, MD, MPH

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Clinical question: Do antibiotics change clinical outcomes for patients with acute uncomplicated diverticulitis?
Bottom line: For nonseptic immunocompetent patients with acute uncomplicated diverticulitis, antibiotics do not alter early complication or recurrence rates.

Author/s:

Michael R Kolber, Clarence K Wong

Male-Partner Treatment to Prevent Recurrence of Bacterial Vaginosis

Erin Blanchette — Mon, 10 Mar 2025 16:52:26 +0000

Date Added:

March 10, 2025

Journal/Publication:

New England Journal of Medicine

Publisher:

Massachusetts Medical Society

Publication Date:

March 6, 2025

Issue:

Volume:

392

Pages:

947-957

URL:

Male-Partner Treatment to Prevent Recurrence of Bacterial Vaginosis

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1056/NEJMoa2405404

Keywords

vaginosis

bacterial vaginosis

bacterial imbalance

reproductive-aged women

sexual partners

PMID (1):

40043236

MeSH

Anti-Infective Agents

anti-bacterial agents

Treatment of male sexual partners can reduce reoccurrence of bacterial vaginosis in women. James W. Mold, MD, MPH

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Background
Bacterial vaginosis affects one third of reproductive-aged women, and recurrence is common. Evidence of sexual exchange of bacterial vaginosis–associated organisms between partners suggests that male-partner treatment may increase the likelihood of cure.

Methods
This open-label, randomized, controlled trial involved couples in which a woman had bacterial vaginosis and was in a monogamous relationship with a male partner. In the partner-treatment group, the woman received first-line recommended antimicrobial agents and the male partner received oral and topical antimicrobial treatment (metronidazole 400-mg tablets and 2% clindamycin cream applied to penile skin, both twice daily for 7 days). In the control group, the woman received first-line treatment and the male partner received no treatment (standard care). The primary outcome was recurrence of bacterial vaginosis within 12 weeks.

Results
A total of 81 couples were assigned to the partner-treatment group, and 83 couples were assigned to the control group. The trial was stopped by the data and safety monitoring board after 150 couples had completed the 12-week follow-up period because treatment of the woman only was inferior to treatment of both the woman and her male partner. In the modified intention-to-treat population, recurrence occurred in 24 of 69 women (35%) in the partner-treatment group (recurrence rate, 1.6 per person-year; 95% confidence interval [CI], 1.1 to 2.4) and in 43 of 68 women (63%) in the control group (recurrence rate, 4.2 per person-year; 95% CI, 3.2 to 5.7), which corresponded to an absolute risk difference of −2.6 recurrences per person-year (95% CI, −4.0 to −1.2; P<0.001). Adverse events in treated men included nausea, headache, and metallic taste.

Conclusions
The addition of combined oral and topical antimicrobial therapy for male partners to treatment of women for bacterial vaginosis resulted in a lower rate of recurrence of bacterial vaginosis within 12 weeks than standard care. (Funded by the National Health and Medical Research Council of Australia; StepUp Australian New Zealand Clinical Trials Registry number, ACTRN12619000196145.)

Author/s:

Lenka A Vodstrcil, Erica L Plummer, Christopher K Fairley, Jane S Hocking, Matthew G Law, Kathy Petoumenos, Deborah Bateson, Gerald L Murray, Basil Donovan, Eric P F Chow, Marcus Y Chen, John Kaldor, Catriona S Bradshaw, StepUp Team

Evaluation of Suspected Antibiotic Allergies

Erin Blanchette — Mon, 16 Sep 2024 13:43:25 +0000

Date Added:

September 16, 2024

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

September 11, 2024

URL:

Evaluation of Suspected Antibiotic Allergies

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2024.14143

Keywords

Anaphylaxis

antibiotics

antibiotic allergies

PMID (1):

39259567

MeSH

Anaphylaxis

Immune Checkpoint Inhibitors

anti-bacterial agents

Anti-Bacterial Agents / adverse effects

Drug Hypersensitivity

RPR Commentary: A CPG for management of patients with a history of allergy to antibiotics. James W. Mold, MD, MPH

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Antibiotic-associated adverse drug reactions are often mild (eg, nausea or diarrhea) and typically occur 1 to 6 hours after drug exposure. IgE-mediated reactions cause urticaria, angioedema, bronchospasm, or, in severe cases, anaphylaxis. Cell-mediated delayed hypersensitivity can occur over days to weeks, most commonly as benign cutaneous morbilliform eruptions, although more severe manifestations, such as Stevens-Johnson syndrome, may occur.

The guideline provides evidence-based recommendations for evaluating possible drug allergy in nonsteroidal anti-inflammatory drugs, chemotherapies, immune checkpoint inhibitors, biologic agents, and excipients (inactive substances formulated with pharmaceuticals). This JAMA Clinical Guidelines Synopsis focuses on practice recommendations for antibiotic allergy evaluation.

Author/s:

Ruchi Singla, Megan C Elios, Andrew M Davis

Cost-effectiveness of management strategies in recurrent acute otitis media

Aubrey Delammermore — Sun, 11 Dec 2022 06:00:00 +0000

Date Added:

December 11, 2022

Journal/Publication:

The Journal of Pediatrics

Publisher:

Elsevier

Publication Date:

December 3, 2022

URL:

Cost-effectiveness of management strategies in recurrent acute otitis media

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1016/j.jpeds.2022.11.032

Keywords

Recurrent acute otitis media

ear infections

Tympanostomy tube placement

nonsurgical medical management

acute otitis media

PMID (1):

36470464

MeSH

Drug Resistance, Microbial

Treatment Failure

anti-bacterial agents

quality of life

Otitis Media

In children with recurrent acute otitis media, medical management is preferred over tympanostomy tubes from a cost-effectiveness perspective. James W. Mold, MD, MPH

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Objective: To evaluate the cost-effectiveness of tympanostomy tube placement vs. nonsurgical medical management, with the option of tympanostomy tube placement in the event of treatment failure, in children with recurrent acute otitis media (AOM).

Study design: A Markov decision model compared management strategies in children ages 6 to 35 months, using patient-level data from a recently completed, multicenter, randomized clinical trial of tympanostomy tube placement vs. medical management. The model ran over a two-year time horizon using a societal perspective. Probabilities, including risk of AOM symptoms, were derived from prospectively collected patient diaries. Costs and quality-of-life measures were derived from the literature. We performed one-way and probabilistic sensitivity analyses, and secondary analyses in predetermined low- and high-risk subgroups. The primary outcome was incremental cost per quality-adjusted life-year gained.

Results: Tympanostomy tubes cost $989 more per child than medical management. Children managed with tympanostomy tubes gained 0.69 more quality-adjusted life-days than children managed medically, corresponding to $520,855 per quality-adjusted life-year gained. Results were sensitive to the costs of oral antibiotics, missed work, special childcare, the societal cost of antibiotic resistance, and the quality of life associated with AOM. In probabilistic sensitivity analyses, medical management was favored in 66% of model iterations at a willingness-to-pay threshold of $100,000/quality-adjusted life-year. Medical management was preferred in secondary analyses of low- and high-risk subgroups.

Conclusions: For young children with recurrent AOM, the additional cost associated with tympanostomy tube placement outweighs the small improvement in quality of life. Medical management for these children is an economically reasonable strategy.

Keywords: acute otitis media; economic analysis; tympanostomy tubes.

Author/s:

Noorbakhsh, K. A., Liu, H., Kurs-Lasky, M., Smith, K. J., Hoberman, A., Shakh, N.

Acid Suppression and Antibiotics Administered During Infancy Are Associated with Celiac Disease

Aubrey Delammermore — Sat, 22 Oct 2022 05:00:00 +0000

Date Added:

October 22, 2022

Journal/Publication:

The Journal of Pediatrics

Publisher:

Elsevier

Publication Date:

October 17, 2022

URL:

Acid Suppression and Antibiotics Administered During Infancy Are Associated with Celiac Disease

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1016/j.jpeds.2022.10.013

Keywords

Infancy

Retrospective Studies

children

prescriptions

celiac disease

PMID (1):

36265574

MeSH

celiac disease

International Classification of Diseases

anti-bacterial agents

proton pump inhibitors

child

Preschool

Another reason to exercise care when prescribing acid suppression and antibiotics in young children. James W. Mold, MD, MPH

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Objective
To investigate why certain at-risk individuals develop celiac disease, we examined the association of proton pump inhibitors (PPI), histamine-2 receptor antagonist (H2RA), and antibiotic prescriptions in the first six months of life with an early childhood diagnosis of celiac disease.
Study design
A retrospective cohort study was performed using the Military Healthcare System (MHS) database. Children with a birth record from October 1, 2001- September 30, 2013, were identified. Outpatient prescription records were queried for antibiotic, PPI, and H2RA prescriptions in the first 6 months of life. Cox proportional hazards regression was used to calculate the hazard ratio (HR) of developing CD based on medication exposure. ICD-9 codes identified children with an outpatient visit for celiac disease.
Results
968,524 children met inclusion criteria with 1,704 cases of celiac in this group. Median follow up for the cohort was about 4.5 years. PPI’s (HR, 2.23; 95% CI, 1.76-2.83), H2RA’s (HR, 1.94 95% CI, 1.67-2.26) and antibiotics (HR 1.14 95%CI 1.02-1.28) were all associated with an increased hazard of celiac disease.
Conclusion
There is an increased risk of developing celiac disease if antibiotics, PPI’s and H2RA’s are prescribed in the first 6 months of life. Our study highlights modifiable factors such as medication stewardship that may change the childhood risk of CD.

Author/s:

Boechler, M., Susi, A., Hisle-Gorman, E., Rogers, P. L., Nylund, C. M.

Optimal Urine Culture Diagnostic Stewardship Practice-Results from an Expert Modified-Delphi Procedure

Aubrey Delammermore — Thu, 08 Sep 2022 05:00:00 +0000

Date Added:

September 8, 2022

Journal/Publication:

Clinical Infectious Diseases

Publisher:

Infectious Diseases Society of America

Publication Date:

August 1, 2022

Issue:

Volume:

Pages:

382-389

URL:

Optimal Urine Culture Diagnostic Stewardship Practice-Results from an Expert Modified-Delphi Procedure

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1093/cid/ciab987

Keywords

Diagnostic Stewardship

Expert consensus

modified Delphi

urinary tract infections

urine cultures

PMID (1):

34849637

MeSH

Anti-bacterial Agents / therapeutic use

Delphi Technique

anti-bacterial agents

urinalysis

Urinary Tract Infections* / diagnosis

A useful summary of practical recommendations for the appropriate ordering and interpretation of urine cultures. James W. Mold, MD, MPH

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Background: Urine cultures are nonspecific and often lead to misdiagnosis of urinary tract infection and unnecessary antibiotics. Diagnostic stewardship is a set of procedures that modifies test ordering, processing, and reporting in order to optimize diagnosis and downstream treatment. In this study, we aimed to develop expert guidance on best practices for urine culture diagnostic stewardship.

Methods: A RAND-modified Delphi approach with a multidisciplinary expert panel was used to ascertain diagnostic stewardship best practices. Clinical questions to guide recommendations were grouped into three thematic areas (ordering, processing, reporting) in practice settings of emergency department, inpatient, ambulatory, and long-term care. Fifteen experts ranked recommendations on a 9-point Likert scale. Recommendations on which the panel did not reach agreement were discussed during a virtual meeting, then a second round of ranking by email was completed. After secondary review of results and panel discussion, a series of guidance statements was developed.

Results: One hundred and sixty-five questions were reviewed. The panel reaching agreement on 104, leading to 18 overarching guidance statements. The following strategies were recommended to optimize ordering urine cultures: requiring documentation of symptoms, sending alerts to discourage ordering in the absence of symptoms, and cancelling repeat cultures. For urine culture processing, conditional urine cultures and urine white blood cell count as criteria were supported. For urine culture reporting, appropriate practices included nudges to discourage treatment under specific conditions and selective reporting of antibiotics to guide therapy decisions.

Conclusions: These 18 guidance statements can optimize use of urine cultures for better patient outcomes.

Keywords: diagnostic stewardship; expert consensus; modified Delphi; urinary tract infection; urine cultures.

Author/s:

Claeys, K. C., Trautner, B. W., Leekha, S., Coffey, K. C., Crnich, C. J., Diekema, D. J., Fakih, M. G., Goetz, M. B., Gupta, K., Jones, M. M., Leykum, L., Liang, S. Y., Pineles, L., Pleiss, A., Spivak, E. S., Suda, K. J., Taylor, J. M., Rhee, C., Morgan, D. J.

Diagnosis and Management of Acute Left-Sided Colonic Diverticulitis: A Clinical Guideline From the American College of Physicians

Saige Blanchard — Wed, 19 Jan 2022 06:00:00 +0000

Date Added:

January 19, 2022

Journal/Publication:

Annals of Internal Medicine

Publisher:

American College of Physicians

Publication Date:

January 18, 2022

URL:

Diagnosis and Management of Acute Left-Sided Colonic Diverticulitis: A Clinical Guideline From the American College of Physicians

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.7326/M21-2710

Keywords

diagnosis

Clinical Guideline

American College of Physicians

Acute Left-Sided Colonic Diverticulitis

PMID (1):

35038273

MeSH

Adult

Diverticulitis, Colonic

abscess

drainage

tomography, x-ray computed

anti-bacterial agents

hospitalization

Abdominal CT is probably the test of choice when the diagnosis of acute left-sided diagnosis is in doubt and important. We still don’t know whether it is necessary to treat uncomplicated left-sided diverticulitis with antibiotics (probably not), and if so, which antibiotics to choose. James W. Mold, MD, MPH

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Description: The American College of Physicians (ACP) developed this guideline to provide clinical recommendations on the diagnosis and management of acute left-sided colonic diverticulitis in adults. This guideline is based on current best available evidence about benefits and harms, taken in the context of costs and patient values and preferences.

Methods: The ACP Clinical Guidelines Committee (CGC) developed this guideline based on a systematic review on the use of computed tomography (CT) for the diagnosis of acute left-sided colonic diverticulitis and on management via hospitalization, antibiotic use, and interventional percutaneous abscess drainage. The systematic review evaluated outcomes that the CGC rated as critical or important. This guideline was developed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology.

Target audience and patient population: The target audience is all clinicians, and the target patient population is adults with suspected or known acute left-sided colonic diverticulitis.

Author/s:

Qaseem, A., Etxeandia-Ikobaltzeta, I., Lin, J. S., Fitterman, N., Shamliyan, T., Wilt, T. J., Clinical Guidelines Committee of the American College of Physicians

Effect of Amoxicillin Dose and Treatment Duration on the Need for Antibiotic Re-treatment in Children With Community-Acquired Pneumonia: The CAP-IT Randomized Clinical Trial

Bethie Seay — Sun, 07 Nov 2021 05:00:00 +0000

Date Added:

November 7, 2021

Journal/Publication:

JAMA

Publication Date:

November 2, 2021

Issue:

Volume:

326

Pages:

1713-1724

Type:

Clinical Research Results

DOI (1):

10.1001/jama.2021.17843

3 days of standard dose amoxicillin was as effective as 7 days of high-dose amoxicillin for treatment of CAP in children discharged from an ED. In both cases, additional antibiotic treatment was required subsequently in around 12.5% of kids.

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Importance
The optimal dose and duration of oral amoxicillin for children with community-acquired pneumonia (CAP) are unclear.

Objective
To determine whether lower-dose amoxicillin is noninferior to higher dose and whether 3-day treatment is noninferior to 7 days.

Design, Setting, and Participants
Multicenter, randomized, 2 × 2 factorial noninferiority trial enrolling 824 children, aged 6 months and older, with clinically diagnosed CAP, treated with amoxicillin on discharge from emergency departments and inpatient wards of 28 hospitals in the UK and 1 in Ireland between February 2017 and April 2019, with last trial visit on May 21, 2019.

Interventions
Children were randomized 1:1 to receive oral amoxicillin at a lower dose (35-50 mg/kg/d; n = 410) or higher dose (70-90 mg/kg/d; n = 404), for a shorter duration (3 days; n = 413) or a longer duration (7 days; n = 401).

Main Outcomes and Measures
The primary outcome was clinically indicated antibiotic re-treatment for respiratory infection within 28 days after randomization. The noninferiority margin was 8%. Secondary outcomes included severity/duration of 9 parent-reported CAP symptoms, 3 antibiotic-related adverse events, and phenotypic resistance in colonizing Streptococcus pneumoniae isolates.

Results
Of 824 participants randomized into 1 of the 4 groups, 814 received at least 1 dose of trial medication (median [IQR] age, 2.5 years [1.6-2.7]; 421 [52%] males and 393 [48%] females), and the primary outcome was available for 789 (97%). For lower vs higher dose, the primary outcome occurred in 12.6% with lower dose vs 12.4% with higher dose (difference, 0.2% [1-sided 95% CI –∞ to 4.0%]), and in 12.5% with 3-day treatment vs 12.5% with 7-day treatment (difference, 0.1% [1-sided 95% CI –∞ to 3.9]). Both groups demonstrated noninferiority with no significant interaction between dose and duration (P = .63). Of the 14 prespecified secondary end points, the only significant differences were 3-day vs 7-day treatment for cough duration (median 12 days vs 10 days; hazard ratio [HR], 1.2 [95% CI, 1.0 to 1.4]; P = .04) and sleep disturbed by cough (median, 4 days vs 4 days; HR, 1.2 [95% CI, 1.0 to 1.4]; P = .03). Among the subgroup of children with severe CAP, the primary end point occurred in 17.3% of lower-dose recipients vs 13.5% of higher-dose recipients (difference, 3.8% [1-sided 95% CI, –∞ to10%]; P value for interaction = .18) and in 16.0% with 3-day treatment vs 14.8% with 7-day treatment (difference, 1.2% [1-sided 95% CI, –∞ to 7.4%]; P value for interaction = .73).

Conclusions and Relevance
Among children with CAP discharged from an emergency department or hospital ward (within 48 hours), lower-dose outpatient oral amoxicillin was noninferior to higher dose, and 3-day duration was noninferior to 7 days, with regard to need for antibiotic re-treatment. However, disease severity, treatment setting, prior antibiotics received, and acceptability of the noninferiority margin require consideration when interpreting the findings.

Trial Registration
ISRCTN Identifier: ISRCTN76888927

Author/s:

Bielicki, J. A., Stöhr, W., Barratt, S., Dunn, D., Naufal, N., Roland, D., Sturgeon, K., Finn, A., Rodriguez-Ruiz, J. P., Malhotra-Kumar, S., Powell, C., Faust, S. N., Alcock, A. E., Hall, D., Robinson, G., Hawcutt, D. B., Lyttle, M. D., Gibb, D. M., Sharland, M.

Efficacy and Safety of Nonantibiotic Outpatient Treatment in Mild Acute Diverticulitis (DINAMO-study): A Multicentre, Randomised, Open-label, Noninferiority Trial

Bethie Seay — Tue, 02 Nov 2021 05:00:00 +0000

Date Added:

November 2, 2021

Journal/Publication:

Annals of Surgery

Publication Date:

November 1, 2021

Issue:

Volume:

274

Pages:

e435-e442

Type:

Clinical Research Results

DOI (1):

10.1097/SLA.0000000000005031

PMID (1):

34183510

MeSH

Humans

Amoxicillin-potassium clavulanate combination

anti-bacterial agents

prospective studies

outpatients

Anti-Inflammatory Agents

Ambulatory Care

hospitalization

pain management

Emergency Service, hospital

hospitals

tomography

pain

Apparently it isn’t necessary to treat patients with mild diverticulitis with antibiotics.

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Objective:
Mild AD can be treated safely and effectively on an outpatient basis without antibiotics.

Summary of Background Data:
In recent years, it has shown no benefit of antibiotics in the treatment of uncomplicated AD in hospitalized patients. Also, outpatient treatment of uncomplicated AD has been shown to be safe and effective.

Methods:
A Prospective, multicentre, open-label, noninferiority, randomized controlled trial, in 15 hospitals of patients consulting the emergency department with symptoms compatible with AD.

The Participants were patients with mild AD diagnosed by Computed Tomography meeting the inclusion criteria were randomly assigned to control arm (ATB-Group): classical treatment (875/125 mg/8 h amoxicillin/clavulanic acid apart from anti-inflammatory and symptomatic treatment) or experimental arm (Non-ATB-Group): experimental treatment (antiinflammatory and symptomatic treatment). Clinical controls were performed at 2, 7, 30, and 90 days.

The primary endpoint was hospital admission. Secondary endpoints included number of emergency department revisits, pain control and emergency surgery in the different arms.

Results:
Four hundred and eighty patients meeting the inclusion criteria were randomly assigned to Non-ATB-Group (n = 242) or ATB-Group (n = 238). Hospitalization rates were: ATB-Group 14/238 (5.8%) and Non-ATB-Group 8/242 (3.3%) [mean difference 2.58%, 95% confidence interval (CI) 6.32 to -1.17], confirming noninferiority margin. Revisits: ATB-Group 16/238 (6.7%) and Non-ATB-Group 17/242 (7%) (mean difference -0.3, 95% CI 4.22 to -4.83). Poor pain control at 2 days follow up: ATB-Group 13/230 (5.7%), Non-ATB-Group 5/221 (2.3%) (mean difference 3.39, 95% CI 6.96 to -0.18).

Conclusions:
Nonantibiotic outpatient treatment of mild AD is safe and effective and is not inferior to current standard treatment.

Trial registration:
ClinicalTrials.gov (NCT02785549); EU Clinical Trials Register (2016-001596-75)

Author/s:

Mora-López, L., Ruiz-Edo, N., Estrada-Ferrer, O., Piñana-Campón, M. L., Labró-Ciurans, M., Escuder-Perez, J., Sales-Mallafré, R., Rebasa-Cladera, P., Navarro-Soto, S., Serra-Aracil, X.

Role of biofilm in catheter-associated urinary tract infection

Bethie Seay — Thu, 23 Sep 2021 05:00:00 +0000

Date Added:

September 23, 2021

Journal/Publication:

American Journal of Infection Control

Publication Date:

May 19, 2004

Issue:

Volume:

Pages:

177-183

Type:

Meta-analyses, Reviews, and Guidelines

DOI (1):

10.1016/j.ajic.2003.08.005

MeSH

Urinary Catheters

Bacteriuria

Catheters, Indwelling

Reinfection

Urinary Catheterization

urinary tract infections

Biofilms

anti-bacterial agents

Biological Products

A classic article on urinary tract infections in patients with indwelling catheters.

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The predominant form of life for the majority of microorganisms in any hydrated biologic system is a cooperative community termed a “biofilm.” A biofilm on an indwelling urinary catheter consists of adherent microorganisms, their extracellular products, and host components deposited on the catheter. The biofilm mode of life conveys a survival advantage to the microorganisms associated with it and, thus, biofilm on urinary catheters results in persistent infections that are resistant to antimicrobial therapy. Because chronic catheterization leads almost inevitably to bacteriuria, routine treatment of asymptomatic bacteriuria in persons who are catheterized is not recommended. When symptoms of a urinary tract infection develop in a person who is catheterized, changing the catheter before collecting urine improves the accuracy of urine culture results. Changing the catheter may also improve the response to antibiotic therapy by removing the biofilm that probably contains the infecting organisms and that can serve as a nidus for reinfection. Currently, no proven effective strategies exist for prevention of catheter-associated urinary tract infection in persons who are chronically catheterized.

Author/s:

Trautner, B. W., Darouiche, R. O.

Effect of 7 vs 14 Days of Antibiotic Therapy on Resolution of Symptoms Among Afebrile Men With Urinary Tract Infection: A Randomized Clinical Trial

Bethie Seay — Thu, 23 Sep 2021 05:00:00 +0000

Date Added:

September 23, 2021

Journal/Publication:

JAMA

Publication Date:

July 27, 2021

Issue:

Volume:

326

Pages:

324-331

Type:

Clinical Research Results

DOI (1):

doi:10.1001/jama.2021.9899

MeSH

Humans

male

trimethoprim, sulfamethoxazole drug combination

Ciprofloxacin

anti-bacterial agents

urinary tract infections

Communicable Diseases

Treatment Adherence and Compliance

This RCT found that 7 days of antibiotics were sufficient for treatment of symptomatic UTI in afebrile men.

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Importance Determination of optimal treatment durations for common infectious diseases is an important strategy to preserve antibiotic effectiveness.

Objective To determine whether 7 days of treatment is noninferior to 14 days when using ciprofloxacin or trimethoprim/sulfamethoxazole to treat urinary tract infection (UTI) in afebrile men.

Design, Setting, and Participants Randomized, double-blind, placebo-controlled noninferiority trial of afebrile men with presumed symptomatic UTI treated with ciprofloxacin or trimethoprim/sulfamethoxazole at 2 US Veterans Affairs medical centers (enrollment, April 2014 through December 2019; final follow-up, January 28, 2020). Of 1058 eligible men, 272 were randomized.

Interventions Participants continued the antibiotic prescribed by their treating clinician for 7 days of treatment and were randomized to receive continued antibiotic therapy (n = 136) or placebo (n = 136) for days 8 to 14 of treatment.

Main Outcomes and Measures The prespecified primary outcome was resolution of UTI symptoms by 14 days after completion of active antibiotic treatment. A noninferiority margin of 10% was selected. The as-treated population (participants who took ≥26 of 28 doses and missed no more than 2 consecutive doses) was used for the primary analysis, and a secondary analysis included all patients as randomized, regardless of treatment adherence. Secondary outcomes included recurrence of UTI symptoms and/or adverse events within 28 days of stopping study medication.

Results Among 272 patients (median [interquartile range] age, 69 [62-73] years) who were randomized, 100% completed the trial and 254 (93.4%) were included in the primary as-treated analysis. Symptom resolution occurred in 122/131 (93.1%) participants in the 7-day group vs 111/123 (90.2%) in the 14-day group (difference, 2.9% [1-sided 97.5% CI, –5.2% to ∞]), meeting the noninferiority criterion. In the secondary as-randomized analysis, symptom resolution occurred in 125/136 (91.9%) participants in the 7-day group vs 123/136 (90.4%) in the 14-day group (difference, 1.5% [1-sided 97.5% CI, –5.8% to ∞]) Recurrence of UTI symptoms occurred in 13/131 (9.9%) participants in the 7-day group vs 15/123 (12.9%) in the 14-day group (difference, –3.0% [95% CI, –10.8% to 6.2%]; P = .70). Adverse events occurred in 28/136 (20.6%) participants in the 7-day group vs 33/136 (24.3%) in the 14-day group.

Conclusions and Relevance Among afebrile men with suspected UTI, treatment with ciprofloxacin or trimethoprim/sulfamethoxazole for 7 days was noninferior to 14 days of treatment with regard to resolution of UTI symptoms by 14 days after antibiotic therapy. The findings support the use of a 7-day course of ciprofloxacin or trimethoprim/sulfamethoxazole as an alternative to a 14-day course for treatment of afebrile men with UTI.

Trial Registration ClinicalTrials.gov identifier: NCT01994538

Author/s:

Drekonja, D. M., Trautner, B., Amundson, C.

Appropriate Use of Short-Course Antibiotics in Common Infections: Best Practice Advice From the American College of Physicians

Devin Evans — Wed, 07 Apr 2021 05:00:00 +0000

Date Added:

April 7, 2021

Journal/Publication:

Annals of Internal Medicine

Publication Date:

April 6, 2021

URL:

Appropriate Use of Short-Course Antibiotics in Common Infections: Best Practice Advice From the American College of Physicians

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.7326/M20-7355

Keywords

pneumonia

Cellulitis

bacterial infections

Anti-Bacterial Agents

Best practive

PMID (1):

33819054

MeSH

Cellulitis

Bacterial Infections

bronchitis

Drug Resistance, Microbial

pneumonia

anti-bacterial agents

Advice from American College of Physicians regarding how long to treat adult patients with antibiotics for common infections. James W. Mold, MD, MPH

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Description: Antimicrobial overuse is a major health care issue that contributes to antibiotic resistance. Such overuse includes unnecessarily long durations of antibiotic therapy in patients with common bacterial infections, such as acute bronchitis with chronic obstructive pulmonary disease (COPD) exacerbation, community-acquired pneumonia (CAP), urinary tract infections (UTIs), and cellulitis. This article describes best practices for prescribing appropriate and short-duration antibiotic therapy for patients presenting with these infections.

Methods: The authors conducted a narrative literature review of published clinical guidelines, systematic reviews, and individual studies that addressed bronchitis with COPD exacerbations, CAP, UTIs, and cellulitis. This article is based on the best available evidence but was not a formal systematic review. Guidance was prioritized to the highest available level of synthesized evidence.

Best practice advice 1: Clinicians should limit antibiotic treatment duration to 5 days when managing patients with COPD exacerbations and acute uncomplicated bronchitis who have clinical signs of a bacterial infection (presence of increased sputum purulence in addition to increased dyspnea, and/or increased sputum volume).

Best practice advice 2: Clinicians should prescribe antibiotics for community-acquired pneumonia for a minimum of 5 days. Extension of therapy after 5 days of antibiotics should be guided by validated measures of clinical stability, which include resolution of vital sign abnormalities, ability to eat, and normal mentation.

Best practice advice 3: In women with uncomplicated bacterial cystitis, clinicians should prescribe short-course antibiotics with either nitrofurantoin for 5 days, trimethoprim-sulfamethoxazole (TMP-SMZ) for 3 days, or fosfomycin as a single dose. In men and women with uncomplicated pyelonephritis, clinicians should prescribe short-course therapy either with fluoroquinolones (5 to 7 days) or TMP-SMZ (14 days) based on antibiotic susceptibility.

Best practice advice 4: In patients with nonpurulent cellulitis, clinicians should use a 5- to 6-day course of antibiotics active against streptococci, particularly for patients able to self-monitor and who have close follow-up with primary care.

Author/s:

Lee, Rachael A., Centor, Robert M., Humphrey, Linda L., Jokela, Janet A., Andrews, Rebecca, Qaseem, Amir

Antibiotic Choice and Clinical Outcomes in Ambulatory Children with Community-Acquired Pneumonia

Devin Evans — Mon, 12 Oct 2020 05:00:00 +0000

Date Added:

October 12, 2020

Journal/Publication:

The Journal of Pediatrics

Publication Date:

October 9, 2020

URL:

Antibiotic Choice and Clinical Outcomes in Ambulatory Children with Community-Acquired Pneumonia

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

https://doi.org/10.1016/j.jpeds.2020.10.005

Keywords

antibiotic stewardship

outcomes research

macrolides

complex chronic condition

MeSH

macrolides

anti-bacterial agents

pneumonia

Based upon this met-analysis and current guidelines, macrolide antibiotics alone (without the addition of narrow- or broad-spectrum antibiotics) are the best treatment for community-acquired pneumonia in children. James W. Mold, MD, MPH

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Objectives

To describe antibiotic prescribing patterns in ambulatory children with community acquired pneumonia, and to assess the relationship between antibiotic selection and clinical outcomes.

Study design

This was a retrospective cohort study of ambulatory Medicaid-enrolled children 0-18 years of age diagnosed with CAP from 2010-2016. The exposure was antibiotic class: narrow-spectrum (aminopenicillins), broad-spectrum (amoxicillin/clavulanate and cephalosporins), macrolide monotherapy, macrolides with narrow-spectrum antibiotics, or macrolides with broad-spectrum antibiotics. The associations between antibiotic selection and the outcomes of subsequent hospitalization and development of severe pneumonia (chest drainage procedure, intensive care admission, mechanical ventilation) were assessed, controlling for measures of illness severity.

Results

Among 252,177 outpatient pneumonia visits, macrolide monotherapy was used in 43.2%, narrow-spectrum antibiotics in 26.1%, and broad-spectrum antibiotics in 24.7%. A total of 1488 children (0.59%) were subsequently hospitalized and 117 (0.05%) developed severe pneumonia. Compared with children receiving narrow-spectrum antibiotics, the odds of subsequent hospitalization were higher in children receiving broad-spectrum antibiotics (aOR=1.34 [95%CI 1.17-1.52]) and lower in children receiving macrolide monotherapy (aOR=0.64 [95%CI 0.55-0.73]) and macrolides with narrow-spectrum antibiotics (aOR=0.62 [95%CI 0.39-0.97]). Children receiving macrolide monotherapy had lower odds of developing severe pneumonia than children receiving narrow-spectrum antibiotics (aOR=0.56, 95%CI 0.33-0.93). However, the absolute risk difference was <0.5% for all analyses.

Conclusions

Macrolides are the most commonly prescribed antibiotic for ambulatory children with CAP. Subsequent hospitalization and severe pneumonia are rare. Future efforts should focus on reducing broad-spectrum and macrolide antibiotic prescribing.

Author/s:

Lipsett, Susan C., Hall, Matthew, Ambroggio, Lilliam, Hersh, Adam L., Shah, Samir S., Brogan, Thomas V., Gerber, Jeffrey S., Williams, Derek J., Grijalva, Carlos G., Blaschke, Anne J., Neuman, Mark I.

A Randomized Trial Comparing Antibiotics with Appendectomy for Appendicitis

Devin Evans — Thu, 10 Sep 2020 05:00:00 +0000

Date Added:

October 9, 2020

Journal/Publication:

The New England Journal of Medicine

Publication Date:

October 5, 2020

URL:

A Randomized Trial Comparing Antibiotics with Appendectomy for Appendicitis

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1056/NEJMoa2014320

Keywords

PMID (1):

33017106

MeSH

Appendectomy

Appendicitis

anti-bacterial agents

Laparoscopy

This looks like the definitive short-term RCT on antibiotics vs. appendectomy for appendicitis. Antibiotics were “non-inferior.” However, 3/10 patients required appendectomy within 90 days. James W. Mold, MD, MPH

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BACKGROUND

Antibiotic therapy has been proposed as an alternative to surgery for the treatment of appendicitis.

METHODS

We conducted a pragmatic, nonblinded, noninferiority, randomized trial comparing antibiotic therapy (10-day course) with appendectomy in patients with appendicitis at 25 U.S. centers. The primary outcome was 30-day health status, as assessed with the European Quality of Life–5 Dimensions (EQ-5D) questionnaire (scores range from 0 to 1, with higher scores indicating better health status; noninferiority margin, 0.05 points). Secondary outcomes included appendectomy in the antibiotics group and complications through 90 days; analyses were prespecified in subgroups defined according to the presence or absence of an appendicolith.

RESULTS

In total, 1552 adults (414 with an appendicolith) underwent randomization; 776 were assigned to receive antibiotics (47% of whom were not hospitalized for the index treatment) and 776 to undergo appendectomy (96% of whom underwent a laparoscopic procedure). Antibiotics were noninferior to appendectomy on the basis of 30-day EQ-5D scores (mean difference, 0.01 points; 95% confidence interval [CI], −0.001 to 0.03). In the antibiotics group, 29% had undergone appendectomy by 90 days, including 41% of those with an appendicolith and 25% of those without an appendicolith. Complications were more common in the antibiotics group than in the appendectomy group (8.1 vs. 3.5 per 100 participants; rate ratio, 2.28; 95% CI, 1.30 to 3.98); the higher rate in the antibiotics group could be attributed to those with an appendicolith (20.2 vs. 3.6 per 100 participants; rate ratio, 5.69; 95% CI, 2.11 to 15.38) and not to those without an appendicolith (3.7 vs. 3.5 per 100 participants; rate ratio, 1.05; 95% CI, 0.45 to 2.43). The rate of serious adverse events was 4.0 per 100 participants in the antibiotics group and 3.0 per 100 participants in the appendectomy group (rate ratio, 1.29; 95% CI, 0.67 to 2.50).

CONCLUSIONS

For the treatment of appendicitis, antibiotics were noninferior to appendectomy on the basis of results of a standard health-status measure. In the antibiotics group, nearly 3 in 10 participants had undergone appendectomy by 90 days. Participants with an appendicolith were at a higher risk for appendectomy and for complications than those without an appendicolith.

Author/s:

CODA Collaborative, Flum, David R., Davidson, Giana H., Monsell, Sarah E., Shapiro, Nathan I., Odom, Stephen R., Sanchez, Sabrina E., Drake, F.T., Fischkoff, Katherine, Johnson, Jeffrey, Patton, Joe H., Evans, Heather, Cuschieri, Joseph, Sabbatini, Amber K., Faine, Brett A., Skeete, Dionne A., Liang, Mike K., Sohn, Vance, McGrane, Karen", Matthew E., Chung, Bruce, Carter, Damien W., Ayoung-Chee, Patricia, Chiang, William, Rushing, Amy, Steinberg, Steven, Foster, Careen S., Schaetzel, Shaina M., Price, Thea P., Mandell, Kathrine A., Ferrigno, Lisa, Salzberg, Matthew, DeUgarte, Daniel A., Kaji, Amy H., Moran, Gregory J., Saltzman, Darin, Alam, Hasan B., Park, Pauline K., Kao, Lilian S., Thompson, Callie M., Self, Wesley H., Yu, Julianna T., Wiebusch, Abigail, Winchell, Robert J., Clark, Sunday, Krishnadasan, Anusha, Fannon, Erin, Lavallee, Danielle C., Comstock, Bryan A., Bizzell, Bonnie, Heagerty, Patrick J., Kessler, Larry G., Talan, David A.