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Arch Bronconeumol. 2000 Jun;36(6):326-33.
[Infection and antibiotic use in COPD in primary care]

[Article in Spanish]

Ruiz Manzano J, Fernandez-Martinez P, Morera J, Prats MS, Rosell A, Andreo F.

Servicio de Neumologia, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona.

OBJECTIVES: The aim of this study was to know the opinion of Spanish primary care physicians regarding various aspects of diagnosis and treatment of chronic obstructive pulmonary disease (COPD), particularly with regard to bacterial infection in COPD. METHODS: A 20-item questionnaire about diagnostic and therapeutic aspects of COPD was distributed to 15,000 primary care physicians. The sample was stratified to be representative of Spanish geographic areas. Participation was voluntary and no incentive was provided; assurance of confidentiality of information given. A specially designed program was used for data analysis. RESULTS: Valid responses were obtained from 1,852 physicians (12.3%), 86% of whom were practicing in public clinics. Increased coughing with mucopurulent expectoration was considered the most important sign leading to suspicion of respiratory infection according to 70% of the respondents. The germs that primary care physicians thought responsible for infection in most cases were H. influenzae (83%), S. pneumoniae (79%), Pseudomonas (65%) and M. catarrhalis (61%). Antimicrobial spectrum was considered the main criterion for choosing an antibiotic (by 91%). The most frequently prescribed antibiotics were by order of preference: amoxicillin-clavulanic (50%), macrolides (24%), second and third generation cephalosporins (15%) and others. Mean duration of treatment was seen to be 10 days in nearly all cases. CONCLUSIONS: The primary care physicians surveyed were shown to have a good level of understanding of bacterial infection and its treatment in COPD.

online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10932342&dopt=Abstract




J Clin Periodontol. 2001 May;28(5):411-8.
The effect of systemic antibiotics in the treatment of patients with recurrent periodontitis.

Serino G, Rosling B, Ramberg P, Hellstrom MK, Socransky SS, Lindhe J.

Department of Periodontology, Institute of Odontology, Goteborg University, Sweden.

BACKGROUND: Subjects with periodontal disease exist who either (i) respond poorly to initial mechanical therapy ("refractory" periodontitis) or (ii) fail to adopt adequate self-performed plaque control techniques and hence develop recurrent disease ("recurrent" periodontitis) at multiple sites during the supportive treatment phase (SPT). Various systemic antibiotic regimens have been tried as adjuncts to the mechanical (re-) treatment of such "difficult to treat"-patients. While most studies indicated a positive outcome of the adjunctive therapy, some clinical investigators reported that this additional measure provided little or no benefit. AIM: The aim of the present investigation was to study the more long term effect of adjunctive antibiotic therapy in the re-treatment of patients with a well defined history of recurrent periodontitis. MATERIAL AND METHODS: 17 subjects with recurrent advanced periodontal disease were, following a baseline examination, subjected to non-surgical therapy including the use of systemic antibiotics (amoxicillin and metronidazole). They were placed in a careful SPT program and re-examined after 1, 3 and 5 years. The examinations included both clinical and microbiological assessments. RESULTS: It was demonstrated that in subjects with advanced and recurrent periodontitis, re-treatment including (i) comprehensive scaling and root planing (SRP), (ii) systemic administration of antibiotics and (iii) meticulous supragingival plaque control by both mechanical and chemical means established periodontal conditions that in the short term (3 years) and in the majority of subjects could be properly maintained by traditional SPT measures. Between 3 and 5 years, however, only 5 of the 17 subjects exhibited stable periodontal attachment levels. CONCLUSIONS: Some deep pockets and furcations were most likely inadequately instrumented during the active treatment phase. Microorganisms residing in biofilms left in such locations were probably not sufficiently affected by the 2 weeks of adjunctive antibiotic therapy. It is suggested that removal of certain subgingival deposits, therefore, may require surgical intervention.

online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11350503&dopt=Abstract




Antimicrob Agents Chemother. 2000 Dec;44(12):3368-73.
Characterization of an In vitro-selected amoxicillin-resistant strain of Helicobacter pylori.

DeLoney CR, Schiller NL.

Division of Biomedical Sciences, University of California, Riverside, Riverside, California 92521, USA.

An amoxicillin-resistant (Amox(r)) strain of Helicobacter pylori was selected for by culturing an amoxicillin-sensitive (Amox(s)) strain in increasingly higher concentrations of amoxicillin, resulting in a 133-fold increase in MIC, from 0.03 to 0.06 microg/ml to 4 to 8 microg/ml. This resistance was stable upon freezing for at least 6 months and conferred cross-resistance to seven other beta-lactam antibiotics. beta-Lactamase activity was not detected in this Amox(r) strain; however, analysis of the penicillin-binding protein (PBP) profiles generated from isolated bacterial membranes of the Amox(s) parental strain and the Amox(r) strain revealed a significant decrease in labeling of PBP 1 by biotinylated amoxicillin (bio-Amox) in the Amox(r) strain. Comparative binding studies of PBP 1 for several beta-lactams demonstrated that PBP 1 in the Amox(r) strain had decreased affinity for mezlocillin but not significantly decreased affinity for penicillin G. In addition, PBP profiles prepared from whole bacterial cells showed decreased labeling of PBP 1 and PBP 2 in the Amox(r) strain at all bio-Amox concentrations tested, suggesting a diffusional barrier to bio-Amox or a possible antibiotic efflux mechanism. Uptake analysis of (14)C-labeled penicillin G showed a significant decrease in uptake of the labeled antibiotic by the Amox(r) strain compared to the Amox(s) strain, which was not affected by pretreatment with carbonyl cyanide m-chlorophenylhydrazone, eliminating the possibility of an efflux mechanism in the resistant strain. These results demonstrate that alterations in PBP 1 and in the uptake of beta-lactam antibiotics in H. pylori can be selected for by prolonged exposure to amoxicillin, resulting in increased resistance to this antibiotic.

online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11083642&dopt=Abstract












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