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To identify factors associated with antimicrobial resistance, data were analyzed from 27,828 isolates of Streptococcus pneumoniae submitted to the Tracking Resistance in the United States Today (TRUST) surveillance program during 4 consecutive respiratory seasons. From the 1998-1999 season to the 2001-2002 season, the prevalence of azithromycin resistance increased by 4.8% to 27.5%, the prevalence of penicillin resistance increased by 3.7% to 18.4%, the prevalence of ceftriaxone resistance increased by 0.5% to 1.7%, and the prevalence of levofloxacin resistance increased by 0.3% to 0.9%. Isolates recovered from patients <18 years of age and lower respiratory tract specimens had elevated rates of penicillin, azithromycin, and trimethoprim-sulfamethoxazole resistance (P<.00001); penicillin resistance correlated with coresistance to trimethoprim-sulfamethoxazole (87.3%), azithromycin (76.3%), ceftriaxone (9.1%), and levofloxacin (1.3%) (P<.00001). Only 62 (0.2%) of 27,828 isolates were concurrently resistant to penicillin and levofloxacin. Minimum inhibitory concentrations (MICs) of penicillin correlated strongly with MICs of ceftriaxone (R2=0.90), trimethoprim-sulfamethoxazole (R2=0.53), and azithromycin (R2=0.41). Patient age, specimen source, and penicillin resistance were factors associated with antimicrobial resistance, particularly for nonfluoroquinolone antimicrobial agents.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12684907&dopt=Abstract
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Arch Intern Med. 2003 Apr 14;163(7):797-802.
Antibiotic therapy for ambulatory patients with community-acquired pneumonia in an emergency department setting.
Malcolm C, Marrie TJ.
Department of Medicine University of Alberta, Edmonton, Canada.
BACKGROUND: Little attention has been paid to the factors that influence choice of antibiotic therapy for patients with community-acquired pneumonia who are treated on an ambulatory basis in an emergency department setting. METHODS: Prospective observational study of all patients who presented to the 6 hospitals for adults in the Capital Health Authority, Edmonton, Alberta, with community-acquired pneumonia (as diagnosed by the emergency department physician) from November 15, 2000, through April 30, 2001, and who were treated on an ambulatory basis. RESULTS: The study population consisted of 768 patients, mean age 51 years. The antibiotics most commonly prescribed were azithromycin (36%), levofloxacin (32%), and clarithromycin (17%). Site of care differences were evident in the frequency of clarithromycin (P<.001) and levofloxacin (P =.01) prescription. Multiple logistic regression analysis showed that older age, presence of chronic obstructive pulmonary disease, antibiotic therapy at the time of presentation, and site of care were factors independently predictive of levofloxacin use (P<.05 for all factors). Levofloxacin prescription did not follow our indications for its use in 51% of the 245 patients who were treated with this antibiotic. The failure rate (defined as admission to the hospital within 3 weeks of emergency department visit) was low (2.2%). CONCLUSIONS: Patient factors and site of care influence the choice of antibiotic therapy in an ambulatory setting, and 50% of levofloxacin use was inappropriate according to our definition.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12695270&dopt=Abstract
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Int J Clin Pharmacol Ther. 1999 Jul;37(7):361-4.
Determination of azithromycin in gastric biopsy samples.
Krichhoff RM, Laufen H, Schacke G, Kirchhoff G, Gallo E.
Institut fur Begutachtungs-, Arbeits- und Sozialmedizin IBAS, Munchen, Germany.
OBJECTIVES: To measure the concentration of azithromycin in gastric biopsy samples of gastritis patients undergoing Heliobacter pylori eradication treatment with azithromycin as one antibiotic constituent of the medication. PATIENTS: Seven male outpatients, non-smokers, non-alcoholics, aged 25-40 years (mean 32 years), suffering from gastritis with involvement of H. pylori. METHODS: The patients received a 5-day treatment with azithromycin (1 x 500 mg on day 1 and 1 x 250 mg on days 2-5), 40 mg pantoprazole once daily and 2 x 400 mg metronidazole once daily. Samples of gastric tissue were obtained from 5 patients and of gastric juice from 2 patients, at the occasion of gastroscopic interventions. The gastric samples were subject to analysis of azithromycin, using a highly sensitive and specific HPLC method with electrochemical detection. RESULTS: The median concentrations of azithromycin in gastric tissue amounted to 7.5 microg/g on day 2 and to 9.7 microg/g on day 5 of the treatment. Four days after the end of treatment, median concentrations were still at 3.9 microg/g. In all tissue samples, azithromycin concentrations were well above the MIC for H. pylori (0.25 microg/ml). The well-known tissue affinity of azithromycin was underlined by the lack of detectable levels in gastricjuice. CONCLUSION: The high concentrations of azithromycin observed in gastric tissue of patients with gastritis on a 5-day dosage regimen point to a favorable pharmacokinetic basis for a role of azithromycin as a component of the eradication therapy of Heliobacter pylori.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10442511&dopt=Abstract
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