Shiloh
Editor, Senior Moderator
Source: https://www.cidrap.umn.edu/news-perspective/2020/06/stewardship-resistance-scan-jun-09-2020
Stewardship / Resistance Scan for Jun 09, 2020
Azithromycin-resistant strep in Burkina Faso; Antibiotic overprescribing for sinusitis
Filed Under:
Antimicrobial Stewardship
Mass distribution of azithromycin linked to resistant strep in Africa
The addition of the antibiotic azithromycin to seasonal malaria chemoprevention (SMC) was associated with an increase in azithromycin-resistant serotypes of Streptococcus pneumoniae in children in Burkina Faso, researchers reported yesterday in The American Journal of Tropical Medicine and Hygiene.
To better understand whether mass distribution of azithromycin was associated with the emergence of resistance in S pneumoniae, the researchers collected and analyzed nasopharyngeal samples from 400 children enrolled in a large trial investigating whether adding the antibiotic to SMC had an effect on child mortality and morbidity. In the trial, children 3 to 59 months received four courses a year of SMC and azithromycin or a placebo over a period of 3 years (2014 through 2016). The researchers analyzed the nasopharyngeal samples for S pneumoniae carriage before and after treatments in each year of the study, and conducted antibiotic susceptibility tests and serotyping on S pneumoniae isolates.
Of the 1,468 S pneumoniae isolates obtained, 698 randomly selected isolates were tested and serotyped. A total of 56 serotypes were detected by polymerase chain reaction, but serotypes 6A, 19A, 19F, 23F, and 35B persisted in all the pre- and post-treatment surveys, both in children who received azithromycin and in those who received placebo. An increase in azithromycin-resistant strains of S pneumoniae was observed in all these serotypes following exposure to the antibiotic.
"In conclusion, this study has shown that the increase in the resistance of nasopharyngeal isolates of S. pneumoniae noted following MDA [mass drug administration] with AZ [azithromycin] used in association with SMC was probably not associated with the emergence of a single resistant clone but due to the emergence of resistance in pneumococci belonging to several different serotypes," the authors of the study wrote.
Jun 8 Am J Trop Med Hygiene abstract
Study finds high rate of antibiotic prescribing for sinusitis
An analysis of antibiotic prescribing for acute sinusitis found that half of the patients visiting an integrated health system in Chicago for the disease met the criteria for antibiotics, but the actual prescribing rate was much higher, researchers from Northwestern University Feinberg School of Medicine reported yesterday in Clinical Infectious Diseases.
For the study, the researchers analyzed data on adult visits to Northwestern Medicine for acute sinusitis in 2017 and selected 500 distinct visits for manual chart review, looking for which patients received an antibiotic. To meet the criteria for antibiotics, patients had to have persistent, severe, or worsening symptoms—the clinical criteria defined by the Infectious Diseases Society of America for treatment of bacterial sinusitis.
Of the 500 visits, 425 met all the inclusion criteria, and 214 patients (50%) met the criteria for antibiotic prescribing, with the most common symptom criteria being persistent symptoms. Clinicians prescribed antibiotics for 205 (96%) of these patients, but they also prescribed antibiotics for 193 of the 211 patients (92%) who did not meet the criteria for antibiotics.
The most commonly prescribed antibiotics were amoxicillin-clavulanate (46% of prescriptions), azithromycin (20%), amoxicillin (12%), and cefdinir (6%). The median duration of treatment was 10 days. Guidelines recommend amoxicillin-clavulanate and amoxicillin as first-line antibiotics for acute sinusitis, and specifically recommend against macrolides and third-generation cephalosporins.
The authors of the study also noted that, because their assessment of guideline-concordant antibiotic-appropriateness was very forgiving, the proportion of patients who met the criteria "likely represents the upper bound of appropriateness."
"Ambulatory stewardship measures have generally addressed only antibiotic-inappropriate diagnoses, such as non-specific upper respiratory tract infections, or the requirement for streptococcal testing with a diagnosis of pharyngitis," the authors wrote. "To meaningfully reduce inappropriate antibiotic prescribing, future stewardship efforts should address the diagnosis of and appropriateness of antibiotic prescribing for sinusitis."
Jun 8 Clin Infect Dis abstract
Stewardship / Resistance Scan for Jun 09, 2020
Azithromycin-resistant strep in Burkina Faso; Antibiotic overprescribing for sinusitis
Filed Under:
Antimicrobial Stewardship
Mass distribution of azithromycin linked to resistant strep in Africa
The addition of the antibiotic azithromycin to seasonal malaria chemoprevention (SMC) was associated with an increase in azithromycin-resistant serotypes of Streptococcus pneumoniae in children in Burkina Faso, researchers reported yesterday in The American Journal of Tropical Medicine and Hygiene.
To better understand whether mass distribution of azithromycin was associated with the emergence of resistance in S pneumoniae, the researchers collected and analyzed nasopharyngeal samples from 400 children enrolled in a large trial investigating whether adding the antibiotic to SMC had an effect on child mortality and morbidity. In the trial, children 3 to 59 months received four courses a year of SMC and azithromycin or a placebo over a period of 3 years (2014 through 2016). The researchers analyzed the nasopharyngeal samples for S pneumoniae carriage before and after treatments in each year of the study, and conducted antibiotic susceptibility tests and serotyping on S pneumoniae isolates.
Of the 1,468 S pneumoniae isolates obtained, 698 randomly selected isolates were tested and serotyped. A total of 56 serotypes were detected by polymerase chain reaction, but serotypes 6A, 19A, 19F, 23F, and 35B persisted in all the pre- and post-treatment surveys, both in children who received azithromycin and in those who received placebo. An increase in azithromycin-resistant strains of S pneumoniae was observed in all these serotypes following exposure to the antibiotic.
"In conclusion, this study has shown that the increase in the resistance of nasopharyngeal isolates of S. pneumoniae noted following MDA [mass drug administration] with AZ [azithromycin] used in association with SMC was probably not associated with the emergence of a single resistant clone but due to the emergence of resistance in pneumococci belonging to several different serotypes," the authors of the study wrote.
Jun 8 Am J Trop Med Hygiene abstract
Study finds high rate of antibiotic prescribing for sinusitis
An analysis of antibiotic prescribing for acute sinusitis found that half of the patients visiting an integrated health system in Chicago for the disease met the criteria for antibiotics, but the actual prescribing rate was much higher, researchers from Northwestern University Feinberg School of Medicine reported yesterday in Clinical Infectious Diseases.
For the study, the researchers analyzed data on adult visits to Northwestern Medicine for acute sinusitis in 2017 and selected 500 distinct visits for manual chart review, looking for which patients received an antibiotic. To meet the criteria for antibiotics, patients had to have persistent, severe, or worsening symptoms—the clinical criteria defined by the Infectious Diseases Society of America for treatment of bacterial sinusitis.
Of the 500 visits, 425 met all the inclusion criteria, and 214 patients (50%) met the criteria for antibiotic prescribing, with the most common symptom criteria being persistent symptoms. Clinicians prescribed antibiotics for 205 (96%) of these patients, but they also prescribed antibiotics for 193 of the 211 patients (92%) who did not meet the criteria for antibiotics.
The most commonly prescribed antibiotics were amoxicillin-clavulanate (46% of prescriptions), azithromycin (20%), amoxicillin (12%), and cefdinir (6%). The median duration of treatment was 10 days. Guidelines recommend amoxicillin-clavulanate and amoxicillin as first-line antibiotics for acute sinusitis, and specifically recommend against macrolides and third-generation cephalosporins.
The authors of the study also noted that, because their assessment of guideline-concordant antibiotic-appropriateness was very forgiving, the proportion of patients who met the criteria "likely represents the upper bound of appropriateness."
"Ambulatory stewardship measures have generally addressed only antibiotic-inappropriate diagnoses, such as non-specific upper respiratory tract infections, or the requirement for streptococcal testing with a diagnosis of pharyngitis," the authors wrote. "To meaningfully reduce inappropriate antibiotic prescribing, future stewardship efforts should address the diagnosis of and appropriateness of antibiotic prescribing for sinusitis."
Jun 8 Clin Infect Dis abstract