Helicobacter pylori infection is an emerging health concern to some northern Canadian Aboriginal communities and their clinicians. Clinicians in the north perceive H. pylori infection to be a major clinical problem because they find H. pylori infection in many patients evaluated for common stomach complaints, leading to frequent demand for treatment, which often fails. Moreover, public health authorities identified the need for information to develop locally appropriate H. pylori control strategies. We described adherence and identified barriers to completing treatment among H. pylori-positive participants in a community-based project inspired by local concerns about H. pylori infection risks.
In 2008, 110 H. pylori-positive participants (diagnosed by a breath test, histopathology and/or culture) of the Aklavik H. pylori project were randomised to standard-of-care or sequential treatment. We ascertained adherence by interviewing participants using a structured questionnaire. We estimated adherence frequencies as the proportion of participants who reported taking either 100% of doses (perfect adherence) or =80% of doses (good adherence). To compare the proportion with perfect or good adherence in subgroups, we report proportion differences and 95% confidence intervals (CI).
Of 87 participants who were interviewed, 64% reported perfect adherence and 80% reported good adherence. We observed more frequent perfect adherence for: standard therapy (67%) versus sequential (62%); males (76%) versus females (52%); participants 40-77 years (79%) versus 17-39 (50%). Proportion differences were 5% (CI: -15, 25) for standard versus sequential therapy; 23% (CI: 4, 43) for male versus female; and 29% (CI: 10, 48) for 40-77 versus 15-39 years for perfect adherence. Of the 29 participants who reported poor adherence (
The aim of this study was to get a general view of the habitual practice of the usage of aminoglycosides in Danish medical departments, regarding choice of drug, dosage regimen and monitoring of drug-related toxicity, as this antimicrobial agent is commonly used in Danish hospitals against severe infections in spite of the potential for nephro- and ototoxicity. The survey, taking place in 1991 and in 1994, showed that gentamicin and netfilmicin were preferred as first choice with an equal frequency in university and county hospital department, whereas in departments in small hospitals gentamicin was preferred twice as often. From 1991 to 1994 the dosage regimen most commonly used had altered from thrice-a-day to once-a-day. Monitoring of serum levels of the drug was performed on all treated patients in fifty-two of the seventy-nine departments questioned. Most of the departments also monitored the kidney function.
During 208 days 2836 patients were admitted to Sundby Hospital, medical ward. A total of 734 antibiotic cures were initiated. About 632 (22-23%) of the patients had antibiotic treatment. Penicillin, ampicillin and sulfamethizole were the most frequently used antibiotics. The use of erythromycin was 42-50% and 64-78% of that of penicillin and ampicillin respectively. Antibiotic treatment was changed in 99 cures in 73 patients. Fifty-seven of ninety-nine (43-71%) shifts were based on culture or serology and 42/99 (29-57%) shifts were based on clinical evaluation including microscopy and urinary stix. In 26 of the latter 42 cases positive culture or serology was obtained after the antibiotic was changed. Thirteen of the 26 shifts improved treatment, six were unlucky and seven indifferent, thus giving a net advantage of 13-6 = 7 of 26 shifts. This net advantage was due to shifts from penicillin. In ten cases the antibiotic was shifted to erythromycin due to suspected atypical pneumonia, but only one case was verified. In ten antibiotic shifts in pneumonia patients the etiologic agents were not identified. In 4/99 shifts in 4/73 patients relevant specimens were not obtained. The antibiotic most often changed compared with its total use was ampicillin (32/152 congruent to 1/5 of initiated cures) and shifts from ampicillin were more often (21/32) based on culture than shifts from penicillin (16/36) (p
The intestinal microbiota has been proposed to play a pathogenic role in coeliac disease (CD). Although antibiotics are common environmental factors with a profound impact on intestinal microbiota, data on antibiotic use as a risk factor for subsequent CD development are scarce.
In this population-based case-control study we linked nationwide histopathology data on 2,933 individuals with CD (Marsh stage 3; villous atrophy) to the Swedish Prescribed Drug Register to examine the association between use of systemic antibiotics and subsequent CD. We also examined the association between antibiotic use in 2,118 individuals with inflammation (Marsh 1-2) and in 620 individuals with normal mucosa (Marsh 0) but positive CD serology. All individuals undergoing biopsy were matched for age and sex with 28,262 controls from the population.
Antibiotic use was associated with CD (Odds ratio [OR]?=?1.40; 95% confidence interval [CI]?=?1.27-1.53), inflammation (OR?=?1.90; 95% CI?=?1.72-2.10) and normal mucosa with positive CD serology (OR?=?1.58; 95% CI?=?1.30-1.92). ORs for prior antibiotic use in CD were similar when we excluded antibiotic use in the last year (OR?=?1.30; 95% CI?=?1.08-1.56) or restricted to individuals without comorbidity (OR?=?1.30; 95% CI?=?1.16 - 1.46).
The positive association between antibiotic use and subsequent CD but also with lesions that may represent early CD suggests that intestinal dysbiosis may play a role in the pathogenesis of CD. However, non-causal explanations for this positive association cannot be excluded.
Intravenous administration of antibiotics is a known risk factor for infusion phlebitis. We have previously demonstrated differences in cell toxicity for 4 antibiotics. Clinical experience indicates that antibiotics differ in their tendency to cause phlebitis. The present study was done prospectively on 550 patients with 1386 peripheral venous catheters. The incidence of phlebitis was 18.5% with antibiotics and 8.8% without (odds ratio 2.34). Dicloxacillin (odds ratio 5.74) and erythromycin (odds ratio 5.33) had the greatest tendency to cause phlebitis in univariate, multivariate and Cox regression analyses. Benzylpenicillin, cefuroxime and cloxacillin were also associated with a greater risk of phlebitis, whereas ampicillin, imipenem/cilastatin, clindamycin, netilmicin and vancomycin were not. Other risk factors were the site of insertion and age 51-60 y. Medication with warfarin was found to be protective, but not with aspirin. Treatment with low molecular weight heparin reduced the risk of phlebitis, but the difference was not significant. With regard to when antibiotics were given, the day-specific risk increased between Days 1 and 2, but no further on subsequent days. The hypothesis that antibiotics differ in their tendency to cause phlebitis was confirmed.
Antibiotic consumption has increased by around 50% in Danish hospitals over the last 7 years. In percentages, the highest increase has been among broad spectrum antibiotics such as cephalosporins, crabapenems and fluoroquinolones. The consequence of this is selection of resistant bacteria and fungi. Control of antibiotic resistance requires implementation of different strategies: better and more rapid diagnosis of infectious origin, restriction on antibiotic use, e.g. through re-evaluation every 2-3 days of patients receiving antibiotics, optimization of dosing and duration of treatment, preferred use of narrow spectrum antibiotics and optimization of hospital hygiene.
BACKGROUND: Transmission of group B Steptococci from mother to child during delivery may cause serious disease in some children, but this can be prevented by use of antibiotic treatment during delivery. We have estimated how antibiotic treatment of all pregnant carriers of group B streptococcus during delivery would affect the total antibiotic use in Norway. MATERIAL AND METHODS: We estimated the use of penicillin G for treatment of 10 %, 20 % and 30 % of streptococcus carriers among those delivering. The Medical Birth Registry was used to obtain number of births and the Norwegian Drug Wholesalers Database to obtain total use of the various substances. RESULTS: If 30 % of delivering women were carriers of group B streptococcus and treated with penicillin G, the treatment would equal 2.8 % of today's total use of penicillin G and 0.09 % of the total use of the whole group of beta-lactam antibacterial agents, penicillins. INTERPRETATION: Prophylactic antibiotic treatment of pregnant carriers of group B streptococcus during delivery would not lead to a substantial change in the current antibiotic use. The possibility of increasing antibiotic resistance should not be a main argument against using antibiotics in prevention of group B streptococcus infection in newborns.
The composition of the intestinal microflora has been proposed as an important factor in the development of inflammatory bowel diseases (IBD). Antibiotics have the potential to alter the composition of the intestinal microflora. A study was undertaken to evaluate the potential association between use of antibiotics and IBD in childhood.
A nationwide cohort study was conducted of all Danish singleton children born from 1995 to 2003 (N=577,627) with individual-level information on filled antibiotic prescriptions, IBD and potential confounding variables. Using Poisson regression, rate ratios (RRs) of IBD were calculated according to antibiotic use. Antibiotic use was classified according to time since use, type, number of courses used and age at use.
IBD was diagnosed in 117 children during 3,173,117 person-years of follow-up. The RR of IBD was 1.84 (95% CI 1.08 to 3.15) for antibiotic users compared with non-users. This association appeared to be an effect on Crohn's disease (CD) alone (RR 3.41) and was strongest in the first 3 months following use (RR 4.43) and among children with =7 courses of antibiotics (RR 7.32).
Antibiotic use is common in childhood and its potential as an environmental risk factor for IBD warrants scrutiny. This is the first prospective study to show a strong association between antibiotic use and CD in childhood. However, as with any observational study, causality cannot be inferred from our results and confounding by indication--in particular, prescribing of antibiotics to children with intestinal symptoms of as yet undiagnosed CD--should also be considered as a possible explanation.
Several studies addressed the association between antibiotic use and breast cancer risk. The objective of this study was to assess the association between antibiotic use and risk of cervical, ovarian, and uterine cancer.
We carried out a population-based case-control study using data from Saskatchewan Health administrative databases (Canada) between the years 1981 and 2000. Cases were matched to 4 controls, using incidence density sampling. The effect of dosage and timing of antibiotic use, over a minimum of 15 years before diagnosis, on cervical, ovarian, or uterine cancer risk was assessed. Number of prescriptions and number of pills were used as exposure definitions. The effect of different classes of antibiotics on cancer risk was also studied.
A total of 1225 cancer cases [192 cervical, 445 ovarian, and 588 uterine] and 4900 matched controls were included in this study. Antibiotic exposure (number of prescriptions) during the period of 1-15 years in the past was significantly associated with a reduced risk of cervical cancer; Relative Risk (RR)=0.40, 0.31, 0.26, and 0.29 for the four exposure quartiles, respectively. No association was found for ovarian or uterine cancer. When number of pills was considered, similar results were found. There was no effect of the timing or class of antibiotic exposure on cervical cancer risk.
Antibiotic exposure up to 15 years in the past was associated with a decreased risk of cervical cancer. The lack of temporal trends and the absence of class specific effects suggest a non-causal relationship.