Drug Topics - January 28, 2008 - (Page H4) 4 HSE DRUG TOPICS JANUARY 28, 2008 www.drugtopics.com Clinical Practice Infectious disease experts rethink length of antibiotic treatment Catherine MacRae Hockmuth inish the prescription even if you feel better. That’s most often the advice pharmacists and physicians give patients along with antibiotics— prescriptions that often dictate taking the medicine for as long as 10 days. But this advice is wrong, said Louis Rice, M.D., of Louis Stokes Cleveland VA Medical Center and Case Western Reserve University, during a lecture at the annual conference of the Infectious Diseases Society of America held in San Diego recently. Physicians who prescribe more than three days of antibiotics for the treatment of pneumonia, for example, may be putting patients at greater risk, Rice said during his presentation, “For the Duration: Rational Antibiotic Administration in an Era of Resistance and Clostridium difficile.” C. difficile-associated disease (CDAD) is a form of infectious diarrhea, and hospitals around the country continue to report increased concerns about inS fections among patients. U.S. TWTF hospital discharge data from the Centers for Disease Control & Prevention report that diagnoses of CDAD doubled from 82,000 in 1996 to 178,000 in 2003. “When people start getting sued for C. difficile, they’re going to be looking to spread the liability around,” said Rice. A British hospital trust chairman resigned on Oct. 15 after a damning report by the U.K. Healthcare Commission on C. difficile outbreaks that caused the deaths of at least 21 patients and as many as 90 patients between 2004 and 2006. L. Clifford McDonald, M.D., a CDC medical epidemiologist speaking at the IDSA meeting, said that recent increases in rates and severity of CDAD may be attributed to a strain known as type BI, North American Pulsed-Field Type 1, and PCR-ribotype 027 (BI/NAP1/027). The strain shows increased resistance to fluoroquinolones and cephalosporins and carries an extra toxin known as binary toxin. F S M three-armed community-acquired pneumonia trial, and a three-day vs. seven-day treatment for cellulitis trial. “We are moving back to what we knew 60 years ago,” noted Rice. “Three days of amoxicillin works fine.” He said prescribing longer courses of antibiotics increases the bacteria’s resistance to the drugs while at the same time doing nothing to decrease the patient’s risk of recurring infection. “Antibiotics are not at worst a therapeutically neutral choice,” he said. He listed three negative side effects of overuse of antibiotics: “the morbidity and expense of infection with resistant bacteria, C. difficile, and toxic side effects.” Rice and the IDSA have endorsed new legislation in Congress that calls for a comprehensive approach to antimicrobial resistance in response to alarming headlines about drug-resistant tuberculosis and hospital-borne bacterial infections. H.R. 3697, otherwise known as the Strategies to Address Anti-Microbial Resistance Act, calls on the Secretary of Health & Human Services to create an Office of Antimicrobial Resistance and establish a Public Health Antimicrobial Advisory Board and an inter-agency antimicrobial task force. Immunization guides updated IDSA also announced at the meeting that it is updating its immunization guidelines due to the emergence of the human papillomavirus, Tdap (tetanus, diphtheria, and pertussis), herpes zoster, rotavirus, and meningococcal vaccines as well as the new nasal spray vaccine for influenza. The guidelines cover vaccinations for infants, children, teens, and adults. There are also new recommendations for old vaccines, according to committee member William Schaffner, M.D. For example, guidelines for vaccinations for hepatitis B have been expanded so that patients no longer have to acknowledge having risky sexual or drug habits to receive the vaccine. “It gives us license to start immunizing a lot of people,” said Schaffner, noting that physicians often don’t like asking patients if they’re engaged in risky behavior—and patients don’t like telling. Now, a hepatitis B vaccination is recommended for all sexually active people who are not in a “long-term mutually monogamous relationship.” THE AUTHOR NIH response and legislation Rice said the National Institutes of Health responded positively last summer to his proposals for three studies on antimicrobial resistance: a placebo-controlled otitis media (middle ear infection) trial, a is a writer based in the San Diego area. http://www.drugtopics.com
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