The Overlooked Issue of Outpatient Combination Antibiotic Prescribing in Low- and Middle-Income Countries: An Example from Syria

This study aimed to determine and describe the prevalence of combination antibiotics dispensed in outpatients with health insurance in Syria. Data on all dispensed medicines between June 2018 and May 2019 for 81,314 adults were obtained, and medicines belonging to the J01 group of the World Health Organization (WHO) anatomical therapeutic classification (ATC) were included in the analysis. Prescriptions were stratified according to the number of antibiotics, age, and sex. Antibiotic utilization was expressed as the number of prescriptions per 1000 persons per year. Out of 59,404 prescriptions for antibiotics, 14.98% contained antibiotic combinations, distributed to 22.49% of the patients. The prevalence of dispensing antibiotic combinations was higher in female patients (23.00%), and the youngest (18–30 years, 26.19%) and oldest age groups (>70 years, 25.19%). The antibiotics most commonly combined were co-amoxiclav, second- and third-generation cephalosporins, and macrolides. Over 60% of the combinations contained ceftriaxone alone or in combination with sulbactam. The present study shows an alarmingly widespread prescription of antibiotic combinations, posing a risk to global health by promoting resistance development.

Case Report: A Pseudoaneurysm Involving the Left Common Iliac Artery Secondary to Brucellosis: A Rare Case Report

Pseudoaneurysms of the common iliac artery caused by Brucellosis are exceedingly uncommon. Infected common iliac artery pseudoaneurysms, particularly those caused by brucellosis, are more difficult to diagnose and cure than general pseudoaneurysms. The risk of mortality is significantly high in this condition. Nonsurgical treatment of a brucellosis-induced common iliac artery pseudoaneurysm is futile, and it should be operated on as soon as feasible. Long-term and multi-course antibacterial therapy with combination antibiotics is required. For the treatment of Brucella-infected pseudoaneurysms, endovascular surgery can be both effective and safe.

RESULTS OF TREATMENT PNEUMONIA FOR CHILDREN FROM 2 MONTHS TO 5 YEARS OLD AT YEN PHONG HEALTH CENTER, PROVINCE BAC NINH

Objectives: To evaluate results of treatment pneumonia for children aged 2 months to 5 years in pediatric deapartment at Yen Phong health center, Bac Ninh. Subjects: Patients with pneumonia aged 2 months to 5 years for treatment from September 2020 to June 2021. Methods: Descriptive study. Results: A total of 146 children were diagnosed with pneumonia, of which 82 were male (56.3%). The mean age was 20.6 ± 14.2 months. Prevalence of antibiotic use in the pre-hospital was 69.9%. The most common clinical manifestations were cough (100.0%), a subcrepitant rales (100.0%) and fever (29.5%). The most common X-ray was widespread patchy infiltrates (61.0%). 77.4% of children used combination antibiotics, in which the most common combination was Cephalosporin + Aminoglycoside (67.8%). Average duration of treatment was 6,7 ± 2,2 days. The cure rate was 100%. Conclusion: Pneumonia is more common in children less than 1 year old, with clinical manifestations of cough, shortness of breath and a subcrepitant rales. Combination antibiotics are effective in treating pneumonia in young children.

Minimum-inhibitory-concentration (MIC) distributions of routinely tested antimicrobials, and rifabutin, eravacycline, delafloxacin, clofazimine, and bedaquiline for Mycobacterium fortuitum

Rapid-growing-mycobacteria (RGM) are environmental organisms, which may cause infections in patients with particular risk factors. Whilst members of the Mycobacterium abscessus complex (MabsC) are the most commonly identified RGM from patient samples, Mycobacterium fortuitum is the second most commonly identified RGM in our setting in Singapore (1, 2). Although less common, the spectrum of clinical infections is similar (3). Treatment guidelines are not species-specific but it is generally recommended that combination antibiotics be used based on susceptibility testing results (4, 5). Due to the low incidence of infections caused by M. fortuitum , clinical evidence is limited, and clinical efficacy of individual antibiotics for treatment is unclear. The majority of the M. fortuitum complex have also been reported to have inducible clarithromycin resistance due to the erm (39) gene (6), indicating the need for alternative antibiotics to treat these infections.

Evaluation of Ceftolozane/Tazobactam, Ceftazidime/Avibactam and Meropenem/Vaborbactam Against Multidrug-Resistant (MDR) Pseudomonas

Background: Data on the patient outcomes for newer β-lactam–β-lactamase inhibitor (BLBI) drugs compared to carbapenem-containing combination antibiotics for multidrug-resistant (MDR)–Pseudomonas aeruginosa infections are limited. Methods: This retrospective, case–control observational study was based on chart review of the patients managed at the University of Kentucky. Results: In total, 143 patients with MDRO Pseudomonas aeruginosa infections were identified and divided into 2 groups: 1 group received newer BLBI combinations with or without aminoglycosides or polymyxins, for at least 72 hours, and the control group received carbapenem containing combination antibiotics or other antibiotics. Baseline characteristics and patient outcomes are shown in Table 1. Discussion: The newer BLBI combinations group consisted of 60.8% MDR Pseudomonas bacteremia, whereas the control group had 68.4% of MDR Pseudomonas respiratory cultures. Overall, the use of newer BLBI combinations such as ceftazidime/avibactam, ceftolozane/tazobactam, and meropenem/vaborbactam was associated with lower rates of acute kidney injury (AKI), shorter LOS, and lower mortality rates compared to the control group, and these differences were statistically significant. Because the 2 populations of patient differed significantly based on the site of infection (sepsis vs pneumonia), the data were reanalyzed to evaluate the impact of therapy on the occurrence of AKI, LOS, and mortality based on the site of infection. Only those patients with sepsis who received the newer combination drugs had significantly better rates of AKI, lower LOS, and had lower rates of mortality. The 2 treatment arms were not statistically different when comparing patients with pneumonia. Additionally, the use of these new combination therapies did not make a difference regarding readmission rates or duration of bacteremia for the patients included in the study.Funding: NoDisclosures: None

Evaluating the clinical effectiveness of new beta-lactam/beta-lactamase inhibitor combination antibiotics: A systematic literature review and meta-analysis

Background: Ceftazidime/avibactam (C/A), ceftolozane/tazobactam (C/T), imipenem/relebactam (I/R), and meropenem/vaborbactam (M/V) combine either a cephalosporin (C/T and C/A) or a carbapenem antibiotic (M/V and I/R) with a β-lactamase inhibitor. They are used to treat carbapenem-resistant Enterobacterales (CRE) and/or multidrug-resistant Pseudomonas aeruginosa (MDRPA). Objective: We compared the pooled clinical success of these medications to older therapies. Methods: PubMed and EMBASE were searched from January 1, 2012, through September 2, 2020, for C/A, C/T, I/R, and M/V studies. The main outcome was clinical success, which was assessed using random-effects models. Stratified analyses were conducted for study drug, sample size, quality, infection source, study design, and multidrug-resistant gram-negative organism (MDRGNO) population. Microbiological success and 28- and 30-day mortality were assessed as secondary outcomes. Heterogeneity was determined using I2 values. Results: Overall, 25 articles met the inclusion criteria; 8 observational studies and 17 randomized control trials. We detected no difference in clinical success comparing new combination antibiotics with standard therapies for all included organisms (pooled OR, 1.21; 95% CI, 0.96–1.51). We detected a moderate level of heterogeneity among the included studies I2 = 56%. Studies that focused on patients with CRE or MDRPA infections demonstrated a strong association between treatment with new combination antibiotics and clinical success (pooled OR, 2.20; 95% CI, 1.60–3.57). Conclusions: C/T, C/A, I/R, and M/V are not inferior to standard therapies for treating various complicated infections, but they may have greater clinical success for treating MDRPA and CRE infections. More studies that evaluate the use of these antibiotics for drug-resistant infections are needed to determine their effectiveness.

GAMBARAN PENGGUNAAN ANTIBIOTIK PADA PASIEN ULKUS DIABETIKUM DI INSTALASI RAWAT JALAN PENYAKIT DALAM RSUD ULIN BANJARMASIN PERIODE JULI – DESEMBER 2018

Diabetic ulcers are a disease that is experienced by many people with diabetes mellitus, open wounds on the skin surface of the diabetic ulcer have the potential to develop into infection, to deal with the problem of infection needed the right treatment, one of them is by using antibiotics. The purpose of this study was to describe the use of diabetic ulcer patients In Installation Of Outpatient in RSUD Ulin Banjarmasin Period July-December 2018. This study is a non-experimental study with a descriptive type of study through a retrospective search for outpatient prescription for diabetic ulcers. This research was conducted in April-May 2019 in Installation Of Outpatient in RSUD Ulin Banjarmasin. Sampling is done by saturation sampling method, the population in this study were 254 prescrptions. While the sample in this study were 228 prescrptions that met the criteria of inclusion and exclusion. The data obtained is copied to the observation sheet, after the data collected is then entered into a computer and a calculation is carried out to find out the percentage of each factor studied and finally the data will be presented in table form. The results obtained from the study of 228 prescriptions of diabetic ulcer patients obtained the use of single antibiotics as much as 182 (79.82%) and combination antibiotics by 46 (20.18%). The single most prescribed group of antibiotics is the Makrolide group of 49.56%, the Makrolide group which is often prescribed namely Clindamycin 300 mg as much as 39.91%.While the most prescribed combination of 2 antibiotics is Clindamycin 300 mg + Metronidazole 500 mg 14.47%.