Doctor Patient Communication and Its Influence on Antimicrobial Prescribing

When physicians perceive that a patient or parent expects an antimicrobial they are significantly more likely to inappropriately prescribe 12, 16, 52-57 . However, physician perceptions are poorly correlated with actual patient or parent expectations for antimicrobials 16, 53-55, 58, 59 . Although 50-70 of patients and parents expect to receive antimicrobials when they attend visits for ARI, only 1-6 make direct verbal requests for them 58, 60 . Even when no direct requests for antimicrobials...

Use of Mathematical Models

The philosophy of disease control through mass chemotherapy is - in principle -simple, but optimizing its success is rather more complex and requires a thorough understanding of the biology of the parasites in question. Helminth infections typically cause chronic infections in humans and it is the intensity of parasite infection that tend to determine the severity of morbidity. Helminth infections of humans tend to have long generation times (ranging from 1 to 10+ years) and not to multiply...

Cba

185 physicians and parents in rural communities of northern Wisconsin (USA) Large and small group meetings for clinicians printed materials based on CDC principles of appropriate antibiotic use CDC pamphlets and posters distributed to parents, childcare providers, schools, community organizations and clinics Belongia, CBA Statewide program 2005 44 targeting primary care physicians, parents and the public in Wisconsin (USA) Printed materials mailed to physicians annually distribution of academic...

Future Directions

The impact of educational interventions on appropriate antimicrobial prescribing has been modest at best, and the sustainability of intervention effects is largely unknown. Research to date has not identified any single intervention that will substantially reduce antimicrobial prescribing in all clinical settings. Factors limiting the generaliz-ability of results include poorly defined targets for prescribing, variation in geographic scope of interventions, organizational priorities and limited...

Hookworm Does Resistance Already Exist

Hookworms are intestinal parasitic nematodes belonging to the group of soil-transmitted helminths. The two species infecting humans are Necator americanus and Ancylostoma duodenale. Hookworms are the second most common human helmint-hiasis, infecting an estimated 1.3 billion people worldwide. The significant morbidity in human populations caused by hookworm can be controlled by periodic chemotherapy using drugs. While a number of anthelmintic drugs are effective against hookworms, the most...

Invasive Fungal Infections

Over the last 2 decades invasive fungal infections, caused primarily by Candida and Aspergillus species, have emerged as an important public health problem creating major challenges for health care professionals. The rising incidence of invasive fungal infections is due in large part to the growing population of immunosuppressed patients, who are at greatest risk for infection. Candida bloodstream infection (BSI) is the most common clinical presentation of invasive candidiasis. Population-based...

Edward A Belongiaa Rita Mangione Smithb Mary Jo Knoblocha

AMarshfield Clinic Research Foundation, Marshfield, Wise., and bDepartment of Pediatrics, University of Washington, Seattle, Wash., USA Acute respiratory tract infections account for the majority of outpatient antimicrobial use, and physicians continue to prescribe these drugs inappropriately for cough, cold and flu symptoms despite lack of efficacy for viral illness. There have been modest reductions in antimicrobial prescribing for respiratory illness in recent years, but inappropriate use of...

Relationship Between Past and Future Pandemics

Given what we know about previous pandemics, a key challenge is to ensure that all patients with secondary bacterial pneumonia are treated appropriately with antibiotics while minimizing the inevitable consequences of promoting antibiotic resistance. By comparing previous pandemics to what might be expected from the next one, it might be possible to identify those questions which, if answered, could aid in preventing cases of secondary bacterial pneumonia, including those resistant to...

Info

A MIC 0.125-1.0 g ml b MIC > 1.0 g ml plasmid mediated-quinolone resistance, sometimes linked to extended-spectrum -lactamase (ESBL) genes 40, 41 . Campylobacter spp. are a common cause of gastroenteritis in most countries. They are commensal in birds, swine and cattle, and infection in humans is invariably food-associated. Campylobacter is intrinsically less susceptible to fluoroquinolones than Salmonella with a wild-type MIC90 of 0.25 g ml. Single point mutations in the quinolone resistance...

Infection Control Practices

Nosocomial transmission of pathogens, including resistant organisms, is attributed in large part to poor hand hygiene by personnel (compliance level), number of contacts (contact rate) and high 'colonization pressure' (frequency of bacterial carriage by adjacent patients). Hand hygiene is cited as the single most important nosocomial infection control measure however, adherence is very low, often not more than 25-50 . The major features associated with poor adherence have been inadequate time...

Prevention of Invasive Fungal Infections

Risks for invasive fungal infections can be understood and prevention strategies can be developed and studied most accurately only after knowing the true burden of infection, morbidity, and mortality. To date, most large-scale and ongoing surveillance for fungal infections has been limited primarily to candidemia and, to a lesser extent, aspergillosis. While there remains more to learn with regard to risk factors for invasive fungal disease, particularly with the increasing numbers of...

Antifungal Drugs in Clinical

The majority of clinically relevant antifungal agents used today in clinical practice can be placed into distinct classes based on their fungal target polyenes, which target ergosterol, the principal sterol in the plasma membrane of susceptible fungal cells azoles, which target ergosterol synthesis echinocandins, which target -1,3 glucan synthesis and flucytosine, which targets DNA and protein synthesis. Each of these classes is discussed below. The polyene class of antifungal drugs, of which...