Duration of antibiotic therapy for common infections

Grant, Jennifer; Saux, Nicole Le

doi:10.3138/jammi-2021-04-29

Cited by 10 publications

(9 citation statements)

References 116 publications

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“…The framework developed here will be useful in investigating other important questions regarding antibiotic responses. While the simulations themselves only cover time scales up to one to two days, an analysis of the sensitivity of the system to parameter changes could also give insights into the types of mutations that can be expected from the evolution of antibiotic resistance mechanisms under regimes of repeated drug exposures on longer time scales [78][79][80][81]. Apart from refining resistance proteins to be effective against specific antibiotics, such mutations could also target regulation to improve the responsiveness of the resistance mechanism.…”

Section: Discussionmentioning

confidence: 99%

Dynamical model of antibiotic responses linking expression of resistance genes to metabolism explains emergence of heterogeneity during drug exposures

Stevanovic,

Teuber Carvalho,

Bittihn

et al. 2024

Phys. Biol.

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Antibiotic responses in bacteria are highly dynamic and heterogeneous, with sudden exposure of bacterial colonies to high drug doses resulting in the coexistence of recovered and arrested cells. The dynamics of the response is determined by regulatory circuits controlling the expression of resistance genes, which are in turn modulated by the drug’s action on cell growth and metabolism. Despite advances in understanding gene regulation at the molecular level, we still lack a framework to describe how feedback mechanisms resulting from the interdependence between expression of resistance and cell metabolism can amplify naturally occurring noise and create heterogeneity at the population level. To understand how this interplay affects cell survival upon exposure, we constructed a mathematical model of the dynamics of antibiotic responses that links metabolism and regulation of gene expression, based on the tetracycline resistance tet operon in E. coli. We use this model to interpret measurements of growth and expression of resistance in microfluidic experiments, both in single cells and in biofilms. We also implemented a stochastic model of the drug response, to show that exposure to high drug levels results in large variations of recovery times and heterogeneity at the population level. We show that stochasticity is important to determine how nutrient quality affects cell survival during exposure to high drug concentrations. A quantitative description of how microbes respond to antibiotics in dynamical environments is crucial to understand population-level behaviors such as biofilms and pathogenesis.

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Section: Discussionmentioning

confidence: 99%

Dynamical model of antibiotic responses linking expression of resistance genes to metabolism explains emergence of heterogeneity during drug exposures

Stevanovic,

Teuber Carvalho,

Bittihn

et al. 2024

Phys. Biol.

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“…Patients were gradually encouraged to sit up, stand beside the bed, walk with assistance, walk with family support inside the room, and nally walk along the corridor; (5) sleep hygiene measures were followed to form a regular sleep-wake cycle. Patients with sleep disorders received sleep-promoting medications as prescribed; (6) multimodal analgesia, including long-acting local anesthetics for abdominal plane blocks after surgery and patient-controlled analgesia (PCA) with nonsteroidal anti-in ammatory drugs administered intravenously every 12 hours; (7) bowel motility assessment, with glycerin suppositories (110 mL) administered rectally if no atus or bowel movement occurred by postoperative day 3; (8) antibiotic therapy for ve days after surgery 19 .…”

Section: Intraoperative Phasementioning

confidence: 99%

Effects of MBP under the ERAS Concept on Electrolyte Disturbances and Functional Recovery after Robotic Surgery for Urologic Tumors in Older Adults

Liu

2024

Preprint

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Background Mechanical bowel preparation (MBP) involves the cleansing of bowel excreta and secretions using methods such as preoperative oral laxatives, retrograde enemas, and dietary adjustments. When combined with oral antibiotics, preoperative MBP can effectively lower the risk of anastomotic leakage, minimize the occurrence of postoperative infections, and reduce the likelihood of other complications. To study the effects of MBP under the Enhanced Recovery After Surgery (ERAS) concept on postoperative electrolyte disorders and functional recovery in older people with urological tumors undergoing robot-assisted surgery. Methods Older people with urological tumors undergoing robot-assisted surgery were randomly divided into two groups. The experimental group underwent preoperative MBP, while the control group did not. The differences in electrolyte levels and functional recovery between the two groups after radical surgery for urological tumors were observed. Results The incidence of postoperative electrolyte disorders in the experimental group was significantly higher than that in the control group (P < 0.05). Subgroup analysis showed that the electrolyte disorder was age-related (P < 0.05). There were no significant differences between the two groups in terms of postoperative complications, gastrointestinal function recovery, laboratory indicators of infection, body temperature, and length of hospital stay (P > 0.05). Conclusion Under the accelerated recovery background, preoperative MBP increases the risk of postoperative electrolyte disorders in older people with urological tumors and does not reduce the incidence of postoperative complications or promote postoperative functional recovery.

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“…The duration of antibiotic courses has been traditionally guided by physician's habits and cultural norms rather than strong scientific data [ 17 , 18 ]. The lack of such data was due to the limited trials examining the minimum effective antibiotic durations, because of the false belief that antibiotics are associated with only few serious adverse events [ 17 , 18 ].…”

Section: Commentarymentioning

confidence: 99%

“…Moreover, physicians have been traditionally taught that antibiotic courses should be long enough to prevent the development of resistance by the treating bacteria, a theory that was essentially based on cases of resistance development from the use of suboptimal penicillin doses for the treatment of Streptococcus pneumoniae [ 19 ]. Both facts ultimately resulted in the frequent use of prolonged antibiotic courses in clinical practice [ 12 , 13 , 15 – 17 ]. During recent decades, however, mounting evidence supports shorter antibiotic courses, which seem to be non-inferior to the longer ones while causing fewer adverse events [ 20 ].…”

Section: Commentarymentioning

confidence: 99%

Medical treatment of pleural infection: antibiotic duration and corticosteroid usefulness

Skouras,

Chatzivasiloglou,

Iliopoulou

et al. 2023

Breathe

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The data about the optimal duration of antibiotics and the usefulness of corticosteroids in the management of parapneumonic effusion and pleural infection are scarce. Two randomised controlled trials evaluating short antibiotic courses (ODAPE and SLIM) and another trial assessing the benefit from corticosteroid use (STOPPE) in this setting were recently published. The aim of this journal club is to present these trials and discuss their significance and limitations. ODAPE compared the efficacy and safety of a short (2 weeks)versusan extended (3 weeks) course of amoxicillin–clavulanate in community-acquired complicated parapneumonic effusions, while SLIM compared the efficacy and safety of short (14–21 days)versuslonger (28–42 days) antibiotic courses in patients with community- or hospital-acquired pleural infection. STOPPE assessed the benefit from dexamethasone use in patients with community-acquired pneumonia and concomitant pleural effusion. Both ODAPE and SLIM found that shorter antibiotic courses produce less adverse events while being equally efficacious to the longer courses in a subgroup of patients, such as those with pleural infection that is stabilised with only medical treatment and does not require surgery. In contrast, STOPPE found no benefit from the use of dexamethasone in unselected patients with pneumonia and pleural effusion. Due to the significant limitations of these trials, further studies are required to confirm these findings.Commentary on:Hassan M,et al. The ShortversusLong Antibiotic Course for Pleural Infection Management (SLIM) randomised controlled open-label trial.ERJ Open Res2023; 9: 00635-2022.Porcel JM,et al. Twovs. three weeks of treatment with amoxicillin–clavulanate for stabilized community-acquired complicated parapneumonic effusions. A preliminary non-inferiority, double-blind, randomized, controlled trial.Pleura Peritoneum2020; 5: 20190027.Fitzgerald DB,et al. Steroid Therapy and Outcome of Parapneumonic Pleural Effusions (STOPPE): a pilot randomized clinical trial.Am J Respir Crit Care Med2022; 205: 1093–1101.

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Duration of antibiotic therapy for common infections

Cited by 10 publications

References 116 publications

Dynamical model of antibiotic responses linking expression of resistance genes to metabolism explains emergence of heterogeneity during drug exposures

Dynamical model of antibiotic responses linking expression of resistance genes to metabolism explains emergence of heterogeneity during drug exposures

Effects of MBP under the ERAS Concept on Electrolyte Disturbances and Functional Recovery after Robotic Surgery for Urologic Tumors in Older Adults

Medical treatment of pleural infection: antibiotic duration and corticosteroid usefulness

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