Effect of Short-Course, High-Dose Amoxicillin Therapy on Resistant Pneumococcal Carriage

Schrag, Stephanie J.; Peña, Chabela; Fernández, Josefina; Sánchez, Jacqueline; Gómez, Virgen; Pérez, E.Romero; Feris, Jesús M; Besser, Richard E.

doi:10.1001/jama.286.1.49

Cited by 213 publications

(121 citation statements)

References 33 publications

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“…• Microbiological data, particularly o Culture and/or detection of DNA antigen from blood, CSF, urine, sputum, pleural fluid, joint aspirates, etc o Antimicrobial susceptibility 5 o Serotype information 6 7 • Date of initial referral to HPU/hospital infection control team…”

Section: Casesmentioning

confidence: 99%

Outbreak of invasive pneumococcal disease at a Belfast shipyard in men exposed to welding fumes, Northern Ireland, April–May 2015: preliminary report

et al. 2015

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SummaryStreptococcus pneumoniae (pneumococcus) can rarely cause clusters of serious disease including septicaemia, pneumonia and meningitis in closed settings. These closed settings include hospitals, long-term care facilities, prisons, military settings and children's day-care centres.These guidelines, produced by the Health Protection Agency (HPA), outline the investigation and public health management of such clusters of serious pneumococcal disease.A suspect cluster is defined as two or more cases of serious pneumococcal disease occurring in a closed setting within a 14 day period. Such clusters should be reported to the Health Protection Unit (HPU) for investigation.Following confirmation of a cluster, recommended interventions to consider include implementation of infection control measures for cases, antimicrobial chemoprophylaxis (first line therapy amoxicillin) and vaccination of close contacts with either pneumococcal conjugate or polysaccharide vaccine (depending upon serotype and age of case). July 20082 Closed setting: a place such as a children's day-care centre, school, residential home, hospital ward, military establishment, prison, homeless shelter, household and other similar settings; Suspect cluster: Two or more probable cases or one confirmed and one or more probable in a closed setting with onset dates within a two week period;Confirmed cluster: At least two confirmed cases of serious pneumococcal disease of the same (or not yet determined) serotype in a closed setting with onsets within a two-week period.Close contact: An individual who has had significant contact with a cluster case in the closed setting. The period of significant contact is from 48 hours before onset of symptoms in the case until completion of 24 hours of systemic antibiotic treatment.

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Section: Casesmentioning

confidence: 99%

Outbreak of invasive pneumococcal disease at a Belfast shipyard in men exposed to welding fumes, Northern Ireland, April–May 2015: preliminary report

et al. 2015

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“…Pharmacokinetic-pharmacodynamic studies support the possibility that dose patterns may affect the selection of resistance and bacterial eradication (11,29,37). Although the impact of such strategies have been assessed at the individual level in clinical studies (40), the possible impact of such strategies on the dissemination of resistant S. pneumoniae has never been challenged at the community level.…”

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confidence: 99%

Antibiotic Dose Impact on Resistance Selection in the Community: a Mathematical Model of β-Lactams and Streptococcus pneumoniae Dynamics

Opatowski

Mandel

Varon

et al. 2010

Antimicrob Agents Chemother

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Streptococcus pneumoniae is a major pathogen in the community and presents high rates of resistance to the available antibiotics. To prevent antibiotic treatment failure caused by highly resistant bacteria, increasing the prescribed antibiotic dose has recently been suggested. The aim of the present study was to assess the influence of ␤-lactam prescribed doses on the emergence of resistance and selection in the community. A mathematical model was constructed by combining S. pneumoniae pharmacodynamic and population-dynamic approaches. The received-dose heterogeneity in the population was specifically modeled. Simulations over a 50-year period were run to test the effects of dose distribution and antibiotic exposure frequency changes on community resistance patterns, as well as the accuracy of the defined daily dose as a predictor of resistance. When the frequency of antibiotic exposure per year was kept constant, dose levels had a strong impact on the levels of resistance after a 50-year simulation. The lowest doses resulted in a high prevalence of nonsusceptible strains (>70%) with MICs that were still low (1 mg/liter), whereas high doses resulted in a lower prevalence of nonsusceptible strains (<40%) and higher MICs (2 mg/liter). Furthermore, by keeping the volume of antibiotics constant in the population, different patterns of use (low antibiotic dose and high antibiotic exposure frequency versus high dose and low frequency) could lead to markedly different rates of resistance distribution and prevalence (from 10 to 100%). Our results suggest that pneumococcal resistance patterns in the community are strongly related to the individual ␤-lactam doses received: limiting ␤-lactam use while increasing the doses could help reduce the prevalence of resistance, although it should select for higher levels of resistance. Surveillance networks are therefore encouraged to collect both daily antibiotic exposure frequencies and individual prescribed doses.

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“…In the Dominican Republic, not only did a high-dose, short-course amoxicillin ther-apy result in lower rates of resistant pneumococcal carriage in a pediatric population, but it also resulted in improved compliance. 29 Shorter courses may not only improve compliance but may also help reduce the phenomenon of "leftover" medications and medication sharing that may be contributing to resistance.…”

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confidence: 99%

The Role of Poverty in Antimicrobial Resistance

Planta¹

2007

The Journal of the American Board of Family Medicine

119

113

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Effect of Short-Course, High-Dose Amoxicillin Therapy on Resistant Pneumococcal Carriage

Abstract: Short-course, high-dose outpatient antibiotic therapy appears promising as an intervention to minimize the impact of antibiotic use on the spread of drug-resistant pneumococci.

Cited by 213 publications

References 33 publications

Outbreak of invasive pneumococcal disease at a Belfast shipyard in men exposed to welding fumes, Northern Ireland, April–May 2015: preliminary report

Outbreak of invasive pneumococcal disease at a Belfast shipyard in men exposed to welding fumes, Northern Ireland, April–May 2015: preliminary report

Antibiotic Dose Impact on Resistance Selection in the Community: a Mathematical Model of β-Lactams and Streptococcus pneumoniae Dynamics

The Role of Poverty in Antimicrobial Resistance

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