Let\u27s talk about antibiotics: A randomised trial of two interventions to reduce antibiotic misuse

BACKGROUND: Children with acute respiratory tract infections (ARTIs) receive ≈11.4 million unnecessary antibiotic prescriptions annually. A noted contributor is inadequate parent-clinician communication, however, efforts to reduce overprescribing have only indirectly targeted communication or been impractical. OBJECTIVES: Compare two feasible (higher vs lower intensity) interventions for enhancing parent-clinician communication on the rate of inappropriate antibiotic prescribing. DESIGN: Multisite, parallel group, cluster randomised comparative effectiveness trial. Data collected between March 2017 and March 2019. SETTING: Academic and private practice outpatient clinics. PARTICIPANTS: Clinicians (n=41, 85% of eligible approached) and 1599 parent-child dyads (ages 1-5 years with ARTI symptoms, 71% of eligible approached). INTERVENTIONS: All clinicians received 20 min ARTI diagnosis and treatment education. Higher intensity clinicians received an additional 50 min communication skills training. All parents viewed a 90 second antibiotic education video. MAIN OUTCOMES AND MEASURES: Inappropriate antibiotic treatment was assessed via blinded medical record review by study clinicians and a priori defined as prescriptions for the wrong diagnosis or use of the wrong agent. Secondary outcomes were revisits, adverse drug reactions (both assessed 2 weeks after the visit) and parent ratings of provider communication, shared decision-making and visit satisfaction (assessed at end of the visit on Likert-type scales). RESULTS: Most clinicians completed the study (n=38, 93%), were doctors (n=25, 66%), female (n=30, 78%) and averaged 8 years in practice. All parent-child dyad provided data for the main outcome (n=855 (54%) male, n=1043 (53%) CONCLUSIONS AND RELEVANCE: Rate of inappropriate prescribing was low in both arms. Clinician education coupled with parent education may be sufficient to yield low inappropriate antibiotic prescribing rates. The absence of a significant difference between groups indicates that communication principles previously thought to drive inappropriate prescribing may need to be re-examined or may not have as much of an impact in practices where prescribing has improved in recent years. TRIAL REGISTRATION NUMBER: NCT03037112

Local iontophoretic administration of cytotoxic therapies to solid tumors

Parenteral and oral routes have been the traditional methods of administering cytotoxic agents to cancer patients. Unfortunately, the maximum potential effect of these cytotoxic agents has been limited because of systemic toxicity and poor tumor perfusion. In an attempt to improve the efficacy of cytotoxic agents while mitigating their side effects, we have developed modalities for the localized iontophoretic delivery of cytotoxic agents. These iontophoretic devices were designed to be implanted proximal to the tumor with external control of power and drug flow. Three distinct orthotopic mouse models of cancer and a canine model were evaluated for device efficacy and toxicity. Orthotopic patient-derived pancreatic cancer xenografts treated biweekly with gemcitabine via the device for 7 weeks experienced a mean log2 fold change in tumor volume of −0.8 compared to a mean log2 fold change in tumor volume of 1.1 for intravenous (IV) gemcitabine, 3.0 for IV saline, and 2.6 for device saline groups. The weekly coadministration of systemic cisplatin therapy and transdermal device cisplatin therapy significantly increased tumor growth inhibition and doubled the survival in two aggressive orthotopic models of breast cancer. The addition of radiotherapy to this treatment further extended survival. Device delivery of gemcitabine in dogs resulted in more than 7-fold difference in local drug concentrations and 25-fold lower systemic drug levels than the IV treatment. Overall, these devices have potential paradigm shifting implications for the treatment of pancreatic, breast, and other solid tumors

Tiny Earth Exploration of Fairfield Farm

Infectious disease was historically a leading cause of death of death for humans until we discovered and harnessed the power of the antibiotic properties of microbes. However, the overuse of known antibiotics and the ability of pathogenic organisms to continually evolve has led us to a critical point. The rise of antibiotic resistant pathogens poses a great risk to future generations, and it is imperative that we find new and novel sources of these life-saving medications. In service to the Tiny Earth Network\u27s mission to crowd-source novel antibiotics from soil microbes, this investigation examined some of the smallest residents of Fairfield Farm in Lawson, MO. From the septic field to its isolation in the lab of SCI 113, DYER012 2-2 has shown antibiotic properties against five of the six ESKAPE pathogens. This Gram-negative, non-spore forming, bacillus will have undergone PCR, Gel Electrophoresis, DNA sequencing, and several other tests in the quest to reveal its identity at this Symposium. It is my hope that this work regarding the identity and characteristics DYER012 2-2 will contribute meaningfully to the global fight against antibiotic resistant pathogens

Tiny Earth Exploration of Fairfield Farm

Infectious disease was historically a leading cause of death of death for humans until we discovered and harnessed the power of the antibiotic properties of microbes. However, the overuse of known antibiotics and the ability of pathogenic organisms to continually evolve has led us to a critical point. The rise of antibiotic resistant pathogens poses a great risk to future generations, and it is imperative that we find new and novel sources of these life-saving medications. In service to the Tiny Earth Network\u27s mission to crowd-source novel antibiotics from soil microbes, this investigation examined some of the smallest residents of Fairfield Farm in Lawson, MO. From the septic field to its isolation in the lab of SCI 113, DYER012 2-2 has shown antibiotic properties against five of the six ESKAPE pathogens. This Gram-negative, non-spore forming, bacillus will have undergone PCR, Gel Electrophoresis, DNA sequencing, and several other tests in the quest to reveal its identity at this Symposium. It is my hope that this work regarding the identity and characteristics DYER012 2-2 will contribute meaningfully to the global fight against antibiotic resistant pathogens