Investigating the impact of poverty on colonization and infection with drug-resistant organisms in humans: a systematic review

Background Poverty increases the risk of contracting infectious diseases and therefore exposure to antibiotics. Yet there is lacking evidence on the relationship between income and non-income dimensions of poverty and antimicrobial resistance. Investigating such relationship would strengthen antimicrobial stewardship interventions. Methods A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Ovid, MEDLINE, EMBASE, Scopus, CINAHL, PsychINFO, EBSCO, HMIC, and Web of Science databases were searched in October 2016. Prospective and retrospective studies reporting on income or non-income dimensions of poverty and their influence on colonisation or infection with antimicrobial-resistant organisms were retrieved. Study quality was assessed with the Integrated quality criteria for review of multiple study designs (ICROMS) tool. Results Nineteen articles were reviewed. Crowding and homelessness were associated with antimicrobial resistance in community and hospital patients. In high-income countries, low income was associated with Streptococcus pneumoniae and Acinetobacter baumannii resistance and a seven-fold higher infection rate. In low-income countries the findings on this relation were contradictory. Lack of education was linked to resistant S. pneumoniae and Escherichia coli. Two papers explored the relation between water and sanitation and antimicrobial resistance in low-income settings. Conclusions Despite methodological limitations, the results suggest that addressing social determinants of poverty worldwide remains a crucial yet neglected step towards preventing antimicrobial resistance

Evaluation of cotrimoxazole use as a preventive therapy among patients living with HIV/AIDS in Gondar University Referral Hospital, northwestern Ethiopia: a retrospective cross-sectional study

Begashaw Melaku Gebresillassie,1 Minaleshewa Biruk Gebeyehum,1 Tadesse Melaku Abegaz,1 Daniel Asfaw Erku,2 Abebe Basazn Mekuria,3 Yokabd Dechassa Tadesse2 1Department of Clinical Pharmacy, 2Department of Pharmaceutical Chemistry, 3Department of Pharmacology, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia Purpose: Cotrimoxazole preventive therapy (CPT) is a feasible, inexpensive, and well-tolerated way of using cotrimoxazole intervention for patients living with HIV/AIDS to reduce HIV/AIDS-related morbidities and mortalities caused by various bacteria, fungi, and protozoa. The aim of this study was to evaluate the use of cotrimoxazole as a prophylaxis therapy among patients living with HIV/AIDS at Gondar University Referral Hospital (GURH), northwestern Ethiopia.Materials and methods: A retrospective cross-sectional study was used to evaluate the use of cotrimoxazole as a prophylaxis therapy among people living with HIV/AIDS at GURH, northwestern Ethiopia from September 2013 to October 2015. Medical records of 264 patients were selected by using systematic random sampling technique from the sampling frame list of all patients’ medical records. Data were collected from patients’ medical records using the structured checklist and evaluated against World Health Organization (WHO) guidelines on the use of cotrimoxazole prophylaxis. The quantitative data were analyzed using the statistical packages for social sciences Version 20. Descriptive and binary logistic regression analyses were used to describe and assess the association between different variables.Results: Approximately 95 (36.0%) patients were at WHO clinical stage III at the start of CPT. The use of CPT was consistent with the guidelines in the rationale for indication 200 (75.75%) and dose 263 (99.62%), despite the presence of contraindications in 24 (9.90%) patients. The occurrence of cotrimoxazole-associated side effects was higher in the first month of therapy. Problems regarding drug–drug interactions were identified in 63 (23.86%) patients, and 92 (34.84%) patients discontinued CPT due to different reasons.Conclusion: Although the practice of discontinuation of CPT and follow-up for adverse drug effects were not consistent with WHO guidelines on the rational use of cotrimoxazole prophylaxis, the use of CPT among people living with HIV/AIDS at GURH was appropriate. Health professionals who were working in the antiretroviral therapy units should update themselves and adhere to the available updated guidelines to reduce the occurrence of adverse effects and prophylaxis failure. Keywords: drug use evaluation, cotrimoxazole, HIV/AIDS, Gonda

Biological control of forest plantation pests in an interconnected world requires greater international focus

The worldwide homogenization of genetic resources used in plantation forestry (primarily Pinus, Eucalypus, Populus and Acacia spp.) together with accelerating rates of human-aided dispersal of exotic pests, is resulting in plantation pests becoming broadly distributed extremely quickly, sometimes reaching a global distribution within a decade. This unprecedented rate of establishment and spread means that the risk associated with new and emerging pests is shared globally. Biological control represents a major component of the strategy to mitigate such risk, but the current efforts and scope for developing such controls are woefully inadequate for dealing with the increasing rates of pest spread. Given the global nature of the problem, biological control would benefit enormously from an international, collaborative focus. Though inherent difficulties and potential pitfalls exist, opportunities for costsharing, growth and maintenance of resources and capacity, and more comprehensive research programmes are critical to the long-term success of biological control. Governments and industries will need to increase their strategic investment in structures specifically designed to promote such focus if they are to successfully protect their forest resources.The Tree Protection Co-operative Programme (TPCP), the THRIP initiative of the Department of Trade and Industry and the National Research Foundation, South Africa.http://www.tandfonline.com/loi/ttpm20ab201