Patients' Interviews and Misuse of Antibiotics

To better evaluate patient contribution in antibiotic use, we questioned 5379 subjects from 9 countries. Antibiotics are perceived as strong, efficient drugs, but they are believed to undermine immunity. Interviewees believe that most respiratory infections, except the common cold, require antibiotic therapy, and 11% of them had to exaggerate their symptoms to get an antibiotic prescription from their physician. About 1 patient in 4 saved part of the antibiotic course for future use. Sixty-nine percent of the patients claimed to have taken the course until the end (United Kingdom, 90%; Thailand, 53%), and 75% claimed that they actually took all the daily doses. In all countries, it was possible to get antibiotics from a pharmacist without a medical prescription. This study shows that patients exert pressure on their doctors to get antibiotics and should allow a design for precise educational action aimed at the public for better control of antibiotic use in the communit

In-vitro activity of RP 59500, a semisynthetic streptogramin, against staphylococci and streptococci

The in-vitro activity of RP 59500, an injectable streptogramin derived from pristinamycin, was determined by agar dilution and compared with that of pristinamycin. Two hundred and sixty-one recent clinical isolates of Gram-positive cocci were tested against both antibiotics. The two compounds displayed similar activities. The MIC90S of RP 59500 ranged from 0·5 to 2 mg/L in 114 strains of Staphylococcus aureus showing various phenotypes of antibiotic resistance (penicillin-susceptible; penicillin-resistant and methicillin-susceptible; methicillin-resistant; erythromycin-resistant, either inducible or constitutive; quinolone-resistant). Similar results were obtained with coagulase-negative staphylococci. RP 59500 was consistently active against streptococci, with MIC90s of 0·25, 0·25 and 0·50 mg/L for Streptococcus pyogenes (n = 20), Streptococcus agalactiae (n = 20) and Streptococcus pneumoniae (n = 20), respectively. Enterococcus faecalis (n = 20) appeared to be notably less susceptible (MIC90, 8 mg/L). In view of this consistent activity against all staphylococci and streptococci tested, including multiply resistant isolates, RP 59500 merits further investigatio

Bacteriological activity of trovafloxacin, a new quinolone, against respiratory tract pathogens

The use of established fluoroquinolones, such as ciprofloxacin and ofloxacin, as empirical therapy for the treatment of moderate-to-severe respiratory tract infections is limited by their poor activity against gram-positive and atypical pathogens. Data from in vitro susceptibility studies and in vivo animal protection models suggest that the new fluoroquinolone, trovafloxacin, compared with ciprofloxacin and ofloxacin offers equivalent activity against gram-negative pathogens and improved activity against gram-positive pathogens. In particular, susceptibility data indicate that trovafloxacin is at least 16-fold more potent than either ciprofloxacin or ofloxacin against penicillin-susceptible and penicillin-resistant strains ofStreptococcus pneumoniae. Other susceptible pathogens includeStreptococcus pyogenes, vancomycin-susceptibleEnterococcus faecalis and the atypical respiratory pathogensLegionella pneumophila, Mycoplasma pneumoniae andChlamydia pneumoniae. In vivo studies involving models of protection against acute systemic infection and pneumococcal pneumonia in mice, and Legionnaires' disease in guinea pigs, indicate that the antibacterial spectrum observed for trovafloxacin in vitro extends to the in vivo setting. Together, these findings suggest that trovafloxacin may offer clinical efficacy against respiratory pathogens superior to that of ciprofloxacin and of ofloxacin, and may find a useful role as empiric therapy in both the community and hospital settin

In-vitro activity of roxithromycin against respiratory and skin pathogens

The activity of roxithromycin was determined by a microdilution method, in comparison with erythromycin, spiramycin and josamycin. Roxithromycin and erythromycin showed very similar MICs against staphylococci, Streptococcus pneumoniae, Str. pyogenes and Haemophilia influenzae. In most cases, spiramycin and josamycin appeared similarly or more active. The activity of roxithromycin against Mycoplasma pneumoniae, Legionella spp., Chlamydia psittaci and, to some extent, against Pasteurella spp. was also assessed, by suitable in-vitro methods. Roxithromycin has a promising potential for treating selected skin and respiratory infection

Laboratory Survey of Fluoroquinolone Activity

Fluoroquinolones are active against a wide variety of bacteria. The antibacterial spectra of fluoroquinolones encompass staphylococci, Bacillus species, and Corynebacterium species implicated in infections of the immunocompromised host; Enterobacteriaceae; most intestinal pathogens; and many gram-negative organisms commonly causing nosocomial infections. Haemophilus influenzae, Haemophilus ducreyi, Neisseria gonorrhoeae, Neisseria meningitidis, and Branhamella catarrhalis are highly susceptible to this class of drugs. Because of their ability to penetrate into phagocytes, fluoroquinolones have been tested against intracellular pathogens: Legionella species, Rickettsia conorii, Rickettsia rickettsii, and Brucella melitensis are very sensitive; Chlamydia trachomatis and the mycoplasmas are borderline; and some antimycobacterial activities deserve further investigation. Species that are generally resistant include Pseudomonas maltophilia, Pseudomonas cepacia, Pseudomonas pseudomallei, Alcaligenes species, Nocardia species, Bordetella bronchiseptica, and most anaerobe

Female sex hormones, salt, and blood pressure regulation

There are gender-associated differences in blood pressure (BP) in humans, with men having higher BP than age-matched pre-menopausal women and being at greater risk for cardiovascular and renal diseases. The mechanisms responsible for the gender differences in BP control and regulation are not clear, although there is some evidence that interactions between sex hormones and the kidneys could play a role. However, the response to salt in pre- and post-menopausal women, and in particular the influence of exogenous and endogenous female sex hormones on renal hemodynamics and tubular segmental sodium handling, have been poorly investigated. Recently we have shown that both endogenous and exogenous female sex hormones markedly influence the systemic and renal hemodynamic response to salt. We have found that BP in young normotensive women, regardless of oral contraceptive use, is rather insensitive to salt. However, the renal hemodynamic and the tubular responses to salt vary significantly during the normal menstrual cycle and with the administration of oral contraceptives. Furthermore, after the menopause, BP tends to become salt sensitive, a pattern that could be due to aging as well as to the modification of the sex hormone profile. These observations provide new insights pertaining to potential mechanisms explaining the lower incidence of cardiovascular disease and progression of renal disease in pre-menopausal women (which tend to disappear with the menopause); these observations also emphasize the importance of considering more carefully the phase of the menstrual cycle whenever conducting physiologic studies in women and enrolling women in clinical studies. Finally, increased salt sensitivity in menopausal women strongly encourages the use of diuretics. Am J Hypertens 2004;17:994-1001 © 2004 American Journal of Hypertension, Lt