Tensions in Antibiotic Prescribing

Since 1999, the Agency for Healthcare Research and Quality has funded seven centers across the country to provide practical guidance to physicians and other health care professionals about the drugs they prescribe. These Centers for Education and Research on Therapeutics (CERTs) develop, translate and disseminate objective information on drugs to improve practice. The University of Pennsylvania’s CERTs focuses on developing evidence for optimal treatment strategies for infectious diseases, and promoting the judicious use of antibiotics to combat the problem of antibiotic resistance. This Issue Brief explores one of the fundamental challenges physicians face in optimizing antibiotic use: the potential conflict between what is best for an individual patient, and what is best for society as a whole

Medication Comprehension and Safety in Older Adults

Older adults constitute just 13% of the U.S. population, but consume 35% of all prescription drugs. They are at a particularly high risk of serious adverse events due to errors in medication-taking, but little is known about the instructions community-dwelling elders receive about their medications, or how they organize their medications at home. This Issue Brief summarizes research that describes home-based patterns of medication use in elderly patients, and for one high-risk medication, analyzes the relationship between recall of instructions and subsequent drug-related hospitalizations. These findings may help clinicians better predict and monitor their patients’ adherence to prescription drug regimens

Distinct features of dendritic cells and anti-Ig activated B cells as stimulators of the primary mixed leukocyte reaction

Highly enriched populations of B lymphoblasts have been isolated after culture with anti-Ig-Sepharose and compared with dendritic cells as stimulators of CD4+ T cells in the murine MLR. The two populations clearly differed in phenotype; anti-Ig blasts were FcR+, B220+, 33D1-, while dendritic cells were FcR-, B220-, 33D1+. However, as MLR stimulators, they shared many common features. Both cells (a) expressed comparable levels of class II MHC products; (b) independently stimulated the primary MLR and the production of several T derived lymphokines including IL-2 and IL-4; and (c) were comparable in stimulating freshly sensitized T cells. However, the relative potencies of dendritic cells and anti-Ig blasts as primary MLR stimulators varied in a strain-dependent fashion. Only anti-Ig blasts could stimulate across an Mls barrier, being at least 100 times more active in stimulating Mls-mismatched, MHC-matched T cells, relative to syngeneic T cells. In contrast, dendritic cells were 10-30 times more potent than anti-Ig blasts when stimulating across an MHC barrier and were likewise more effective in binding MHC-disparate T cells to form the clusters in which the MLR was generated. Dendritic cell-T cell clustering was resistant to anti-LFA-1 mAb, while B blast-T cell clustering was totally blocked. Thus, anti-Ig B lymphoblasts and dendritic cells, two cell types which differ markedly in phenotype, also differ in efficiency and mechanism for initiating responses in allogeneic T cells

Hospital-Reported Pneumococcal Susceptibility to Penicillin

Geographic variation in drug susceptibility among isolates of Streptococcus pneumoniae has influenced national treatment guidelines for community-acquired pneumonia. Whether individual hospital susceptibility data provide reliable and valid information for providers is unclear. We examined the geographic and temporal variability in hospital-reported rates of pneumococcal susceptibility. We surveyed all 52 hospitals that provided acute adult care in the five counties surrounding Philadelphia and collected data on levels of penicillin susceptibility among all pneumococcal blood isolates from 1998 to 2000. In 1998, pneumococcal nonsusceptibility to penicillin varied from 0% to 67% of all blood isolates across the 33 hospitals with ≥10 isolates in that year. Hospital location did not correlate with the level of reported pneumococcal susceptibility (p = 0.8). In addition, correlations were not significant in reported pneumococcal susceptibility to penicillin within individual hospitals during the 3 years

The distinct leukocyte integrins of mouse spleen dendritic cells as identified with new hamster monoclonal antibodies

Metlay, J.P., Witmer-Pack, M.D., Agger, R., Crowley, M.T., Lawless, D., and Steinman, R.M. The distinct leukocyte integrins of mouse spleen dendritic cells as identified with new hamster monoclonal antibodies. J. Exp. Med. 171: 1753-1771, 1990https://digitalcommons.rockefeller.edu/historical-scientific-reports/1025/thumbnail.jp

The distinct leukocyte integrins of mouse spleen dendritic cells as identified with new hamster monoclonal antibodies

[No abstract available

Severe Flooding and Malaria Transmission in the Western Ugandan Highlands: Implications for Disease Control in an Era of Global Climate Change

Background. There are several mechanisms by which global climate change may impact malaria transmission. We sought to assess how the increased frequency of extreme precipitation events associated with global climate change will influence malaria transmission in highland areas of East Africa

Macrolide Resistance in Adults with Bacteremic Pneumococcal Pneumonia

We conducted a case-control study of adults with bacteremic pneumococcal pneumonia to identify factors associated with macrolide resistance. Study participants were identified through population-based surveillance in a 5-county region surrounding Philadelphia. Forty-three hospitals contributed 444 patients, who were interviewed by telephone regarding potential risk factors. In multivariable analyses, prior exposure to a macrolide antimicrobial agent (odds ratio [OR] 2.8), prior flu vaccination (OR 2.0), and Hispanic ethnicity (OR 4.1) were independently associated with an increased probability of macrolide resistance, and a history of stroke was independently associated with a decreased probability of macrolide resistance (OR 0.2). Fifty-five percent of patients with macrolide-resistant infections reported no antimicrobial drug exposure in the preceding 6 months. Among patients who reported taking antimicrobial agents in the 6 months preceding infection, failure to complete the course of prescribed drugs was associated with an increased probability of macrolide resistance (OR 3.4)

Antimicrobial Drug Resistance, Regulation, and Research1

Research models and regulatory measures could aid in developing antimicrobial drugs to address bacterial resistance