Archive for July 3, 2013

Fatal Influenza A(H1N1)pdm09 Encephalopathy in Immunocompetent Man

EID June 2013  Volume 19, Number 6

Marie Simon1, Romain Hernu1, Martin Cour, Jean-Sébastien Casalegno, Bruno Lina, and Laurent Argaud

Author affiliations: Hospices Civils de Lyon, Lyon, France (M. Simon, R. Hernu, M. Cour, J.S. Casalegno, B. Lina, L. Argaud); Université Claude Bernard Lyon 1, Lyon (M. Cour, B. Lina, L. Argaud); Institut National de la Santé et de la Recherche Médicale, Lyon (M. Cour, L. Argaud); Centre National de Référence des Virus Influenza Région Sud France, Lyon (J.S. Casalegno, B. Lina)


We report an immunocompetent patient who had fatal encephalopathy after mild influenza. He rapidly died after unusual symptoms related to intracerebral thrombosis and hemorrhage. A brain biopsy specimen was positive for influenza A(H1N1)pdm09 virus RNA, but a lung biopsy specimen and cerebrospinal spinal fluid samples were negative.


July 3, 2013 at 11:04 pm

Evolution of use of antibiotics of restricted prescription and trend of bacterial susceptibility in Concepcion Regional Hospital, Chile.

Rev Chilena Infectol. 2012 Oct;29(5):492-8.

Morales FE, Villa LA, Fernández PB, López MA, Mella S, Muñoz M.


Departamento de Farmacia, Universidad de Concepción, Concepción, Chile.


The aim of this study was analyze the use of restricted antibiotics by patients hospitalized between 2004 and 2008 in Guillermo Grant Benavente Hospital in Concepcion. Also we attempted to identify possible correlations between antibiotic consumption and patterns of bacterial susceptibility. We performed a retrospective observational study that quantified the use of restricted antibiotics using DDD/100-bed-days, and cumulative susceptibility reports informed by the hospital’s microbiology laboratory for bacterial susceptibility. The consumption of restricted antibiotics significantly increased between 2004 and 2008 (35%, p = 0.005). The groups with largest use were glycopeptides (37%) and carbapenems (30 %). These results can be explained by the emergence of endemic Methicillin-resistant Staphylococcus aureus (MRSA) and of Extended-spectrum beta-lactamase (ESBL) Gram negative bacilli. Results showed a decrease in susceptibility of P. aeruginosa to imipenem (p = 0.038) and K. pneumoniae to ciprofloxacin (p = 0.021). The total consumption of restricted antibiotic has significantly increased, especially among complex medical services. A significant decrease in bacterial susceptibility has been observed mainly in gram-negative bacilli. The monitoring of antimicrobial prescribing practices and local susceptibility patterns are essential to promote the rational use of antibiotics.


July 3, 2013 at 11:01 pm

Antibiotics Smart Use: a workable model for promoting the rational use of medicines in Thailand.

Bull World Health Organ. 2012 Dec 1;90(12):905-13.

Sumpradit N, Chongtrakul P, Anuwong K, Pumtong S, Kongsomboon K, Butdeemee P, Khonglormyati J, Chomyong S, Tongyoung P, Losiriwat S, Seesuk P, Suwanwaree P, Tangcharoensathien V.


Food and Drug Administration, Ministry of Public Health, 88/24 Tiwanon Road, Muang, Nonthaburi, 11000, Thailand.


The Antibiotics Smart Use (ASU) programme was introduced in Thailand as a model to promote the rational use of medicines, starting with antibiotics. The programme’s first phase consisted of assessing interventions intended to change prescribing practices; the second phase examined the feasibility of programme scale-up. Currently the programme is in its third phase, which centres on sustainability. This paper describes the concept behind ASU, the programme’s functional modalities, the development of its conceptual framework and the implementation of its first and second phases. To change antibiotic prescription practices, multifaceted interventions at the individual and organizational levels were implemented; to maintain behaviour change and scale up the programme, interventions at the network and policy levels were used. The National Health Security Office has adopted ASU as a pay-for-performance criterion, a major achievement that has led to the programme’s expansion nationwide. Despite limited resources, programme scale-up and sustainability have been facilitated by the promotion of local ownership and mutual recognition, which have generated pride and commitment. ASU is clearly a workable entry point for efforts to rationalize the use of medicines in Thailand. Its long-term sustainability will require continued local commitment and political support, effective auditing and integration of ASU into routine systems with appropriate financial incentives.



July 3, 2013 at 11:00 pm

Physicians with access to point-of-care tests significantly reduce the antibiotic prescription for common cold.

Rev Esp Quimioter. 2013 Mar;26(1):12-20.

Llor C, Hernández S, Cots JM, Bjerrum L, González B, García G, Alcántara Jde D, Guerra G, Cid M, Gómez M, Ortega J, Pérez C, Arranz J, Monedero MJ, Paredes J, Pineda V; Grupo de Trabajo Happy Audit España.

Collaborators (307)


Centro de Atención Primaria Jaume I, Tarragona, Universidad Rovira i Virgili, Spain.



This study was aimed at evaluating the effect of two levels of intervention on the antibiotic prescribing in patients with common cold.


Before and after audit-based study carried out in primary healthcare centres in Spain. General practitioners registered all the episodes of common cold during 15 working days in January and February in 2008 (preintervention). Two types of intervention were considered: full intervention, consisting in individual feedback based on results from the first registry, courses in rational antibiotic prescribing, guidelines, patient information leaflets, workshops on rapid tests -rapid antigen detection and C-reactive protein tests- and provision of these tests in the surgeries; and partial intervention, consisting of all the above intervention except for the workshop and they did not have access to rapid tests. The same registry was repeated in 2009 (postintervention). In addition, new physicians filled out only the registry in 2009 (control group).


210 physicians underwent the full intervention, 71 the partial intervention and 59 were assigned to the control group. The 340 doctors prescribed antibiotics in 274 episodes of a total of 12,373 cases registered (2.2%).The greatest percentage of antibiotic prescription was found in the control group (4.6%). The partial intervention increased the antibiotic prescription percentage from 1.1% to 2.7% while only doctors who underwent the complete intervention lead to a significant reduction of antibiotics prescribed, from 2.9% before to 0.7% after the intervention (p<0.001).


Only physicians with access to rapid tests significantly reduced antibiotic prescription in patients with common cold.


July 3, 2013 at 11:00 pm

The knowledge, attitude and the perception of prescribers on the rational use of antibiotics and the need for an antibiotic policy-a cross sectional survey in a tertiary care hospital.

J Clin Diagn Res. 2013 Apr;7(4):675-9.

Remesh A, Gayathri AM, Singh R, Retnavally KG.


Associate Professor, Department of Pharmacology & Therapeutics, Dr. Somervell Memorial CSI Medical College , Karakonam,Trivandrum, Kerala, India .


Background: Antibiotics are prescribed frequently and there is always an overuse with a risk of resistance and increasing costs. Rational drug prescribing is essential for minimizing the health care costs and for reducing the resistance. The implementation of a strict antibiotic policy by all the health care institutes is being made mandatory nowadays. An improving awareness among the prescribers which can be created through educational interventions, can promote the rational use of antibiotics. Hence, we considered it worthwhile to study the knowledge, attitude and the perception of the practitioners towards a rational antibiotic use. Materials and Methods: All the registered practitioners who were working in the hospital setting and were willing to give written informed consents, were enrolled in the study. All the participants who were enrolled in the study during a one month period, had to fill up a predesigned, structured and validated questionnaire which was used to assess the knowledge, attitude and the perception among physicians towards the rational use of antibiotics. Results: About 65% of the participants who provided complete information in the questionnaire, were included in analysis. Among them, more than 50 % agreed on the existence of an essential drug list, on the knowledge about new antibiotics and on prescribing antibiotics rationally and on the interpretation of the culture and the sensitivity results. A majority strongly agreed that they ensured that their patients completed the course, that they provided counselling and that they took special interest in the proper use of antibiotics. There was a consensus on the overuse, issues of resistance, and on the input from fellow colleagues. Conclusion: The participants in our study had knowledge about the rational use of antibiotics, an attitude to prescribe drugs as per the essential drug list and a perception that antibiotics were being overused and that rational drug prescribing had an important role in the antibiotic resistance.


July 3, 2013 at 10:59 pm


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