Quality Measures of Antimicrobal Drug Use

Clinical Microbiology and Antimicrobial Chemotherapy. 2001; 3(2):133-147

​ Gyssens I.C.
antibiotics antibiotic policy antibiotic resistance audit
Section
Antimicrobial Use
Type
Journal article
Publication
Clinical Microbiology and Antimicrobial Chemotherapy. 2001; 3(2):133-147

Abstract

Translated and reprinted with permission from «International Journal of Antimicrobial Agents» 2001;17:9-19.

Antimicrobial use is the major determinant in the development of resistance. Many parameters of importance for optimal quality of antimicrobial therapy have already been defined. Maximal efficacy of the treatment should be combined with minimal toxicity at the lowest cost. Quality of antimicrobial drug use is dependent on knowledge of many aspects of infectious diseases. Considering efficacy, many of our indications for antimicrobial use need critical evaluation. Irrational use should be discouraged. Avoidance of the development of resistance is a quality parameter that will need increasing attention. This paper reviews the well.established factors that may influence the appropriateness of pharmacotherapy with antimicrobial drugs. It cites recent evidence supporting principles of prudent prescribing and gives an overview of audits that have addressed these parameters. Measures relating to resistance are discussed. All rights reserved.

  • 1. Seppala H., Klaukka T., Vuopio-Varkila J., et al. The effect of changes in the consumption of macrolide antibiotics on erythromycin resistance in group A streptococci in Finland. New Engl J Med 1997;337:441-6.
  • 2. Kristinsson K.G. Modification of prescribers’ behavior: the Icelandic approach. Clin Microbiol Infect 1999;5:4S43-7.
  • 3. Chen D.K, McGeer A., de Azavedo J.C., Low D.E. Decreased susceptibility of Streptococcus pneumoniae to fluoroquinolones in Canada. New Engl J Med 1999;341:233-9.
  • 4. Johnson А.Р, Speller D.C.E., George R.C., Efstratiou A. Prevalence of antibiotic resistance to pneumococci in England and Wales: results of observational surveys in 1990 and 1995. Br Med J 1996;312:1454-6.
  • 5. Struelens M.J. The epidemiology of antimicrobial resistance in hospital acquired infections: problems and possible solutions. Br Med J 1998;317:652-4.
  • 6. Huyck M.M., Sahm D.F., Gilmore M.S. Multiple drug resistant enterococci: the nature of the problem and an agenda for the future. Emerg Infect Dis 1998;4:239-49.
  • 7. Centers for Disease Control and Prevention. Fluoroquinolone-resistant Neisseria gonorrhoeae. MMWR 1998;29: 405-8.
  • 8. Winstanley T.G., Limb D.I., Eggington R., Hancock F. A 10 year survey of the antimicrobial susceptibility of urinary tract isolates in the UK; the microbe base project. J Antimicrob Chemother 1997;40:591-4.
  • 9. Rotimi V.O., Khoursheed M., Brazier J.S., Jamal W.Y., Khodakhast F.B. Bacteroides species highly resistant to metronidazole: an emerging clinical problem? Clin Microbiol Infect 1999;5:166-9.
  • 10. Helweg-Larsen J., Benfield T.L., Eugen-Olsen J., Lundgren J.D., Lundgren B. Effects of mutations in Pneumocystis carinii dihydropteroate synthetase gene on outcome of AIDS-associated P. carinii pneumonia. Lancet 1999;354:1347-51.
  • 11. Weinstein M.P., Towns M.L., Quartey S.M., et al. The clinical significance of positive blood cultures in the 1990s: a prospective comprehensive evaluation of the microbiology, epidemiology, and outcome of bacteraemia and fungemia in adults. Clin Infect Dis 1997;24:584-602.
  • 12. Byl В., Clevenberg P., Jacobs F., et al. Impact of infectious diseases specialists and microbiological data on the appropriateness of antimicrobial therapy for bacteriemia. Clin Infect Dis 1999;29:60-6.
  • 13. Turett G.S., Blum S., Fazal B.A., Justman J.E., Telzak Е.Е. Penicillin resistance and other predictors of mortality in pneumococcal bacteriemia in a population with high human immunodeficiency virus seroprevalence. Clin Infect Dis 1999;29:321-7.
  • 14. Shlaes D.M., Gerding D.N., John J.F., et al. Society for Healthcare Epidemiology of America and Infectious Diseases Society of America Joint Committee on the prevention of antimicrobial resistance: guidelines for the prevention of antimicrobial resistance in hospitals. Infect Control Hosp Epidemiol 1997;18:275-91.
  • 15. Gyssens I.C. How to optimize prescription of antimicrobial drugs. Acta Clin Belg 1999;54:7-12.
  • 16. Belongia E.A., Schwartz B. Strategies for promoting judicious use of antibiotics by doctors and patients. Br Med J 1998;317:668-71.
  • 17. Couper M.R. Strategies for the rational use of antimicrobials. Clin Infect Dis 1997;24(Suppl. 1):S154-6.
  • 18. Gould I.M., Hampson J., Taylor E.W., Wood M.J. For the Working Party of the British Society for antimicrobial chemotherapy. Hospital antibiotic control measures in the UK. J Antimicrob Chemother 1994;34:21-42.
  • 19. Gyssens I.C., Van den Broek P.J., Kullberg B.J., Hekster Y.A., Van der Meer J.W.M. Optimizing antimicrobial therapy. A method for antimicrobial drug evaluation. J Antimicrob Chemother 1992;30:724-7.
  • 20. Gyssens I.C., Geerligs I.E.J., Dony J.M.J., et al. Optimising antimicrobial drug use in surgery: an intervention study in a Dutch university hospital. J Antimicrob Chemother 1996;38:1001-12.
  • 21. Gyssens I.C., Geerligs I.E.J., Nannini-Bergman M.G., Knape J.T.A., Hekster Y.A., van der Meer J.W.M. Optimizing the timing of antimicrobial drug prophylaxis in surgery: an intervention study. J Antimicrob Chemother 1996;38:301-8.
  • 22. Gyssens I.C., Blok W.L., Van den Broek P.J., Hekster Y.A., Van der Meer J.W.M. Implementation of an educational program and an antibiotic order form to optimize quality of antimicrobial drug use in a department of internal medicine. Eur J Clin Microbiol Infect Dis 1997;16:904-12.
  • 23. Classen D.C., Evans R.S., Pestotnik S.L., Horn S.D., Menlove R.L., Burke J.P. The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. New Engl J Med 1992;326:281-6.
  • 24. Evans R.S., Pestotnik S.L., Classen D.C., et al. A computer-assisted management program for antibiotics and other anti-infective agents. New Engl J Med 1998; 338:232-8.
  • 25. Heininger A., Niemetz A.H., Keim M., Fretschner R., Doering G., Unertl K. Implementation of an interactive computer-assisted infection monitoring program at the bedside. Infect Control Hosp Epidemiol 1999;20:440-7.
  • 26. Kunin C.M. Use of antibiotics: a brief exposition of the problem and some tentative solutions. Ann Intern Med 1973;79:555-60.
  • 27. Dunagan W.C., Woodward R.S., Medoff G., et al. Antimicrobial misuse in patients with positive blood cultures. Am J Med 1989;87:253-9.
  • 28. Volger B.W., Ross M.B., Brunetti H.R., Baumgartner D.D., Therasse D.G. Compliance with a restricted antimicrobial agent policy in a university hospital. Am J Hosp Pharm 1988;45:1540-4.
  • 29. Maki D.G., Schuna A.A. A study of antimicrobial misuse in a university hospital. Am J Med Sci 1978;275:271-82.
  • 30. Woodward R.S., Medoff G., Smith M.D., Gray J.L. Antibiotic cost savings from formulary restrictions and physician monitoring in a medical-school-affiliated hospital. Am J Med 1987;83:817-23.
  • 31. Swindell P.J., Reeves D.S., Bullock D.W., Davies A.J., Spence C.E. Audits of antibiotic prescribing in a Bristol hospital. Br Med J 1983;286:118-22.
  • 32. Sturm A.W. Rational use of antimicrobial agents and diagnostic microbiology facilities. J Antimicrob Chemother 1988;22:257-60.
  • 33. Raz R., Sharir R., Ron A., Laks N. The influence of an infectious disease specialist on the antimicrobial budget of a community teaching hospital. J Infect 1989;18:213-9.
  • 34. White A.C., Atmar R.L., Wilson J., Cate T.R., Stager C.E., Greenberg S.B. Effects of requiring prior authorization for selected antimicrobials: expenditures, susceptibilities, and clinical outcomes. Clin Infect Dis 1997;25:230-9.
  • 35. Fowler V.G., Jr, Sanders L.L., Sexton D.J. et al. Outcome of Staphylococcus aureus bacteremia according to compliance with recommendations of infectious disease specialists: experience with 244 patients. Clin Infect Dis 1998; 27:478-86.
  • 36. Nathwani D., Davey P., France A.J., Phillips G., Orange G., Parratt D. Impact of an infection consultation service for bacteraemia on clinical management and use of resources. Q J Med 1996:89:789-97.
  • 37. Gomez J., Conde Cavero S.J., Hernandez Cardona J.L., et al. The influence of the opinion of an infectious disease consultant on the appropriateness of antibiotic treatment in a general hospital. J Antimicrob Chemother 1996;38:309-14.
  • 38. Gyssens I.C., Smits-Caris C., Stolk-Engelaar M.V., Slooff T.J.J.H., Hoogkamp-Korstanje J.A.A. An audit of microbiology laboratory utilization. The diagnosis of infection in orthopedic surgery. Clin Microb Infect 1997;3:518-22.
  • 39. Garner J.S., Jarvis W.R., Emori T.G., Horan T.C., Hughes J.M. CDC definitions for nosocomial infections. Am J Infect Control 1988;16:128-40.
  • 40. Weirich E., Rabin R.L., Maldonado Y., et al. Neutrophil CD11b expression as a diagnostic marker for early-onset neonatal infection. J Pediatr 1998;132:445-51.
  • 41. Franz A.R., Steinbach G., Kron M., Pohlandt F. Reduction of unnecessary antibiotic therapy in newborn infants using interleukin-8 and C-reactive protein as markers of bacterial infections. Pediatrics 1999;104:447-53.
  • 42. Gendrel D., Raymond J., Coste J., et al. Comparison of procalcitonin with C-reactive protein, interleukin-6 and interferon-alpha for differentiation of bacterial vs. viral infections. Pediatr Infect Dis J 1999;18:875-81.
  • 43. Ugarte H., Silva E., Mercan D., De Mendonca A., Vincent J.-L. Procalcitonin used as a marker of infection in the intensive care unit. Crit Care Med 1999;27:498-504.
  • 44. O’Brien K.L., Dowell S.F., Schwartz B., Marcy M., Phillips W.R., Gerber M.A. Acute sinusitis – principles of judicious use of antimicrobial agents. Pediatrics 1998;101:174-7.
  • 45. Dowell S.F., Marcy S.M., Phillips W.R., Gerber M.A., Schwartz B. Otitis media – principles of judicious use of antimicrobial agents. Pediatrics 1998;101:165-71.
  • 46. Bauchner H., Pelton S.I., Klein J.O. Parents, physicians, and antibiotic use. Pediatrics 1999;103:395-401.
  • 47. Baker M.D., Bell L.M., Avner J.R. The efficacy of routine outpatient management without antibiotics of fever in selected infants. Pediatrics 1999;103:627-31.
  • 48. Enlund A.L., Varenhorst E. Morbidity of ultrasound-guided transrectal cor biopsy of the prostate without prophylactic antibiotic therapy. A prospective study in 415 cases. Br J Urol 1997;79:777-80.
  • 49. Harris A., Chan A.C., Torres-Viera C. Hammett R, Carr-Locke D. Meta-analysis of antibiotic prophylaxis in endoscopic retrograde pancreatography (ERCP). Endoscopy 1999;31:718-24.
  • 50. Villalobos Т., Arango C., Kubilis P., Rathore M. Antibiotic prophylaxis after basilar skull fractures: a meta-analysis. Clin Infect Dis 1998;27:364-9.
  • 51. Schlager Т.А., Anderson S., Trudell J. Owen Hendley J. Nitrofurantoin prophylaxis for bacteriuria and urinary tract infection in children with neurogenic bladder on intermittent catherization. J Pediatr 1998;132:704-8.
  • 52. Cummings P., Del Beccaro M.A. Antibiotics to prevent infection of simple wounds: a meta-analysis of randomized studies. Am J Emerg Med 1995;13:396-400.
  • 53. Bonten M., Kullberg B.J., van Dalen R., et al. Selective digestive decontamination in patients in intensive care. J. Antimicrob. Chemother. 2000, in press.
  • 54. Egarter C., Leitich H., Husslein P., Kaider A., Schemper M. Adjunctive antibiotic treatment in preterm labor and neonatal morbidity: a meta-analysis. Obstet Gynecol 1996;88:303-9.
  • 55. Fahey Т., Stocks N., Thomas T. Systematic review of the treatment of upper respiratory tract infection. Arch Dis Child 1998;79:225-30.
  • 56. Bent S., Saint S., Vittinghoff E., Grady D. Antibiotics in acute bronchitis: a meta-analysis. Am J Med 1999;107:62-7.
  • 57. Nickman N.A., Blissenbach H.F., Herrick J.D. Medical committee enforcement of policy limiting postsurgical antibiotic use. Am J Hosp Pharm 1984;41:2053-6.
  • 58. Everitt D.E., Soumerai S.B., Avorn J., Klapholz H., Wessels M. Changing surgical antimicrobial prophylaxis practices through education targeted at senior department leaders. Infect Control Hosp Epidemiol 1990;11: 578-83.
  • 59. Silver A., Eichorn A., Krai J., et al. Timeliness and use of antibiotic prophylaxis in selected inpatient surgical procedures. Am J Surg 1996;171:548-52.
  • 60. Gorecki P., Schein M., Rucinski J.C., Wise L. Antibiotic administration in patients undergoing common surgical procedures in a community teaching hospital: the chaos continues. World J Surg 1999;23:429-32.
  • 61. Girotti M.J., Fodoruk S., Irvine-Meek J., Rotstein O.D. Antibiotic handbook and pre-printed perioperative order forms for surgical antibiotic prophylaxis: do they work? Can J Surg 1990;33:385-8.
  • 62. Griffiths L.R., Bartzokas C.A., Hampson J.P., Ghose A.R. Antibiotic cost and prescribing patterns in a recently commissioned Liverpool teaching hospital. Part 1: antimicrobial therapy. J Hosp Infect 1986;48:159-67.
  • 63. Mozillo N., Greco D., Pescini A., Formato A. Chemoprophylaxis in the surgical ward: results of a national survey in Italy. Eur J Epidemiol 1988,4;357-9.
  • 64. Sasse A., Mertens R., Sion J.P., et al. Surgical prophylaxis in Belgian hospitals: estimate of costs and potential savings. J Antimicrob Chemother 1998;41:267-72.
  • 65. Finkelstein R., Reinhertz G., Embom A. Surveillance of the use of antibiotic prophylaxis in surgery. Isr J Med Sci 1996;32:1093-7.
  • 66. Johnston J., Harris J., Hall J.C. The effect of an educational intervention on the use of perioperative antimicrobial agents. Austr Clin Rev 1992;12:53-6.
  • 67. Dunagan W.C., Woodward R.S., Medoff G., et al. Antibiotic misuse in two clinical situations: positive blood culture and administration of aminoglycosides. Rev Infect Dis 1991;13:405-12.
  • 68. Gross P.A., Barrett T.L., Patchen Dellinger E., et al. Quality standard for the treatment of bacteremia. Clin Infect Dis 1994;18:428-30.
  • 69. Elhanan G., Sarhat H., Raz R. Empiric antibiotic treatment and the misuse of culture results and antibiotic sensitivities in patients with community-acquired bacteraemia due to urinary tract infection. J Infect 1997;35:283-8.
  • 70. Wilkins E.G.L., Hickey M.M., Khoo S., et al. Northwick Park Infection Consultation Service. Part II. Contribution of the service to patient management: an analysis of results between September 1987 and July 1990. J Infect 1991;23:57-63.
  • 71. Cunney R.J., McNamara E.B., Alansari N., Loo B., Smyth E.G. The impact of blood culture reporting and clinical liaison on the empiric treatment of bacteraemia. J Clin Pathol 1997;50:1010-2.
  • 72. Doern G.Y., Vautour R., Gaudet M., Levy B. Clinical impact of rapid in vitro susceptibility testing and bacterial identification. J Clin Microbiol 1994;32:1757-62.
  • 73. Rybak M.J., Abate B.J., Kang S.L., Ruffing M.J., Lerner S.A., Drusano G.L. Prospective evaluation of the effect of an aminoglycoside dosing regimen on rates of observed nephrotoxicity and ototoxicity. Antimicrob Agents Chemother 1999;43:1549-55.
  • 74. Li S.C., Ioannides-Demos L.L., Spicer W.J., et al. Prospective audit of aminoglycoside usage in a general hospital with assessments of clinical processes and adverse clinical outcomes. Med J Aust 1989;151:224-32.
  • 75. Shrimpton S.B., Milmoe M., Wilson A.P.R., et al. Audit of prescription and assay of aminoglycosides in a UK teaching hospital. J Antimicrob Chemother 1993;31:599-606.
  • 76. Gyssens I.C., Lennards C.A., Hekster Y.A., Van der Meer J.W.M. The cost of antimicrobial chemotherapy. A method for cost evaluation. Pharm Weekbl Sci 1991;13(6):248-53.
  • 77. Briceland L.L., Quintiliani R., Nightingale C.H. Multidisciplinary cost-containment program promoting oral metronidazole for treatment of antibiotic associated colitis. Am J Hosp Pharm 1988;45:122-5.
  • 78. Crist K.D., Nahata M.C., Ety J. Positive impact of a therapeutic drug-monitoring program on total aminoglycoside dose and cost of hospitalization. Ther Drug Monit 1987;9:306-10.
  • 79. Karki S.D., Holden J.M.C., Mariano E. A team approach to reduce antibiotic costs. DICP Ann Pharmacother 1990;24:202-5.
  • 80. Evans R.S., Pestotnik S.L., Burke J.P., Gardner R.M., Larsen R.A., Classen D.C. Reducing the duration of prophylactic antibiotic use through computer monitoring of surgical patients. DICP Ann Pharmacother 1990;24:351-4.
  • 81. Grasela T.H. Jr., Paladino J.A., Schentag J.J., et al. Clinical and economic impact of oral ciprofloxacin as follow-up to parenteral antibiotics. DICP Ann Pharmacother 1991;25:857-62.
  • 82. Macris M.H., Hartman N., Murray B., et al. Studies of the continuing susceptibility of group A streptococcal strains to penicillin during eight decades. Pediatr Infect Dis J 1998;17:377-81.
  • 83. Van der Meer J.W.M., Gyssens I.C. Considerations in providing antibiotic therapy. The APUA Newsletter I992;winter:3-5.
  • 84. Frimodt-Moller N., Espersen F., Jacobsen B., Schlundt J., Meyling A., Wegener H. Problems with antibiotic resistance in Spain and their relation to antibiotic use in humans elsewhere. Clin Infect Dis 1997;25:939-41.
  • 85. Halls G.A. The management of infections and antibiotic therapy: a European survey. J Antimicrob Chemother 1993;31:985-1000.
  • 86. Kashuba A.D., Nafziger A.N., Drusano G.L., Bertino J.S.J. Optimizing aminoglycoside therapy for nosocomial pneumonia caused by gram-negative bacteria. Antimicrob Agents Chemother 1999;43:623-9.
  • 87. Thomas J.K., Forrest A., Bhavnani S.M., et al. Pharmacodynamic evaluation of factors associated with the development of bacterial resistance in acutely ill patients during therapy. Antimicrob Agents Chemother 1998;42:521-7.
  • 88. Van Houten M.A., Luinge K., Laseur M., Kimpen J.L. Antibiotic utilisation for hospitalised paediatric patients. Int J Antimicrob Agents 1998;10:161-4.
  • 89. Guillemot D., Carbon C., Balkau B., et al. Low dosage and long treatment duration of bete-lactam. Risk factors for carriage of penicillin-resistant Streptococcus pneumoniae. J Am Med Assoc 1996;279:365-70.
  • 90. Guillemot D., Carbon C., Vauzelle-Kervroedan F., et al. Inappropriateness and variability of antibiotic prescription among French office based physicians. J Clin Epidemiol 1998;51:61-8.
  • 91. Visser L.G., Arnouts P., van Furth R., Mattie H., van den Broek P.J. Clinical pharmacokinetics of continuous intravenous administration of penicillins. Clin Infect Dis 1993;17:491-5.
  • 92. Tanner D.J. Cost containment of reconstituted parenteral antibiotics: personnel and supply costs associated with preparation, dispensing, and administration. Rev Infect Dis 1984;6(suppl 4):S924-37.
  • 93. Sexton D.J., Tenenbaum M.J., Wilson W.R., et al. Ceftriaxone once daily for four weeks compared with ceftriaxone plus gentamycin once daily for two weeks for treatment of endocarditis due to penicillin-susceptible streptococci. Clin Infect Dis 1998;27:1470-4.
  • 94. Conus P., Francioli P. Relationship between ceftriaxone use and resistance of Enterobacter species. J Clin Pharm Ther 1992;17:303-5.
  • 95. Feder H.M., Gerber M.A., Randolph M.F., Stelmach P.S., Kaplan E.L. Once-daily therapy for streptococcal pharyngitis with amoxycillin. Pediatrics 1999;103:47-51.
  • 96. Paladino J.A., Sperry H.E., Backes J.M., et al. Clinical and economic evaluation of oral ciprofloxacin after an abbreviated course of intravenous antibiotics. Am J Med 1991;91:462-70.
  • 97. Ehrenkranz N.J., Nerenberg D.E., Shultz J.M., Slater К.С. Intervention to discontinue parenteral antimicrobial therapy in patients hospitalized with pulmonary infections: effect on shortening hospital stay. Infect Control Hosp Epidemiol 1992;13:21-32.
  • 98. Frighetto L., Nickoloff D., Martinusen S.M., Mamdani F.S., Jewesson P.J. Intravenous-to-oral stepdown program: four years of experience in a large teaching hospital. Ann Pharmacother 1992;26:1447-51.
  • 99. Schentag J.J., Ballow C.H., Fritz A.L., et al. Changes in antimicrobial agent usage resulting from interactions among clinical pharmacy, the infectious diseases division, and the microbiology laboratory. Diagn Microbiol Infect Dis 1993;16:255-64.
  • 100. MacGregor R.R., Graziani A.L. Oral administration of antibiotics: a rational alternative to the parenteral route. Clin Infect Dis 1997;24:457-67.
  • 101. Seligman S.J. Reduction in antibiotic costs by restricting use of an oral cephalosporin. Am J Med 1981;71:941-4.
  • 102. Shetty N., Shulman R.I., Scott G.M. An audit of first generation cephalosporin usage. J Hosp Infect 1999;41:229-32.
  • 103. Frieden T.R., Mangi R.J. Inappropriate use of oral ciprofloxacin. J Am Med Assoc 1990;264:1438-40.
  • 104. Davey P., Nathwani D. Sequential antibiotic therapy: the right patient, the right time and the right outcome. J Infect 1998;37(Suppl 1):37-44.
  • 105. Moss F., McNicol M.W., McSwiggan D.A., Miller D.L. Survey of antibiotic prescribing in a district general hospital I. Pattern of use. Lancet 1981; ii:349-52.
  • 106. Gould I.M., Jappy B. Trends in hospital antibiotic prescribing after introduction of an antibiotic policy. J Antimicrob Chemother 1996;38:896-904.
  • 107. Fong Т., Akriviadis E.A., Runyon B.A., Reynolds Т.В. Polymorphonuclear cell count response and duration of antibiotic therapy in spontaneous bacterial peritonitis. Hepatology 1989;9:423-6.
  • 108. Pestotnik S.L., Classen D.C., Evans R.S., Burke J.P. Implementing antibiotic practice guidelines through computer-assisted decision support: clinical and financial outcomes. Ann Intern Med 1996;124:884-90.
  • 109. Meehan T.P., Fine M.J., Krumholz H.M., et al. Quality of care. process, and outcomes in elderly patients with pneumonia. J Am Med Assoc 1997;278:2080-4.
  • 110. Natsch S., Kullberg B.J., Meis J.F.G.M., Van der Meer J.W.M. Earlier initiation of antibiotic treatment for severe infections after intervention to improve the organization and specific guidelines in the emergency room. Arch. Intern. Med. 2000; in press.
  • 111. Lingnau W., Berger J., Javorsky F., Fille M., Allerberger F., Benzer H. Changing bacterial ecology during a period of selective intestinal decontamination. J Hosp Infect 1998;39:195-206.
  • 112. Guslandi M. Antibiotics should not be used for non-ulcer dyspepsia. Br Med J 1999;318:670.
  • 113. Cheesbrough M.J. Antibiotics should not be first treatment for acne. Br Med J 1999;318:669.
  • 114. Kozyrskyj A.L., Hildes-Ripstein G.E., Longstaffe S.E., Wincott J.L., Sita Klassen T.P., Moffatt M.E. Treatment of acute otitis media with a shortened course of antibiotics: a meta-analysis. J. Am. Med. Assoc. 1998;279.
  • 115. Froom J., Culpepper L., Jacobs M., et al. Antimicrobials for otitis media? A review from the primary care network. Br Med J 1997;315:98-102.
  • 116. Rowe-Jones D.C., Peel A.L.G., Kingston R.D., Shaw J.F.L., Teasdale C., Cole D.S. Single dose cefotaxime plus metronidazole versus three dose cefuroxime plus metronidazole as prophylaxis against wound infection in colorectal surgery: multicentre prospective randomized study. Br Med J 1990;30:18-22.
  • 117. Carmeli Y., Troillet N., Eliopuolos G.M., Samore M.H. Emergence of antibiotic-resistant Pseudomonas aeruginosa: comparison of risks associated with different antipseudomonal agents. Antimicrob Agents Chemother 1999;43:1379-82.
  • 118. Zimmerii W., Widmer A.F., Blatter M., Ochsner P.E. Role of rifampin for treatment of orthopedic implant-related staphylococcal infections. J Am Med Assoc 1998;279:1537-41.
  • 119. Darouiche R.O., Raad I.I., Heard S.O., et al. A comparison of two antimicrobial-impregnated central venous catheters. Catheter Study Group. New Engl J Med 1999;340:1-8.
  • 120. Lipsitch M., Levin B. The population dynamics of antimicrobial chemotherapy. Antimicrob Agents Chemother 1997;41:363-73.
  • 121. John J.F.J. Antibiotic cycling: is it ready for prime time? Infect Control Hosp Epidemiol 2000;21:9-11.
  • 122. Rahal J.J., Urban C., Horn D., et al. Class restriction of cephalosporin use tot control total cephalosporin resistance in nosocomial Klebsiella. J Am Med Assoc 1998;280:1233-7.
  • 123. Hoiby N., Jarlov J.O., Kemp M. et al. Excretion of ciprofloxacin in sweat and multiresistant Staphylococcus epidermidis. Lancet 1997;349:167-9.
  • 124. Graham D.R., Correa-Villasenor A., Andersen R.L., Vollman J.H., Baine W.B. Epidemic neonatal gentamycin-methicillin-resistant Staphylococcus aureus infection associated with nonspecific topical use of gentamycin. J Pediatr 1980;97:972-8.
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