Considerations for implementing an antibiotic policy in hospital practice

An antibiotic policy should aim for the safe, effective and economical use of antimicrobial drugs, and to prevent their indiscriminate use and development of resistant bacterial strains. The term 'antibiotic' is used as a general term for all antimicrobial drugs. Antibiotics prescriptions should be based on clinical evidence of bacterial infection, preferably substantiated by appropriate laboratory culture and sensitivity tests. Viral infections are not an indication for antibiotic prescriptions. Patient factors to be considered for choice and dose of an antibiotic are age, pregnancy, lactation, renal and hepatic impairment. Immunodeficient patients should receive only bactericidal drugs. Severity of infection determines the route of administration. Duration of therapy should not exceed five days, unless specifically prescribed by the physician. An antibiotic should, if started as an empirical therapy not be changed before a minimum of three days trial. Prescriptions of drugs such as aztreonam, imipenem, vancomycin, piperacillin and amphotericin are to be restricted due to cost and toxicity and should be reviewed by the microbiologist (AU)

Manchincel poisoning complicated by streptococcal pharyngitis and impetigo

A Danish tourist to Antigua in the West Indies, ate a fruit of Hippomane mancinella and developed acute poisoning with blistering of the oral mucosa and diarrhoea and a streptococcal superinfection. Ignorant tourists and their travel advisers are warned against this potentially deadly apple-tree-like plant and its tempting fruits. (AU)

Patterns of antibiotic usage in children at the Queen Elizabeth Hospital, Barbados

Seven hundred and thirty-two paediatric patients treated with antibiotics at the Queen Elizabeth Hospital were reviewed. There were 522 outpatients seen in the casualty area and 230 inpatients admitted to the Paediatric wards. Six hundred and forty-seven (87 percent) patients were on the medical service and 105 (13 percent) on the surgical service respectively. Tonsillitis, otitis media and pneumonia were the most commonly documented conditions treated in inpatients whereas upper respiratory tract infections, tonsillitis and otitis media were the most commonly treated conditions in outpatients. In both patient groups, penicillin and trimethoprim-sulphamethoxazole were the most frequently prescribed antimicrobial agents. Antibiotic therapy was further classified according to the documented diagnoses into groups of (1) indicated, (2) not indicated, (3) inappropriate or (4) prophylactic. In 34 percent of inpatients and 54 percent outpatients, antibiotic therapy was classified as no indicated. Conditions in inpatients most frequently treated with "not indicated" antibiotics included cases of post-operative tonsillectomy and andenoidectomy without documented clinical or bacteriological evidence of infection, gingivostomatitis and upper respiratory tract infections. Bacterial culture negative gastroenteritis, gingivostomatitis and bronchial asthma were the most frequently treated conditions receiving "not indicated" therapy in outpatients. In most of these conditions, the infection was most frequently of viral aetiology (AU)

The families of patients with acute rheumatic fever or glomerulonephritis in Trinidad

The families of 21 patients with acute rheumatic fever (ARF) and 44 patients with acute glomerulonephritis (AGN) in Trinidad were examined in their homes. The ARF and AGN families were equally large and crowded and they lived in the same largely rural areas. However, only 22 percent of the ARF family members had skin infections in contrast to 61 percent of the AGN family members. Sixty-eight per cent of skin infections in ARF families and 69 percent of skin infection in AGN families yielded group A streptococci. Throat cultures were positive in 19 percent of ARF family members and 25 percent of AGN family members. Thirty-two per cent of 51 group A strains isolated from ARF family members (29 from throat, 22 from skin) were M11 of "M41" strains which were associated with ARF during the study, while only 8 percent were M1, T4 (MNT or 60) or M55 strains which were associated with AGN. In contrast, 49 percent of 171 group A strains isolated from AGN family members (64 from throat, 107 from skin) were M1, T4 (MNT or 60) of M55 while only 10 percent were M11 of "M41." Serum antibody titres were similar in both groups: antistreptolysin-0 titres were not markedly increased in either while anti-hyaluronidase and/or antideoxyribonuclease-B titres were increased in both. Evidence of subclinical AGN was found equally often in both groups: 6 percent of each had abnormal urine and 4 percent of each had decreased serum complement while 2 percent of the ARF and 3 percent of the AGN family members had both abnormal urine and decreased serum complement.(AU)

Incidence and types of group a streptococcal pyoderma and pharyngitis in children in Barbados

Group A streptococci recovered with equal frequency from the skin or upper respiratory tract during two winter months from children in Barbados under 15 years of age. Pyoderma affected 21 percent of this group and nearly half (44 percent) of the cases were associated with Group A streptococci. No evidence of nephritis was found in patients with pyoderma or upper respiratory tract isolates and may be due to the absence of nephritogenic strains in the population at the time of the study or a low attack rate of disease within a small group. T-type patterns 11/12 in the skin and 3/13/B 3264 in the upper respiratory tract were recovered most commonly. Further studies are needed to determine the importance of streptococci infection in this population (AU)