Changes in the Profile of Antibiotic Prescriptions by Dentists in Brazil during the Pandemic.

During the COVID-19 pandemic, people worldwide, including the scientific community, were insecure and fearful. The lack of vaccines at the beginning of the pandemic and the high mortality rate led to a search for alternative treatments for COVID-19. Among these proposals, a postulated activity of azithromycin was frequently studied in early treatment. In view of this, many countries saw an increase in the consumption of this antibiotic. Thus, the objective of this study was to evaluate, in Brazil, whether there was an increase in azithromycin prescriptions made by dentists, as they may have been prescribing this antibiotic as a probable treatment for COVID-19. This is an interrupted time series that analyzed antimicrobial prescriptions data between January 2014 and July 2021. The data were taken from the National System of Controlled Products Management, and pre- and postpandemic periods were compared. To assess changes in azithromycin consumption, Joinpoint regression and analysis of variance, followed by Dunnett's test, were used. More than 38 million prescriptions written during the period were analyzed. Amoxicillin (72.3%), azithromycin (18.0%), cephalexin (6.1%), and metronidazole (3.58%) were the most prescribed antibiotics. At the beginning of the pandemic, there was a drop in amoxicillin prescriptions motivated by a decrease in consultations, but conversely, in less than three months, azithromycin prescriptions grew by more than 100%. The exaggerated use of this antibiotic during the pandemic will certainly have consequences in the short and medium term on indicators of bacterial resistance. The use of guidelines and respect for the therapeutic protocols of government agencies should be fundamental for collective and strategic action in the fight against health emergencies.

ABCDE and ABCDEF care bundles: A systematic review protocol of the implementation process in intensive care units.

BACKGROUND: The awakening and breathing coordination of daily sedation and ventilator removal trials, delirium monitoring and management, and early mobility and exercise (ABCDE) and assessment, prevent and manage pain, both spontaneous awakening and spontaneous breathing trials, choice of analgesia and sedation, assess, prevent and manage delirium, early mobility and exercise, family engagement (ABCDEF) bundles are part of the science of the liberation of the intensive care unit (ICU). There are not enough studies that have evaluated the effectiveness and safety of the implementation of these bundles. This study will analyze the implementation process, estimate their effectiveness and safety, and identify barriers, facilitators and attitudes that have influenced the implementation process. METHODS: Qualitative and quantitative studies will be eligible for our systematic review with adult patients who have been exposed to the implementation of the ABCDE or ABCDEF bundles compared to the usual care in the ICU. In order to search the implementation interventions of the bundles, we will search electronically: MEDLINE (PubMed); Excerpta Medica Database (Ovid); Cumulative Index to Nursing and Allied Health Literature (EBSCO); The Cochrane Library (Wiley); Web of Science; Virtual Health Library; and OpenGrey. We will not impose any language restrictions or publication status. Outcomes of interest include ICU and hospital length of stay; mechanical ventilation time; incidence and prevalence of delirium or coma; level of agitation and sedation; early mobilization; mortality in ICU and hospital; change in perception, attitude or behavior of the stakeholders; and change in knowledge of health professionals. The team of reviewers will independently screen search results, extract data from eligible studies, and assess risk of bias. Disagreements between the reviewers will be solved through consensus or arbitration by a third-party investigator. To assess the quality and risk of bias in randomized and quasi-randomized trials we will use the domain-based evaluation recommended by The Cochrane Handbook. Studies with other methodological designs will be evaluated using the Critical Appraisal Tools developed by The Joanna Briggs Institute. Other instruments may be used, if necessary. RESULTS: The evidence derived from this study will increase the knowledge of effectiveness and safety of the implementation process of ABCDE and ABCDEF bundles. CONCLUSION: The results could guide patients and healthcare practitioners by helping to facilitate evidence-based shared care decision making. PROTOCOL REGISTRATION: PROSPERO CRD42019121307.

Changes in weight and body fat after use of tetracycline and Lactobacillus gasseri in rats

ABSTRACT Recent studies have shown a role of intestinal microbiota in obesity. The consumption of antibiotics in the last 70 years has led to changes in intestinal microbiota, which has led to weight gain and body fat accumulation. To evaluate the possibility of weight gain induced by antibiotics and the possible protective effect of probiotics, we divided 45 animals (Rattus norvegicus) into groups and administered the following treatments over two weeks: tetracycline, tetracycline + Lactobacillus gasseri, and NaCl. The animals were weighed over the course of 8 weeks, and at the end of the treatment period, they were measured and subjected to bioelectrical impedance analysis. The results show that the group receiving tetracycline alone had a higher body mass index (p=0.030), a greater Lee index (p=0.008), and a lower body water percentage than the control group, indicating a greater accumulation of body fat. The group receiving the probiotics with tetracycline presented similar results to the control group, indicating a possible protective effect of body fat accumulation in the group receiving tetracycline alone. The results show that tetracycline increased the concentration of body fat, and the use of probiotics was associated with an ability to protect the animals from the pro-obesity effect.

Level of patient information on antibiotic use / Nível de informação do paciente sobre o uso de antibióticos

Establishing an effective antimicrobial therapeutic requires choosing the appropriate antibiotic and ensuring compliance with times and doses prescribed. Problems concerning early abandonment and unfinished prescriptions due to lack of information, as well as more resistant microorganisms, have been identified as the major factors responsible for therapeutic failure in bacterial infections. This study aimed to determine the level of information among antibiotic users undergoing treatment with these drugs, and habits related to other therapies. A survey was applied to 403 users and identified great difficulties in understanding prescriptions, especially among users with no formal schooling who understood only 21 to 28 percent of the prescribed instructions. This same group reported having received the lowest amount of information during the consultation, with only 28.6 percent receiving verbal information from the prescriber on the length of course with the drug. Additionally, 21 percent of this group reported a tendency to use the antibiotic until symptoms resolved, without heeding the length of course prescribed. Guidance on antibiotics use should be an integral and fundamental part of effective therapy.

Para se estabelecer uma terapêutica antimicrobiana eficaz, é necessário que se escolha o fármaco adequado e que este seja utilizado na dose e tempo prescritos. Abandonos precoces e o não cumprimento da prescrição, originados por falta de informação adequada, têm sido apontados, juntamente com microrganismos resistentes, como os grandes responsáveis por falhas terapêuticas no tratamento de infecções bacterianas. Este trabalho teve por objetivo conhecer o nível de informação de usuários de antibióticos sobre estes fármacos, tanto na terapêutica a que estavam sendo submetidos, quanto em seus hábitos em outras terapêuticas. Por meio de um questionário aplicado a 403 usuários, notou-se uma grande dificuldade de entendimento da prescrição, especialmente por usuários sem estudo formal, chegando a níveis de entendimento de apenas 21 a 28 por cento das prescrições estabelecidas. Esse mesmo grupo relatou ter recebido a menor quantidade de informações durante a consulta, apenas 28,6 por cento receberam informações verbais do prescritor sobre o tempo que deveriam utilizar o medicamento. Adicionalmente, foi percebido que 21 por cento desse grupo informaram que têm o costume de utilizar o antibiótico até desaparecer os sintomas, sem se preocupar com o tempo prescrito. A orientação para a utilização do medicamento é parte integrante e fundamental de uma terapêutica eficaz.

A febre maculosa no Brasil / Rocky Mountain spotted fever in Brazil

Embora no Brasil o número de casos confirmados de febre maculosa esteja em declínio desde 2005, a taxa de mortalidade (20 a 30 por cento) ainda é muito alta quando comparada a outros países. Esse alto índice de mortalidade tem estreita relação com a dificuldade em fazer o diagnóstico e estabelecer a terapia apropriada. Apenas dois grupos de antibióticos têm comprovada eficácia clínica, o cloranfenicol e as tetraciclinas. Até pouco tempo atrás, as tetraciclinas eram reservadas aos pacientes adultos em virtude das alterações dentárias e ósseas em crianças. Recentemente, entretanto, a Academia Americana de Pediatria e diversos autores têm recomendado a utilização da doxiciclina também em crianças. Em casos mais severos, a falta de experiência com uma tetraciclina injetável no Brasil faz com que se opte pelo cloranfenicol injetável. Como o pronto diagnóstico e a escolha adequada do fármaco são fatores determinantes de um prognóstico positivo, todos os profissionais da saúde devem estar melhor preparados para reconhecer e tratar a febre maculosa.

Although the number of confirmed cases of spotted fever has been declining in Brazil since 2005, the mortality rate (20 percent to 30 percent) is still high in comparison to other countries. This high mortality rate is closely related to the difficulty in making the diagnosis and starting the correct treatment. Only two groups of antibiotics have proven clinical effectiveness against spotted fever: chloramphenicol and tetracyclines. Until recently, the use of tetracyclines was restricted to adults because of the associated bone and tooth changes in children. Recently, however, the American Academy of Pediatrics and various researchers have recommended the use of doxycycline in children. In more severe cases, chloramphenicol injections are often preferred in Brazil because of the lack of experience with injectable tetracycline. Since early diagnosis and the adequate drug treatment are key to a good prognosis, health care professionals must be better prepared to recognize and treat spotted fever.

Resistência bacteriana / bacterial resistance

A resistência bacteriana é um sério problema de saúde pública e cresce verticalmente por todo o mundo. Algumas açöes de combate à resistência devem ser tomadas e incluem: desenvolvimento de novas drogas, melhor controle sobre infecçöes hospitalares e, principalmente, conservaçäo do atual arsenal terapêutico, através de educaçäo continuada no uso de antimicrobianos. Desta forma o objetivo desta revisäo é mostrar como a resistência bacteriana pode ser tranferida de uma bactéria resistente para uma sensível, como esses microorganismos podem manifestar essa resistência e o que cada profissional de saúde deve fazer para combater esse problema.(au)