Macrolide prescriptions and erythromycin resistance of Streptococcus pyogenes.

This study shows a significant association between the number of macrolide prescriptions reimbursed by the Italian National Health Service and resistance of Streptococcus pyogenes to erythromycin in children from a region in northern Italy with high prevalence of erythromycin resistance. Recent prescription of a macrolide (especially azithromycin) is a predictor of erythromycin resistance, as well as a possible risk factor for resistance at a community level.

A three-year population-based study of antibiotic treatments for children.

AIM: To describe the use of systemic antibiotics in the paediatric population of the Emilia-Romagna region (Italy) during the period 2000-2002. METHODS: Data were extracted from the drug prescription database of Emilia-Romagna. RESULTS: Treatment rates were within the range 1016-1151 treatments per 1000 children-years, according to the observed year. Chephalosporins were the most prescribed antibiotic class. CONCLUSION: The paediatric population of Emilia-Romagna is heavily exposed to systemic antibiotics. Further studies are needed to find out determinants of antibiotic overuse.

Meta-analysis of trials comparing oral anticoagulation and aspirin versus dual antiplatelet therapy after coronary stenting. Clues for the management of patients with an indication for long-term anticoagulation undergoing coronary stenting.

The combination of oral anticoagulation (OAC) and aspirin was the antithrombotic treatment initially adopted after coronary stenting (PCI-S). Although dual antiplatelet therapy with aspirin and a thienopyridine subsequently proved safer and more effective, OAC and aspirin combination is still used in patients with an indication for long-term OAC undergoing PCI-S. The absolute (AR) and relative (RR) risk of cardiac events and hemorrhagic/vascular complications of OAC and aspirin versus antiplatelet therapy were evaluated in a meta-analysis of four historical clinical trials. In 2,436 patients, the RR of a 30-day primary composite endpoint of death, myocardial infarction and the need for revascularization was significantly reduced by antiplatelet therapy (RR 0.41; 95% CI 0.25-0.69), whereas the RR of stent thrombosis (RR 0.26; 95% CI 0.06-1.14) and major bleeding (RR 0.36; 95% CI 0.14-1.02) was not statistically different. The 30-day AR of death, myocardial infarction, need for revascularization, major bleedings and vascular complications with OAC and aspirin were 0.65, 3.8, 4.2, 6.4 and 6.6%, respectively. In conclusion, due to the low AR of adverse events, the combination of OAC and aspirin appears an acceptable treatment after PCI-S in patients in whom long-term OAC is deemed mandatory.

Children's views of microbes: current beliefs about bacteria in Italian grade school children.

INTRODUCTION: The misuse of antibacterials and the consequent emergence of resistance indicate that enhanced awareness is required among clinicians, patients and the general population of the collaborative roles of the bacterial ecosystem in health preservation. The objective of this work is to assess school students' knowledge and perception of microbes. METHODS: In preparation for a meeting of health professionals concerning antimicrobial policies, a questionnaire for administration to children from fourth to eighth school grades was developed, exploring their understanding of bacteria, use of antibiotics and hygiene. SETTING: Twenty-eight classrooms in north-central Italy, 7 from fourth to fifth grade and 21 from sixth to eighth grade. RESULTS: Four hundred ninety-nine students with a mean age of 12 years participated in the study. For 60% of the children, the notion of bacteria centered on their harmfulness; only 25% of the interviewees acknowledged a positive role. Antibiotics were perceived as the absolute weapon against both viruses and bacteria by 56% of respondents and most cases of domestic health impairment by 46% of respondents. The proportions of children being treated at the time once or more than once with an antibiotic were 23 and 24%, respectively. Little difference emerged between the notion of cleansing as opposed to disinfecting. CONCLUSION: Children's confused understanding of bacteria and the lack of a specific contribution from schools suggest that health professionals should engage further in educational activities in the community to overcome this problem. Relevant policies may benefit from being targeted at children directly because they are more open to new ideas and can spread in their milieu the idea of a "reconciliation" with the microbial world.