Antibiotics inappropriate

Compliance is essential to ensure efficacy of a particular agent. Patients may stop taking their antibiotics once the symptoms subside and save them for a future infection. If the patient does not complete the course of therapy, the infection may not be eradicated, and resistance may emerge. Self-medication of saved antibiotics may be inappropriate and harmful and may select for resistant organisms. Poor patient adherence maybe due to adverse effects, tolerability, cost, and lack of patient education. 

Upper respiratory tract infection (URI) is a term that refers to various upper airway infections, including otitis media, sinusitis, pharyngitis, and rhinitis. Most URIs are viral and often selflimited. Over 1 billion viral URIs occur annually in the United States, resulting in millions of physician office visits each year.1 Excessive antibiotic use for URIs has contributed to the significant development of bacterial resistance. Guidelines have been established to reduce inappropriate antibiotic use for viral URIs.2 This chapter will focus on acute otitis media, sinusitis, and pharyngitis because they are frequently caused by bacteria and require appropriate antibiotic therapy to minimize complications. 

Nosocomial Clostridium difficile-associated diarrhea (CDAD) is almost always associated with antimicrobial use therefore, we should avoid unnecessary and inappropriate antibiotic therapy. Almost all antibiotics except aminoglycosides have been associated with CDAD. 

Locally advanced cancer breast cancer generally refers to breast carcinomas with significant primary tumor and nodal disease but in which distant metastases cannot be documented. A wide variety of clinical scenarios can be seen within this group of patients, including neglected tumors that have spread locally and inflammatory breast cancers that are a unique clinical entity. Many locally advanced breast cancers are diagnosed in patients who have had symptoms for months to years and have neglected to seek medical attention. Patients with inflammatory breast cancer often are treated inappropriately for cellulitis with antibiotics for several weeks to months. 

Rapid tests have allowed for prompt diagnosis and initiation of antiviral therapy and decreased inappropriate use of antibiotics. 

These examples were inappropriate. Overuse of ampicillin in medical practice was discussed by Wescoe on p. 27 of the FDA s own National Advisory Food and Drug Committee Report, on January 24, 1977. Wescoe said (speaking of antibiotics in animal feeds), "I really find it difficult to understand how you believe a hazard exists for instance, relative to Neisseria gonorrheae, where the disease is practically all human, where it has been treated worldwide for many years by ampicillin. .. and then strain to say that maybe that is in part due to subtherapeutic doses of the antibiotic in feed." Dr. Wescoe chaired the committee. 

Because of concerns about inappropriate use of antibiotics leading to increase in resistant organisms, carefully consider alternatives before initiating treatment with linezolid in the outpatient setting. 

Nephrogenic diabetes insipidus is due to resistance to action of vasopressin, and therefore DDAVP is not indicated, but some benefit may be gained by using thiazide diuretics or chlorpropamide. The syndrome of inappropriate antidiuretic hormone (SIADH) can be treated by using the antibiotic derivative demeclocycline to induce a state of vasopressin resistance and partial nephrogenic diabetes insipidus. 

The emergence of microbial antibiotic drug resistance was speeded by the indiscriminate use of antibiotics in humans and livestock. Exposure to very low concentrations of antibiotic in meat or milk may have provided a path whereby human pathogens could eventually evolve high-level antibiotic drug resistance. Recently some strains of enterococcus and tuberculosis have developed resistance to all known antibiotic drugs. Inappropriate use of antibiotics is very common, and it accelerates the development of resistance in pathogens. 

Many patients receive lengthy courses of antibiotics that probably should not have been started. More than half of courses of antimicrobial chemotherapy are inappropriate. Influenza pneumonia and viral upper respiratory infections, for example, are impervious to assault by antibiotics, although many patients with these illnesses receive such antibiotics. Of course, influenza may be complicated by postinfluenzal staphylococcal pneumonia, for which antibiotics are indicated. Careful sequential evaluation of seriously ill patients for whom antibiotics are deferred is as important as in patients for whom antibiotics are prescribed. 

Improper administration of antimicrobial prophylaxis leads to excessive surgical wound infection rates. Common errors in antibiotic prophylaxis include selection of the wrong antibiotic, administering the first dose too early or too late, failure to repeat doses during prolonged procedures, excessive duration of prophylaxis, and inappropriate use of broad-spectrum antibiotics. 

As soon as the first case of anthrax was confirmed in Florida, a relatively new drug gained notoriety—Cipro . This fluoroquinolone (ciprofloxacin) became the mode of therapy for those people exposed to the anthrax bacillus (approved by the FDA for anthrax on July 28, 2000). Despite appeals for restraint in the use of Cipro, pharmacies in Mexican border towns reported being cleaned out of the antibiotic by Americans searching for the readily available and relatively cheap drug. Only time will tell if inappropriate, irrational use of Cipro results in loss of effectiveness in treating anthrax infection. However, the CDC did determine that 19 percent of 490 people in Florida experienced side effects 1-2 weeks after beginning therapy with Cipro. 

Correct answer = A. Most gonoccocal infections are now resistant to penicillin, the previous drug of choice. The other antibiotics are inappropriate. 

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