amoxicillin-potassium-clavulanate-combination and Clostridium-Infections

Outpatient diverticulitis is commonly treated with either a combination of metronidazole and a fluoroquinolone (metronidazole-with-fluoroquinolone) or amoxicillin-clavulanate alone. The U.S. Food and Drug Administration advised that fluoroquinolones be reserved for conditions with no alternative treatment options. The comparative effectiveness of metronidazole-with-fluoroquinolone versus amoxicillin-clavulanate for diverticulitis is uncertain.. To determine the effectiveness and harms of metronidazole-with-fluoroquinolone versus amoxicillin-clavulanate for outpatient diverticulitis.. Active-comparator, new-user, retrospective cohort studies.. Nationwide population-based claims data on U.S. residents aged 18 to 64 years with private employer-sponsored insurance (2000 to 2018) or those aged 65 years or older with Medicare (2006 to 2015).. Immunocompetent adults with diverticulitis in the outpatient setting.. Metronidazole-with-fluoroquinolone or amoxicillin-clavulanate.. 1-year risks for inpatient admission, urgent surgery, and. In MarketScan (IBM Watson Health), new users of metronidazole-with-fluoroquinolone (. Residual confounding is possible, and not all harms associated with these antibiotics, most notably drug-induced liver injury, could be assessed.. Treating diverticulitis in the outpatient setting with amoxicillin-clavulanate may reduce the risk for fluoroquinolone-related harms without adversely affecting diverticulitis-specific outcomes.. National Institutes of Health.

Topics: Adolescent; Adult; Ambulatory Care; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Clostridium Infections; Comparative Effectiveness Research; Cost of Illness; Diverticulitis; Female; Fluoroquinolones; Hospitalization; Humans; Male; Metronidazole; Middle Aged; Retrospective Studies; Risk Factors; Young Adult

This quasi-experimental study investigated the effect of an antibiotic cycling policy based on time-series analysis of epidemiologic data, which identified antimicrobial drugs and time periods for restriction. Cyclical restrictions of amoxicillin/clavulanic acid, piperacillin/tazobactam, and clarithromycin were undertaken over a 2-year period in the intervention hospital. We used segmented regression analysis to compare the effect on the incidence of healthcare-associated Clostridioides difficile infection (HA-CDI), healthcare-associated methicillin-resistant Staphylococcus aureus (HA-MRSA), and new extended-spectrum β-lactamase (ESBL) isolates and on changes in resistance patterns of the HA-MRSA and ESBL organisms between the intervention and control hospitals. HA-CDI incidence did not change. HA-MRSA incidence increased significantly in the intervention hospital. The resistance of new ESBL isolates to amoxicillin/clavulanic acid and piperacillin/tazobactam decreased significantly in the intervention hospital; however, resistance to piperacillin/tazobactam increased after a return to the standard policy. The results question the value of antibiotic cycling to antibiotic stewardship.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Antimicrobial Stewardship; beta-Lactamases; Clostridioides difficile; Clostridium Infections; Cross Infection; Drug Resistance, Bacterial; Hospitals; Humans; Incidence; Methicillin-Resistant Staphylococcus aureus; Northern Ireland; Staphylococcal Infections

Community-associated Clostridium difficile infection (CA-CDI; defined as cases without prior hospitalization in the previous 12 weeks who were either tested outside of hospital or tested within 2 days of admission to hospital) is a major public health problem. This study estimates the magnitude of the association between temporal and cumulative prescribing of antimicrobials in primary care and CA-CDI.. Three national patient-level datasets, covering CDI cases, community prescriptions and hospitalizations, were linked by the NHS Scotland unique patient identifier, the Community Health Index (CHI). All validated cases of CDI from August 2010 to July 2013 were extracted and up to six population-based controls were matched to each case from the CHI register for Scotland. Statistical analysis used conditional logistic regression.. The 1446 unique cases of CA-CDI were linked with 7964 age-, sex- and location-matched controls. Cumulative exposure to any antimicrobial in the previous 6 months has a monotonic dose-response association with CA-CDI. Individuals with more than 28 DDDs to any antimicrobial (19.9% of cases) had an OR of 4.4 (95% CI 3.4-5.6) compared with those unexposed. Individuals exposed to 29+ DDDs of high-risk antimicrobials (cephalosporins, clindamycin, co-amoxiclav or fluoroquinolones) had an OR of 17.9 (95% CI 7.6-42.2). Elevated CA-CDI risk following high-risk antimicrobial exposure was greatest in the first month (OR = 12.5, 95% CI 8.9-17.4), but was still present 4-6 months later (OR = 2.6, 95% CI 1.7-3.9). Cases exposed to 29+ DDDs had prescription patterns more consistent with repeated therapeutic courses, using different antimicrobials, than long-term prophylactic use.. This analysis demonstrated temporal and dose-response associations between CA-CDI risk and antimicrobials, with an impact of exposure to high-risk antimicrobials remaining 4-6 months later.

Topics: Aged; Aged, 80 and over; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; beta-Lactamase Inhibitors; Case-Control Studies; Clostridioides difficile; Clostridium Infections; Community-Acquired Infections; Drug Prescriptions; Female; Hospitalization; Humans; Logistic Models; Male; Middle Aged; Registries; Retrospective Studies; Scotland

To compare the infective complications between two different antibiotic regimens used as prophylaxis for transrectal ultrasound-guided prostate biopsy (TRUSP Bx).. The records of 709 consecutive patients undergoing TRUSP Bx over a period of 20 months at a UK teaching hospital were examined retrospectively. All clinic letters, microbiology reports and admission records were examined for each patient.. Within the study period a total of 454 patients received prophylaxis with ciprofloxacin; 11 of these patients (2.4%) developed an infective complication within 4 weeks of the TRUSP Bx. A total of 255 patients received prophylaxis with co-amoxiclav and gentamicin; 33 patients (12.9%) in this group had an infective complication. No cases of Clostridium difficile infection were recorded for any of these patients within 1 month of receiving antibiotics. Re-introduction of the original regimen led to a fall in infective complications.. Understandable concerns about the development of hospital-acquired infection led to a new protocol for antibiotic prophylaxis which in turn led to a number of patients being put at increased risk of potentially serious infective complications. Antibiotic prophylaxis must reflect tissue penetration, the organisms encountered and their susceptibilities, as well as being based on objective evidence.

Topics: Aged; Amoxicillin-Potassium Clavulanate Combination; Antibiotic Prophylaxis; Biopsy, Needle; Ciprofloxacin; Clinical Protocols; Clostridioides difficile; Clostridium Infections; Cross Infection; Gentamicins; Humans; Male; Prostate; Ultrasonography, Interventional

A case of a subcutaneous abscess caused by Clostridium perfringens infection in a five-month-old dog is reported in this study. Clinical examination, radiological findings and cytological analysis of abscess fluid were consistent with Clostridium induced disease. Treatment including drainage of the abscess and antibiotic therapy led to rapid clinical improvement. However, despite aggressive medical therapy and proper wound care, the deep soft tissue infection led to osteomyelitis with premature closure of the growth plates of the tibia and secondary bone shortening. Prolonged treatment with metronidazole and amoxicillin-clavulanic acid resulted in an excellent outcome with normal weight bearing.

Topics: Abscess; Amoxicillin-Potassium Clavulanate Combination; Animals; Anti-Bacterial Agents; Clostridium Infections; Clostridium perfringens; Dog Diseases; Dogs; Drainage; Hindlimb; Male; Metronidazole; Osteomyelitis; Treatment Outcome; Wound Infection