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Objectives: Carbapenem-resistant organisms (CROs) are a significant public health threat globally, particularly in countries like India with high antibiotic resistance rates. The current study investigates the prevalence of CROs, detects resistance mechanisms using phenotypic methods and assesses the efficacy of newer antibiotics against CROs., Methods: A prospective study conducted at a tertiary care hospital in India during 2021-23. Clinical specimens were processed and bacterial identification was performed using MALDI-TOF mass spectrometry followed by antimicrobial susceptibility testing using CLSI guidelines against a plethora of newer antibiotics for CROs. Carbapenemase production was detected using phenotypic methods, and the presence of the mcr-1 gene was assessed by real-time PCR., Results: During the study period, predominantly (70 %) Gram-negative bacteria were isolated; amongst which 5692 strains were carbapenem-resistant, wherein resistance to different carbapenems ranged from 34.1% to 79 %. Majority of the carbapenemase producers were metallo-β-lactamases (MBL) producers (75 %). Colistin resistance was noted in 5.4 % of selected carbapenem-resistant isolates. Among newer antibiotics, cefiderocol demonstrated the lowest resistance rates (0-14 %), while resistance to newer β-lactam/β-lactamase inhibitor combinations was very high in carbapenem-resistant isolates. Fosfomycin, minocycline and tigecycline, each showing variable efficacy depending on the site of infection. Moreover, newer β-lactam/β-lactamase inhibitor combinations offer restricted benefits due to widespread prevalence of MBL in the region., Conclusion: The escalating prevalence of CROs in India underscores the urgency for alternative treatment options beyond colistin. Hence, highlighting the critical importance of developing effective strategies to combat carbapenem resistance., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Japanese Society of Chemotherapy, Japanese Association for Infectious Diseases, and Japanese Society for Infection Prevention and Control. Published by Elsevier Ltd. All rights reserved.)

The Aeromonadaceae family, comprised of gram-negative bacilli, is ubiquitously distributed across the globe. Infections by Aeromonas species encompass gastroenteritis, septicaemia, skin and soft tissue infections (SSTIs), pneumonia, and peritonitis. This report delineates a case of Aeromonas hydrophila infection, manifesting as an array of pustules on the patient's lower extremities subsequent to the ingestion of marine crustaceans, specifically prawns. Prompt diagnosis and the initiation of an appropriate antibiotic regimen are imperative to mitigate the risk of further complications., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Indian Association of Medical Microbiologists. Published by Elsevier B.V. All rights reserved.)

Purpose: The study explores the impact of significant interpretative breakpoint changes for aminoglycosides and piperacillin-tazobactam in Enterobacterales and Pseudomonas aeruginosa, considering PK/PD, clinical data, and susceptibility on clinical reporting and use., Procedure: Between January 2021 and June 2023, a total of 189,583 samples were processed for bacterial pathogens and antimicrobial susceptibility testing was performed using disc diffusion method/VITEK® 2 Compact system/broth microdilution. WHONET software was utilised to capture and analyse the changes in the interpretation of disc diffusion method, following updates to CLSI M100 documents in comparison to previous editions. Antimicrobial consumption data was collected and interpreted as DDD/100 bed days using AMC tool software. Here, we present data for 13,615 members of Order Enterobacterales and 1793 Pseudomonas aeruginosa isolates., Finding: Enterobacterales exhibited a significant susceptibility drop of 14.7% for gentamicin and 21.7% for amikacin. Pseudomonas aeruginosa showed an increase in isolates with intermediate tobramycin susceptibility, from 0.6% to 29.7%, with relatively minor changes in piperacillin-tazobactam interpretation., Conclusion: The changes indicate a shift toward increased 'resistance' and 'intermediate susceptibility' for these antibiotics, emphasizing the need for cautious use and leveraging PK/PD knowledge for improved antibiotic utilization, patient outcomes, and antimicrobial stewardship., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Indian Association of Medical Microbiologists. Published by Elsevier B.V. All rights reserved.)

Paeniclostridium sordellii, an anaerobic bacterium, causes hepatic infections in alcoholics and post-surgery (liver transplantation). While liver and brain abscesses are rare, drainage procedures and targeted antibiotic therapy assisted by early microbiological diagnosis have reduced mortality rates. We report a rare case of pyogenic liver abscess caused by Paeniclostridium sordellii in India, the early diagnosis of which has led to life saving outcome for the patient. Hence, the microbiological diagnosis and comprehensive medical-surgical treatment are vital for preventing mortality in Paeniclostridium sordellii infections., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Indian Association of Medical Microbiologists. Published by Elsevier B.V. All rights reserved.)

Introduction: Infections are a common cause of paediatric morbidity. Antibiotics are vital in treating them. Erratic prescribing practices are an important cause for the development of antibiotic resistance. Our objective was to estimate the effectiveness of educational interventions to improve empirical antibiotic prescribing practices among paediatric trainees. We aimed to improve the compliance to antibiotic protocols and to sustain it over 6 months., Methods: It is a time interrupted non-randomised trial conducted in a tertiary hospital in India. Initially, 200 admitted children were selected randomly. Their antibiotic prescriptions, adherence of prescriptions to the then existing antibiotics guidelines, course during hospital stay and the final outcome were noted. The existing antibiotic policy and its use were reviewed. It was then considered essential to prepare a fresh antibiotic policy based on national guidelines, local sensitivity patterns and with inputs from microbiologists. This was distributed to the residents through seminars, posters and cellphone friendly documents. Compliance to the policy was also tracked twice a week. The adherence to guideline was recorded in the subsequent 6 months., Results: The adherence of empirical antibiotic prescriptions was 59% before intervention which improved to 72% in the first month, 90% in the second month, 86% and 78% in the third and sixth months, respectively. There was no significant difference in duration of stay and the outcome at discharge in the patients in adherent and non-adherent groups., Conclusion: Educational interventions and frequent monitoring improved antibiotic prescribing practices among residents with no negative impact on patient outcomes. Quality improvements need persistent reinforcement and frequent monitoring to be sustainable., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: Antimicrobial resistance [AMR] has emerged as a global and national priority and establishing an effective surveillance system for antimicrobial resistance is an essential prerequisite for generating evidence for informed policymaking at both national and state levels., Methods: Twenty-four laboratories were enrolled after assessment in the WHO-IAMM Network for Surveillance of Antimicrobial Resistance in Delhi [WINSAR-D]. The NARS- NET standard operating procedures were adopted along with its priority pathogen lists and antibiotic panels. The members were trained to use WHONET software and monthly data files were collected, collated, and analyzed., Results: Multiple logistic issues such as procurement, erratic supply of consumables, non-availability of standard guidelines, lack of automated systems, high workload and low manpower were reported by the majority of member laboratories. Microbiological challenges such as differentiation between colonization and pathogen in absence of patient details, lack of confirmation of resistance, identification of isolates and lack of dedicated computer and genuine windows software for data were common to most laboratories. The total number of isolates of priority pathogens in 2020 was 31,463. Of these, 50.1% isolates were from urine 20.6% were from blood and 28.3% were from pus aspirate and other sterile body fluids. High levels of resistance were observed for all antibiotics., Conclusion: There are many challenges in generating quality AMR data in lower-middle-income countries. There is a need for resource allocation and capacity building at all levels to ensure the collection of quality assured data., (Copyright © 2022 Indian Association of Medical Microbiologists. Published by Elsevier B.V. All rights reserved.)

Due to the rapid emergence of multi-drug resistant (MDR) bacteria, existing antibiotics are becoming ineffective. So, researchers are looking for alternatives in the form of antibacterial peptides (ABPs) based medicines. The discovery of novel ABPs using wet-lab experiments is time-consuming and expensive. Many machine learning models have been proposed to search for new ABPs, but there is still scope to develop a robust model that has high accuracy and precision. In this work, we present StaBle-ABPpred, a stacked ensemble technique-based deep learning classifier that uses bidirectional long-short term memory (biLSTM) and attention mechanism at base-level and an ensemble of random forest, gradient boosting and logistic regression at meta-level to classify peptides as antibacterial or otherwise. The performance of our model has been compared with several state-of-the-art classifiers, and results were subjected to analysis of variance (ANOVA) test and its post hoc analysis, which proves that our model performs better than existing classifiers. Furthermore, a web app has been developed and deployed at https://stable-abppred.anvil.app to identify novel ABPs in protein sequences. Using this app, we identified novel ABPs in all the proteins of the Streptococcus phage T12 genome. These ABPs have shown amino acid similarities with experimentally tested antimicrobial peptides (AMPs) of other organisms. Hence, they could be chemically synthesized and experimentally validated for their activity against different bacteria. The model and app developed in this work can be further utilized to explore the protein diversity for identifying novel ABPs with broad-spectrum activity, especially against MDR bacterial pathogens., (© The Author(s) 2021. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

The overuse of antibiotics has led to emergence of antimicrobial resistance, and as a result, antibacterial peptides (ABPs) are receiving significant attention as an alternative. Identification of effective ABPs in lab from natural sources is a cost-intensive and time-consuming process. Therefore, there is a need for the development of in silico models, which can identify novel ABPs in protein sequences for chemical synthesis and testing. In this study, we propose a deep learning classifier named Deep-ABPpred that can identify ABPs in protein sequences. We developed Deep-ABPpred using bidirectional long short-term memory algorithm with amino acid level features from word2vec. The results show that Deep-ABPpred outperforms other state-of-the-art ABP classifiers on both test and independent datasets. Our proposed model achieved the precision of approximately 97 and 94% on test dataset and independent dataset, respectively. The high precision suggests applicability of Deep-ABPpred in proposing novel ABPs for synthesis and experimentation. By utilizing Deep-ABPpred, we identified ABPs in the tail protein sequences of Streptococcus bacteriophages, chemically synthesized identified peptides in lab and tested their activity in vitro. These ABPs showed potent antibacterial activity against selected Gram-positive and Gram-negative bacteria, which confirms the capability of Deep-ABPpred in identifying novel ABPs in protein sequences. Based on the proposed approach, an online prediction server is also developed, which is freely accessible at https://abppred.anvil.app/. This web server takes the protein sequence as input and provides ABPs with high probability (>0.95) as output., (© The Author(s) 2021. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Globally, rapid development of antibiotic resistance amongst pathogens has led to limited treatment options and high indirect costs to health management. There is a need to avoid misuse of available antibiotics and to develop rapid, affordable and accessible diagnostic technologies to detect drug resistance even in resource limited settings. This study reports the development of instrument-free point-of-care devices for detection of antibiotic resistance for rapid diagnosis of drug resistance in the penicillin, cephalosporin and carbapenem groups of antibiotics. The simple paper-based devices for flow through assay determine the presence of resistant bacteria in a sample by a visible colour change within 30 minutes. At the center of this technology is the unique sensing nanomaterial comprising of core-shell nanoparticles layered with specific antibiotics. The core is comprised of chitosan nanoparticles of size ∼15 nm coated with the starch-iodine indicator to form a shell increasing the size to ∼47 nm. The test strip is coated with the nanoparticles, air-dried and overlayed with the required antibiotic. In the presence of penicillin, cephalosporin and carbapenem resistant bacteria, the core-shell nanoparticles undergo a visible colour change from blue to white. The core-shell nanoparticles were deposited on paper to form a point-of-care device. Devices were developed to screen for three main classes of antibiotics namely penicillins, cephalosporins and carbapenems. The devices were validated using standard resistant and susceptible ATCC strains in three different sample types, pure colony, broth culture and saline suspensions. The change of colour from blue to white was considered a positive test. The time of detection was found to be 30 min, while the limit of detection was 10 5 cfu ml -1 . The device exhibited 100% sensitivity and specificity with known resistant and susceptible cultures not only from pure colonies but also from direct samples of spiked saline suspensions with graded confounding factors of albumin, glucose, and urea. The inter-device reproducibility and storage stability of the devices was established. The developed point-of-care devices have potential as screening devices for antimicrobial resistance.

Antibiotic resistance has reached alarming proportions globally, prompting the World Health Organization to advise nations to take up antibiotic awareness campaigns. Several campaigns have been taken up worldwide, mostly by governments. The government of India asked manufacturers to append a 'redline' to packages of antibiotics as identification marks and conducted a campaign to inform the general public about it and appropriate antibiotic use. We investigated whether an antibiotic resistance awareness campaign could be organized voluntarily in India and determined the characteristics of the voluntarily organized campaign by administering a questionnaire to the coordinators, who participated in organizing the voluntary campaign India. The campaign characteristics were: multiple electro-physical pedagogical and participatory techniques were used, 49 physical events were organized in various parts of India that included lectures, posters, booklet/pamphlet distribution, audio and video messages, competitions, and mass contact rallies along with broadcast of messages in 11 local languages using community radio stations (CRS) spread all over India. The median values for campaign events were: expenditure-3000 Indian Rupees/day (US$~47), time for planning-1 day, program spread-4 days, program time-4 h, direct and indirect reach of the message-respectively 250 and 500 persons/event. A 2 min play entitled 'Take antibiotics as prescribed by the doctor' was broadcast 10 times/day for 5 days on CRS with listener reach of ~5 million persons. More than 85%ofcoordinators thought that the campaign created adequate awareness about appropriate antibiotic use and antibiotic resistance. The voluntary campaign has implications for resource limited settings/low and middle income countries.

Background: Throughout the world multi drug resistant nosocomial infections are one of the leading causes of death and morbidity among hospitalized patients. Antimicrobial resistance [AMR] has become a major problem in treatment of such infections. High consumption of antimicrobials particularly in ICUs is often described as the most important factor leading to AMR., Objective: The aim of the study was to study the magnitude of antimicrobial resistance amongst nosocomial pathogens and the antimicrobial prescription patterns of patients admitted in intensive care unit., Methods: The study was conducted in I.C.U of a tertiary care government hospital in Delhi over a period of 4 months, on 100 patients admitted in I.C.U. Depending on clinical suspicion laboratory samples were collected and subjected to antimicrobial sensitivity testing. Antimicrobial prescription of these patients were collected from I.C.U records and analyzed., Observations: Staphylococcus aureus and Klebsiella species were the most common organism [23%]. Among patients where causative organism was isolated, two or more organisms were isolated from 50% of the samples. Most of the Klebsiella species and Acinetobacter species were resistant to beta lactam group of antibiotics such as cephalosporins and piperacillin-tazobactam. 60% of isolates of S. aureus were found to be MRSA while none of the S. aureus were resistant to linezolid and vancomycin. All patients were prescribed two or more antimicrobials while 66% patients were prescribed 3-5 antimicrobials. Commonest combination was beta lactam with metronidazole followed by levofloxacin with metronidazole with addition of aminoglycosides or linezolid as third drug. Total 20 antimicrobial agents were used in the treatment of the patients. Among these consumption [in DDD/100bed days] of metronidazole was highest [100.9] followed by fluconazole [76.6] and levofloxacin [62.7]., Conclusion: High usage of antimicrobial consumption has been noted in this study, prompting institution of measures to formulate and adherence to antimicrobial policy strictly., (Copyright © 2019. Published by Elsevier Ltd.)

Antimicrobial resistance represents a growing threat to global health, yet antibiotics are frequently prescribed in primary care for acute childhood illness, where there is evidence of very limited clinical effectiveness. Moral philosophy supports the need for doctors to consider wider society, including future patients, when treating present individuals, and it is clearly wrong to waste antibiotics in situations where they are largely clinically ineffective at the expense of future generations. Doctors should feel confident in applying principles of antibiotic stewardship when treating children in primary care, but they must explain these to parents. Provision of accurate, accessible information about the benefits and harms of antibiotics is key to an ethical approach to antimicrobial stewardship and to supporting shared decision making. Openness and honesty about drivers for antibiotic requests and prescribing may further allow parents to have their concerns heard and help clinicians to develop with them an understanding of shared goals.

Objectives: Inaccurate antibiotic dosing can lead to treatment failure, fuel antimicrobial resistance and increase side effects. The British National Formulary for Children (BNFC) guidance recommends oral antibiotic dosing according to age bands as a proxy for weight. Recommended doses of amoxicillin for children were increased in 2014 'after widespread concerns of under dosing'. However, the impact of dose changes on British children of different weights is unknown, particularly given the rising prevalence of childhood obesity in the UK. We aimed to estimate the accuracy of oral amoxicillin dosing in British children before and after the revised BNFC guidance in 2014., Setting and Participants: We used data on age and weights for 1556 British children (aged 2-18 years) from a nationally representative cross-sectional survey, the Health Survey for England 2013., Interventions: We calculated the doses each child would receive using the BNFC age band guidance, before and after the 2014 changes, against the 'gold standard' weight-based dose of amoxicillin, as per its summary of product characteristics., Primary Outcome Measure: Assuming children of different weights were equally likely to receive antibiotics, we calculated the percentage of the children who would be at risk of misdosing by the BNFC age bands., Results: Before 2014, 54.6% of children receiving oral amoxicillin would have been underdosed and no child would have received more than the recommended dose. After the BNFC guidance changed in 2014, the number of children estimated as underdosed dropped to 5.8%, but 0.5% of the children would have received too high a dose., Conclusions: Changes to the BNFC age-banded amoxicillin doses in 2014 have significantly reduced the proportion of children who are likely to be underdosed, with only a minimal rise in the number of those above the recommended range., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Background Antibiograms often act as a reference guide for empirical selection of antibiotics. Hospital-wide antibiograms constructed on the basis of cumulative antimicrobial susceptibility data from diverse patient groups can often be misleading. In order to show the significance of age- and location-stratified antibiograms, this study compared hospital-wide antibiograms with stratified antibiograms for the clinical isolates of Pseudomonas aeruginosa. Methods Stratified antibiograms were created on the basis of patient age (<18 years, 18-50 years, >50 years) and location (inpatient or outpatient) using all 2011, 2012 and 2013 clinical isolates of P. aeruginosa isolates. Susceptibility rates were compared among cumulative and stratified antibiograms using non-parametric inferential statistics. Results The hospital-wide antibiogram under-estimated susceptibility rates in adult patients isolates (age group = 18-50 years) and over-estimated susceptibility rates in isolates from the paediatric patients and elderly. Paediatric isolates were found to be less susceptible to amikacin and imipenem, whereas isolates from elderly patients >50 years were less susceptible to ciprofloxacin. Statistically significant difference was seen in the susceptibility rates of OPD and IPD isolates of P. aeruginosa in the case of the paediatric age group. Susceptibility rates for all drugs were lower for isolates from inpatients than from outpatients. Conclusion Age and location associated differences in susceptibility rates have the potential to influence empirical antibiotic selection, which was shown in stratified antibiograms of P. aeruginosa that is obscured by hospital-wide antibiograms.

In the present study, we have designed imidazo[2,1-b]thiazole and benzo[d]imidazo[2,1-b]thiazole derivatives from earlier reported imidazo[1,2-a]pyridine based Mycobacterium tuberculosis (MTB) pantothenate synthetase (PS) inhibitors. We synthesized thirty compounds and they were evaluated for MTB PS inhibition study, in vitro anti-TB activities against replicative and non-replicative MTB, in vivo activity using Mycobacterium marinum infected Zebra fish and cytotoxicity against RAW 264.7 cell line. Among them compound 2-methyl-N'-(4-phenoxybenzoyl)benzo[d]imidazo[2,1-b]thiazole-3-carbohydrazide (5bc) emerged as potent compound active against MTB PS with IC50 of 0.53±0.13 μM, MIC of 3.53 μM, 2.1 log reduction against nutrient starved MTB, with 33% cytotoxicity at 50 μM. It also showed 1.5 log reduction of M. marinum load in Zebra fish at 10mg/kg., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background: Drug-eluting stents (DES) have been shown to reduce the rate of acute complications and the need for subsequent revascularization in cases where single-vessels are treated. The performance of DES in patients with multivessel disease and complex lesions, however, remains controversial. This study assessed and compared clinical outcomes following single vs. multivessel percutaneous coronary intervention (PCI), using the Supraflex sirolimus-eluting stent (SES), in an all-comers patient population., Methods: We conducted retrospective, multicenter, all-comers, observational study of 995 patients, who underwent either single-vessel PCI (n=769 patients; group-I) or multivessel PCI (n=226 patients; group-II), treated with the biodegradable polymer coated Supraflex SES, between July-2013 and May-2014 at nine different centers in India. Pre-specified primary endpoint, rate of major adverse cardiac events (MACE) [defined as composite of cardiac death, myocardial infarction (MI), target lesion revascularization (TLR) and non-target lesion target vessel revascularization (non-TL TVR)], was analyzed during 12 months after the post-index procedure. We also analyzed the incidence of stent thrombosis (ST) as a safety endpoint during the follow-up period, as defined by the Academic Research Consortium (ARC)., Results: Of the whole study group, 1,242 lesions were treated in 995 patients (mean age 61.6±10.8 years; 80.0% male) with average stent length of 26.8±9.3 mm. Multivessel PCI patients were older, had a higher prevalence of arterial hypertension, were smoker, had a family history of coronary artery disease, previous stroke and previous PCI compared to single-vessel PCI patients. Follow-up was available in 99.0% (761/769) of patients with single-vessel intervention and 96.9% (219/226) of patients with multivessel intervention at the end of 12 months. In-hospital MACE was similar for both the groups [group-I, 3 (0.4%) vs. group-II, 1 (0.4%); p=1.000]. The observed MACE for group-I and group-II, at 30 days, 6 and 12 months follow-up were 9 (1.2%) vs. 2 (0.9%); p=1.000, 15 (2.0%) vs. 7 (3.2%); p=0.302 and 24 (3.2%) vs. 12 (5.5%); p=0.109, respectively. The cumulative incidence curves for MACE showed no significant differences between the two groups, at the end of 12 months (p=0.109)., Conclusion: Our study shows that use of the Supraflex SES in single and multivessel coronary artery disease produces good clinical outcomes during 12 months of follow-up with a low rate of revascularization, despite complex lesion morphology.

Antibiotics with good therapeutic value and novel mechanism of action are becoming increasingly important in today's battle against bacterial resistance. One of the popular targets being DNA gyrase, is currently becoming well-established and clinically validated for the development of novel antibacterials. In the present work, a series of forty eight quinoline-aminopiperidine based urea and thiourea derivatives were synthesized as pharmacophoric hybrids and evaluated for their biological activity. Compound, 1-(4-chlorophenyl)-3-(1-(6-methoxy-2-methylquinolin-4-yl)piperidin-4-yl)thiourea (45) was found to exhibit promising in vitro Mycobacterium smegmatis GyrB IC₅₀ of 0.95 ± 0.12 μM and a well correlated Mycobacterium tuberculosis (MTB) DNA gyrase supercoiling IC₅₀ of 0.62 ± 0.16 μM. Further, compound 45 also exhibited commendable MTB MIC, safe eukaryotic cytotoxic profile with no signs of cardiotoxicity in zebrafish ether-a-go-go-related gene (zERG)., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Background: The British National Formulary for Children (BNFC) recommends dosing oral penicillins according to age-bands, weight-bands, or weight-based calculations. Because of the rising prevalence of childhood obesity, age-band-based prescribing could lead to subtherapeutic dosing., Aim: To investigate actual oral penicillin prescribing by GPs in the UK with reference to the current BNFC age-band recommendations., Design and Setting: Descriptive analysis of UK prescriptions in the 2010 IMS Disease-Analyzer database (IMS-DA)., Method: A detailed database analysis was undertaken of oral penicillin prescriptions for 0-18 year olds from the 2010 IMS-DA. The prescription analysis included all available data on formulation, strength (mg), prescription quantity unit, package size, prescribed quantity, and volume., Results: Considering amoxicillin alone, no infants (aged <1 year) were prescribed the BNFC 2011 edition recommended unit dose (62.5 mg), while the majority received double the dose (125 mg); among children aged 1-5 years, 96% were prescribed the recommended unit dose (125 mg), but 40% of 6-12 year olds and 70% of 12-18 year olds were prescribed unit doses below the BNFC recommendations. For otitis media, only those children aged <1 year received the recommended dose of amoxicillin (40-90 mg/kg/day). Similar variations in dosing across age-bands were observed for phenoxymethylpenicillin and flucloxacillin., Conclusion: There is wide variation in the dosing of penicillins for children in UK primary care, with very few children being prescribed the current national recommended doses. There is an urgent need to review dosing guidelines, in relation to the weights of children today.

The prevalence of nalidixic acid-resistant Salmonella Typhi (NARST) infection is increasing worldwide. We are reporting an unusual case of infected haematocolpos presenting as urinary obstruction in a patient with fever of unknown origin (FUO). This case report highlights the importance of quinolone-resistant typhoid fever in the differential diagnosis of any acute febrile illness in countries, like India, where Salmonella infection is endemic.

The increase in incidence of variety of infections due to Staphylococcus aureus and especially methicillin resistant Staphylococcus aureus has highlighted on the need for better agents to treat such infections. Also the resistance to antimicrobial agents among staphylococci is an increasing problem. The macrolide-lincosamide-streptogramin B (MLS(B)) groups of antibiotics are commonly used in the treatment of staphylococcal infections with clindamycin being the preferred agent. This study demonstrates a simple phenotypic method (D-test) for detecting inducible clindamycin resistance in erythromycin resistant strains of staphylococcus aureus & coagulase negative Staphylococcus. A total of 181 erythromycin resistant staphylococcal isolates were obtained from various clinical specimens. Among the Staphylococcus aureus isolates, 38 (25.4%) were methicillin resistant Staphylococcus aureus (MRSA) and 112 (74.6%) were methicillin sensitive staphylococcus aureus (MSSA). Constitutive resistance was seen in 56 (37.3%) of isolates. Of these 18 (47.4%) were MRSA and 38 (33.9%) were MSSA. Inducible resistance was seen in 25 (16.6%) isolates, in which 11(28.9%) were methicillin resistant Staphylococcus aureus & 14 (12.6%) were methicillin sensitive staphylococcus aureus. It is likely that the true percentage of clindamycin resistance is being underestimated, since testing for inducible resistance is not being routinely performed. So the test should be done routinely in all the labs to avoid therapeutic failures.

Purpose of Review: Most childhood respiratory infections including acute otitis media (AOM), sore throat, upper respiratory tract infections (URTIs) and sinusitis are self-limiting illnesses. Yet, despite extensive guidance discouraging routine use of antibiotics to limit side-effects and combat antimicrobial resistance, antibiotic prescribing for these conditions remains high in many developed countries, fuelled by the fear of rare but serious bacterial complications including mastoiditis, quinsy, pneumonia and brain abscess. This review summarizes evidence for the role of antibiotics in preventing serious complications of URTIs in children., Recent Findings: From a key observational study reporting antibiotic use in children, the calculated excess risk of suppurative complications of respiratory tract infections in children who did not receive an antibiotic was 3.8 per 10 000. Despite extensive searches of the literature, no data were found to assess the affect of antibiotics upon the risk of brain abscess after sinusitis in children., Summary: New information from observational studies suggests antibiotics show little benefit in preventing complications of mastoiditis following AOM, quinsy following sore throat and pneumonia following URTI/bronchitis. Further research should focus on stratifying the key risk factors for such complications and optimizing long-term monitoring strategies to detect any future changes in the risk-benefit analysis for antibiotic prescription.

Objective: To analyse changes in clinical indications for community antibiotic prescribing for children in the UK between 1996 and 2006 and relate these findings to the new NICE guidelines for the treatment of upper respiratory tract infections in children., Study Design: Retrospective cohort study., Method: The IMS Health Mediplus database was used to obtain annual antibiotic prescribing rates and associated clinical indications in 0-18-year-old patients between 1 January 1996 and 31 December 2006 in the UK., Results: Antibiotic prescribing declined by 24% between 1996 and 2000 but increased again by 10% during 2003-2006. Respiratory tract infection was the most common indication for which an antibiotic was prescribed, followed by "abnormal signs and symptoms", ear and skin infections. Antibiotic prescriptions for respiratory tract infections have decreased by 31% (p<0.01) mainly because of reduced prescribing for lower respiratory tract infections (56% decline, p<0.001) and specific upper respiratory tract infections including tonsillitis/pharyngitis (48% decline, p<0.001) and otitis (46% decline, p<0.001). Prescribing for non-specific upper respiratory tract infection increased fourfold (p<0.001). Prescribing for "abnormal signs and symptoms" increased significantly since 2001 (40% increase, p<0.001)., Conclusion: There has been a marked decrease in community antibiotic prescribing linked to lower respiratory tract infection, tonsillitis, pharyngitis and otitis. Overall prescribing is now increasing again but is associated with non-specific upper respiratory tract infection diagnoses. General practitioners may be avoiding using diagnoses where formal guidance suggests antibiotic prescribing is not indicated. The new NICE guidance on upper respiratory tract infections is at risk of being ignored.

Background: Information is needed on whether mastoiditis has increased in association with the decline in antibiotics prescribed to children by primary care physicians in the United Kingdom., Objective: To determine time trends in mastoiditis incidence, the frequency of antecedent otitis media, and the effect of antibiotics for otitis media on the risk of mastoiditis in children., Patients and Methods: We conducted a retrospective cohort study by using the UK General Practice Research Database. Children aged 3 months to 15 years between 1990 and 2006 were included. Risk of mastoiditis within 3 months after otitis media diagnosis and the protective effect of antibiotics were determined., Results: There were 2 622 348 children within the General Practice Research Database; 854 had mastoiditis, only one third of whom (35.7%) had antecedent otitis media. Mastoiditis incidence remained stable between 1990 and 2006 ( approximately 1.2 per 10 000 child-years). Risk of mastoiditis, after otitis media, was 1.8 per 10 000 episodes (139 of 792 623) after antibiotics compared with 3.8 per 10 000 (149 of 389 649) without antibiotics, and increased with age. Antibiotics halved the risk of mastoiditis. General practitioners would need to treat 4831 otitis media episodes with antibiotics to prevent 1 child from developing mastoiditis. If antibiotics were no longer prescribed for otitis media, an extra 255 cases of childhood mastoiditis would occur, but there would be 738 775 fewer antibiotic prescriptions per year in the United Kingdom., Conclusions: Most children with mastoiditis have not seen their general practitioner for otitis media. Antibiotics halve the risk of mastoiditis, but the high number of episodes needing treatment to prevent 1 case precludes the treatment of otitis media as a strategy for preventing mastoiditis. Although mastoiditis is a serious disease, most children make an uncomplicated recovery after mastoidectomy or intravenous antibiotics. Treating these additional otitis media episodes could pose a larger public health problem in terms of antibiotic resistance.

Background: Since 1997, UK guidance has advocated limiting antibiotic prescribing for otitis media. It is not known whether this has influenced general practitioner prescribing practice. Aims and objectives To investigate the trends in diagnoses and antibiotic prescribing for otitis media in children in relation to guidance., Methods: We used the General Practice Research Database to conduct time-trend analyses of diagnoses and antibiotic prescribing for otitis media in 3 months to 15 years old, between 1990 and 2006., Results: A total of 1 210 237 otitis media episodes were identified in 464 845 children; two-thirds (68%; 818 006) received antibiotics. Twenty-two percent (267 335) were classified as acute, 85% (227 335) of which received antibiotics. Overall, antibiotic prescribing for otitis media declined by 51% between 1995 and 2000. Much of this reduction predated guidance. During this period, prescribing for otitis media coded as acute increased by 22%. Children diagnosed with acute otitis media were more likely to receive antibiotics than otitis media not coded as acute (P < 0.05). From 2000 prescribing plateaued, despite publication of further guidance. Otitis media diagnoses consistently paralleled prescribing., Conclusions: The reduction in antibiotic prescribing for otitis media predated guidance. The simultaneous decrease in prescribing for non-acute otitis media and increase for acute otitis media suggest diagnostic transfer, possibly to justify the decision to treat.

The present study assesses the reliability of the in vitro susceptibility tests E-test, disc diffusion and Alamar blue-based microbroth dilution assays for evaluating the efficacy of chloramphenicol, ciprofloxacin and cefaclor against clinical and reference isolates of Staphylococcus aureus, Escherichia coli and Pseudomonas spp. for use in empirical therapy. Ciprofloxacin showed 82% agreement between E-test and microbroth dilution by the visible dye reduction method against all organisms. This figure was 67% for cefaclor and 60% for chloramphenicol. E-test and microbroth dilution showed excellent correlation against S. aureus with all three antibiotics; however, correlation was not observed in Pseudomonas spp. between E-test and microbroth dilution by the percentage dye reduction method. E. coli did not show significant correlation, indicating the presence of heteroresistance. Chloramphenicol, being bacteristatic in nature, did not show clear agreement between the susceptibility test methods used. This study indicates that E-test provides an indication of minimum inhibitory concentration (MIC) of a panel of antibiotics against clinical isolates; however, microbroth dilution (dye reduction) is the most sensitive method for the determination of MIC due to intracellular enzymatic reduction of the dye to formazan, which only occurs in viable organisms. The study highlights the need for harmonisation between E-test and microbroth dilution methods in clinical trials of new antibiotics and in monitoring the drug resistance patterns in community and healthcare settings.

Objectives: To examine the relationship between ambulatory antibiotic prescribing for acute bronchitis and cough with hospital admissions for respiratory infections in the USA between 1996 and 2003., Design: Analysis of data on antibiotic prescribing for episodes of acute bronchitis/cough illness in ambulatory care and hospitalization for respiratory infections for adults between 1996 and 2003 in the USA., Setting: USA: ambulatory prescribing behaviour was derived from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey while hospitalizations in acute care hospitals were assessed in the National Hospital Discharge Survey., Participants: Adults 18-64 years old., Interventions: None., Main Outcome Measures: Proportion of visits for acute bronchitis/cough receiving a prescription for antibiotics and hospitalization for respiratory infections., Results: Ambulatory antibiotic prescribing practices for acute bronchitis/cough and hospitalizations for respiratory infections exhibited non-linear patterns over the 8 year period. However, antibiotic prescribing practices for acute bronchitis/cough and hospitalizations for respiratory infections had a weak/moderate negative association. For three of the seven yearly changes in prescribing and hospitalizations as one increased the other decreased (P<0.01)., Conclusions: Ambulatory antibiotic prescribing for respiratory tract infections was inversely associated with hospital admissions for respiratory tract infections.

A simple, clean, environmentally benign route to the synthesis of 2-amino-chromenes is described using K2CO3 as a green catalyst in water under microwave irradiation. This implies a convenient route avoiding the usage of hazardous organic solvents and organic bases. This technique requires only water in both the reaction step and workup, thus rendering the whole procedure into a truly ecofriendly green protocol. All the synthesized compounds were shown to possess antibacterial activity as tested in vitro against standard strains of Escherichia coli, Pseudomonas aeruginosa, and Staphylococcus aureus.

A novel, ecofriendly, one pot solvent free method for the synthesis of 4-aryl-7,7-dimethyl-1,2,3,4,5,6,7,8-octahydroquinazoline-2-one/thione-5-one derivatives is described which devoids the use of any organic solvents and auxiliaries. All the synthesized compounds were screened for their in vitro antibacterial activity against standard strains of Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa.

National Salmonella & Escherichia Centre situated at Central Research Institute, Kasauli receives Salmonella strains from all over the country. Eight hundred and fourteen Salmonella strains belonging to 14 serotypes received during 1986 were studied for antibiotic resistance and Minimum Inhibitory concentration (MIC) with regard to ampicillin (A), chloramphenicol (C), furazolidone (Fz) and gentamicin (G). Resistance to ampicillin was found to be highest (80%) and furazolidone the least (0.1%). Similarly a large number of strains (31%) had very high MIC values greater than 640 mcg per ml for chloramphenicol, whereas only 3.4% strains were found to have MIC values greater than 640 mcg per ml for gentamicin. The present findings have been discussed in the light of similar data published from this Centre earlier and from other sources in India.

Out of 3001 salmonella received during 1984-85, 2985 strains were tested for antibiotic resistance and R-pattern transfer. Multidrug resistance was observed in 73% of diarrhoeal and 43% of non-diarrhoeal isolates. Antibiotic resistance markers were transferable in 46.6% of diarrhoeal and 41.1% of non-diarrhoeal isolates. Two out of 4 salmonella sero-types isolated for the first time in India during this period were multidrug resistant.