ArticleLiterature Review

Antibiotics and the development of resistant microorganisms. Can homeopathy be an alternative?

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Abstract

Antibiotic resistance is a global public health problem. Once confined primarily to hospitals it is now increasingly common in primary care. The prevalence of resistant bacteria is rising, and organisms resistant to almost all antibiotics have been identified. The main causes are indiscriminate prescribing and the use of antibiotics in animal feeds and other agricultural applications. Policies to restrict use of antibiotics have had limited success. Homeopathy may have a role to play in combating the development of antibiotic resistance. Clinical research suggests that homeopathy is effective in the treatment of upper respiratory tract infections in children, a frequent cause of inappropriate antibiotic prescribing. The EU recommends the use of homeopathy in organic animal husbandry, and it is used by significant numbers of farmers. At present there is little data on the effectiveness of homeopathy in this setting. Further research should be done.

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... 16 Homeopathic treatments are potential alternatives to control diseases in cultivated animals, aquatic and terrestrial. It is known that homeopathic treatments reduced or eliminated some antibiotics, 17 improved general health of animals by strengthening their immune system, 18 and even controlling the spread of endoparasites and ectoparasites. 19À22 Homeopathy has been successfully applied to including chickens and pigs as growth promoters, 23,24 to control pathogenicity of Escherichia coli in pigs, 25 improve rabbit production, 26 and facilitate chicken vaccination. ...
... 58 Infection when a host's immune system is weak is common. 17 Antibiotics have been widely used to fight against pathogenic bacteria, applying the principle of contraries, which characterizes allopathic therapy and generally acts with non-specific bactericide effects and often harms the host's beneficial microbiota. 17,59 It includes commensal microorganisms, normally found in the digestive tract, that are essential for life, since they occupy specific Changes in SOD activity determined by percentage inhibition during formation of the water-soluble tetrazolium complex (WST-1 formazan) in juvenile Catarina scallop Argopecten ventricosus treated with homeopathic complexes TH1 (Pass/Pha) and TH2 (Pass/Sit); antibiotics OXY (oxytetracycline) and AMP (ampicillin), and reference treatments ETH (ethanol) and CTRL (challenged without homeopathy or antibiotics) after challenge with pathogenic bacteria Vibrio alginolythicus strain CAIM57. ...
... 17 Antibiotics have been widely used to fight against pathogenic bacteria, applying the principle of contraries, which characterizes allopathic therapy and generally acts with non-specific bactericide effects and often harms the host's beneficial microbiota. 17,59 It includes commensal microorganisms, normally found in the digestive tract, that are essential for life, since they occupy specific Changes in SOD activity determined by percentage inhibition during formation of the water-soluble tetrazolium complex (WST-1 formazan) in juvenile Catarina scallop Argopecten ventricosus treated with homeopathic complexes TH1 (Pass/Pha) and TH2 (Pass/Sit); antibiotics OXY (oxytetracycline) and AMP (ampicillin), and reference treatments ETH (ethanol) and CTRL (challenged without homeopathy or antibiotics) after challenge with pathogenic bacteria Vibrio alginolythicus strain CAIM57. Data show the mean AE SE. * denotes significant differences (P < 0.05). ...
Article
Background: Mortality from vibriosis in mollusk production is attributed to pathogenic bacteria, particularly Vibrio alginolyticus. Use of increasingly potent antibiotics has led to bacterial resistance and increased pathogenicity. Alternatives in sanitation, safety, and environmental sustainability are currently under analysis. To-date, homeopathy has been investigated in aquaculture of freshwater fish, but not in marine mollusks. The effect of the homeopathic complexes in the growth, survival, and immune response of the Catarina scallop Argopecten ventricosus were assessed. Methods: A bioassay to assess the potential of homeopathy in improving cultivation of juvenile A. ventricosus was conducted for 21 days, with a final challenge of 120 h with V. alginolyticus. The experimental design included two homeopathic formulas The homeopathic complex Passival, consisting of Passiflora incarnata 30 CH, Valeriana officinalis 30 CH, Ignatia amara 30 CH and Zincum valerianicum 30 CH plus Phosphoricum acid 30 CH (treatment TH1) or Silicea terra 30 CH (TH2), two antibiotics (ampicillin = AMP, oxytetracycline = OXY), and two reference treatments (without homeopathic or antibiotic treatment = CTRL, ethanol 30° GL = ETH). Additionally, a negative control CTRL- (untreated/uninfected) is included in the challenge test. Juvenile scallops (4.14 ± 0.06 mm, 13.33 mg wet weight) were cultivated in 4 L tanks provided with aerated, filtered (1 μm), and UV-sterilized seawater that was changed every third day. They were fed a blend of the microalgae Isochrysis galbana and Chaetoceros calcitrans (150,000 cells mL(-1) twice a day). All treatments were directly added to the tank water and then 500 mL challenge units were inoculated with 1 × 10(7) CFU/mL (LD50) of V. alginolyticus. Results: Juveniles grew significantly larger and faster in height and weight with TH2 compared to the ETH and CTRL (P < 0.05, ANOVA). Higher concentrations of proteins occurred in scallops exposed to TH2 (160.57 ± 7.79 mg g(-1)), compared to other treatments and reference treatments. Higher survival rate during the challenge bioassay occurred with TH1 (85%), compared to AMP (53%), OXY (30%), and CTRL (0%), and superoxide dismutase (P < 0.05) was significantly higher in scallops treated with TH1, compared to other treatments and reference treatments. Conclusions: Homeopathic treatments improved growth and survival and enhanced survival against V. alginolyticus in juvenile A. ventricosus. This suggests that homeopathy is a viable treatment for this mollusk to reduce use of antibiotics in scallops and its progressive increase in pathogenicity in mollusk hatcheries.
... 16 Homeopathic treatments are potential alternatives to control diseases in cultivated animals, aquatic and terrestrial. It is known that homeopathic treatments reduced or eliminated some antibiotics, 17 improved general health of animals by strengthening their immune system, 18 and even controlling the spread of endoparasites and ectoparasites. 19À22 Homeopathy has been successfully applied to including chickens and pigs as growth promoters, 23,24 to control pathogenicity of Escherichia coli in pigs, 25 improve rabbit production, 26 and facilitate chicken vaccination. ...
... 58 Infection when a host's immune system is weak is common. 17 Antibiotics have been widely used to fight against pathogenic bacteria, applying the principle of contraries, which characterizes allopathic therapy and generally acts with non-specific bactericide effects and often harms the host's beneficial microbiota. 17,59 It includes commensal microorganisms, normally found in the digestive tract, that are essential for life, since they occupy specific Changes in SOD activity determined by percentage inhibition during formation of the water-soluble tetrazolium complex (WST-1 formazan) in juvenile Catarina scallop Argopecten ventricosus treated with homeopathic complexes TH1 (Pass/Pha) and TH2 (Pass/Sit); antibiotics OXY (oxytetracycline) and AMP (ampicillin), and reference treatments ETH (ethanol) and CTRL (challenged without homeopathy or antibiotics) after challenge with pathogenic bacteria Vibrio alginolythicus strain CAIM57. ...
... 17 Antibiotics have been widely used to fight against pathogenic bacteria, applying the principle of contraries, which characterizes allopathic therapy and generally acts with non-specific bactericide effects and often harms the host's beneficial microbiota. 17,59 It includes commensal microorganisms, normally found in the digestive tract, that are essential for life, since they occupy specific Changes in SOD activity determined by percentage inhibition during formation of the water-soluble tetrazolium complex (WST-1 formazan) in juvenile Catarina scallop Argopecten ventricosus treated with homeopathic complexes TH1 (Pass/Pha) and TH2 (Pass/Sit); antibiotics OXY (oxytetracycline) and AMP (ampicillin), and reference treatments ETH (ethanol) and CTRL (challenged without homeopathy or antibiotics) after challenge with pathogenic bacteria Vibrio alginolythicus strain CAIM57. Data show the mean AE SE. * denotes significant differences (P < 0.05). ...
Article
Mortality by vibriosis in marine pectinids such as scallop A. ventricosus is mainly caused by the pathogen bacteria Vibrio alginolyticus. The use of potent antibiotics has increased bacterial resistance and pathogenicity, so new alternatives are required to attain more efficient and eco-sustainable production practices. Homeopathy is being applied with positive results in human health, agriculture, livestock and veterinary… Why not in Marine Mollusk Aquaculture ? Introduction Results Conclusions  Homeopathic drugs really improved growth, survival, and immune response against the pathogenic bacteria Vibrio alginolyticus in juvenile scallop Argopecten ventricosus, an edible and cultivable marine mollusk.  Homeopathy outperformed antibiotics in juvenile scallop bioassay ; it is a natural and eco-friendly therapy and a great alternative to the use and abuse of antibiotics in mollusk spat hatcheries.  Significative benefits can be expected with the use of homeopathy to reduce the progressive increase in bacterial pathogenicity associated to the routinary use of antibiotics in mollusk aquaculture in the hatchery. Funds provided by joint venture R&D Projects (PROINNOVA-CONACYT / PEASA Company) in Tabasco Mexico and Basic Science Project (SEP-CONACYT / CIBNOR). FAP b and MGB c are Doctorate students at CIBNOR, with advice and academic direction of JMMS a , AICC d and PES e .
... The word homeopathy comes from the Greek words homoion pathos, which means "similar illness" that refers to the use of drugs to treat illnesses that can induce similar effects in healthy patients when injested (10,12). Homeopathic medications are used to help the body's own healing processes in the fight against disease (13,14). When the body's immune system is unable to adequately defend itself against the pathogenic effects of bacteria or some other microorganism, an infection occurs. ...
... The body develops several symptoms during infection in an effort to combat the microorganism, the most well-known example being fever. Homeopaths claim that a properly selected homeopathic drug will aid the body's own battle against a microbe, allowing it to defeat it and improve natural immunity resulting in reduced frequency of infectious diseases (13)(14)(15). ...
... Assim, o uso de medicamentos de origem homeopática no setor leiteiro mostra-se como uma alternativa viável aos antibióticos atuais, uma vez que auxilia na redução da expansão da resistência microbiana 73 . Além disso, impossibilita a ocorrência MEDICINA VETERINARIA Y ZOOTECNIA de resíduos nos produtos lácteos, dispensando o período de carência e o descarte do leite. ...
Article
Full-text available
A homeopatia pode ser utilizada na pecuária leiteira como uma alternativa segura aos antibióticos, capaz de reduzir a expansão da resistência microbiana, ao passo que mantém a saúde dos rebanhos. No entanto, os compostos homeopáticos podem também ser usados como protetores do fígado, podendo atuar na modulação da função hepática. Os medicamentos homeopáticos a base de plantas podem ser utilizados como agentes hepatoprotetores, uma vez que possuem a capacidade de prevenir e reparar desordens hepáticas que comumente acometem vacas em lactação. Assim, o conhecimento das propriedades terapêuticas de plantas permite a elaboração de preparos homeopáticos, capazes de preservar a saúde dos animais de produção. Baseado nisso, objetivou-se com esta revisão discorrer sobre compostos vegetais utilizados na homeopatia como hepatoprotetores e seus efeitos no metabolismo hepático e na resposta produtiva de animais ruminantes em lactação.
... Homoeopathy can be a good alternative for this, even for resistant organisms. 52 After a comprehensive search of different databases, we found many studies evaluating the positive effect of homoeopathy and very few studies with no/minimal effect. Some of the studies used 'homoeopathic syrup', 'complex nosodes', 'combination medicines', 'predetermined medicines with fixed potency' etc. are quite deviated from basic principles of individualised homoeopathy. ...
Article
Background: Upper respiratory tract infection (URTI) is one of the leading causes of morbidity worldwide, especially in the paediatric age group. Conventional medications have a minimal role in treating and preventing those diseases and an alternative for this is warranted. In this regard, homoeopathy can be a proper consideration, but the comparative effect and safety need critical evaluation. Methods: To evaluate the role of homoeopathic treatment in URTI, particularly in children, we conducted a comprehensive search in PubMed, Core-Hom, Cochrane library and Cam-quest database. All the relevant studies were included for a critical review. Results: One-hundred forty articles were found in a preliminary search, and for review, we included 17 studies related to URTI in paediatric age group. All the studies were very diverse in the methodology, type of homoeopathy used and outcome measurement. Different types of homoeopathy in terms of individualised, complex syrup and home-medication were used in studies. Fourteen studies reported the role of homoeopathy in reducing the severity of symptoms, efficacy beyond placebo, superiority or non-inferiority over conventional medications, in lowering the consumption of antibiotics and as prophylaxis. On the other hand, three studies found little or no effect in reducing symptoms or number of visits. Conclusions: Homoeopathic treatment improves the symptoms and reduces the severity of URTI in the paediatric age group. It can be an effective and safe way of treatment for reducing the burden of the disease, thus improving the quality of life. Owing to the diversity among the studies, more high-quality trials with focused questions are needed for further conclusion.
... Most URTIs are caused by a selflimiting viral illness (such as influenza and rhinoviruses) with symptoms lasting 7 to 10 days; however, complications such as otitis media, 19 pharyngitis, 20 tonsillitis 21 and sinusitis 22 are frequently treated with antibiotics. [23][24][25][26][27] In the United States, 23% of paediatric medical visits from 2004 to 2008 resulted in prescriptions for antibiotics 9 with otitis media, the most common reason for prescribing antibiotics in children. Other pharmacological treatments include antipyretics, anti-inflammatory drugs, expectorants, decongestants, and cough suppressants, either alone or in combination. ...
Article
Full-text available
Background Acute upper respiratory tract infections (URTIs) and their complications are the most frequent cause of antibiotic prescribing in primary care. With multi-resistant organisms proliferating, appropriate alternative treatments to these conditions are urgently required. Homeopathy presents one solution; however, there are many methods of homeopathic prescribing. This review of the literature considers firstly whether homeopathy offers a viable alternative therapeutic solution for acute URTIs and their complications, and secondly how such homeopathic intervention might take place. Method Critical review of post 1994 clinical studies featuring homeopathic treatment of acute URTIs and their complications. Study design, treatment intervention, cohort group, measurement and outcome were considered. Discussion focused on the extent to which homeopathy is used to treat URTIs, rate of improvement and tolerability of the treatment, complications of URTIs, prophylactic and long-term effects, and the use of combination versus single homeopathic remedies. Results Multiple peer-reviewed studies were found in which homeopathy had been used to treat URTIs and associated symptoms (cough, pharyngitis, tonsillitis, otitis media, acute sinusitis, etc.). Nine randomised controlled trials (RCTs) and 8 observational/cohort studies were analysed, 7 of which were paediatric studies. Seven RCTs used combination remedies with multiple constituents. Results for homeopathy treatment were positive overall, with faster resolution, reduced use of antibiotics and possible prophylactic and longer-term benefits. Conclusions Variations in size, location, cohort and outcome measures make comparisons and generalisations concerning homeopathic clinical trials for URTIs problematic. Nevertheless, study findings suggest at least equivalence between homeopathy and conventional treatment for uncomplicated URTI cases, with fewer adverse events and potentially broader therapeutic outcomes. The use of non-individualised homeopathic compounds tailored for the paediatric population merits further investigation, including through cohort studies. In the light of antimicrobial resistance, homeopathy offers alternative strategies for minor infections and possible prevention of recurring URTIs.
... Most URTIs are caused by a selflimiting viral illness (such as influenza and rhinoviruses) with symptoms lasting 7 to 10 days; however, complications such as otitis media, 19 pharyngitis, 20 tonsillitis 21 and sinusitis 22 are frequently treated with antibiotics. [23][24][25][26][27] In the United States, 23% of paediatric medical visits from 2004 to 2008 resulted in prescriptions for antibiotics 9 with otitis media, the most common reason for prescribing antibiotics in children. Other pharmacological treatments include antipyretics, anti-inflammatory drugs, expectorants, decongestants, and cough suppressants, either alone or in combination. ...
Article
Background Acute upper respiratory tract infections (URTIs) and their complications are the most frequent cause of antibiotic prescribing in primary care. With multiresistant organisms proliferating, appropriate alternative treatments to these conditions are urgently required. Homeopathy presents one solution; however, there are many methods of homeopathic prescribing. This review of the literature considers firstly whether homeopathy offers a viable alternative therapeutic solution for acute URTIs and their complications, and secondly how such homeopathic intervention might take place. Method Critical review of post 1994 clinical studies featuring homeopathic treatment of acute URTIs and their complications. Study design, treatment intervention, cohort group, measurement and outcome were considered. Discussion focused on the extent to which homeopathy is used to treat URTIs, rate of improvement and tolerability of the treatment, complications of URTIs, prophylactic and long-term effects, and the use of combination versus single homeopathic remedies. Results Multiple peer-reviewed studies were found in which homeopathy had been used to treat URTIs and associated symptoms (cough, pharyngitis, tonsillitis, otitis media, acute sinusitis, etc.). Nine randomised controlled trials (RCTs) and 8 observational/ cohort studies were analysed, 7 of which were paediatric studies. Seven RCTs used combination remedies with multiple constituents. Results for homeopathy treatment were positive overall, with faster resolution, reduced use of antibiotics and possible prophylactic and longer-term benefits. Conclusions Variations in size, location, cohort and outcome measures make comparisons and generalisations concerning homeopathic clinical trials for URTIs problematic. Nevertheless, study findings suggest at least equivalence between homeopathy and conventional treatment for uncomplicated URTI cases, with fewer adverse events and potentially broader therapeutic outcomes. The use of non-individualised homeopathic compounds tailored for the paediatric population merits further investigation, including through cohort studies. In the light of antimicrobial resistance, homeopathy offers alternative strategies for minor infections and possible prevention of recurring URTIs. received August
... The aim of this work is to give a general presentation on the scope of research associated with the application of homeopathy in the aquiculture sector, and propose it as an alternative therapy to the aquiculture industry. recido la prevalencia de bacterias patógenas cada vez más abundantes 14 y más resistentes a casi todos los antibióticos, lo cual tiene impacto en la producción, pero además constituye un problema de salud pública mundial 15 . Para lograr un efectivo tratamiento preventivo y correctivo de las enfermedades en la acuicultura, es necesario realizar una rigurosa investigación científica básica para sustentar el uso de terapias alternativas que actúen fortaleciendo el sistema inmune 16 e incrementen la resistencia del huésped ante la enfermedad 17 . ...
Article
La homeopatía es un sistema médico alternativo propuesto por Samuel Hahnemann en el siglo xviii, que se basa en el “principio de similitud”, que establece que “lo similar cura lo similar” y utiliza sustancias altamente diluidas y agitadas, derivadas de plantas, minerales o animales. La homeopatía se utiliza para tratar padecimientos en humanos, pero también se aplica en agronomía y veterinaria. El uso de medicamentos homeopáticos durante la crianza de animales de producción se ha desarrollado rápidamente en los últimos años, motivado en gran parte por el uso inadecuado de potentes fármacos (hormonas, antibióticos y otros), que al resolver un problema generan diversos efectos colaterales. Algunos de estos agentes son bioacumulables; inducen o favorecen una mayor resistencia a los antibióticos en las cepas patógenas que idealmente deberían eliminar, y pueden tener repercusiones ambientales negativas cuando finalmente se incorporan en los efluentes de las unidades de producción. Ante esta problemática creciente e irreversible, se asume que la homeopatía tiene un gran potencial en la acuicultura. En los últimos 10 años se han publicado algunos artículos científicos sobre su aplicación en peces de agua dulce nativos de Brasil, que obtiene efectos benéficos en supervivencia, desarrollo de fibras musculares, reducción de la inclusión de lípidos hepáticos, en el índice hepatosomático y en el contenido total de lípidos en tejido muscular. Nuevos estudios se desarrollan actualmente en el CIBNOR-México, para determinar experimentalmente el efecto de medicamentos homeopáticos en el cultivo de especies marinas de importancia económica como el camarón blanco, la almeja catarina y peces marinos. El objetivo de este trabajo es presentar de manera general los alcances de las investigaciones relacionados con la aplicación de la homeopatía en el sector acuícola, y proponerla como una terapia alternativa a la industria acuícola.
... 30 Though homeopathy cannot replace the mechanical art of dentistry, it is undoubtedly a useful adjunct to conventional dentistry and may be used effectively in place of orthodox treatment which may have unpleasant side effects. 31 It is especially important in the context of increasing antibiotic resistance, 32,33 inadequate evidence to support the use of routine scaling, 34 willingness of patients to participate in complementary and alternative medicine trials, 35,36 self-medication tendencies with homeopathic drugs by dental students, 37 and low cost of homeopathic medicines associated with wide social acceptance and minimal chances of toxic effects. 29 Our work was initiated as a larger scale dental data collection project in the model developed by Mathie and Farrer 2 and later carried out successfully by Farrer et al. 26 This type of research is especially helpful to gain an insight into the dental practice scenario in a government homeopathic school in West Bengal, India, and will help uptake dental randomized controlled trials in the near future. ...
... Therefore, there is a world-wide urgent need to develop and implement strategies that reduce inappropriate use of antibiotics [30]. Homeopathic treatment may be such an alternative treatment strategy to reduce the use of antibiotics [31]. A cohort study showed that patients with URTI, who visited a general practitioner that also practiced homeopathy, had lower consumption of antibiotics compared to patients visiting a physician who only practiced regular medicine [32]. ...
Article
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Background The present study was initiated to investigate the effectiveness, safety and tolerability of complex homeopathic CalSuli-4-02 tablets on prevention of recurrent acute upper respiratory tract infections (URTIs) in children, in comparison to another complex homeopathic product. Methods The study was designed as a prospective, multicenter, randomized, open, clinical trial with two parallel treatment groups at four outpatient pediatric clinics in Russia. Children aged ≤ 6 years with susceptibility to acute URTIs (≥ three occasions during the last 6 months) were randomized to receive either CalSuli-4-02 or a comparator homeopathic product (control group) for 3 weeks. Primary outcome was the frequency of acute URTIs after 3 and 6 months post-treatment follow-up. Secondary endpoints were changes in complaints and symptoms (total and individual scores), treatment satisfaction, antibiotic use, safety and tolerability. ResultsThe intention-to-treat analysis involved 200 children (CalSuli-4-02: N = 99, Control: N = 101). In both treatment groups, the median number of acute URTIs was one for 3 months and two, respectively, for the full 6 months post-treatment (Relative Risk: 0.86 (95 %-CI: 0.72–1.03), p = 0.1099). Seasons had no influence on the outcome. At the end of study, CalSuli-4-02 had overall higher odds of getting lower complaints severity total score (Odds ratio: 1.99 (95 %-CI: 1.31–3.02), p = 0.0012) and showing symptom improvement (Odds ratio: 1.93 (95 %-CI: 1.25–3.00), p = 0.0033). Specifically, the complaint “appetite disorder” and the symptom “child’s activities” significantly improved more in the CalSuli-4-02 group (p = 0.0135 and p = 0.0063, respectively). Antibiotic use was decreased in both treatment groups at the study end. Overall assessment for satisfaction with and tolerability of treatment was higher with CalSuli-4-02. A low number of non-serious adverse drug reactions was reported (CalSuli-4-02: N = 4, Control: N = 1). Conclusions Both complex homeopathic products led to a comparable reduction of URTIs. In the CalSuli-4-02 group, significantly less URTI-related complaints and symptoms and higher treatment satisfaction and tolerability were detected. The observation that the use of antibiotics was reduced upon treatment with the complex homeopathic medications, without the occurrence of complications, is interesting and warrants further investigations on the potential of CalSuli-4-02 as an antibiotic sparing option. Clinical trial registration numberRoszdravnadzor: Study No 164–563
... [16] This rapid rise in usage of veterinary antibiotics necessitates the development of sustainable alternative; antibiotics are partly replaced by complementary or alternative medicine of which Homoeopathy is the most frequently applied. [17] Limited reports have been published in homoeopathic and alternative medicine journals on veterinary clinical trials with homoeopathic medicine/drugs where methodological weakness is noticed. Homoeopathic remedies have significant benefits since there are no residues in animal products nor does Homoeopathy generate resistant microorganisms. ...
Article
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Objective: To study, the effect of a homoeopathic medicine Crotalus horridus 200C on ehrlichiosis in dogs in an endemic area of Aizawl district of Mizoram state of India. Materials and Methods: To evaluate the efficacy of Crotalus horridus 200C against ehrlichiosis dogs. 12 positive cases confirmed by polymerase chain reaction (PCR) were divided into two groups comprising six dogs in each group. One group was treated with standard therapy (doxycycline) and other group was treated with Crotalus horridus 200C at 4 pills orally for 20 days. Clinical improvement of affected dogs was recorded after therapy. Important haemato-biochemical parameters before and after therapy such as haemoglobin (Hb), packed cell volume (PCV), total erythrocyte count (TEC), total leukocyte count (TLC), differential leukocyte count (DLC), platelet count, total protein, albumin, globulin, A:G ratio, total bilirubin, serum creatinine, blood urea nitrogen (BUN), and liver-specific enzymes namely alanine aminotransferase (ALT) and alkaline phosphatase (ALP) were assessed following standard protocol. All the parameters were compared with a control healthy group (T3). All experiment dogs were from different age with different breeds and bloods were collected at forenoon only. Results: PCR test yielded 13 dogs positive out of 67 suspected samples screened (19.40%) with an amplification of 387 bp fragment from 16S rRNA gene of E. Canis. Off total positive, only 8 (61.53%) could be detected in peripheral blood smear. Crotalus horridus-treated group of dogs showed clinical recovery from fever and temperature to normalcy by the 14th day posttreatment. Haemato-biochemical profiles of affected dogs such as Hb, PCV, TEC, TLC, DLC, platelet count, total protein, albumin, globulin, A:G ratio, total bilirubin, serum creatinine, BUN, and liver-specific enzymes namely ALT and ALP were turned to normalcy within 21 days of post-treatment. Conclusion: Nested PCR assay had been shown to be sensitive and specific for detection of Ehrlichia canis. Crotalus horridus 200C may be an effective and choice of drug for control of canine ehrlichiosis.
... We reviewed all the methods of functionalization to investigate the bioproperties of nanotubes. Antibiotic-resistant microorganisms have become one of the common and most serious health obstacles over recent decades (Fedorka-Cray, 2014; Viksveen, 2003). These microorganisms are capable of inducing some severe diseases (Heinemann et al., 2000). ...
Chapter
Carbon nanotubes (CNTs) are new materials with promising applications in biotechnology. Drug delivery, biomedical imaging, nanoresonator sensors, are carbon-based tissue are some of the applications of CNTs. Researchers have agreed that CNTs hold significant antimicrobial activities against different pathogens (Gram-negative and -positive bacteria, fungal pathogens) such as human gut bacteria, Escherichia coli, Staphylococcus aureus, Salmonella enteric, etc. Recent results have shown that CNTs can be promising alternatives to antibiotics for annihilation of multidrug-resistant bacterial strains. The antimicrobial activity of CNTs is dependent on different factors, one of which is decorated functional groups. Here, the methods of CNT functionalization and their antimicrobial activity in the presence of different functional groups are investigated.
... Homeopatik ilaçların diğer yöntemlere göre tercih edilmesinin birçok nedeni vardır (Viksveen, 2003). Homeopatik ilaçlar ile belli bir prensip dahilinde yapılan tedavilerde, yan etkiler görülmez ve geniş kullanım alanına sahiptir (Kirşan, 2010). ...
... In recent decades, the problems of multi-drug resistant microorganisms have reached on alarming level in many countries around the world (80)(81)(82) . A number of recent clinical reports describe the increasing occurrence of meticillin-resistant Staphylococcus aureus (MRSA), vancomycinresistant enterococci (VRE) and other antibioticresistant human pathogenic microorganisms in the United States and European countries (83) . Infections caused by these microorganisms pose a serious challenge to the humanity and need for an effective therapy has led to search for novel antimicrobial agents. ...
Article
Full-text available
The transition metals are compounds where the compound has an incomplete d sub shell i.e. Mn (II), Fe (II), Fe (III) etc and due to their instability in structure it has variable oxidation number as well as unstable electronic configuration which modulate the variable redox system present inside the biological system and it exhibit different oxidation states and can interact with a number of negatively charged molecules. This activity of transition metals has started the development of metal based drugs with promising pharmacological application and may offer unique therapeutic opportunities and show remarkable therapeutic success of anticancer drugs such as cisplatin, carboplatin and oxaliplatin, metallodrugs have also shown promising results in the treatment of diseases other than cancer also. They have been developed to treat/cure a variety of ailments viz. diabetes, ulcer, rheumatoid arthritis, inflammatory and cardiovascular diseases etc. Phytoconstituent like Curcumin has keto-enol form transformation property and utilising that property in the open chain configuration of enolic form metal ion will attach and its gives a structure of chelates where curcumin will act as ligand. This chelate can be synthesized in different proportion depending on the chemical nature of metal central cation as well also.
... In recent decades, the problems of multi-drug resistant microorganisms have reached on alarming level in many countries around the world [57][58][59]. A number of recent clinical reports describe the increasing occurrence of meticillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE) and other antibiotic-resistant human pathogenic microorganisms in the United States and European countries [60]. Infections caused by these microorganisms pose a serious challenge to the humanity and need for an effective therapy has led to search for novel antimicrobial agents. ...
Article
Full-text available
Besides the remarkable therapeutic success of anticancer drugs such as cisplatin, carboplatin and oxaliplatin, metallodrugs have also shown promising results in the treatment of diseases other than cancer. They have been developed to treat/cure a variety of ailments viz. diabetes, ulcer, rheumatoid arthritis, inflammatory and cardiovascular diseases etc. The enzymes in our body and many drugs of organic nature require traces of metal ion for proper functioning. Due to a wide variety of coordination spheres, ligands design, oxidation states and redox potential, coordination and organometallic complexes are supposed to alter the kinetic and thermodynamic properties of the complexes towards biological receptors. Thus, chelation causes drastic change in biological properties of ligands as well as metal moiety. Metal complexes are supposed to exert their effect by inhibition of enzymes, interaction with intracellular biomolecules, enhanced lipophilicity, alteration of cell membrane functions and arrest of cell cycle etc. The review includes the current use and future potential of some metal based drugs used/showed promising results in the treatment of diseases/conditions such as diabetes, ulcer, infection, mania and hypertension etc. which are being developed as therapeutic agents during the recent past.
... C.E. 1804/99), and it is used by significant numbers of farmers also for the absence of withdrawal periods for meat and milk. In spite of the growing attention towards alternative medicines, at present there are few data on the effectiveness of homeopathy in this setting (Viksveen, 2003), especially in the veterinary medicine and in particular in the ovine one. In this section of the animal production, a major health constraint to sheep productivity is represented by ovine helminthosis. ...
Article
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The aim of this research was to evaluate the state of some haematochemical parameters in dry and lactating Sarda sheep breed. Twenty lactating sheep (Group A) and twenty dry sheep (Group B) were selected for this study; all the sheep were pluriparous and non-pregnant. Blood samples were collected from each animal of Group A on days 7 th and 30 th of the lactation period, and from each animal of Group B on day 60 th of the dry period. Plasma levels of NEFA, glucose, triglycerides, total cholesterol, total proteins, albumin, urea, Ca, P, Mg, Na and K were determined. Data were submitted to statistical analysis. As regards Group A, the plasmatic concentration of NEFA, glucose and triglycerides were higher on day 7 th (P<0.01) than those determined on day 30 th . As regards the comparison between the two groups, lactating sheep showed in both the samples plasmatic levels of NEFA (P<0.01), glucose (P<0.01), triglycerides (P<0.01) and urea (P<0.05) higher than those recorded in dry sheep. The concentrations of Na and K in Group A were lower on day 7 th than those recorded on day 30 th . In conclusion, the results indicate that the patterns of the parameters of the two groups is clearly affected by the different metabolic engagement that is necessary to satisfy udder requirements for milk production.
... 30 Though homeopathy cannot replace the mechanical art of dentistry, it is undoubtedly a useful adjunct to conventional dentistry and may be used effectively in place of orthodox treatment which may have unpleasant side effects. 31 It is especially important in the context of increasing antibiotic resistance, 32,33 inadequate evidence to support the use of routine scaling, 34 willingness of patients to participate in complementary and alternative medicine trials, 35,36 self-medication tendencies with homeopathic drugs by dental students, 37 and low cost of homeopathic medicines associated with wide social acceptance and minimal chances of toxic effects. 29 Our work was initiated as a larger scale dental data collection project in the model developed by Mathie and Farrer 2 and later carried out successfully by Farrer et al. 26 This type of research is especially helpful to gain an insight into the dental practice scenario in a government homeopathic school in West Bengal, India, and will help uptake dental randomized controlled trials in the near future. ...
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This pilot investigation initiated a research-targeted systematic dental homeopathy data collection in the dental outpatient section in a government homeopathic hospital in West Bengal, India. One conventionally trained dentist and 3 homeopathic doctors collected data from 949 appointments of 411 patients over 3 months. A specifically designed Excel spreadsheet enabled recording of consecutive dental appointments that was subjected to data synthesis and analysis in the end. A total of 87.3% conditions were chronic, and chronic periodontitis was most frequent (27.5%). Positive outcome was observed in 72.3% appointments. Strongly positive outcomes (scores of +2 or +3) were achieved most notably in toothache (84.6%). Single medicines were prescribed in 83.5% encounters, and mostly in tincture form (29.9%). Arnica montana constituted of 17.8% prescriptions. Considerable insight was gained into the homeopathic dental practice scenario in West Bengal, India. Positive findings suggest that dental homeopathy is a promising area for research in near future.
... Here, antibiotics are partly replaced by complementary or alternative medicines (CAM), of which homeopathy is the most frequently applied. 3 Homeopathy has demonstrated in many medical areas its effectiveness in practice, but scientific evidence is lacking. 4,5 The veterinary homeopathy research literature comprises less than 20 published, peer-reviewed randomised controlled trials (RCTs). ...
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The use of antibiotics in the livestock sector is increasing to such an extent that it threatens negative consequences for human health, animal health and the environment. Homeopathy might be an alternative to antibiotics. It has therefore been tested in a randomised placebo-controlled trial to prevent Escherichia coli diarrhoea in neonatal piglets. On a commercial pig farm 52 sows of different parities, in their last month of gestation, were treated twice a week with either the homeopathic agent Coli 30K or placebo. The 525 piglets born from these sows were scored for occurrence and duration of diarrhoea. Piglets of the homeopathic treated group had significantly less E. coli diarrhoea than piglets in the placebo group (P<.0001). Especially piglets from first parity sows gave a good response to treatment with Coli 30K. The diarrhoea seemed to be less severe in the homeopathically treated litters, there was less transmission and duration appeared shorter.
... In recent decades, the problems of multi-drug resistant microorganisms have reached on alarming level in many countries around the world [1][2][3]. A number of recent clinical reports describe the increasing occurrence of meticillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE) and other antibiotic-resistant human pathogenic microorganisms in the United States and European countries [4]. Infections caused by those microorganisms pose a serious challenge to the medical community and need for an effective therapy has led to a search for novel antimicrobial agents. ...
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The new various metal complexes of 5-benzoyl-4-hydroxy-2-methyl-6-phenyl-2H-pyridazin-3-one were synthesized. All the complexes were evaluated for their antimicrobial activities against Gram-positive, Gram-negative bacteria and fungi using microdilution procedure. The Cd(II) and Ni(II) complexes exhibited selective and effective activities against one Gram-positive bacterium (Staphylococcus aureus ATCC 6538), one Gram-negative bacterium (Pseudomonas putida ATCC 12633) and against two yeast (Candida albicans ATCC 27541 and Candida tropicalis 1828) in contrast to poor activity observed other microorganisms. The new synthesized complexes were characterized using IR, 1H-NMR and UV spectral data together with elemental analysis.
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In this study, an improved Susceptible-Infected-Recovered (SIR) epidemic diffusion model for cholera is extended by including migration for susceptible people. This model is applied to a metapopulation that consists of two isolated cities where just susceptible individuals can migrate between the cities. The disease-free equilibrium, the endemic equilibrium points, and the basic reproductive number with unequal migration rates are analyzed for this metapopulation. Firstly, the study showed that the basic reproductive number depends on the migration rates between the cities. Then, showed that when the epidemic SIR system is stable, then the infected cases for cholera outbreak can reach zero in one city, but the infected cases in the other city still can stay positive. Finally, discussed three scenarios that depend on population sizes and migration rates of susceptible people between the cities and showed how important the migration rates are in the diffusion of the cholera outbreak by visualizing these three scenarios. Mathematics Subject Classification Primary: 92B05; Secondary: 92D40
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Aim: The mechanisms behind antibiotic resistance by bacteria are important to create alternative molecules. Objective: This study focuses on the impact of environmental pollutants on bacterial resistance to antibiotics. Materials & methods: The effect of various environmental pollutants on noninherited bacterial resistance to antibiotics was examined. Results: The tolerance to the polymyxin-B antibiotic was shown to be conferred to Escherichia coli, by pretreatment with subinhibitory concentrations of environmental toxicants. The cell survival to a sublethal dosage of antibiotics was tested. Exposure to low concentrations of toxic compounds (500 ppb copper, 2% [v/v] ethanol or 0.5 μg/ml trimethoprim) stimulated the bacterial heat shock systems and led to increased tolerance to polymyxin B. Conclusion: Environmental pollutants induce a temporary bacterial noninheritable resistance to antibiotic. Graphical abstract: The effects of various environmental pollutants on noninherited bacterial resistance to antibiotics were explored. The results show that pretreatment of bacteria with subinhibitory concentrations of some compounds, found in common environmental milieus (e.g., copper, ethanol, antibiotics), may induce temporary noninherited resistance to polymyxin B. The data suggest that environmental toxicants may stimulate bacterial heat shock repair systems, thereby conferring the bacteria temporary noninheritable resistance. Keywords: antibiotic resistancebacteriaE. colienvironmental pollutantsnoninherited resistancepolymyxin B
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One of the most common reasons children visit the doctor is middle ear problems, whether they be acute otitis media or the more chronic manifestations of otitis media with effusion (glue ear). This paper offers an approach to treating children suffering from a whole spectrum of middle ear problems using Earmix plus a constitutional remedy and dietary changes. A retrospective case series analysis was carried out on clients who were treated in this way and the results of the study showed a high success rate in many of the cases. Penny Barron is a homoeopath at the Harbord Homoeopathic Children's Clinic, and Research Coordinator at the Aurum Project, a charity dedicated to homoeopathic research into children's health.
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A set of novel series of 1,3,4-thiadiazolyl-sulfanyl-4,5-dihydropyridazin-3(2H)-ones with anticipated antimicrobial activity has been synthesized. The synthetic protocol of the targeted compounds was accomplished by treating β-aroylacrylic acid 1 with 5-amino-1,3,4-thiadiazole-2-thiol (2) to afford the thia-Michael adduct 3. Afterwards, the obtained thia-Michael adduct 3 was cyclized to 4,5-dihydropyridazin-3(2H)-ones 4a–d and the non-cyclized product hydrazone 5 by using different hydrazines. Moreover, adduct 3 was reacted with esters like diethyl malonate and ethyl acetoacetate affording 1,3,4-thiadiazolobutanamides 6a, b. Furthermore, the concurrent reaction of later butamides 6a, b with the hydrazine derivatives furnished thiadiazolopyridazin-3(2H)-ones 7a–d, 8, and butanoic acid 9. Graphical Abstract Fullsize Image
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The aim of this study was compare the potential of an antibiotic and homeopathic complex on the prevention and treatment of diarrhea in suckling piglets and to compare and evaluate the performance results and mortality during the lactation. Ninety eight litters, totaling 988 piglets, from females with reproductive cycles order of 5.92 ± 2.65. The litters were allotted to a randomized block experiment consisting of the control, antibiotic and homeopathic complex treatments. It was adopted the reproductive cycle order of the females as blocking criteria. On the second day of life, litters were weighed and submitted to oral application of 2.0mL colistin antibiotic or 4.0mL of homeopathic complex per piglet. The piglets were weaned at an average age of 22.97 ± 2.43 days. No effect of treatments on performance and mortality of piglets was noted. Difference was found in the percentage of efficiency in the treatment of diarrhea, and the homeopathic complex showed superior efficiency in relation to the antibiotic (95.2% versus 90.0%). It was concluded that the homeopathic complex was effective in the prevention and treatment of diarrhea of suckling piglets and may be used as a substitute to the antibiotic.
Article
Background: Resistance to antibiotics is a major public health concern worldwide. New treatment options are needed and homeopathy is one such option. We sought to assess the effect of the homeopathic medicine Belladonna (Bell) and a nosode (biotherapy) prepared from a multi-drug resistant bacterial species, methicillin-resistant Staphylococcus aureus (MRSA), on the same bacterium. Methods: Bell and MRSA nosode were prepared in 6cH and 30cH potencies in 30% alcohol and sterile water, according to the Brazilian Homeopathic Pharmacopeia and tested on MRSA National Collection of Type Cultures (NCTC) 10442. We assessed in vitro bacterial growth, deoxyribonuclease (DNAase) and hemolysin activity, and in vitro bacterial growth in combination with oxacillin (minimum inhibitory concentration - MIC). All values were compared to control: 30% alcohol and water. Results: In vitro growth of MRSA was statistically significantly inhibited in the presence of Bell and nosode 6cH and 30cH compared to controls (p < 0.0001); and with combination of Bell or nosode 6cH and 30cH and oxacillin (p < 0.001). Bell 30cH and nosode 6cH and 30cH significantly decreased bacterial DNAse production (p < 0.001) and reduced red blood cell lysis. Conclusions: Cultures of MRSA treated with Belladonna or MRSA nosode exhibited reduced growth in vitro, reduced enzymatic activity and became more vulnerable to the action of the antibiotic oxacillin. Further studies are needed on the biomolecular basis of these effects.
Article
Resumen La otitis media se encuentra entre las enfermedades infecciosas más frecuentes de la infancia y puede ser desde un episodio de corta evolución hasta una patología crónica que genera ausentismo escolar y deterioro auditivo permanente. El tratamiento convencional en algunos casos no es suficiente para curar casos relacionados con recurrencia y el exceso en el uso de antibióticos de manera innecesaria ha generado resistencia bacteriana. Para la homeopatía unicista, la otitis debe ser manejada bajo el principio de individualidad teniendo en cuenta la integralidad de los síntomas del paciente y no solamente los que hacen referencia al oído en particular. Hasta el momento existen algunos estudios relacionados con unicismo. No obstante, es necesario realizar nuevos planteamientos que permitan demostrar su utilidad para exponerlos a la comunidad científica y aplicarlos en los servicios de salud en general.
Article
The aim of this study was compare the potential of an antibiotic and homeopathic complex on the prevention and treatment of diarrhea in suckling piglets and to compare and evaluate the performance results and mortality during the lactation. Ninety eight litters, totaling 988 piglets, from females with reproductive cycles order of 5.92 ± 2.65. The litters were allotted to a randomized block experiment consisting of the control, antibiotic and homeopathic complex treatments. It was adopted the reproductive cycle order of the females as blocking criteria. On the second day of life, litters were weighed and submitted to oral application of 2.0mL colistin antibiotic or 4.0mL of homeopathic complex per piglet. The piglets were weaned at an average age of 22.97 ± 2.43 days. No effect of treatments on performance and mortality of piglets was noted. Difference was found in the percentage of efficiency in the treatment of diarrhea, and the homeopathic complex showed superior efficiency in relation to the antibiotic (95.2% versus 90.0%). It was concluded that the homeopathic complex was effective in the prevention and treatment of diarrhea of suckling piglets and may be used as a substitute to the antibiotic.
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It was researched the effect of Core Homeopathic Homeopatila 100® on the integrity branchial histological, weight, final length, survival, feed conversion and apparent index hepatossomátic in fingerlings from Nile tilapia (Oreochromis niloticus). We used in the control treatment (T1) with 20mL/kg water-alcohol solution (alcohol 30 GL) and three treatments with 20mL/kg (T2), 40mL/kg (T3) e 60mL/kg (T4) of core homeopathic Homeopatila 100® in fingerlings male reversed, with initial weight and initial length the 1,05 ± 0,32g and 4,15 ± 0,42cm respectively. It was distributed a total of 832 fingerlings in 16 polyethylene water tanks with individual capacity of 2000 liters, contends 1000 liters each one, where they ha remained during 61 days. At the end of experiment, was not observed statistic difference between the different treatments in histological changes examined in gills: epithelial lifting, hyperplasia, telangectasy and lamellar fusion. The fingerlings which received 40mL/kg of Homeopatila 100® (T3) showed a higher rate of survival and also lower rate than the other hepatossomátic the fingerlings in control group (T1).
Article
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It was researched the effect of Core Homeopathic Homeopatila 100® on the integrity branchial histological, weight, final length, survival, feed conversion and apparent index hepatossomátic in fingerlings from Nile tilapia (Oreochromis niloticus). We used in the control treatment (T1) with 20mL/kg water-alcohol solution (alcohol 30 GL) and three treatments with 20mL/kg (T2), 40mL/kg (T3) e 60mL/kg (T4) of core homeopathic Homeopatila 100® in fingerlings male reversed, with initial weight and initial length the 1,05 ± 0,32g and 4,15 ± 0,42cm respectively. It was distributed a total of 832 fingerlings in 16 polyethylene water tanks with individual capacity of 2000 liters, contends 1000 liters each one, where they ha remained during 61 days. At the end of experiment, was not observed statistic difference between the different treatments in histological changes examined in gills: epithelial lifting, hyperplasia, telangectasy and lamellar fusion. The fingerlings which received 40mL/kg of Homeopatila 100® (T3) showed a higher rate of survival and also lower rate than the other hepatossomátic the fingerlings in control group (T1).Foi pesquisado o efeito do Núcleo Homeopático Homeopatila 100® na integridade histológica branquial, na sobrevivência, peso, comprimento final, conversão alimentar aparente e índice hepatossomático em alevinos de tilápia do Nilo (Oreochromis niloticus). Foi utilizado um tratamento controle (T1) com 20mL de solução hidroalcólica (álcool 30° GL) a cada kg de ração e três tratamentos com 20mL/kg (T2), 40mL/kg (T3) e 60mL/kg (T4) do Núcleo Homeopático Homeopatila 100®, em alevinos machos revertidos, com peso e comprimento médio inicial de 1,05 ± 0,32g e 4,15 ± 0,42cm respectivamente. Foi distribuído um total de 832 alevinos em 16 caixas d´agua com capacidade individual de 2000 litros, contendo 1000 litros cada uma, onde permaneceram durante 61 dias. No final do experimento, não foi observada diferença estatística entre os diferentes tratamentos nas alterações histológicas examinadas nas brânquias: elevação epitelial, hiperplasia, telangectasia e fusão lamelar. Os alevinos que receberam 40mL/kg de ração de Homeopatila 100® (T3) apresentaram maior sobrevivência e índice hepatossomático menor do que os alevinos do grupo controle (T1).
Article
Background: Acute viral tonsillitis is an upper respiratory tract infection prevalent in school-aged children. Because this condition is self-limiting, conventional treatment options are usually palliative. Homeopathic remedies are a useful alternative to conventional medications in acute uncomplicated upper respiratory tract infections in children, offering earlier symptom resolution, cost-effectiveness, and fewer adverse effects. This study aimed to determine the efficacy of a homeopathic complex on the symptoms of acute viral tonsillitis in African children in South Africa. Methods: This was a randomized, double-blind, placebo-controlled, 6-day pilot study. Thirty children, age 6 to 12 years, with acute viral tonsillitis were recruited from a primary school in Gauteng, South Africa. Participants took two tablets of the medication four times daily. The treatment group received lactose tablets medicated with the homeopathic complex (Atropa belladonna D4, Calcarea phosphoricum D4, Hepar sulphuris D4, Kalium bichromat D4, Kalium muriaticum D4, Mercurius protoiodid D10, and Mercurius biniodid D10). The placebo consisted of the unmedicated vehicle only. The Wong-Baker FACES Pain Rating Scale measured pain intensity, and a Symptom Grading Scale assessed changes in tonsillitis signs and symptoms. Results: The treatment group had a statistically significant improvement in the following symptoms compared with the placebo group: pain associated with tonsillitis, pain on swallowing, erythema and inflammation of the pharynx, and tonsil size. Conclusion: The homeopathic complex used in this study exhibited significant anti-inflammatory and pain-relieving qualities in children with acute viral tonsillitis. No patients reported any adverse effects. These preliminary findings are promising; however, the sample size was small and therefore a definitive conclusion cannot be reached. A larger, more inclusive research study should be undertaken to verify the findings of this study.
Article
Patients who usually attend Traditional Chinese Medicine (TCM) need to go to western medicine (WM) doctors for antibiotics in Hong Kong. They might have different knowledge, attitude and practice (KAP) with antibiotics from the WM-attenders. This study compares TCM attenders with the WM-attenders in Hong Kong about their KAP with antibiotics. The comparison could help future campaigns/education on appropriate antibiotic use. A questionnaire on KAP with antibiotics was designed after eight focus groups of purposively selected participants. A territory-wide telephone survey then interviewed randomly selected residents who were aged 18 years or above and spoke the local dialect. Of 2471 respondents, 270 and 2092 usually attended TCM and WM, respectively. Majority of both the TCM- and WM-attenders preferred doctors who were judicious in prescribing antibiotics and seldom asked for them. The TCM-attenders were significantly more likely to be female and with lower household income. They were also more likely to agree that antibiotics were not useful for upper respiratory tract infections and that antibiotic resistance was a serious local problem. They were less likely to accept or be treated with antibiotics. The TCM-attenders were also more concerned about the side-effects of antibiotics. However, they were also less likely than the WM-attenders to always finish a full course of antibiotic. Apart from non-compliance, the TCM-attenders' KAP with antibiotics favour the appropriate use of antibiotics.
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The public health and individual risks of inappropriate antibiotic prescribing and conventional over-the-counter symptomatic drugs in pediatric treatment of acute otitis media (AOM) and upper respiratory infections (URIs) are significant. Clinical research suggests that over-the-counter homeopathic medicines offer pragmatic treatment alternatives to conventional drugs for symptom relief in children with uncomplicated AOM or URIs. Homeopathy is a controversial but demonstrably safe and effective 200-year-old whole system of complementary and alternative medicine used worldwide. Numerous clinical studies demonstrate that homeopathy accelerates early symptom relief in acute illnesses at much lower risk than conventional drug approaches. Evidence-based advantages for homeopathy include lower antibiotic fill rates during watchful waiting in otitis media, fewer and less serious side effects, absence of drug-drug interactions, and reduced parental sick leave from work. Emerging evidence from basic and preclinical science research counter the skeptics' claims that homeopathic remedies are biologically inert placebos. Consumers already accept and use homeopathic medicines for self care, as evidenced by annual US consumer expenditures of $2.9 billion on homeopathic remedies. Homeopathy appears equivalent to and safer than conventional standard care in comparative effectiveness trials, but additional well-designed efficacy trials are indicated. Nonetheless, the existing research evidence on safety supports pragmatic use of homeopathy in order to "first do no harm" in the early symptom management of otherwise uncomplicated AOM and URIs in children.
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One novel Schiff base and its five complexes were synthesized and characterized by elemental analyses, FT-IR, 1H NMR, 13C NMR, UV, LC–MS, thermal analyses and the X-ray powder diffraction method and their antibacterial activities were investigated against Gram-positive (Staphylococcus aureus ATCC 25923, Bacillus cereus ATCC 11778, Enterococcus faecalis ATCC 29212, Bacillus subtilis ATCC 6633, Staphylococcus epidermidis ATCC 12228, Enterobacter aerogenes ATCC 13048, Micrococcus luteus ATCC 10240, Listeria monocytogenes ATCC 19115 and Corynebacterium renale ATCC 19412) and Gram-negative bacteria (Pseudomonas fluorescens ATCC 49838, Klebsiella pneumonia ATCC 13883, Escherichia coli ATCC 25922, Pseudomonas aeruginosa ATCC 27853 and Proteus mirabilis ATCC 25933) by the MİC method. The compound’s quantum mechanical descriptors were calculated. The QSAR model for antimicrobial activity was suggested.
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The resurgence of infectious diseases and the emergence of infectious diseases raise questions on how to cope with the situation. The germ or clinical approach is the hegemonic biomedical paradigm. In this article, the author argues that the spread of infectious diseases has posted a challenge to the biomedical paradigm and shows how lock-in procedures maintain alternative and complementary medicine paradigms in the backyard.
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Otitis media with effusion (OME) or 'glue ear' is the most common cause of pediatric hearing loss, and a drain on global healthcare resources. It is associated with frequent episodes of acute otitis media (AOM) and upper respiratory tract infections (URTIs) and linked with environmental and social factors, including diet, smoking households, overcrowding and day care use. Current conventional treatment for OME is unsatisfactory, the area constitutes an 'effectiveness gap'. Homeopathy is a relatively common and popular choice of complementary and alternative medicine (CAM) treatment for childhood conditions, including otitis media. Antibiotic resistance is now a major global problem, homeopathy may have a role to play in combating its further development. Systematic review of the literature for clinical studies of homeopathy for AOM and upper respiratory tract disorders. Discussion in the context of current treatment options and public health issues including antibiotic resistance. Several randomized trials and outcome studies of homeopathy for AOM and upper respiratory tract disorders have been published. The results are encouraging, but the volume of research is small and insufficient to draw definitive conclusions. A strategy based on multi-centre or multiple, linked clinical trials of homeopathy for OME, using a pragmatic framework and evaluating long-term effects in different settings, in conjunction with other healthcare and social services should be considered. Reduction of antibiotic use is an important outcome.
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Six Cu(II) complexes of Schiff base ligands of arylidene-2-(4-(4-bromo/methoxy-phenyl)thiazol-2-yl) hydrazines have been synthesized, characterized and screened for DNA cleavage and antimicrobial activities. The chemical structures of the complexes were deduced by physicochemical and spectroscopic methods. Elemental analyses indicated that the stoichiometry of the complexes is CuL2 (L=Schiff base ligand). The DNA cleavage activities of the complexes were evaluated by agarose gel electrophoresis in the presence and absence of oxidant (H2O2) and free radical scavenger (DMSO). All the six complexes showed significant nuclease activity in the presence of H2O2, and two of the complexes showed moderate nuclease activity even in the absence of oxidant. The complexes did not show nuclease activity in the presence of free radical scavenger. The compounds were tested for activity against selected bacteria and fungi.
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The proposal to respect the body's healing ability and to treat otitis media with simple cure to form a contrast with the usual excess of medication that have children who suffer from otitis media. In these lines we carry out a review and a proposal of treatments that may to come in useful for mothers and doctors to plan children's care. La propuesta de respetar la capacidad curativa del cuerpo y tratar con medios sencillos la otitis media contrasta con el habitual exceso de medicación al que son sometidos los niños que la padecen. En estas líneas realizamos una revisión y una propuesta de tratamientos que pueden ser útiles a madres y médicos a la hora de plantear el cuidado.
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A series of benzyl-[3-(benzylamino-methyl)-cyclohexylmethyl]-amine derivatives with different substitution pattern on the aromatic ring have been prepared and evaluated for their antibacterial activity against Gram-positive and Gram-negative bacterial strains. Most of the compounds exhibit potent activity against Pseudomonas aeruginosa and Staphylococcus epidermidis while compounds 6l and 6m showed antibacterial activity against all the four bacterial strains with MIC values ranging from 0.002 to 0.016 microg/mL and no hemolytic activity up to 512 microg/mL in mammalian erythrocytes was observed.
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A search of the literature and the experiments carried out by the authors of this review show that there are a number of animal models where the effect of homeopathic dilutions or the principles of homeopathic medicine have been tested. The results relate to the immunostimulation by ultralow doses of antigens, the immunological models of the 'simile', the regulation of acute or chronic inflammatory processes and the use of homeopathic medicines in farming. The models utilized by different research groups are extremely etherogeneous and differ as the test medicines, the dilutions and the outcomes are concerned. Some experimental lines, particularly those utilizing mice models of immunomodulation and anti-inflammatory effects of homeopathic complex formulations, give support to a real effect of homeopathic high dilutions in animals, but often these data are of preliminary nature and have not been independently replicated. The evidence emerging from animal models is supporting the traditional 'simile' rule, according to which ultralow doses of compounds, that in high doses are pathogenic, may have paradoxically a protective or curative effect. Despite a few encouraging observational studies, the effectiveness of the homeopathic prevention or therapy of infections in veterinary medicine is not sufficiently supported by randomized and controlled trials.
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To investigate the intrinsic effects of individually prescribed homoeopathic medicines. Randomised double blind placebo controlled study. Paediatric outpatient department of university hospital. 175 children with frequently recurring upper respiratory tract infections. Of the 170 children evaluable, 86 were randomised to homoeopathic medicines (47 boys, 39 girls; median age at start 4.2 years; median number of episodes in past year 4) and 84 to placebo (43 boys, 41 girls; median age at start 3.6 years; median number of episodes in past year 4). Mean score for daily symptoms, number of antibiotic courses, and number of adenoidectomies and tonsillectomies over one year of follow up. The mean daily symptom score was 2.61 in the placebo group and 2.21 in the treatment group (difference 0.41; 95% confidence interval -0.02 to 0.83). In both groups the use of antibiotics was greatly reduced compared with that in the year before entering the trial (from 73 to 33 in the treatment group and from 69 to 43 in the placebo group). The proportion of children in the treatment group having adenoidectomies was lower in the treatment group (16%, 8/50) than in the placebo group (21%, 9/42). The proportion having tonsillectomies was the same in both groups (5%). Individually prescribed homoeopathic medicines seem to add little to careful counselling of children with recurrent upper respiratory tract infection in reducing the daily burden of symptoms, use of antibiotics, and need for adenoidectomy and tonsillectomy.
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To determine the effect of antibiotic treatment for acute otitis media in children. Systematic search of the medical literature to identify studies that used antibiotics in randomised controlled trials to treat acute otitis media. Studies were examined blind, and the results of those of satisfactory quality of methodology were pooled. Six studies of children aged 7 months to 15 years. Pain, deafness, and other symptoms related to acute otitis media or antibiotic treatment. 60% of placebo treated children were pain free within 24 hours of presentation, and antibiotics did not influence this. However, at 2-7 days after presentation, by which time only 14% of children in control groups still had pain, early use of antibiotics reduced the risk of pain by 41% (95% confidence interval 14% to 60%). Antibiotics reduced contralateral acute otitis media by 43% (9% to 64%). They seemed to have no influence on subsequent attacks of otitis media or deafness at one month, although there was a trend for improvement of deafness at three months. Antibiotics were associated with a near doubling of the risk of vomiting, diarrhoea, or rashes (odds ratio 1.97 (1.19 to 3.25)). Early use of antibiotics provides only modest benefit for acute otitis media: to prevent one child from experiencing pain by 2-7 days after presentation, 17 children must be treated with antibiotics early.
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Increasing worldwide resistance of bacteria to antimicrobial drugs is causing a crisis, manifested by higher morbidity, mortality, and costs.1 In 1992 the Institute of Medicine in the United States warned of the growing threat posed by resistant bacteria,2 and in 1994 the Centers for Disease Control in Atlanta initiated a prevention strategy,3 linked to a global plan by the World Health Organisation.4 Proposed remedies include development of new antimicrobials, improved sanitation, and educating patients not to ask for antimicrobials when they are not useful and physicians to prescribe them conservatively.5 About 30% of British children under the age of 3 visit their general practitioner for acute otitis media each year6 and 97% receive antimicrobials.7 In America it is the most common reason for outpatient antimicrobial use. Because this use has uncertain benefits, it merits reconsideration. Increasing resistance to antimicrobial agents has been reported for the three most common bacterial causes of otitis media ( Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis ), but rates differ between countries.8 9 In England and Wales in 1990-5, resistance to penicillin by S pneumoniae increased from 1.5% to 3.9% and to erythromycin from 2.8% to 8.6%.10 Except in the Netherlands, antimicrobials are standard treatment for acute otitis media in most developed countries.7 11 Although type and duration vary between countries, generally ampicillin, amoxycillin, or co-amoxiclav (amoxycillin-clavulanate) are preferred, with co-trimoxazole a low cost alternative.7 In the Netherlands, treatment of symptoms without antimicrobials has been adopted as routine initial treatment for otitis media,12 and this policy is associated with decreased emergence of resistance among organisms commonly found in otitis media.13 14 This approach also is being adopted in Iceland.15 Seven randomised blinded studies have compared antimicrobials with placebo in patients with acute otitis …
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Homeopathy seems scientifically implausible, but has widespread use. We aimed to assess whether the clinical effect reported in randomised controlled trials of homeopathic remedies is equivalent to that reported for placebo. We sought studies from computerised bibliographies and contracts with researchers, institutions, manufacturers, individual collectors, homeopathic conference proceedings, and books. We included all languages. Double-blind and/or randomised placebo-controlled trials of clinical conditions were considered. Our review of 185 trials identified 119 that met the inclusion criteria. 89 had adequate data for meta-analysis, and two sets of trial were used to assess reproducibility. Two reviewers assessed study quality with two scales and extracted data for information on clinical condition, homeopathy type, dilution, "remedy", population, and outcomes. The combined odds ratio for the 89 studies entered into the main meta-analysis was 2.45 (95% CI 2.05, 2.93) in favour of homeopathy. The odds ratio for the 26 good-quality studies was 1.66 (1.33, 2.08), and that corrected for publication bias was 1.78 (1.03, 3.10). Four studies on the effects of a single remedy on seasonal allergies had a pooled odds ratio for ocular symptoms at 4 weeks of 2.03 (1.51, 2.74). Five studies on postoperative ileus had a pooled mean effect-size-difference of -0.22 standard deviations (95% CI -0.36, -0.09) for flatus, and -0.18 SDs (-0.33, -0.03) for stool (both p < 0.05). The results of our meta-analysis are not compatible with the hypothesis that the clinical effects of homeopathy are completely due to placebo. However, we found insufficient evidence from these studies that homeopathy is clearly efficacious for any single clinical condition. Further research on homeopathy is warranted provided it is rigorous and systematic.
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To pilot a model for determining whether homoeopathic treatment of children suffering from glue ear is more effective than standard GP care at producing a return to normal hearing (a hearing loss of less than 20 dB) within 12 months. Non-blind, randomized controlled trial. General practice in two locations in southern England. Thirty-three children aged 18 months to 8 years with otitis media with effusion, hearing loss > 20 dB and an abnormal tympanogram. Hearing loss, tympanogram, referrals to specialists and number of courses of antibiotics at 12 month follow-up. A higher proportion of children receiving homoeopathic care had a hearing loss less then 20 dB at follow-up (64 vs 56%), though this difference did not reach statistical significance (95% confidence interval for the difference between means of -25 and 42%). More homoeopathy patients than controls had a normal tympanogram (75 vs 31%, P = 0.015). Referrals to specialists and antibiotic consumption was lower in the homoeopathy group, though differences between groups did not reach statistical significance. Further research comparing homoeopathy to standard care is warranted. Assuming recovery rates of 50 and 30% in homoeopathy and standard care groups respectively, 270 patients would be needed for a definitive trial.
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To estimate the occurrence of and associations between upper respiratory tract infections in preschool children, and to assess constitutional and environmental factors as determinants of these infections. Population-based cross-sectional study. Oslo, Norway. Preschool children, aged 4 to 5 years (3853 completed questionnaires). Acute and recurrent acute otitis media, tonsillopharyngitis, common cold, and rhinitis. Upper respiratory tract infections were common at age 4 years. During the last month, 7.1% of the children had acute otitis media and 7.5% experienced tonsillopharyngitis. Corresponding figures for common cold and rhinitis were 58.3% and 16. 4%, respectively. During the last 12 months, 9.5% of the children experienced more than 1 bout of acute otitis media, 6.9% had more than 1 tonsillopharyngitis episode, 47.7% contracted more than 2 common colds, and 3.2% had rhinitis weekly or monthly. The lifetime prevalence of recurrent acute otitis media (>/=4 episodes in any 12-month period) was 12.7% (n = 473). Bivariate correlations showed small-to-moderate relationships between the infections. Common cold was only weakly related to otitis media, tonsillopharyngitis, and chronic rhinitis. The probability for developing acute otitis media was almost 4-fold increased in children who had tonsillopharyngitis in the last year (adjusted odds ratio = 4.19; 95% confidence interval, 3.09-5.66). In logistic regression analysis, atopic disease was a strong determinant of all upper respiratory tract infections. Low birth weight increased the risk of acute otitis media. Day care attendance and the presence of siblings, which were considered to be indicators of exposure to respiratory pathogens, increased the risk of upper respiratory tract infections. In preschool children, acute otitis media, tonsillopharyngitis, and common cold were quite common, while chronic rhinitis was less prevalent and strongly associated with atopic disease. Attendance at day care centers increased the risk of upper respiratory tract infections in this age group, although the effect was weaker than that in younger children.
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Antimicrobial-drug resistance in hospitals is driven by failures of hospital hygiene, selective pressures created by overuse of antibiotics, and mobile genetic elements that can encode bacterial resistance mechanisms. Attention to hand hygiene is constrained by the time it takes to wash hands and by the adverse effects of repeated handwashing on the skin. Alcohol-based hand rubs can overcome the time problem and actually improve skin condition. Universal glove use could close gaps left by incomplete adherence to hand hygiene. Various interventions have been described to improve antibiotic use. The most effective have been programs restricting use of antibiotics and computer-based order forms for health providers.
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Recent meta-analyses of randomized controlled trials in homeopathy have suggested that homeopathy is more than a placebo response. Comparison of the effectiveness of homeopathy in primary care with conventional medicine in primary care for three commonly encountered clinical conditions. An international multicenter, prospective, observational study in a real world medical setting comparing the effectiveness of homeopathy with conventional medicine. Thirty (30) investigators with conventional medical licenses at six clinical sites in four countries enrolled 500 consecutive patients with at least one of the following three complaints: (1) upper respiratory tract complaints including allergies; (2) lower respiratory tract complaints including allergies; or (3) ear complaints. The primary outcomes criterion was the response to treatment, defined as cured or major improvement after 14 days of treatment. Secondary outcomes criteria were: (1) rate of recovery; (2) occurrence of adverse events; (3) patient satisfaction; and (4) length of consultation. Four hundred and fifty-six (456) patient visits were compared: 281 received homeopathy, 175 received conventional medicine. The response to treatment as measured by the primary outcomes criterion for patients receiving homeopathy was 82.6%, for conventional medicine it was 68%. Improvement in less than 1 day and in 1 to 3 days was noted in 67.3% of the group receiving homeopathy and in 56.6% of those receiving conventional medicine. The adverse events for those treated with conventional medicine was 22.3% versus 7.8% for those treated with homeopathy. Seventy-nine percent (79.0%) of patients treated with homeopathy were very satisfied and 65.1% of patients treated with conventional, medicine were very satisfied. In both treatment groups 60% of cases had consultations lasting between 5 and 15 minutes. Homeopathy appeared to be at least as effective as conventional medical care in the treatment of patients with the three conditions studied.
Article
Antimicrobial-drug resistance in hospitals is driven by failures of hospital hygiene, selective pressures created by overuse of antibiotics, and mobile genetic elements that can encode bacterial resistance mechanisms. Attention to hand hygiene is constrained by the time it takes to wash hands and by the adverse effects of repeated handwashing on the skin. Alcohol-based hand rubs can overcome the time problem and actually improve skin condition. Universal glove use could close gaps left by incomplete adherence to hand hygiene. Various interventions have been described to improve antibiotic use. The most effective have been programs restricting use of antibiotics and computer-based order forms for health providers.
Article
Background. Data on overall consumption of antibacterials are an important basis for measures against antibiotic resistance. Material and methods. Salesdata of antibacterials (ATC group J01) for systemic use was collected from all hospitals in Norway for the year 1998. The sale to hospitals was subtracted from the total sale of antibacterials in Norway and the consumption for outpatient settings was estimated. Results. The total use of antibacterials for systemic use in Norway was 14.4 DDD/1,000 inhabitants/day in 1998, which has been regarded as low. The use of antibacterials in hospitals was 7.5 % of the total market, i.e. 1.09 DDD/1,000 inhabitants/day. The estimated use in ambulatory practice was 13.3 DDD/1,000 inhabitants/day. Different consumption patterns in the two settings were observed. The penicillins comprised around half of the antibacterials in both settings although the use of beta-laktamase sensitive penicillins represented a higher fraction in the outpatient setting. Cephalosporins represented 16% of the use of antibacterials in hospitals while the tetracyclins are the second most used antibacterial group outside hospitals. The use of newer broad spectrum antibacterials such as the quinolones are now increasing in Norway both inside and outside hospitals. Interpretation. Relatively high consumption of penicillins supports the assumption that antibacterial resistance is low in Norway. It is, however, important to continue to follow the consumption of antibacterials in order to detect a potential negative trend early and instigate efforts like information, to possibly change the trend. It also offers the potential of measuring effects of legislative changes and informational efforts as well as defining the need for further investigation of drug therapy traditions.
Article
Objectives To estimate the occurrence of and associations between upper respiratory tract infections in preschool children, and to assess constitutional and environmental factors as determinants of these infections. Design Population-based cross-sectional study. Setting Oslo, Norway. Participants Preschool children, aged 4 to 5 years (3853 completed questionnaires). Main Outcome Measures Acute and recurrent acute otitis media, tonsillopharyngitis, common cold, and rhinitis. Results Upper respiratory tract infections were common at age 4 years. During the last month, 7.1% of the children had acute otitis media and 7.5% experienced tonsillopharyngitis. Corresponding figures for common cold and rhinitis were 58.3% and 16.4%, respectively. During the last 12 months, 9.5% of the children experienced more than 1 bout of acute otitis media, 6.9% had more than 1 tonsillopharyngitis episode, 47.7% contracted more than 2 common colds, and 3.2% had rhinitis weekly or monthly. The lifetime prevalence of recurrent acute otitis media (≥4 episodes in any 12-month period) was 12.7% (n = 473). Bivariate correlations showed small-to-moderate relationships between the infections. Common cold was only weakly related to otitis media, tonsillopharyngitis, and chronic rhinitis. The probability for developing acute otitis media was almost 4-fold increased in children who had tonsillopharyngitis in the last year (adjusted odds ratio = 4.19; 95% confidence interval, 3.09-5.66). In logistic regression analysis, atopic disease was a strong determinant of all upper respiratory tract infections. Low birth weight increased the risk of acute otitis media. Day care attendance and the presence of siblings, which were considered to be indicators of exposure to respiratory pathogens, increased the risk of upper respiratory tract infections. Conclusions In preschool children, acute otitis media, tonsillopharyngitis, and common cold were quite common, while chronic rhinitis was less prevalent and strongly associated with atopic disease. Attendance at day care centers increased the risk of upper respiratory tract infections in this age group, although the effect was weaker than that in younger children.
Article
Antibiotic resistance is agent specific, and is not related to volume or duration of use nor limited to certain antibiotic classes. Antibiotics should be viewed as having little or no resistance potential or having a high resistance potential. Antibiotics with a low resistance potential should not be restricted but those with a high resistance potential should be restricted. The only effective mechanism to control antibiotic resistance is by limiting hospital formularies to include only antibiotics with little or no resistance potential. Physicians in the ambulatory setting need to be more selective in antibiotic prescribing and preferentially select antibiotics with a low resistance potential.
Article
In pneumococcal meningitis, it is well accepted that resistance in Streptococcus pneumoniae compromises clinical outcome. However, the clinical impact of increasing resistance on community-acquired respiratory tract infections (RTIs) is less clear. Bacteriological eradication should be the aim of antimicrobial therapy. The pharmacodynamics (potency and pharmacokinetics) of an antimicrobial agent against the infecting pathogen can be used to predict the potential for bacterial eradication. Surveillance of clinical isolates from community-acquired RTIs shows that, in many countries, there is a trend towards an increasing prevalence of drug-resistant S. pneumoniae. Results from a number of published clinical trials suggest that resistance has not compromised the clinical efficacy of aminopenicillins when used at the correct dose. However, emerging data indicate that resistance is compromising the efficacy of some other routinely used antimicrobials. There are reports of clinical and bacteriological failure with macrolides and fluoroquinolones in patients with community-acquired pneumonia. Recent retrospective analyses and increasing sporadic reports of clinical failure with these agents may be more representative of the true situation. These reports suggest a need to reassess current empirical therapeutic recommendations for the treatment of community-acquired RTIs.
Article
The results of a pilot study suggest that doctors practising homœpathic medicine issue fewer prescriptions and at a lower cost than their colleagues. Despite the severe limitations of the study the implications of these figures justify fuller and more rigorous enquiry. The limitations of this study and requirements for future cost effectiveness of studies are discussed.
Article
In a controlled randomized double-blind trial carried out by 47 physicians in private practice with totally 152 patients with sinusitis the therapeutic success of the following homeopathic drug preparations was investigated: Group A: combination of luffa operculata D4, kalium bicromicum D4 and cinnabaris D3. Group B: combination of kalium bicromicum D4 and cinnabaris D3. Group C: luffa operculata D4. Group D: placebo. Criteria for the therapeutic result were headache, blocked nasal breathing, trigeminal tenderness, reddening and swelling of nasal mucosa and postnasal secretion. There was no remarkable difference in the therapeutic success among the investigated homeopathic drug combinations nor between the active drugs and placebo. Averaged over all four groups 81% of the patients with acute sinusitis and 67% of the patients with chronic sinusitis recovered. In the literature comparable therapeutic results are reported for antibiotic therapy, decongestant nose drops and for the drainage of nasal cavities.
Article
Investigations of respiratory illnesses and infections in Tecumseh, Michigan, USA, were carried out in two phases, together covering 11 years. During the second phase, there were 5363 person-years of observation. Respiratory illness rates in both males and females peaked in the 1-2 year age group and fell thereafter. Adult females had more frequent illnesses than adult males; illnesses were less common in working women than in women not working outside the home. Isolation of viruses fell with increasing age; rhinoviruses were the most common isolate. Influenza infection rates, determined serologically, suggested relative sparing of young children from infection with type A (H1N1) and type B. Infection rates were highest in adult age groups for type A (H3N2). The isolation and serological infection rates were used to estimate the extent to which laboratory procedures underestimated the proportion of respiratory illnesses caused by each infectious agent; data from other studies were also used in this estimation. Severity of respiratory illnesses was assessed by the proportion of such illnesses that resulted in consultation of a physician. Rhinoviruses produced the greatest number of consultations. Overall, physician consultations were associated with 25.4% of respiratory illnesses.
Article
In 1988 and 1989 all general practitioners (GPs) in Møre & Romsdal recorded all encounters with patients over a period of two months. The participation rate was close to 100% and a total of 90,458 encounters were recorded. Of all encounters 61% involved female patients. Female GPs had more female patients than their male colleagues (71% versus 59%). The discrepancy was most pronounced for sex-specific diagnoses. Home visits accounted for 9% of all direct encounters, an increase from the 5-6% reported in the 1970s. 37% of all contacts occurred by phone or messenger. The diagnostic distribution compares well with Olav Rutle's findings in 1978. Cardiovascular diseases, however, seem to have become less prominent since that time. The most frequent ICPC diagnoses were musculoskeletal (17%), respiratory (14%), cardiovascular (12%), and psychiatric (12%). Respiratory diseases dominated among children, musculoskeletal diseases among adults, and cardiovascular diseases among the elderly.
Article
In a prospective observational study carried out by 1 homoeopathic and 4 conventional ENT practitioners, the 2 methods of treating acute pediatric otitis media were compared. Group A received treatment with homoeopathic single remedies (Aconitum napellus, Apis mellifica, Belladonna, Capsicum, Chamomilla, Kalium bichromicum, Lachesis, Lycopodium, Mercurius solubilis, Okoubaka, Pulsatilla, Silicea), whereas group B received nasal drops, antibiotics, secretolytics and/or antipyretics. The main outcome measures were duration of pain, duration of fever, and the number of recurrences after 1 year, whereby alpha < 0.05 was taken as significance level. The secondary measures were improvement after 3 hours, results of audiometry and tympanometry, and necessity for additional therapy. These parameters were only considered descriptively. The study involved 103 children in group A and 28 children in group B, aged between 6 months and 11 years in both groups. For duration of pain, the median was 2 days in group A and 3 days in group B. For duration of therapy, the median was 4 days in group A and 10 days in group B: this is due to the fact that antibiotics are usually administered over a period of 8-10 days, whereas homoeopathics can be discontinued at an earlier stage once healing has started. Of the children treated, 70.7% were free of recurrence within a year in group A and 29.3% were found to have a maximum of 3 recurrences. In group B, 56.5% were free of recurrence, and 43.5% had a maximum of 6 recurrences. Out of the 103 children in group A, 5 subsequently received antibiotics, though homoeopathic treatment was carried through to the healing stage in the remaining 98. No permanent sequels were observed in either group.
Article
To describe general practitioners' (GPs) prescribing patterns for antibiotics and to compare them with therapeutic guidelines. Cross-sectional, observational study. In the Norwegian county Møre & Romsdal the GPs recorded all contacts with patients and prescriptions during two months. 69,843 contacts with 56,758 prescriptions, of which 7905 were for systemic antibiotics. Prescriptions in relation to diagnosis, kind of consultation, and patients' age and sex. 61% of all antibiotic prescriptions were for females, 26% were issued during indirect contacts, and 14% were repeat prescriptions. Phenoxymethylpenicillin was prescribed most frequently (32%), followed by co-trimoxazole (19%), tetracyclines (18%), erythromycin (16%), and penicillins with extended spectrum (6%). Urinary tract infection was the most frequent diagnosis for antibiotic prescribing (24%), followed by acute bronchitis (13%), ear infections (9%), upper respiratory tract infections (8%), and acute tonsillitis (8.2%). A regression analysis showed that first-time consultations for tonsillitis and otitis, but not for acute bronchitis and pneumonia, patient age 13-64 years, female physician, urban practice location, and a fixed. GP salary were associated with the prescribing of phenoxymethylpenicillin in contrast to other antibiotics. Antibiotics are often prescribed for viral infections (e.g., acute bronchitis). Broad spectrum antibiotics are often prescribed for diagnoses where penicillin is recommended as first choice. The issue of antibiotic misuse should be addressed more explicitly in general practice.
Article
Rates of antibiotic prescription in Canada far exceed generally accepted rates of bacterial infection, which led the authors to postulate that rates of antibiotic prescription depend to some extent on factors unrelated to medical indication. The associations between antibiotic prescription rates and physician characteristics, in particular, method of remuneration and patient volume, were explored. The authors evaluated all 153,047 antibiotic prescriptions generated by 476 Newfoundland general practitioners and paid for by the Newfoundland Drug Plan over the 1-year period ending Aug. 31 1996, and calculated rates of antibiotic prescription. Linear and logistic regression models controlling for several physician characteristics, specifically age, place of education (Canada or elsewhere), location of practice (urban or rural) and proportion of elderly patients seen, were used to analyse rates of antibiotic prescription. Fee-for-service payment (rather than salary) and greater volume of patients were strongly associated with higher antibiotic prescription rates. Fee-for-service physicians were much more likely than their salaried counterparts to prescribe at rates above the median value of 1.51 antibiotic prescriptions per unique patient per year. The association between rate of antibiotic prescription and patient volume (as measured by number of unique patients prescribed to) was evident for all physicians. However, the association was much stronger for fee-for-service physicians. Physicians with higher patient volumes prescribed antibiotics at higher rates. In this study factors other than medical indication, in particular method of physician remuneration and patient volume, played a major role in determining antibiotic prescribing practices.
Article
Treatment of acute otitis is one of the most common reasons for prescribing antibiotics for children. Recent studies have shown no, or only a small, effect of antibiotic treatment of this condition. We examined the files from the City of Tromsø's Emergency Department, which catchment area includes about 12,300 children under the age of 15. During the period from March 1997 to May 1998, 784 children presented with acute otitis, 91.5% of whom received antibiotic treatment. The most frequently drug used drug was penicillin V. Even if there are no or only a small effect of antibiotic treatment of this condition, most children receive such treatment. This study will give baseline data for new studies aimed at reducing the use of antibiotics.
Due to the conditions of modern industrial pig fattening in intensive livestock farms, 24% to 69% of the animals become ill. The antibiotic metaphylaxis that is routinely administered leads to several problems in animals, human health, and the environment. To investigate whether a homeopathic metaphylaxis is effective and potentially useful for replacing antibiotic metaphylaxis. Animal subjects were divided into groups of 10 per pen, 2 pens sharing 1 trough. Twenty pigs were randomly assigned within a stall and were administered either antibiotics, homeopathy, or placebo. A typical intensive livestock farm in Northern Germany. 1440 piglets. Homeopathic metaphylaxis is compared with placebo, the routine low-dose antibiotic metaphylaxis, and an antibiotic metaphylaxis in therapeutic dosage. Incidence of diseases in general and of diseases of the respiratory tract. Homeopathic metaphylaxis is significantly effective compared with placebo and routine low-dose antibiotic metaphylaxis for incidence of disease and rate of disease of the respiratory tract among the animals studied. Only by increasing the dosage of antibiotics to a therapeutic level does antibiotic metaphylaxis surpass homeopathic metaphylaxis. An unacceptably high percentage of pigs in modern livestock management become ill, suffering mainly from diseases of the respiratory tract. The routine antibiotic dosage of metaphylaxis is too low to be effective. As a result, the problems of resistance and danger to human health and the environment are increasing. To confirm whether antibiotic metaphylaxis may be replaced by homeopathic metaphylaxis, this study should be repeated independently.
Article
The efficacy and safety of a fixed-combination homeopathic medication (Sinusitis PMD) consisting of Lobaria pulmonaria, Luffa operculata, and potassium dichromate were investigated in an open-label practice-based study of 119 male and female patients, 12 to 57 years of age, with clinical signs of acute sinusitis not previously treated. At the first visit, after a mean of 4.1 days of treatment, secretolysis had increased significantly and typical sinusitis symptoms, such as headache, pressure pain at nerve exit points, and irritating cough, were reduced. Ninety-nine patients received only the test medication. Twenty patients were able to discontinue concomitant medication at the first visit. Only one patient needed an antibiotic. The average treatment duration was 2 weeks. At the end of treatment, 81.5% of patients described themselves as symptom free or significantly improved. Adverse drug effects were not reported.
Article
The financial crisis of health insurance systems sometimes drives public policy-makers to take precipitate action dominated by economic imperatives. The question addressed here consists in defining homeopathy's scope of intervention, its place in health care strategies, recourse to treatment, and especially economic data appraising homeopathy's impact on expenditures and outlay covered by health insurance in France. We used the General Evaluation Model to define the study (to whom is the evaluation made, situations, criteria, measurement of these criteria, quality and precision). The main results are in terms of costs, as follows: * For reimbursable medicines the public sales price of homeopathic products is a quarter of the average. * The total reimbursement for a prescription of allopathic products is three times more than for a prescription of homeopathic products. * Homeopathic physicians incur annual reimbursement outlays which are half those of general practitioners. The differences observed cannot be explained by the patient profile or the diseases treated. Furthermore, a study carried out in France showed that 87% of patients whose physicians had prescribed homeopathic treatment did not see another physician for the same problem. Once basic analysis has been done, so that the economic and epidemiological impact of a certain health strategy can be determined, it is necessary to proceed further, helping healthcare providers and public authorities to make decisions. Various possibilities exist and should be investigated.
Article
The practical implementation of a staged, multifaceted research agenda for the economic evaluation of complementary medicine (CM) at the Royal London Homeopathic Hospital (RLHH). The relative importance of economic evaluation as an evidence base of CM was assessed via a survey conducted with purchasers (n=481). The marginal costs of providing complementary care for patients with rheumatoid arthritis were calculated. The use, and changes in the use, of conventional medicines for patients' main complaints were established retrospectively (n=499) and prospectively (n=70). Health-related quality of life (patient utility) of newly referred patients was assessed with the EQ-5D (EuroQol) instrument (n = 70) on a 100 mm (0 = worst, 100 = best) scale. Economic evaluation was rated 'important' as an evidence base, after safety and RCT data ('very important'). Consultation time (doctors and dietician) contributed 29% of the total costs of treating rheumatoid arthritis. The retrospective survey showed that many patients on conventional medication were able to stop (29%) or reduce (32%) intake in the course of treatment. The median (quartiles) health state of newly referred patients was 70 mm (50,78) in men and 60 mm (36,73) in women. Some results of an interim analysis of 6 months follow-up data are reported. Economic evaluation of CM is becoming increasingly important and should take place by using a multifaceted, staged approach. Before embarking on randomised trials, observational data on cost, effectiveness and utility should be collected. The cost-effectiveness of CM appears to be most sensitive to the duration of the consultation.
Article
Significant increases in prevalence of resistance to antibiotics have been observed in common pathogens of humans in the United States and worldwide. The consequences of the appearance and spread of antibiotic resistance have included increasing morbidity, mortality, and cost of health care. The fundamental cause for the appearance and spread of antimicrobial resistance has been increasing antimicrobial use. However, other factors contribute in both inpatient and outpatient settings. Recognizing the important causes of increasing antibiotic resistance in these settings has led to practical recommendations, which health care facilities and outpatient practitioners will need to review, adapt, and apply for maximum local effectiveness for progress to be made in addressing one of the most challenging problems facing modern medicine.
Article
Antibiotic resistance is an increasing problem worldwide that is exacerbated by the overuse and misuse of antibiotics. Patients, pharmaceutical marketing, and the use of antibiotics in veterinary medicine and animal husbandry are important factors to consider in the emergence of resistance. Infection control measures to prevent the spread of antibiotic-resistant bacteria are compromised by poor compliance to basic measures such as handwashing and standards of environmental cleanliness. Wider epidemiological factors such as global travel and complacency towards public health must also be considered. This article aims to improve understanding of antibiotic resistance and suggests ways in which nurses can contribute towards the strategy to address the problem.
Article
The current epidemic of bacterial resistance is attributed, in part, to the overuse of antibiotics. Recent studies have documented increases in resistance with over-use of particular antibiotics and improvements in susceptibility when antibiotic use is controlled. The most effective means of improving use of antibiotics is unknown. Comprehensive management programs directed by multi-disciplinary teams, computer-assisted decision-making, and antibiotic cycling have been beneficial in controlling antibiotic use, decreasing costs without impacting patient outcomes, and possibly decreasing resistance.
Article
More and more we are moving patients from hospitals to homes for continued treatment. Vancomycin and triclosan were used for 30 years before any resistance emerged, because their applications were strictly limited. Today, after greatly increased use, resistance to both antibiotics and antibacterials has appeared. Of importance there are genetic links between resistance to antibiotics and to antibacterials. Health professionals and the public need to be educated about the rational use of drugs that affect the microbial world. The Alliance for the Prudent Use of Antibiotics, an international organization established in 1981 with members in more than 100 countries, has adopted education as its prime mission. Via its web site (www.apua.org) and linked information on reservoirs of antibiotic resistance (ROAR) among nonpathogenic bacteria, it reaches both providers and consumers. The message is simple: bacteria are needed for our survival. The vast majority of bacteria perform important functions that are crucial for our lives. Prudent use of both antibiotics and antibacterials must be championed to achieve and maintain the balanced microbial environment in which we have entered and evolved.
Article
Available guidelines for the diagnosis and treatment of sore throat give conflicting recommendations. Our aim was to develop evidence-based guidelines. We searched The Cochrane Library, Medline and other sources for systematic reviews and other evidence that met explicit inclusion criteria for all of the relevant options and outcomes we identified. The validity of included studies was assessed. Draft recommendations based on assessment of this evidence were widely circulated and discussed in focus groups with patients and physician assistants. Throat infections are self-limiting and complications rare. Penicillin shortens the duration of symptoms in tonsillitis caused by beta-haemolytic streptococci and reduces the risk of complications. Penicillin has adverse effects and increases the risk of reinfections. Patients with sore throat should usually be treated without antibiotics. Visiting a physician is normally unnecessary. Antibiotics should be considered in serious cases or if the patient prefers this, but should only be prescribed for throat infections caused by beta-haemolytic streptococci. The diagnosis should be based on clinical criteria and a rapid antigen test in cases of doubt. Benefits of antibiotics must be weighed against harms. Patients should be given good information and involved in decision/making if they want antibiotics.
Article
Antimicrobial resistance is a global concern. Over the past 10 years, considerable efforts and resources have been expended to detect, monitor, and understand at the basic level the many different facets of emerging and increasing resistance. This review summarizes our current understanding of bacterial antimicrobial resistance issues in Canada with particular emphasis given to the Enterobacteriaceae, Pseudomonas aeruginosa, Staphylococcus aureus, Enterococcus, Neisseria meningitidis, Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis, and Streptococcus pyogenes. In addition, future concerns and programs for ongoing surveillance are discussed.
Article
The extensive use of antibiotics in long-term-care facilities has led to increasing concern about the potential for the development of antibiotic resistance. Relatively little is known, however, about the quantitative relation between antibiotic use and resistance in this population. A better understanding of the underlying factors that account for variance in antibiotic use, unexplained by detected infections, is needed. To optimize antibiotic use, evidence-based standards for empirical antibiotic prescribing need to be developed. Limitations in current diagnostic testing for infection in residents of long-term-care facilities pose a substantial challenge to developing such standards.
Article
The intestinal microflora may have more influence on infectious diseases, than the mere control of growth of opportunistic micro-organisms by colonisation resistance (CR) and unspecific stimulation of the immune system. In compromised patients the CR may become decreased for several reasons but mostly because antibiotics reach the intestine during treatment. The consequence of a CR-decrease is that antibiotic-resistant opportunistic micro-organisms may increase in numbers in the gut. In this context, it is hypothesised that if the CR could be maintained at a normal level, the risk for maintenance and spread of resistant strains could be mitigated. Such maintenance requires absence of active antibiotic substance in the gut. This might be brought by the inactivation of antimicrobial agents by intestinal contents. Intra-intestinal inactivation has been described to occur along two possible routes: (1) inactivation by chemical binding or absorption and (2) by enzymatic destruction. Secondly, the composition of the intestinal microflora should be maintained at a normal level in case of other reasons for CR-decrease than antibiotic activity. Comprehensive study of the composition of normal microflora and the strains of species which play a role in CR with techniques which have become available during last decade, is recommended as well as the application of certain pre- and probiotics. It is concluded that antibiotic inactivation may be an ancient strategy of nature which should become incorporated in antibiotic treatment. Antibiotic use and development of resistance may have occurred when ecosystems formed several billions of years ago. Protection against antibiotics produced by newcomers into the ecosystem may have developed as it was necessary to maintain locally available nutrients for the inhabitants of the ecosystem. Should this hypothesis be correct, it is plausible that antimicrobial inactivation by antibiotic inactivating molecules is ubiquitous. In the ecosystem of the digestive tract, molecules involved in inactivation may predominantly be formed by microorganisms.
Article
Deciding whether an antibiotic is necessary, when to begin therapy and selecting an optimal drug is an everyday challenge in clinical practice. In vitro susceptibility testing which determines the minimum concentration necessary for a particular antibiotic to inhibit or kill most strains of a bacterial species and pharmacodynamic modeling are useful but have limitations. The need for antibiotic therapy for acute otitis media (AOM) has been recently questioned. However, explanations for uniformly positive results with many antibiotic and placebo comparative trials include overdiagnosis of AOM at study entry, inclusion of patients with mild or uncomplicated AOM and broad criteria for the definition of clinical success. Recurrent and persistent AOM does not have as favorable a natural history as uncomplicated AOM; children below 2 years of age benefit most from antibiotic therapy. Selecting the best choice among the many antibiotics that can be used to treat AOM has become more complex over the last decade due to escalating antibiotic resistance among the pathogens that cause this infection. Broader spectrum antibiotics such as cefdinir, the newly introduced third generation cephalosporin, have their most prominent use in the treatment of persistent and recurrent AOM. In the early 1950s and 1960s penicillin clearly was the best available agent for the treatment of group A streptococcal (GAS) infections. In the 1970s the situation began to change as cephalosporin antibiotics became available. Superior eradication rates with cephalosporins such as cefdinir have now been well-documented. The leading hypothesis to explain the widening gap in efficacy between penicillin and cephalosporins relates to two major concepts: the presence of copathogens and differential alteration of the normal microbial ecology in the throat as a consequence of the selected therapy. There are positive and negative consequences to early initiation of antibiotic therapy for GAS tonsillopharyngitis. Penicillin has persisting good efficacy in patients older than the age of 12 years and in those who have been ill for >2 days. Shortening therapy for GAS tonsillopharyngitis offers a therapeutic advantage. Cefpodoxime proxetil and cefdinir have a 5-day indication for the treatment of GAS tonsillopharyngitis. Antibiotics with lower side effect profile, infrequent dosing, good palatability in suspension formulation and efficacy with short duration of treatment may lead to better outcomes because noncompliance often results in failed therapy, persistence of infection and morbidity.
Article
Though with the advent of more and more numbers of antibiotics, infection control has become easier but it has been established more resistant strains of microbes are appearing. These resistant strains are becoming major public health problem. Drug misuse is one of the factors for resistant strains. While discussing mechanisms of drug resistance, gene transfer plays an important part. Drug resistance can be prevented by taking several strategies. There are several methods for performing antibiotic sensitivity test e.g., diffusion methods and dilution methods which are discussed elaborately.
Article
Antibiotic resistance is increasing worldwide, also in Belgium. A few examples to illustrate this problem: S. pneumoniae are becoming increasingly resistant to penicillin and erythromycin; resistance of S. pyogenes to erythromycin is increasing year-by-year; Salmonella and Campylobacter are becoming more and more resistant to the fluoroquinolones. In hospitals, the problem of methicillin-resistant Staphylococcus aureus appears to be decreasing, but two clones of ceftazidime-resistant Enterobacter aerogenes are spreading throughout the Belgian hospitals. Antibiotic resistance has become a serious health care issue both in hospitals and in the community. The popular press has termed some of the multiresistant organisms "killer bugs" or "superbugs". Infection with such organisms has been associated with treatment failures, higher morbidity and mortality and increased costs. In this paper, we will review the problems of antibiotic resistance in the community setting. We will briefly discuss those pathogens with important consequences of morbidity and mortality in the community, such as: Streptococcus pneumoniae, Streptococcus pyogenes, Neisseria meningitidis, the enteric pathogens Salmonella and Campylobacter, and the urinary tract pathogen E. coli. This resistance has in response to various conditions and opportunities, such as: clustering and overcrowding, increased number of immunodeficient patients, increased elderly population, population mobility, increased use of (broad-spectrum) antibiotics, over-the-counter sale and self-dosing with antibiotics, inappropriate antibiotic prescriptions and lack of compliance, fewer resources for education and infection control, decreased funding for public health surveillance. In Belgium, we should be able to develop, implement and evaluate a good antibiotic policy. Our country has a wealth of information on antibiotic consumption in hospitals and the community. This information has been used for benchmarking of antibiotic consumption in hospitals. A unique system for reimbursement of prophylactic use of antibiotics in surgery was developed which resulted in a more adequate use of antibiotics. However, a policy should not be limited to the human ecosystem. Therefore, a Coordination Commission for Antibiotic Policy was installed recently by the Ministers of Social Affairs, Public Health and Agriculture.
Article
Preventing recurrent acute otitis media (AOM) is a goal of child health care. The objective is to reduce the frequency of pain and fever, shorten the duration of hearing loss, reduce the costs of physician visits, surgery and drugs, reduce parent anxiety, and prevent long term sequelae. Preventive approaches include understanding individual and familial risk factors, avoidance of environmental risk factors, antibiotic drug prophylaxis, polyvalent pneumococcal vaccination, myringotomy with tympanostomy tubes, and adenoidectomy. Earlier and more aggressive treatment can be provided to infants at increased risk. Antibiotic prophylaxis is challenged by a relatively small benefit and emerging resistant bacteria. Tympanostomy tubes are beneficial in chronic otitis media with effusion (OME), but of less value in recurrent AOM absent chronic OME. Adenoidectomy after tympanostomy tube failure is supported by at least one clinical trial.
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The last decade is characterized by the increase in antibiotic resistance among respiratory bacterial pathogens in the presence of only modest progress in the development of new antibacterial agents to overcome this resistance. A series of recent studies show clearly that the increased resistance among the main AOM pathogens (namely Streptococcus pneumoniae and Haemophilus influenzae) is associated with a dramatic decrease in bacteriologic response to antibiotic treatment, which in turn has an impact on clinical response. Thus, the individual patient is affected by the increasing antibiotic resistance. Moreover, the society as a whole is now also affected because the carriage and spread of antibiotic resistant AOM pathogens is remarkably impacted by antibiotic treatment. New studies show the remarkable ability of antibiotics to rapidly promote nasopharyngeal carriage and spread of antibiotic-resistant AOM pathogens. In these studies, the increase in carriage of antibiotic resistant S. pneumoniae is shown already after 3-4 days from initiation of antibiotic treatment and may last for weeks to months after treatment. Children carrying antibiotic-resistant organisms transmit those organisms to their family and to their day care centers and thus a vicious cycle is created in which increased antibiotic resistance with decreased response leads to increased antibiotic use, which in turn leads to further increase in resistance. New antibiotics are not likely to improve this situation. It is clear that the challenge in the next decade is to prevent AOM rather than to treat it. Efforts to prevent AOM include improved environmental factors, immunization with bacterial and viral vaccines and some creative measures such as prevention of colonization and attachment to epithelium of AOM pathogens. Whether these efforts will prove successful or, even if successful, will only modify the clinical and bacteriologic picture presenting new challenges, only time will tell.
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Otitis media is the most frequent reason that children go to the doctor for illness. In developing countries, where children have limited access to medical care, suppurative complications of otitis media (OM) are frequent and permanent hearing loss results. In developed countries, the most common morbidity of OM is conductive hearing loss due to middle ear effusion. Infants with severe and recurrent OM and persistent middle ear effusion are at risk for problems in behavior and development of speech, language and cognitive abilities. Parent stress is frequent. The cost of otitis media is large (>$5 billion in the United States). Selection and spread of multi-drug resistant bacterial pathogens arising from extensive use of antimicrobial agents for OM is a problem for management of all diseases due to the pathogens. The incidence and severity of OM may diminish with introduction of new bacterial and viral vaccines.
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The antimicrobial resistance problem in hospitals continues to worsen. In particular, extended-spectrum beta-lactamase-producing Klebsiella pneumoniae (ESBL-KP) and vancomycin-resistant enterococci (VRE) are significant causes of morbidity and mortality among critically ill patients. Treating infections caused by these pathogens presents therapeutic dilemmas. The association between broad-spectrum beta-lactam overutilization and selection for ESBL-KP has been appreciated for some time; several institutions have reported a decrease in the prevalence of ESBL-KP with a shift in antibiotic utilization from third-generation cephalosporins to other broad-spectrum drugs. Currently, optimal treatment of ESBL-KP includes the carbapenems, but widespread use of these drugs is expensive and may be associated with further selection of antibiotic resistance and/or superinfection with other inherently resistant pathogens. VRE are especially difficult organisms to treat because of their inherent and acquired resistance to most currently available antibiotics. The prevalence of VRE has also been documented to decrease upon a shift in antibiotic use from third-generation cephalosporins to broad-spectrum antibiotics of other classes. Thus, antibiotic utilization measures appear to contribute to the control of the emergence of multidrug-resistant pathogens such as ESBL-KP and VRE.
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Global antibacterial resistance is becoming an increasing public health problem. Bacteria resistant to almost all of the available antibacterials have been identified. The pharmaceutical industry and fledgling biotechnology companies are responding to the threat of antibiotic resistance with renewed efforts to discover novel antibacterials in attempts to overcome bacterial resistance. Both short term and long term strategies are being vigorously pursued. Short-term efforts are focused on developing novel antibacterial agents with a narrow spectrum of action to combat the problem of gram-positive resistant bacteria. Long-term approaches include the use of microbial genomic sequencing techniques to discover novel agents active against potentially new bacterial targets. Better use of existing agents using pharmacodynamic data to optimise antibiotic regimens is increasingly being addressed and the hope is that such measures will prevail until the newer agents are available.
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Pharmacoeconomic study models have a number of inherent problems that significantly limit their use within the medical community. They are frequently retrospective and thus have only limited relevance in a field in which resistance patterns are highly volatile. Moreover, the study models do little to consider the numerous economic perspectives involved, such as the patients themselves as well as society at large. Prescribing patterns profoundly affect overall healthcare costs. As much as $8.4 billion is spent on community-acquired pneumonia each year; 8% of that cost is for antibiotic therapies. Moreover, studies show that inappropriate prescribing for upper respiratory tract infections is the norm not the exception, with significant cost and health consequences. Also adding to costs is patient noncompliance, which could possibly be reduced with once-daily dosing regimens and widespread patient education about appropriate use of antibiotics.
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Antimicrobial drug resistance is a growing concern for the medical community. Although cases of drug resistance to Streptococcus pneumoniae are on the increase, there has been no change in mortality rates. The fact that the medical literature shows no proven correlation between drug-resistant S pneumoniae and clinical failure suggests that concerns about drug resistance in S pneumoniae may be overstated. Therefore, in treating community-acquired pneumonia, physicians should also weigh other important considerations such as pharmacology, safety, tolerability, and dosing convenience.
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Antimicrobial and anthelmintic resistance are growing issues for the equine practitioner. The development of antimicrobial or anthelmintic resistance is a source of significant concern because of increased frequency of treatment failures and increased treatment costs. In addition, antimicrobial resistance may have important consequences for public health. Only through judicious use can the efficacy of antimicrobials and anthelmintics be prolonged. This article discusses the development of resistance and suggestions for control.
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The use of antibiotics in the initial treatment of acute otitis media is currently being questioned. Homeopathy has been used historically to treat this illness, but there have been no methodologically rigorous trials to determine whether there is a positive treatment effect. A randomized double blind placebo control pilot study was conducted in a private pediatric practice in Seattle, WA. Seventy-five children ages 18 months to 6 years with middle ear effusion and ear pain and/or fever for no more than 36 h were entered into the study. Children received either an individualized homeopathic medicine or a placebo administered orally three times daily for 5 days, or until symptoms subsided, whichever occurred first. Outcome measures included the number of treatment failures after 5 days, 2 weeks and 6 weeks. Diary symptom scores during the first 3 days and middle ear effusion at 2 and 6 weeks after treatment were also evaluated. There were fewer treatment failures in the group receiving homeopathy after 5 days, 2 weeks and 6 weeks, with differences of 11.4, 18.4 and 19.9%, respectively, but these differences were not statistically significant. Diary scores showed a significant decrease in symptoms at 24 and 64 h after treatment in favor of homeopathy (P < 0.05). Sample size calculations indicate that 243 children in each of 2 groups would be needed for significant results, based on 5-day failure rates. These results suggest that a positive treatment effect of homeopathy when compared with placebo in acute otitis media cannot be excluded and that a larger study is justified.
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Despite the lack of evidence of efficacy of antibiotic agents for treating upper respiratory tract infection (URI) symptoms (i.e., acute cough, sore throat, purulent nasal discharge, bronchitis, and the common cold), primary care providers frequently prescribe antibiotic agents for patients presenting with such symptoms. Far from being a harmless practice, prescribing antibiotics for conditions for which there is no proven benefit of such therapy contributes to a number of adverse consequences, including the development of antimicrobial resistance and an unnecessary expense to patients and the healthcare system as a whole. An evidence-based approach to practice can guide nurse practitioners in making the best clinical management decisions for patients presenting with URI symptoms.
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Antibiotic resistance was once confined primarily to hospitals but is becoming increasingly prevalent in family practice settings, making daily therapeutic decisions more challenging. Recent reports of pediatric deaths and illnesses in communities in the United States have raised concerns about the implications and future of antibiotic resistance. Because 20 percent to 50 percent of antibiotic prescriptions in community settings are believed to be unnecessary, primary care physicians must adjust their prescribing behaviors to ensure that the crisis does not worsen. Clinicians should not accommodate patient demands for unnecessary antibiotics and should take steps to educate patients about the prudent use of these drugs. Prescriptions for targeted-spectrum antibiotics, when appropriate, can help preserve the normal susceptible flora. Antimicrobials intended for the treatment of bacterial infections should not be used to manage viral illnesses. Local resistance trends may be used to guide prescribing decisions.
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There is significant evidence that the global problem of microbial resistance to antibiotics has reached the dental community both in our practices and our family lives. This paper will present a global overview of microbial resistance, discuss how this problem directly affects the dental community, and show what we can do to change the situation, both as concerned citizens and as dental health care practitioners.