6 VIEWS & REVIEWS
Focus on infectious . diseases
Worldwide attention turns to infectious diseases
This month, a concerted effort by 36 medical journals worldwide aims to focus international attention on the subject of emerging and re-emerging infections, reports lAMA, one of the 3 originating journals involved in the global collaboration.I,2 'The problems are worldwide; so must be the perspective and the solutions', say Dr Margaret Winker and Ms Annette Flanagin, who are the senior editor and associate senior editor of lAMA. I They note that infectious disease is now the third leading cause of death in the US.
Attendees of the Workshop to Prevent and Control the Emergence and Spread of Antimicrobial-Resistant Microorganisms in Hospitals* published a consensus statement in lAMA that specifies high-priority strate-gies and actions that they considered would be likely to have a significant impact on reducing antimicrobial resistance, if implemented successfully by hospitals.3
Strategies developed at the Workshop to Prevent and Control the Emergence and
Spread of AntimicrobiaJ..Resisb Microorganisms in. HOspitals
A. Strategies to optimise the used . antimicrobials in 1he hospilal t. Optimise antimicrobial prophylaxis for operative procedllres~.;./i ... ..... . ...................... ./ 2. Optimise choice and duration of empirical antimicropial therapy. .. . 3. Improve antimicrobial prescribing practices by ~ducational and administrative means. 4. Establish a system to monitor and provide feedback on the occurrence and impact of antibacterial resistance. S. Define and implementinstltutional or health care delivery system guidelines for irnPortanttypesof antimicrobial use,
B. Strategies for detecting, reporting and preventing transmission of antimicrobial-. resistant micro-organisms 1. Develop a systemto recognise and promptly report significant changes and trends in antimicrobial resistance within the hospital. 2. Develop a system for rapid detection and reporting of resistant microorganisms in individual patients and devise means of ensuring a rapid response by caregivers. . 3. Increaseadherencetorelevanfpoliciesand proc:edures,especia!!y. handnygiene . barrier precautions and environmental control measures.
VIEWS & REVIEWS
Pneumonia caused by penicillin-resistant S. pneumoniae can be successfully treated with a second- or third-generation cephalosporin, according to 3 of the specialists consulted.
In the case of bacteraemia due to penicillin-resistant S. pneumoniae, concern was expressed that checks be made to ensure the infection had not spread to a secondary site. Given the scenario of initial treatment with 1M ceftriaxone followed by oral amoxicillin, opinion on continuing therapy was divided. Two specialists suggested continuing amoxicillin while the others recommended using an alternative oral agent. Bradley JS, Kaplan SL, Klugman KP, et al. Consensus: management of infections in children caused by Streptococcus pneumoniae with decreased susceptibility to penicillin. Pediatric Infectious Disease Journal 14: 1037-1041, Dec 1995 800416154
Bestbreahnentforconunurnrl~acquired pneumonia unclear
Even though the new quinolone sparfIoxacin is a 'reliable' agent for the initial treatment of non-severe community-acquired penumonia. its inappropriate and extensive use could lead to a reduction in its value as a treatment for bacterial infections, according to an editorial in the European Respiratory Journal. The authors say that the older antibacterials, especially the penicillins, are still very effective in the treatment of non-severe community-acquired pneumonia.
Physicians seem to have differing views on the treatment of uncomplicated community-acquired pneumonia. The British Thoracic Society still recommends the use of penicillins; however, the American Thoracic Society recommends the use of macrolides. The authors point out that the increasing use of macrolides over the last decade for the treatment of community-acquired pneumonia has been associated with resistance to erythromycin.
The authors conclude that there is no sufficiently strong reason to withdraw the penicillins from the first-line treatment of non-severe community-acquired pneumonia.
See also Therapy section, this issue,pl3; 800414807
Torres A, Ausina V. Empirical treatment of nonsevere communityacquired pneumonia: still a difficult issue. European Respiratory Journal 8: 1996-1998, Dec 1995 800414806
01562703196110210007I$Ol.0r!' Adls International Limited 1996. All rights reaervad
INPHARMA" 27 Jan 1996