Shiloh
Editor, Senior Moderator
Source: http://www.cidrap.umn.edu/news-perspective/2018/06/stewardship-resistance-scan-jun-04-2018
Stewardship / Resistance Scan for Jun 04, 2018
Antibiotic alternative for acne; Fecal transplant for primary C diff
Filed Under:
Fecal transplants; Antimicrobial Stewardship; Clostridium difficile
[h=3]Study suggests potential antibiotic alternative for women's acne[/h] A new study in the Journal of Drugs and Dermatology suggests that a diuretic drug may be as effective as antibiotics for treatment of women's acne.
In the study, researchers from the University of Pennsylvania Perelman School of Medicine conducted a retrospective analysis comparing data on 6,684 women and girls taking spironolactone to 31,164 who were prescribed oral tetracycline antibiotics. They were looking to determine the frequency of switching to a different systematic agent within the first year of treatment, a proxy for ineffectiveness.
Among the women who were started on spironolactone, 14.4% were prescribed a different systematic agent within a year, compared with 13.4% of the women treated with antibiotics. After adjusting for age, topical retinoid, and oral contraceptive, the odds ratio for being prescribed a different systematic agent within a year was 1.07 for those prescribed spironolactone when compared with antibiotics, and the risk difference was 0.007.
"These numbers suggest dermatologists should consider spironolactone first instead of antibiotics when it comes to women with acne," lead study author John Barbieri, MD, said in a University of Pennsylvania press release.
Oral antibiotics are the most common systematic treatment for acne. More than 50% of women in the United States between the ages of 20 and 29, and more than 35% of women between the ages of 30 and 39, are treated for acne. According to the Centers for Disease Control and Prevention, dermatologists prescribe the highest level of antibiotics per provider among all medical specialties.
Spironolactone is currently approved to treat high blood pressure, heart failure, and conditions that cause people to retain fluid.
June J Drugs Dermatol abstract
Jun 4 University of Pennsylvania press release
[h=3]Small trial shows promise for fecal microbiota transplant for primary C diff[/h] The results of a small proof-of-concept clinical trial in Norway suggest fecal microbiota transplantation (FMT) may be an alternative to antibiotics for primary treatment of Clostridium difficile infection (CDI).
The trial randomly assigned 20 patients with acute CDI at six hospitals in Norway to receive either the recommended treatment of oral metronidazole (400 mg three times a day for 10 days) or FMT. The primary end point was clinical cure with no evidence of recurrent CDI at day 70. Secondary end points were evaluations conducted at 4 and 35 days after initial treatment and adverse events.
Nine patients were assigned to FMT and 11 to metronidazole. Patients who were clinically cured after initial treatment and had no recurrence were defined as having a full primary response; patients who received additional treatment to achieve clinical cure but experienced no recurrence were defined as having a full secondary response.
A full primary response was observed in five patients in the FMT group (56%) and in five in the metronidazole group (45%). Three of the four remaining patients in the FMT group received antibiotics by day 4 after initial treatment, and two of them had a full secondary response. In the metronidazole group, none of the six remaining patients had a full secondary response. The overall response to treatment (full primary or secondary response) was achieved in seven of the FMT patients (78%), compared with five in the metronidazole group (45%).
While previous research has shown that FMT is an effective alternative to antibiotics for treating recurrent CDI, this is the first study to assess FMT for primary CDI treatment. The authors of the study, which was published in the New England Journal of Medicine, say a phase 3 trial is currently under way.
Jun 2 N Engl J Med correspondence
Stewardship / Resistance Scan for Jun 04, 2018
Antibiotic alternative for acne; Fecal transplant for primary C diff
Filed Under:
Fecal transplants; Antimicrobial Stewardship; Clostridium difficile
[h=3]Study suggests potential antibiotic alternative for women's acne[/h] A new study in the Journal of Drugs and Dermatology suggests that a diuretic drug may be as effective as antibiotics for treatment of women's acne.
In the study, researchers from the University of Pennsylvania Perelman School of Medicine conducted a retrospective analysis comparing data on 6,684 women and girls taking spironolactone to 31,164 who were prescribed oral tetracycline antibiotics. They were looking to determine the frequency of switching to a different systematic agent within the first year of treatment, a proxy for ineffectiveness.
Among the women who were started on spironolactone, 14.4% were prescribed a different systematic agent within a year, compared with 13.4% of the women treated with antibiotics. After adjusting for age, topical retinoid, and oral contraceptive, the odds ratio for being prescribed a different systematic agent within a year was 1.07 for those prescribed spironolactone when compared with antibiotics, and the risk difference was 0.007.
"These numbers suggest dermatologists should consider spironolactone first instead of antibiotics when it comes to women with acne," lead study author John Barbieri, MD, said in a University of Pennsylvania press release.
Oral antibiotics are the most common systematic treatment for acne. More than 50% of women in the United States between the ages of 20 and 29, and more than 35% of women between the ages of 30 and 39, are treated for acne. According to the Centers for Disease Control and Prevention, dermatologists prescribe the highest level of antibiotics per provider among all medical specialties.
Spironolactone is currently approved to treat high blood pressure, heart failure, and conditions that cause people to retain fluid.
June J Drugs Dermatol abstract
Jun 4 University of Pennsylvania press release
[h=3]Small trial shows promise for fecal microbiota transplant for primary C diff[/h] The results of a small proof-of-concept clinical trial in Norway suggest fecal microbiota transplantation (FMT) may be an alternative to antibiotics for primary treatment of Clostridium difficile infection (CDI).
The trial randomly assigned 20 patients with acute CDI at six hospitals in Norway to receive either the recommended treatment of oral metronidazole (400 mg three times a day for 10 days) or FMT. The primary end point was clinical cure with no evidence of recurrent CDI at day 70. Secondary end points were evaluations conducted at 4 and 35 days after initial treatment and adverse events.
Nine patients were assigned to FMT and 11 to metronidazole. Patients who were clinically cured after initial treatment and had no recurrence were defined as having a full primary response; patients who received additional treatment to achieve clinical cure but experienced no recurrence were defined as having a full secondary response.
A full primary response was observed in five patients in the FMT group (56%) and in five in the metronidazole group (45%). Three of the four remaining patients in the FMT group received antibiotics by day 4 after initial treatment, and two of them had a full secondary response. In the metronidazole group, none of the six remaining patients had a full secondary response. The overall response to treatment (full primary or secondary response) was achieved in seven of the FMT patients (78%), compared with five in the metronidazole group (45%).
While previous research has shown that FMT is an effective alternative to antibiotics for treating recurrent CDI, this is the first study to assess FMT for primary CDI treatment. The authors of the study, which was published in the New England Journal of Medicine, say a phase 3 trial is currently under way.
Jun 2 N Engl J Med correspondence