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Tag Archives: Antibiotics

SAMJ: South African Medical Journal – Diagnosis of bacterial infection

This article gives a helpful reminder of current practice – it details the classic medical process of …  history –> clinical examination –> beside tests –> laboratory tests. Of relevance to General Practice it explores the use of CRP and Procalcitonin tests. Thereafter it highlights upcoming technologies that show potential to be helpful in the future.

From their website;

New technologies

New technologies that are likely to emerge as important diagnostic tools in future include nanoparticle probe technology and matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOFMS). Nanosphere’s Verigene Gram-positive (BC-GP) blood culture assay is performed directly on positive blood cultures using nucleic acid extraction and PCR amplification. Target DNA is then hybridised to oligonucleotides on a microarray with automated qualitative analysis. The test was approved by the US Food and Drug Administration in 2014 and currently has the ability to identify 10 Gram-positive and 8 Gram-negative organisms along with multiple resistance genes. Currently, two MALDI-TOFMS platforms are available in the USA, MALDI Biotyper (Bruker Corporation, Billerica, Mass.) and VitekMS System (bio-Merieux, Durham, NC). MALDI-TOF performs MS on target molecules following ionisation and disintegration; these patterns are compared with known organism fingerprints. It is capable of analysing thousands of samples from specimens per day, including blood, sputum and urine. Another promising infection testing platform that uses PCR followed by electrospray ionisation MS (PCR/ESI-MS) technology is able to rapidly detect >800 bacteria, including unculturable organisms and three classes of antibiotic resistance markers, directly from clinical specimens. In a recent study of 331 blood samples it was able to detect twice as many organisms as culture.[21]



Antibiotic Use Linked to Type 2 Diabetes Diagnosis | Endocrine Society

From their website;

“In our research, we found people who have Type 2 diabetes used significantly more antibiotics up to 15 years prior to diagnosis compared to healthy controls,” said one of the study’s authors, Kristian Hallundbæk Mikkelsen, MD, of Gentofte Hospital in Hellerup, Denmark. “Although we cannot infer causality from this study, the findings raise the possibility that antibiotics could raise the risk of Type 2 diabetes. Another equally compelling explanation may be that people develop Type 2 diabetes over the course of years and face a greater risk of infection during that time.”


Sinusitis Prediction Algorithm

Sinusitis Prediction Rule

This page gives 3 different tools to allow the clinical decision of whether antibiotics can be expected to be helpful in sinusitis or not. [1] Williams Prediction Rules, [2] Berg Prediction Rules and [3] the Task Force on Rhinosinusitis Rules from 1999, 92 and 97 respectively.

Centor Criteria – Classic



The original Centor Criteria use 4 simple questions to assess the chances that a sore throat is caused by a bacterial infection.

Centor Criteria – Modified

Centor Score (Modified) for Strep Pharyngitis – MDCalc

Centor Score (Modified) for Strep Pharyngitis

Is your purse a hotbed of bacterial infection? – Health News – NHS Choices

Many of the bacteria found in the study can cause serious infections

This is a report about an interesting study but ultimately it may not have a strong relevance or applicability in most situations. The research was conducted in Mauritius and they swabbed the outside of 145 womens’ handbags and mens’ wallets. The primary finding was that 95% carried bacteria. However as they point out themselves;

From their website;

In about three-quarters (73%) this was scanty growth; 13% showed moderate growth and 14% showed heavy growth. … and … In fact, all of the things we use in the environment around us, like mobile phones, computers, keyboards and other equipment are all likely to carry some bacteria.

Otherwise there were interesting if unsurprising secondary findings;

From their website;

  • 11% often placed them on kitchen tables

  • 18% placed them on dining tables

  • 18% allowed their children to handle them

  • 82% never emptied them

  • Most women kept purses in handbags, most men in trouser pockets



In conclusion it might be fair to say that in day-to-day life this study does not have a notable impact. However in settings where individuals are particularly susceptible to infections then this study does back up and re-inforce the current practice of making every effort to reduce their exposure to risk.

Women should be able to get antibiotics for urinary tract infection without a prescription | The BMJ

From their website;

Uncomplicated cystitis is common and easily treated with drugs such as nitrofurantoin. Kyle Knox asks why women cannot treat themselves, without using up precious appointments in general practice

Acute uncomplicated urinary tract infections (AUUTIs) are common, especially in premenopausal, sexually active women, of whom about 30% will have been affected by age 26.1 AUUTIs usually resolve without sequelae and rarely progress to pyelonephritis, but they result in considerable morbidity, and the goal of treatment is to ameliorate the severity and duration of symptoms.

Source: Women should be able to get antibiotics for urinary tract infection without a prescription | The BMJ


In one of the online BMJ responses;

(The article) argues that: a) the clinical recognition of an uncomplicated cystitis does not require the assessment of a health professional, b) there is good evidence of the efficacy and safety of a 3 day-course of Nitrofurantoin, and c) the threat of a growing resistance to Nitrofurantoin do not outweigh the benefits of easy access to this antibiotic. Thus, why cannot women with an uncomplicated cystitis treat themselves, without using up precious appointments in general practice?

RCGP response to BMJ article on treating cystitis with antibiotics

Dr Maureen Baker, Chair of the Royal College of GPs, said: “Cystitis can cause a huge amount of discomfort for patients, and whilst antibiotics can help in some cases, they are not always the most appropriate treatment as the cause is not always bacterial.

“Aside from the patient safety risks associated with deregulating access to some of these powerful drugs, we are currently amidst an international drive to reduce antibiotic use, in order to curb growing global resistance to them.

“Although the strain of antibiotics referenced in the article has actually seen very little resistance built up against it so far, making it more widely available would inevitably increase resistance to it and remove one of the few antibiotics with low resistance rates from the formulary, therefore adding to this global problem.

“GPs already face enormous pressure to prescribe antibiotics, and it often takes a lot of effort to persuade patients that they are not always the answer to treating illness – making them available without a prescription would simply undermine this. There is also the risk that bypassing the GP for patients with cystitis might lead to recurrent strains of the infection being treated inappropriately, and more serious conditions going undetected.

“Instead of increasing the availability of antibiotics for patients suffering from cystitis, we should concentrate our efforts on making alternative treatments to cystitis more widely available – and identifying new non-antibiotic strategies – to reduce the need for and resistance to the drugs, so that they will still be effective when our patients really need them.”

Source: RCGP response to BMJ article on treating cystitis with antibiotics