It is difficult to determine the impact of community-acquired pneumonia (CAP) in Europe, because precise data are scarce Mortality attributable to CAP varies widely between European countries and with the site of patient management This review analysed the clinical and economic burden, aetiology and resistance patterns of CAP in European adults All primary articles reporting studies in Europe published from January 1990 to December 2007 addressing the clinical and economic burden of CAP in adults were included A total of 2606 records were used to identify primary studies CAP incidence varied by country, age and gender, and was higher in individuals aged ≥65 years and in men Streptococcus pneumoniae was the most common agent isolated Mortality varied from

https://thorax.bmj.com/content/thoraxjnl/67/1/71.full.pdf

Clinical and economic burden of community-acquired pneumonia among adults in Europe

Background.Operating on the principle that most acute otitis media (AOM) episodes resolve without antibiotics, doctors in the Netherlands usually manage AOM in children with initial observation. Prescription of antibiotics is limited to children with a complicated course of AOM and those categorized

National differences in incidence of acute mastoiditis: relationship to prescribing patterns of antibiotics for acute otitis media?

The surveillance in Spain of Streptococcus pneumoniae isolated in hospitals from different regions of the country was initiated in our laboratory in 1979. In that year we found that 6% of the pneumococci isolated from blood, cerebrospinal fluid (CSF), or lower respiratory tract (LRT) specimens were

Evolution of Streptococcus pneumoniae Serotypes and Antibiotic Resistance in Spain: Update (1990 to 1996)

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 …

/pdf/antimicrobials-for-acute-otitis-media-a-review-from-the-4syrun2lt5.pdf

Antimicrobials for acute otitis media? A review from the International Primary Care Network.

/pdf/antenatal-and-neonatal-haemoglobinopathy-screening-in-the-uk-gjqz37uhzd.pdf

Antenatal and neonatal haemoglobinopathy screening in the UK: review and economic analysis.

Objective: To assess the prevalence of antibiotic resistance and serotype distribution among pneumococci in England and Wales in 1990 and 1995. Design: Observational surveys in March 1990 and March 1995. During two weeks in each survey period all pneumococci isolated in public health laboratories in England and Wales were collected and assessed for sensitivity to antibiotics and the distribution of serogroups or serotypes. Setting: The network of public health laboratories throughout England and Wales. Subjects: 1127 individual patient isolates of Streptococcus pneumoniae obtained during the two surveys. Main outcome measures: Sensitivity or resistance to a range of antibiotics; serogroup or serotype. Results: The prevalence of intermediate or full resistance to penicillin increased from 1.5% in 1990 to 3.9% in 1995 and resistance to erythromycin increased from 2.8% to 8.6%. About 92% of isolates belonged to serogroups or serotypes included in the currently available pneumococcal vaccine. Conclusion: Resistance to penicillin and erythromycin has increased among pneumococci in England and Wales. Continued surveillance to assess further increases in the prevalence of pneumococcal resistance to antibiotics is essential. Key messages Resistance to cefotaxime or ceftriaxone, which may be the drugs of choice for pneumococcal meningitis caused by penicillin resistant pneumo- cocci, is still fairly rare Roughly 92% of pneumococcal isolates in England and Wales belong to serogroups or serotypes included in the currently available 23 valent vaccine Between 65.1% and 73.9% of pneumococcal isolates from children aged 2 or less belong to sero- groups or serotypes included in the five, seven, or nine valent conjugate vaccines under development for use in children of this age group Continued surveillance of pneumococcal resist- ance to antibiotics is essential if clinicians are to make rational decisions concerning the treatment of pneumococcal infections

/pdf/prevalence-of-antibiotic-resistance-and-serotypes-in-24cjpn092q.pdf

Gil Domingue

Papers

Prevalence of antibiotic resistance and serotypes in pneumococci in England and Wales: results of observational surveys in 1990 and 1995.