Stewardship / Resistance Scan for Sep 17, 2020

Bacteriophages for UTI
Excessive antibiotic courses

Phase 3 trial shows some promise for bacteriophages for UTI treatment

The results of a randomized, controlled clinical trial show that intravesical bacteriophage treatment was non-inferior to standard-of-care antibiotic treatment and safe for treating urinary tract infection (UTI) patients, but it was not superior to placebo in terms of efficacy or safety, researchers reported yesterday in the Lancet Infectious Diseases.

In the trial, which was conducted by Swiss and Georgian researchers at a urology clinic in Tblisi, Georgia, 113 men who had complicated UTI or recurrent uncomplicated UTI and were scheduled for transurethral reaction of the prostate (TURP) were randomized 1:1:1 to receive three different treatments for 7 days: the bacteriophage cocktail Pyophage (37 men), bladder irrigation with an intravesical placebo solution (38), or systematically applied antibiotics (38). The primary outcome was microbiologic treatment response after 7 days, measured by urine culture. Secondary outcomes included clinical and safety parameters.

Rates of treatment success did not differ significantly between the three groups. After 7 days of treatment, normalization of urine culture was achieved in 27 of 97 patients (28%): 5 of 28 (18%) in the Pyophage group, compared with 9 of 32 (28%) in the placebo group (odds ratio [OR], 1.60; 95% confidence interval [CI], 0.45 to 5.71; P = 0.47) and 13 of 37 (35%) in the antibiotic group (OR, 2.66; 95% CI, 0.79 to 8.22; P = 0.11). Adverse events occurred in 6 of 28 patients (21%) in the Pyophage group compared with 13 of 32 patients (41%) in the placebo group and 11 of 37 patients (30%) in the antibiotic group.

The authors of the study say that while the results revealed little about the efficacy of bacteriophage therapy for treating UTI patients undergoing TURP, they confirm the safety profile of bacteriophage application.

"In conclusion, our findings are encouraging and provide important stimuli for physicians and authorities to support further large-scale clinical studies using bacteriophages for otherwise virtually untreatable infections, in order to further establish their efficacy," they wrote.
Sep 16 Lancet Infect Dis abstract


Study: Long antibiotic duration for many common conditions

An analysis of the duration of antibiotic therapy for common outpatient conditions found that in many cases prescribers are exceeding guideline-recommended durations, researchers from the Centers for Disease Control and Prevention and the University of Utah reported yesterday in Clinical Infectious Diseases.

Using the National Disease and Therapeutic Index dataset for 2017, the researchers identified antibiotic prescriptions (excluding azithromycin) associated with sinusitis, pharyngitis, acute otitis media (AOM), community-acquired pneumonia (CAP), skin and other soft-tissue infection (SSTI), and acute cystitis, including adult and pediatric prescriptions. They then estimated the proportions of prescriptions by course duration and median duration and interquartile range (IQR) and calculated potentially excessive days above minimum recommended duration.

Among more than 28 million prescriptions, median antibiotic course duration was 10 days for every condition except acute cystitis, for which the median duration was 7 days (IQR 5 to 7 days). Overall, 55% (95% CI, 53% to 58%) of non-azithromycin courses exceeded the guideline-recommended minimum effective durations, translating to up to 54,496,316 excessive days of therapy.

The authors of the study note that recent guidelines recommend shorter antibiotic courses of 5 to 7 days for many of these conditions, and that the longer-than-necessary courses are likely driven by clinician habit.

"For some conditions and age groups, such as pharyngitis, pediatric sinusitis, and pediatric AOM, 10 days of antibiotic therapy aligns with guidelines. However, for many conditions, specifically sinusitis and CAP in adults and cellulitis, 10 days of antibiotic therapy is likely excessive for most patients based on guideline recommendations," the authors wrote.

"Increased focus on appropriate duration of antibiotic therapy for these common conditions could reduce unnecessary outpatient antibiotic use," they concluded.
Sep 16 Clin Infect Dis abstract

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