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Nephrotoxicity. The effect is probably associated with prolonged high antibiotic serum levels and is cumulative. 2. Vestibular and ototoxicity 1, 2 ; . This effect is also associated with high peak levels and is cumula tive with aminoglycoside use and additive with other ototoxic agents. In order to reduce toxicity associated with aminoglycosides, a new approach of single daily dosage was investigated 3-6 ; . This approach is based on the following observations: 1. The bactericidal effect of aminoglycosides is dose-dependent 3 ; . While the concept of minimal inhibitory and bactericidal concentrations is still valid, the speed and completeness of bactericidal action are dose-dependent. 2. The postantibiotic effect 7 ; . After the exposure of bacteria to antibiotics, there is a period of stunted growth of bacteria even if drug concentrations fall below the inhibitory concentrations. 3. Increased susceptibility to phagocytosis after bacteria were exposed to antibiotics. Several experiments done on neutropenic animals and femara. As noted above, a limited time to discuss nonantibiotic number of factors treatment alternatives is a factor in busy influence the practices.4 Studies have found that patient decision to prerequests and physician diagnostic and Very scribe antibiotics treatment uncertainty are among the 62.5% inappropriately most common reasons for increased for acute respiraantibiotic prescribing and for prescribing Fairly tory infections broad- rather than narrow-spectrum 30.4% Table 5 - page agents. Thus, the decision to prescribe 7 ; . Physicians antibiotics for acute respiratory infections have often appears to be a result of complex blamed patient or interactions among patient, physician, parent attitudes and system factors Table 5 - page 7 ; . and demands for Effective strategies to improve antibiotic the overuse prescribing behavior will probably need Minimally: 3.6% No Answer: 2.6% abuse of antibito address each of these domains. Not At All: 0.9% otics, and numerSupporting this hypothesis is the fact that interventions to decrease total antibiotic FIGURE 4. Degree of Concern Among Respondents to the NJAFP ous studies have shown that use in acute respiratory infections that 2002 Survey About the Correlation Between Antibiotic Resistance and Increased Use of Certain Antibiotic Classes N 530 ; patient expectafocus on either clinician education or tions and depatient education alone have not been 1997. Many public health experts hope mands for antibiotics are highly correlated effective.1, 24, 25 For example, appropriate with excess and inappropriate antibiotic educational initiatives like videos but that the Hib vaccine success story can use. Physicians have often expressed not passively provided pamphlets ; be repeated with a new conjugated the fear that not prescribing an antibiotic increased patient knowledge and vaccine against antibiotic strains of will lead to patient dissatisfaction with awareness about antibiotic indications Streptococcus pneumoniae. care or increased return visits.1 However, and antibiotic resistance. This reduced studies have generally shown that this their expectation of receiving an antibiotic Optimizing drug regimens based on is not the case and that the most for viral infections, 25, 26 but failed to alter pharmacodynamic principles could help important factor in determining patient the number of antibiotic prescriptions to reduce the development of antibiotic satisfaction with the quality of care was written.25 However, interventions that resistance.21, 22 For concentration-dependent the clinician-patient interaction. Barden combined clinician education and drugs fluoroquinolones, aminoglycosides ; , et al., found that parents would be profiling with patient education have the higher the drug concentration, the satisfied with a medical visit in which decreased the inappropriate prescription faster the eradication of pathogens.21 antibiotics were not prescribed for their of antibiotics.1, 27 One such initiative from Peak concentrations to 10 times the children if the physician took the time to Finland resulted in a 40% reduction in minimal inhibitory concentrations MIC ; explain the reasons for the decision.23 community use of macrolides that was are clinically effective. For concentrationA recent patient and independent, or time-dependent, drugs clinician educational the -lactams ; , the duration of time intervention that reduced exposed to drug concentrations above antibiotic prescribing the MIC is key to clinical success. The for adults with acute quinolones exhibit concentration-dependPatient bronchitis did not lead 67.5 ent killing. Bactericidal activity increases Answers to increased return visits as serum drug concentration increases or dissatisfaction with to 30 times the MIC then begins to 25.1 Physicians care.1 As noted previously, decrease as higher drug concentrations the CDC study in inhibit RNA and protein synthesis. Insurance Georgia found just the Companies 0.8 opposite--that physicians The primary strategy to reduce the with the highest antibiotic development of resistance and, hopefully, Pharmaceutical 1.5 prescribing behaviors Companies reverse the current level of resistance, is to had substantially more reduce inappropriate antibiotic use. Such return visits.15 an approach must address the management No Response, for instance, prednisone.
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