27th March 2024

Should antibiotics be taken with food or on an empty stomach? Is it time to start therapeutic drug monitoring of liposomal amphotericin B in children? And what are the unwritten rules affecting antibiotic prescribing? Find out more with the latest Editors’ picks from Journal of Antimicrobial Chemotherapy (JAC) and JAC-Antimicrobial Resistance (JAC-AMR).

Agnieszka Wiesner and others, Do dietary interventions exert clinically important effects on the bioavailability of β-lactam antibiotics? A systematic review with meta-analyses. Journal of Antimicrobial Chemotherapy 2024, dkae028, https://doi.org/10.1093/jac/dkae028

Food, drinks, antacids and supplements can significantly affect how well some β-lactam antibiotics work, with milk in particular reducing absorption for some drugs, according to this systemic review by Wiesner et al. They caution that the heterogeneity of the included studies and lack of data for some antibiotics mean that the quality of evidence is low and randomized controlled trials are needed to fully understand antibiotic–food interactions.

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Tony Lai and others, Therapeutic drug monitoring of liposomal amphotericin B in children. Are we there yet? A systematic review. Journal of Antimicrobial Chemotherapy 2024, dkae003, https://doi.org/10.1093/jac/dkae003

This systematic review by Lai et al. assessed the evidence for the use of therapeutic drug monitoring for liposomal amphotericin B in children. While there was significant pharmacokinetic variation, there is not enough evidence to recommend routine monitoring yet. More studies are needed to see if monitoring improves outcomes.

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Sebastián Moya and others, A qualitative analysis of the unwritten rules influencing antibiotic prescribing practices among French poultry veterinarians. JAC-Antimicrobial Resistance 2024, dlae044, https://doi.org/10.1093/jacamr/dlae044

Moya et al. examined how unwritten rules and social factors, not just official guidelines, influence antibiotic prescribing in French poultry vets. Junior vets learn from senior colleagues, peers share prescribing habits, and veterinary corporate groups shape practices. To improve antibiotic use, stewardship interventions should address these social influences alongside official guidelines.

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Lukas Arenz and others, Effect and sustainability of a stepwise implemented multidisciplinary antimicrobial stewardship programme in a university hospital emergency department. JAC-Antimicrobial Resistance 2024, dlae026, https://doi.org/10.1093/jacamr/dlae026

Arenz et al. assessed the long-term effects of an antimicrobial stewardship (AMS) intervention in a multidisciplinary university hospital emergency department (ED). Distributing pocket cards to remind ED staff of the treatment guidelines improved guideline adherence and antibiotic choice. Compliance decreased over time but was restored and further improved with the addition of AMS ward rounds, and persisted even during shifts when AMS experts were not available for consultation.

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Abdelwahab Boulekbache and others, Comparison of daptomycin and glycopeptide efficacy and safety for the treatment of Gram-positive infections: a systematic review and meta-analysis. Journal of Antimicrobial Chemotherapy 2024, dkae026, https://doi.org/10.1093/jac/dkae026

In this systematic review, Boulekbache et al. compared daptomycin with glycopeptides (the standard of care treatment) for complex Gram-positive infections. Daptomycin had better microbiological eradication but significantly fewer side effects. However, evidence for daptomycin efficacy and safety for bacteraemia and endocarditis is lacking, and some studies only looked at low doses of daptomycin, indicating the need for further randomized controlled trials.

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Kaunda Yamba and others, Antibiotic prescribing patterns and carriage of antibiotic-resistant Escherichia coli and Enterococcus species in healthy individuals from selected communities in Lusaka and Ndola districts, Zambia. JAC-Antimicrobial Resistance 2024, dlae027, https://doi.org/10.1093/jacamr/dlae027

Yamba et al. report antibiotic prescribing patterns in primary healthcare facilities and antimicrobial resistance among healthy individuals in Zambia. Resistance was highest in the WHO Access group of antibiotics, which were also the most commonly prescribed. Treatments guidelines in line with the WHO AWaRe classification but adapted according to local susceptibility data are needed.

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