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Antibiotics are a group of drugs, about which can be said as many good and many bad things. To begin with, the clindamycin is one of the antibiotics, which has both bactericidal and bacteriostatic action. This antibiotic has found its wide application in the fight against almost all infectious and inflammatory diseases that are characterized by severe treatment. 1Assistant Professor, Department of General Medicine, Nizam's Institute of Medical Sciences, Hyderabad, Andhra Pradesh. Ever since the advent of antibiotics, the phenomenon of increasing resistance to antibiotics has been well-recognized.
Previous exposures to antibiotics favor the emergence of multi drug resistant organisms by two mechanisms. Another important issue that contributes to and has to be critically addressed in India is the indiscriminate dispensing of the antibiotics off the pharmacy counters without any licensed prescriptions.
While the extent of resistance and the costs involved in treating infection are well-documented in developed countries, relatively little is known about the burden and consequences of antibiotic resistance in developing countries. Guide therapy of infections in terms of empiric, broad spectrum & reserve drugs, which will be used only for MDROs. Nosocomial infections are associated with increased mortality, morbidity, length of hospital stay and cost of treatment.
A thorough clinical assessment of the patient is imperative to ascertain the underlying disease process and to predict the pathogens associated with infection based on local flora and their resistance patterns and select an antibiotic that will target the likely pathogens. Antibiotics are frequently prescribed in a community for indications in which their use is not warranted. The duration and selection of antibiotic for perioperative prophylaxis should be based on prescribed guidelines and the locally prevailing organisms5. Knowledge of the pharmacokinetics and pharmacodynamics of antibiotics is helpful to the clinician in treating infections successfully. The clinician responsible for infection control along with the hospital management should make measures to check and control the prescriptions of antibiotics that are newly introduced and those that target highly resistant bacteria. The greatest benefit of staining and culturing respiratory secretions is to alert physician of unsuspected and resistant pathogens and to permit modification of therapy. A serious issue that has to be addressed and resolved is the differences and shortcomings that exist among microbiology laboratories across the country performing antibiotic susceptibility tests without any strict adherence to the standard or recommended procedures9. Establishing and maintaining a proper microbiology laboratory is technically demanding and costly.
Gram positive infections particularly MRSA and VRE are on the rise in critical care units of the hospitals. Multi drug resistant gram negative infections account for most of the nosocomial infections. Gram positive infections: Gram positive isolates constitute one third the total number of organisms isolated.
Staphylococci: There is an increasing trend in the prevalence of MRSA over 2 years (Tables 1, 2).
Gram negative infections: These were the most predominant isolates among the hospitalised patients and often difficult to treat especially in the ICU settings. Acinetobacter species: Acinetobacter species account for 1-3% of hospital acquired infections in patients admitted to intensive care units14. At our institute Acinetobacter species was isolated from 257 patients in 2007 and from 316 patients in the year 2008, with an alarmingly increasing Carbapenem resistance (Fig. Stenotrophomonas maltophila: There is a misconception among clinicians that a combination of vancomycin and carbapenem will cover all organisms in the intensive care units.
Cross-infection of patients by health care workers with contaminated hands is a major source of nosocomial infections.
Strategies such as good infection control practices, establishment of national antimicrobial guideline, surveillance programs, audits, continuous training and education amongst health care personnel are necessary and vital to promote and ensure the quality use of antibiotics. Michel Wolf, Christian Bvun-Buisson, Hartmut Lode, Dilip Mathai, David Lewis and Didier Pittet. They are good that they can be used to get rid of very serious viral and infectious diseases.
This antibiotic has the wide application in combating both gram-positive and gram-negative bacteria.
These are bronchitis, endometritis, lung abscesses, osteomyelitis, adnexitises, empyema and purulent infectious processes of the skin and soft tissues. Also, it should not be used by people with diseases of the kidneys and liver, myasthenia gravis, ulcerative colitis, bronchial asthma.

We will not list all the side effects of the drug, but will try to note at least some of the most frequent. I appeared on the web for the problem and located most people will go together with along with your website.
The rapid development of resistance to antibiotics in our country is because of the high prevalence rates of infectious diseases, uncontrolled access to high-end antibiotics combined with unreliable laboratory facilities and weakness in the health care system due to lack of appropriate guidelines for therapy of infections and facilities for infection control. For example, third-generation cephalosporins1, fluoroquinolones and vancomycin2 have been found to be risk factors for colonization or infection with vancomycin-resistant enterococci.
Uniform surveillance is needed to monitor the spread of resistance, and thus understand the scale of the problem, in order to provide crucial data for the development of containment strategies. Predisposing factors for increased risk of nosocomial infection are: prolonged hospital stay, antibiotic usage, mechanical ventilation, central venous access, stress ulcer prophylaxis, urinary catheterization, steroid use and poor nutritional status. The clinicians should be aware of difference between infections, colonization and carrier state. It is important that the clinician must ensure appropriate bacterial and fungal cultures before initiation of empiric antibiotic therapy. Extending routine perioperative antibiotic prophylaxis does not protect against infection postoperatively and on the contrary may lead to emergence of infections with resistant strains6.
Study by Rahal et al showed that restricting cephalosporin use resulted in a 44% decline in 1 year in the frequency of ESBL isolates.
The campaign centers on four main strategies: prevent infection, diagnose and treat infection, use antimicrobials wisely, and prevent transmission. Rare causative agents of pneumonia like Burkholderia pseudomallei needs special attention in diagnosis as the treatment is for a prolonged duration. For this reason, many of the times both the patient and clinicians have a tendency to avoid microbiological investigations and rely on empiric antibiotic therapy. Methicillin Resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococc(VRE)i, Extended Spectrum Beta-lactamase (ESBL) producing organisms like Escherechia coli and Klebsiella pneumoniae, highly resistant pathogens like Acinetobacter species & Pseudomonas aeruginosa, are now major adversaries in our critical care settings. Recently, MRSA infections have been described in patients without established risk factors who are living in the community. Wide variety of ß-Lactams are hydrolyzed by plasmid-mediated ESBL enzymes like TEM1, TEM2, and SHV1 enzymes produced by organisms in the Enterobacteriaceae family. Vancomycin is still the most preferred antibiotic both for MRSA and Enterococci at our institute.
It is alarming to note that the sensitivity to meropenem decreased from 64% in year 2007 to 35% in 2008.
However, organisms like S.maltophila, an emerging nosocomial pathogen, are sensitive to Cotrimoxazole and the clinician should be aware of the fact that they are intrinsically resistant to most antibiotics including Carbapenems.
Other than a positive culture, no specific laboratory test is diagnostic for enteric fever. If every caregiver would reliably practice simple hand hygiene when leaving the bedside of every patient and before touching the next patient, there would be an immediate and profound reduction in the spread of resistant bacteria16. Cephalosporins as risk factors for nosocomial Enterococcus faecalis bacteremia: a matched case-control study. Epidemiology and mortality risk of vancomycin-resistant enterococcal bloodstream infections. One year trends in the gram-negative bacterial antibiotic susceptibility patterns in a medical intensive care unit in South India. Effect of extended perioperative antibiotic prophylaxis on intravascular catheter colonization and infection in cardiothoracic surgery patients.
Detection of extended-spectrum ß-Lactamases in clinical isolates of Klebsiella pneumoniae and Escherichia coli.
An outbreak of multidrug-resistant Acinetobacter baumannii-calcoaceticus complex infection in the US military health care system associated with military operations in Iraq. Ceftazidime-resistant Klebsiella pneumoniae isolates recovered at the Cleveland Department of Veterans Affairs Medical Center. Having taken by the patient, clindamycin begins to exert its therapeutic effect after sixty minutes.
Clindamycin is very effective to fight against ENT disorders such as: tonsillitis, sinusitis, otitis media, pharyngitis. So, the most common side effects of clindamycin are: nausea, vomiting, decreased blood pressure, dizziness, weakness, allergic reactions, as well as pain in the abdomen.
The problem is further compounded by truncated therapy for reasons of cost as the sick-poor do not have insurance and cannot afford to complete course of treatment. The final selection of antibiotic therapy should be based on the bacterial cultures and clinical response.

Even in the best microbiology laboratory the sensitivity and specificity of the sputum grams stain and culture is less than 50%. Unusual infections like Nocardia reported from reliable microbiology laboratories should never be mistaken for contamination and colonization. Hence, there is a need for reliable and quality assured microbiology laboratories, as per CLSI guidelines, at an affordable cost across the country.
Broad spectrum antibiotics like the carbapenems, which a couple of years ago were very effective for most gram negative organisms are now experiencing resistance. It is important to avoid indiscriminate use of higher antibiotics in the management of methicillin sensitive staphylococcal infections where cloxacillin is the drug of choice.
Most of these plasmids also carry genes conferring resistance to several non-ß-Lactam antibiotics. The data suggests that only 8% of E.coli were sensitive to third generation cephalosporins like ceftriaxone which is a frequently used empiric antibiotic.
There is also an increasing cross resistance to other groups of antibiotics such as the Aminoglycosides, Flouroquinolones and of late the Carbapenems (Fig. Most alarming is the organism's ability to accumulate diverse mechanisms of resistance and the emergence of strains that are resistant to all commercially available antibiotics. At our institute we have isolated S.maltophila in 75 patients in year 2008 with a sensitivity of 99% to co-tromoxazole. Irrational antibiotic prescribing is documented as one of the main factors that encourage emergence of antibiotic-resistant pathogens e.g. Class Restriction of Cephalosporin Use to Control Total Cephalosporin Resistance in Nosocomial Klebsiella. This antibiotic is not allowed to use for older people, as well as to children under one month. In this article we discuss Multidrug resistant organisms (MDROs), the factors responsible for antibiotic resistance, role of clinicians, need for laboratory quality assurance, prevailing pathogens at a south Indian tertiary care hospital and methods to prevent of MDRO. Interventions like discontinuing cephalosporins4 in certain settings need to be planned at a large scale.
Reserve antibiotics like Linezolid are being misused as they are available in the oral form. The most frequent co-resistances found in ESBL-producing organisms are aminoglycosides, fluoroquinolones, tetracyclines, chloramphenicol, and sulfamethoxazole-trimethoprim10. Similarly, many clinicians start cefepime as empiric therapy but the sensitivity is as low as 3% for E.coli in the year 2007 at our institute. It is prescribed in the treatment of endometritis, chlamydia, ovarial inflammatory processes, vaginosis and various vaginal infections. We note that you can lower the risk of side effects to the minimum by special dietary supplements. Indiscriminate use of antibiotics like faropenem which is available orally may promote increased resistance to carbapenems. There were 32 isolates in the year 2007 and all the isolates are sensitive to cotrimoxazole and to 92% of the isolates are sensitive to ciprofloxacin.
Duration of treatment depends on site of infection and type of organism as complicated urinary tract infection and infective endocarditis needs to be treated for at least 3 weeks.
This article is about which diseases clindamycin is used to treat. Right now you can read the instructions for use of clindamycin. Bacterial endocarditis, acute and chronic osteomyelitis, septicemia – all these diseases may also be cured by the antibiotic.
I believe if more people thought of it doing this, they’d possess a better time period receive the hold ofing the matter. This data confirms that Vancomycin is the drug of choice and the requirement for Linezolid is limited and should be used in only highly select cases of VRE. De-escalation of antibiotics should be considered once data on culture reports are available and depending on the patient's clinical response. Guideline for prevention of surgical site infection, 1999; Centers for Disease Control and Prevention (CDC). It depends on the age of the patient, his general condition, as well as the current disease. For example, it must be taken with a great caution by people with diseases of the gastrointestinal tract.

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18.05.2016, author: admin

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