A survey of primary care patients in Texas found that most expected to receive antibiotics for illnesses commonly caused by viruses, researchers reported yesterday in the Annals of Family Medicine.

The survey, developed by researchers at Baylor College of Medicine and administered from January 2020 to June 2021 at six public primary care clinics and two private emergency departments in Harris County, Texas, sought to assess patient expectations for antibiotics for acute diarrhea, sore throat, cold/flu, sinus infections, and bronchitis symptoms. 

For each symptom illness, respondents were asked to respond to the statements "Taking antibiotics will help you get better quickly" and "You should take antibiotics to avoid getting sicker" using a 5-point Likert scale, and were asked if they knew about risks associated with antibiotic use. The researchers also compared the difference in patient expectations by sociodemographic groups and between public and private healthcare systems.

Lack of knowledge about potential risks

Of the 564 patients surveyed, 93% expected to receive an antibiotic for one of the five pre-defined illnesses/symptoms, with 84% believing that antibiotics would improve bronchitis, followed by sinus infections (72%), sore throat (66%), cold/flu (64%), and diarrhea (36%). Overall, 37% of patients lacked knowledge of antibiotic risks.

Compared with private, public clinic patients were nearly twice as likely to expect antibiotics for diarrhea (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.2 to 2.8), sore throat (OR, 2.2; 95% CI, 1.5 to 3.2), cold/flu (OR, 1.5; 95% CI, 1.0 to 2.3), and overall (OR, 1.6; 95% CI, 1.1 to 2.3). Lack of knowledge of potential risks of antibiotic use was associated with increased antibiotic expectations for diarrhea (OR, 1.6; 95% CI, 1.1 to 2.4) and cold/flu symptoms (OR, 2.9; 95% CI, 2.0 to 4.4). Lower education and inadequate health literacy were predictors of antibiotic expectations for diarrhea. 

"Future stewardship interventions to reduce inappropriate patient antibiotic expectations should (1) inform patients of the symptoms/illnesses that antibiotics treat and (2) emphasize the individual harms/risks (or harms/risks to others close to an individual) of antibiotics," the researchers wrote, adding that they are developing a patient-clinician antibiotic education tool based on the findings.

The Biomedical Advanced Research and Development Authority (BARDA) announced last week that it has awarded $29 million to Swiss drugmaker Basilea Pharmaceutica to develop two first-in-class antifungal drugs to treat drug-resistant invasive fungal infections. 

The funding will help Basilea develop Fosmanogepix, a broad-spectrum antifungal that targets drug-resistant invasive candidiasis—including infections caused by Candida auris—and invasive mold infections, and BAL2062, which has activity against drug-resistant Aspergillus strains. 

Part of preparedness efforts

BARDA is part of the Administration for Strategic Preparedness and Response within the US Department of Health and Human Services and is one the leading public sector funders of antibiotics and diagnostics for both biothreat pathogens and opportunistic secondary infections. The award is a component of BARDA's medical countermeasures portfolio.

"Fosmanogepix and BAL2062 are the first antifungals to enter the BARDA portfolio and will address the urgent need for novel drugs to treat fungal infections that might arise following a mass casualty incident, such as a radiological or nuclear incident," the agency said in a Basilea press release.

As part of the contract, BARDA will also develop pediatric formulations of the drugs, along with antifungal susceptibility testing diagnostics.

A survey of pharmacists from 19 Arab nations revealed a wide and concerning variation in knowledge, attitudes, and practice regarding the use of antibiotics and antimicrobial resistance (AMR), researchers reported last week in Antimicrobial Resistance and Infection Control.

Of the 3,100 pharmacists who received the survey, 2,833 (91.3%) completed it. Respondents were mostly male (57.4%), aged from 19 to 31 years (76.2%), and from community pharmacies (71.2%). Nearly half (45.7%) did not know antibiotics can be used for prevention, 33.3% didn't know that the wrong choice of antibiotics may promote resistance, and 34.2% didn't consider AMR to be a global problem. In addition, 41.2% had the wrong answer when asked whether antibiotics can help treat the common cold, cough, flu, or fever.

Regarding practice patterns, more than half (53.8%) said they do not consistently adhere to guidelines when dispensing antibiotics, 36.8% said they do not agree with policies of not dispensing antibiotics without a prescription, and 67.5% said that refusing to dispense antibiotics without a prescription would negatively affect sales and profits. Three quarters of respondents believed that community pharmacists had qualifications to prescribe antibiotics for suspected infections.

More education needed

The study authors say the findings highlight the need for governments in the region to develop and implement policies to change antibiotic dispensing practices and promote sensible antibiotic use among community pharmacists, who are primary sources of antibiotics intended for self-medication in the countries surveyed. 

"Ultimately our discoveries underscore why enhancing education about responsible antibiotic use via awareness campaigns is vital to battling bacterial resistance levels that continue to rise within our communities," they wrote.

A study yesterday in JAMA Network Open shows a higher risk of childhood seizures—but not epilepsy—in kids born to moms who contracted flu during pregnancy. 

Maternal fever in pregnancy has been linked to poor outcomes in children, including increased risk of neuropsychiatric conditions such as autism and depression. The study sought to define the relationship between maternal flu and febrile seizures, which typically occur from 6 months to 5 years of age.

The findings come from 1,316,107 mother-baby pairs identified from January 1, 2004, to December 31, 2013, using records in Taiwan's Maternal and Child Health Database. Children were followed up until December 31, 2020.

Among the 75,835 children whose mothers had flu during pregnancy, 2,456 (3.2%) developed seizures during their follow-up period, the authors said. 

Boys more likely to have seizures

The cumulative risk of childhood seizures was significantly higher among children who had been exposed to maternal influenza virus infections. 

The adjusted hazard ratios were 1.09 (95% confidence interval [CI], 1.05 to 1.14) for seizures, 1.11 (95% CI, 1.06 to 1.17) for febrile convulsions, and 1.04 (95% CI, 0.97 to 1.13) for epilepsy. Further analysis showed the risk of epilepsy was not statistically significant. 

For all children in the study, advanced maternal age, gestational high blood pressure, cesarean delivery, and being a boy were associated with increased risk of seizures. 

"Further studies are needed to elucidate the mechanisms underlying childhood neurological development," the authors concluded.