Journal of Research in Pharmacy Practice

Abstract The present study aims to evaluate the awareness of a sample of the general population and health-care professionals regarding the use of antibiotics and antibiotic resistance and identify the factors associated with antibiotic resistance. Methods: This prospective questionnaire-based study was conducted for 3 months, from July to September 2020, in Karaikal, Puducherry (India). The health professionals included doctors in pre- and paraclinical teaching departments (those not involved in clinical practice), laboratory technicians, and PhD students pharmacists. The questionnaire had two parts which health professionals answered, whereas the general population answered only the second part. Findings: About 38.5% of the population reported using antibiotics frequently among the responses obtained. Around 66.5% of the general population usually stop the antibiotic within 1 or 2 days after they feel better, and 11% of the people believed that adding an extra antibiotic would make them better. Among the health professionals, more than 90% responded that self-medication is the major reason for antibiotic resistance and was unsure of the overprescription of antibiotics. Conclusion: The results show variable responses and suggest the need for intervention programs to increase the knowledge among the general population regarding the rational use of antibiotics.

Abstract The aim of the present study was to determine the pattern of antimicrobial resistance of Gram-positive bacteria during three consecutive years at the nephrology ward of Namazi Hospital in Shiraz, Southwest of Iran.
Methods: During a 3-year period from 2013 to 2015, data of all biological samples of hospitalized patients at the adult nephrology ward of Namazi Hospital were sent to the central laboratory for identification of Gram-positive microorganisms and subsequently, their antimicrobial susceptibility testing by Kirby–Bauer disc diffusion method were analyzed in a retrospective manner.
Findings: Coagulase-negative Staphylococci (CONS) (38.5%), Staphylococcus aureus(25.4%), and Enterococcus spp. (23.8%) were the most common isolated Gram-positive bacteria from all biological samples. All Enterococcus spp. isolates within the 3 years were resistant to oxacillin. The rate of vancomycin-resistant enterococci (VRE) increased from 40.63% in 2013 to 72.73% in 2015. Enterococcus spp. resistance rates to aminoglycosides during 3 years were above 85%. The frequencies of oxacillin-resistant S. aureus (ORSA) in 2013, 2014, and 2015 were 95.24%, 80.95%, and 36.36%, respectively. Two out of 11 (6.67%) S. aureus isolates were resistant to vancomycin. More than 90% of CONS were sensitive to vancomycin within the study period. The frequency of gentamicin-resistant CONS ranged from 40% to 57.14%.
Conclusion: The rates of ORSA, VRE, and aminoglycoside-resistant CONS as well as Enterococcus spp. in our clinical setting were considerably high and concerning. These may be due to the failure or lack of infection control activities and antimicrobial selection pressure.

Abstract
Evidences regarding the efficacy of different antibiotic regimens proposed for treatment of 
multidrug‑resistant (MDR) Gram‑negative pathogens have been reviewed. Available data in 
Scopus, Medline, EMBASE, the Cochrane central register of controlled trials, and Cochrane 
database of systematic reviews have been collected. Several antibiotic regimens are proposed 
for treatment of MDR Gram‑negative infections (defined as nonsusceptibility to at least 
one agent in three or more antimicrobial categories). The most challenging issue is the 
treatment of carbapenem‑resistant (CR) Gram‑negative pathogens. A carbapenem plus either 
colistin or tigecycline was the most effective regimen for treatment of CR Gram‑negative 
pathogens with low‑level resistance (minimal inhibitory concentration [MIC] ≤ 8 mg/L). 
However, in high‑level resistance (MIC > 8 mg/L), combination of colistin and tigecycline 
showed promising effect.

Abstract Objective: Synergistic effect between commonly used antibiotics against nosocomial 
multidrug-resistant strains of Staphylococcus aureus, if present, could provide a viable 
option as an alternative therapy for infections due to this pathogen. The aim of this study 
was searching for any synergistic effect between several antibiotics against drug-resistant 
strains of S. aureus with nosocomial origin using double-disk synergy test and to determine 
the applicability of this test for such a purpose.
Methods: Over a 6-month period, strains of S. aureus isolated from clinical specimens 
of hospitalized patients with documented nosocomial infection underwent disk diffusion 
test using antibiotic disks of oxacillin, cephalothin, clindamycin, ciprofloxacin, vancomycin, 
cotrimoxazole, rifampin, erythromycin, gentamicin and meropenem. Double-disk synergy test 
was performed for all isolates resistant to at least two of applied antibiotics. Combinations 
of all possible pairs of antibiotics (to which the microorganism was resistant) were tested 
by placing antibiotic disks at distance of 20 mm from each other (center to center). After 
16-20 hours of incubation, if synergistic effect was present among two antibiotics, an inhibition 
zone was formed between their disks.
Findings: Among all of possible two-antibiotic combinations tested for 41 resistant isolates, 
only two cases of synergistic effect were detected; both effects were among rifampin and 
cotrimoxazole.
Conclusion: The combination of rifampin and cotrimoxazole could provide a viable option 
for treatment of infections due to resistant strains of S. aureus; however, clinical trials are 
needed before any new recommendation. Also, double-disk synergy test seems to be capable 
of detecting the synergistic effect between antibiotics at in vitro level.