Ian Harding - Academia.edu (original) (raw)

Papers by Ian Harding

Research paper thumbnail of Infective endocarditis and glycopeptides

Journal of Infection, 1998

Background: despite the number of antibacterial agents currently available, endocarditis remains ... more Background: despite the number of antibacterial agents currently available, endocarditis remains a difficult disease to treat and the mortality rate has not fallen in recent years. The glycopeptides have good activity against the Gram-positive bacteria commonly implicated in endocarditis (staphylococci, both coagulase-positive and negative; enterococci and streptococci). Objectives: to assess the impact of the glycopeptides vancomycin and teicoplanin on the therapy of infectious endocarditis caused by Gram-positive bacteria. Methods: a retrospective review of all major published or recently conducted studies using vancomycin or teicoplanin to treat endocarditis. Results: cure rates obtained with vancomycin and teicoplanin are similar, but there are no controlled studies to investigate this. Vancomycin nephrotoxicity limits its use in endocarditis, in particular when used in combination with an aminoglycoside. By contrast, teicoplanin shows little nephrotoxic potential, even in patients with some degree of renal impairment or when given in combination with an aminoglycoside. Teicoplanin should be used at doses of 6 mg/kg/day or higher to achieve satisfactory cure rates. Conclusions: clinical data on the use of glycopeptides in endocarditis suffer from a lack of controlled trials. Although teicoplanin appears to offer some advantages over vancomycin in the therapy of endocarditis, there is an urgent need for randomized, clinical trials before definitive conclusions can be drawn.

Research paper thumbnail of Impact of antimicrobial resistance on health outcomes in the out-patient treatment of adult community-acquired pneumonia: a probability model

Journal of Antimicrobial Chemotherapy, 2003

Outpatient treatment of community-acquired pneumonia (CAP) is a major challenge in an era of incr... more Outpatient treatment of community-acquired pneumonia (CAP) is a major challenge in an era of increasing prevalence of antimicrobial resistance. However, data describing the clinical impact of such resistance are scarce. A probability model was developed to estimate the impact of antimicrobial resistance on clinical outcomes for adults with CAP, eligible for outpatient care. The model assumed patients would be evaluated at 48-72 h, with those failing to improve being either hospitalized or switched to a different antibiotic. Two strategies were considered: amoxicillin followed by erythromycin (amoxicillin/erythromycin) and erythromycin followed by levofloxacin (erythromycin/levofloxacin). Analyses were conducted based on susceptibility of the major pathogens in France and the UK. Primary model-generated outcome measures were the proportion of patients successfully treated with first-line therapy and the proportion of patients subsequently hospitalized. The model estimated that in France, the amoxicillin/erythromycin strategy would lead to 67.8% improving within 48-72 h and 12.7% subsequently being hospitalized, compared with 48.6% and 13.7% for erythromycin/levofloxacin. For the UK, first-line success and hospitalization rates were, respectively, 71.7% and 8.1% for amoxicillin/erythromycin, and 65.3% and 9.3% for erythromycin/levofloxacin. The model estimated that antimicrobial resistance was responsible for >40% of hospitalizations in France and 15% in the UK. These data suggest that in areas with substantially reduced levels of susceptibility, antimicrobial resistance may be a significant contributor to subsequent hospitalization in adults initially treated as outpatients for CAP. Choice of outpatient treatment strategy should consider local resistance rates in order to maximize the likelihood of early cure, thereby minimizing hospitalizations.

Research paper thumbnail of Detection of glycopeptide resistance in clinical isolates of Gram-positive bacteria

Journal of Antimicrobial Chemotherapy, 1991

Research paper thumbnail of Teicoplanin in the treatment of infections caused by coagulase-negative staphylococci

Journal of Antimicrobial Chemotherapy, 1988

A total of 88 patients were treated with teicoplanin for infections caused by coagulase-negative ... more A total of 88 patients were treated with teicoplanin for infections caused by coagulase-negative staphylococci in open clinical studies in France and the UK. Teicoplanin was administered once daily, with a mean dose of 323 mg, for a mean duration of 16 days. Thirty-nine patients received teicoplanin alone while 49 received combination treatment. Clinical cure or improvement occurred in 79 of 82 evaluable cases (96.3%) and bacteriological elimination in 82 cases (95.1%). Treatment with teicoplanin alone was clinically successful in all cases, including 20 septicaemias, and the elimination rate was 93%. There was no apparent correlation between clinical and bacteriological outcomes and results of in-vitro testing. The variation in MICs between France and the UK was attributed to differences in the methods used.

Research paper thumbnail of Teicoplanin in Endocarditis: A Multicentre, Open European Study

Chemotherapy, 1995

The efficacy of teicoplanin, a glycopeptide antibiotic, in endocarditis is controversial, with di... more The efficacy of teicoplanin, a glycopeptide antibiotic, in endocarditis is controversial, with differences observed in the efficacies of the regimens used in clinical trials in the USA and Europe. This retrospective study examined the outcomes, efficacy and safety of mono- and combination antibiotic therapy using teicoplanin, particularly in cases of Staphylococcus aureus endocarditis. A total of 115 patients, typically mixed

Research paper thumbnail of Infective endocarditis and glycopeptides

Journal of Infection, 1998

Background: despite the number of antibacterial agents currently available, endocarditis remains ... more Background: despite the number of antibacterial agents currently available, endocarditis remains a difficult disease to treat and the mortality rate has not fallen in recent years. The glycopeptides have good activity against the Gram-positive bacteria commonly implicated in endocarditis (staphylococci, both coagulase-positive and negative; enterococci and streptococci). Objectives: to assess the impact of the glycopeptides vancomycin and teicoplanin on the therapy of infectious endocarditis caused by Gram-positive bacteria. Methods: a retrospective review of all major published or recently conducted studies using vancomycin or teicoplanin to treat endocarditis. Results: cure rates obtained with vancomycin and teicoplanin are similar, but there are no controlled studies to investigate this. Vancomycin nephrotoxicity limits its use in endocarditis, in particular when used in combination with an aminoglycoside. By contrast, teicoplanin shows little nephrotoxic potential, even in patients with some degree of renal impairment or when given in combination with an aminoglycoside. Teicoplanin should be used at doses of 6 mg/kg/day or higher to achieve satisfactory cure rates. Conclusions: clinical data on the use of glycopeptides in endocarditis suffer from a lack of controlled trials. Although teicoplanin appears to offer some advantages over vancomycin in the therapy of endocarditis, there is an urgent need for randomized, clinical trials before definitive conclusions can be drawn.

Research paper thumbnail of Impact of antimicrobial resistance on health outcomes in the out-patient treatment of adult community-acquired pneumonia: a probability model

Journal of Antimicrobial Chemotherapy, 2003

Outpatient treatment of community-acquired pneumonia (CAP) is a major challenge in an era of incr... more Outpatient treatment of community-acquired pneumonia (CAP) is a major challenge in an era of increasing prevalence of antimicrobial resistance. However, data describing the clinical impact of such resistance are scarce. A probability model was developed to estimate the impact of antimicrobial resistance on clinical outcomes for adults with CAP, eligible for outpatient care. The model assumed patients would be evaluated at 48-72 h, with those failing to improve being either hospitalized or switched to a different antibiotic. Two strategies were considered: amoxicillin followed by erythromycin (amoxicillin/erythromycin) and erythromycin followed by levofloxacin (erythromycin/levofloxacin). Analyses were conducted based on susceptibility of the major pathogens in France and the UK. Primary model-generated outcome measures were the proportion of patients successfully treated with first-line therapy and the proportion of patients subsequently hospitalized. The model estimated that in France, the amoxicillin/erythromycin strategy would lead to 67.8% improving within 48-72 h and 12.7% subsequently being hospitalized, compared with 48.6% and 13.7% for erythromycin/levofloxacin. For the UK, first-line success and hospitalization rates were, respectively, 71.7% and 8.1% for amoxicillin/erythromycin, and 65.3% and 9.3% for erythromycin/levofloxacin. The model estimated that antimicrobial resistance was responsible for >40% of hospitalizations in France and 15% in the UK. These data suggest that in areas with substantially reduced levels of susceptibility, antimicrobial resistance may be a significant contributor to subsequent hospitalization in adults initially treated as outpatients for CAP. Choice of outpatient treatment strategy should consider local resistance rates in order to maximize the likelihood of early cure, thereby minimizing hospitalizations.

Research paper thumbnail of Detection of glycopeptide resistance in clinical isolates of Gram-positive bacteria

Journal of Antimicrobial Chemotherapy, 1991

Research paper thumbnail of Teicoplanin in the treatment of infections caused by coagulase-negative staphylococci

Journal of Antimicrobial Chemotherapy, 1988

A total of 88 patients were treated with teicoplanin for infections caused by coagulase-negative ... more A total of 88 patients were treated with teicoplanin for infections caused by coagulase-negative staphylococci in open clinical studies in France and the UK. Teicoplanin was administered once daily, with a mean dose of 323 mg, for a mean duration of 16 days. Thirty-nine patients received teicoplanin alone while 49 received combination treatment. Clinical cure or improvement occurred in 79 of 82 evaluable cases (96.3%) and bacteriological elimination in 82 cases (95.1%). Treatment with teicoplanin alone was clinically successful in all cases, including 20 septicaemias, and the elimination rate was 93%. There was no apparent correlation between clinical and bacteriological outcomes and results of in-vitro testing. The variation in MICs between France and the UK was attributed to differences in the methods used.

Research paper thumbnail of Teicoplanin in Endocarditis: A Multicentre, Open European Study

Chemotherapy, 1995

The efficacy of teicoplanin, a glycopeptide antibiotic, in endocarditis is controversial, with di... more The efficacy of teicoplanin, a glycopeptide antibiotic, in endocarditis is controversial, with differences observed in the efficacies of the regimens used in clinical trials in the USA and Europe. This retrospective study examined the outcomes, efficacy and safety of mono- and combination antibiotic therapy using teicoplanin, particularly in cases of Staphylococcus aureus endocarditis. A total of 115 patients, typically mixed