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Bactrim ds vs amoxicillin ) was not different (P = 0.726), but in the case of cefuroxime ds and clindamycin the differences between antibiotics appeared not to have been related differences in antimicrobial susceptibility but because the of one antibiotics to other group was found be different for the two groups (P = 0.04). The results of this study, together with our earlier studies in the Netherlands, strongly suggest that resistance to cefuroxime ds may arise from the use of antibiotics that are commonly used in the hospital or other outpatient care (Pichini et al, 1999). Such resistance would have an impact, in all probability, on the outcome of antibiotic therapy and should be considered in all decisions to use antibiotics for clinical conditions involving serious infections. In summary, we describe for the first time a systematic study using data derived only from the Dutch population where resistance to cefunrofloxacin was reported and where patients received cefuroxime ds in the course of medical treatment, thus not allowing us to define cefuroxime resistance in the individual population. Our results on the prevalence of antibiotic-resistant bacterial Tamoxifen 20mg $82.99 - $0.69 Per pill species in cefuroxime-resistant Klebsiella pneumoniae are consistent with similar epidemiological information reported at the time of publication in 1989 by Pichini and colleagues who studied patients in two centers: the University Clinic of Valkenburg and a tertiary care hospital in The Hague (Pichini et al, 1989). These investigators found that in both sites the prevalence of resistant bacteria in hospitalized patients was higher (4-fold increases) than the rate expected (P = 0.01) from the frequencies of antibiotic-resistant Enterococcus species reported by the manufacturers, national microbiology laboratory, and elsewhere (1-6%). In addition to antibiotic resistance being related the profiles of microorganisms, other factors that influence the emergence of resistance are important. The epidemiology in two of our clinical centers is very similar to that in two Dutch microbiology centers, the Netherlands and in Europe, that were not reported in Pichini et al. The first difference in epidemiological pattern observed for Klebsiella is in the prevalence of antibiotic-resistant Escherichia coli. A similar trend of increased antibiotic resistance occurred in Europe. a recent study conducted in two Dutch microbiology centers (Netherlands, 2001), it was reported that in patients treated with rifampin, the prevalence of resistance to cefuroxime, cefdinir, and azithromycin were higher (13.5-fold increased) than would be expected by multiplying the frequencies 3 and by 2.5 (P = 0.01, 0.04, and 0.07, respectively) (Rietveld, 2001). The findings of our study for Klebsiella pneumoniae are similar to the results obtained at time of the publication Pichini's initial study (Pichini et al, 1989), which suggested that resistance to cefuroximes was more common than expected from the frequencies obtained manufacturers for enterococcelain, cefotaxime, cefmetazole, and clindamycin-resistant E. faecalis. The results of further investigations carried out in Europe show a very significant increase, up to 12.3-fold, in the use of a variety antimicrobials by intensive care units (CCUs) (Pichini Generic tadalista et al, 1991). One of the important advantages using a national dataset, instead of using only selected clinical centers, is that the national data on antibiotic use, used to calculate the national prevalence of resistance, are not affected by hospital characteristics. Thus, we can compare the national prevalence of antibiotic resistance among different geographical areas, without using a regional model. Furthermore, because the epidemiological information concerning clinical use of antibiotics is collected more directly by the national microbiology laboratory (NLB), we feel that this provides a better overview of resistant microorganisms that are not only in outpatient care but the intensive units as well (Visser, 2003). a consequence, this study can serve to support the recommendations from European Centre for Disease Prevention and Control the Committee for Information on Antimicrobial Resistance (Visser, 2003.) We had a large sample, including patients, hospital facilities, and microbiology laboratories. These data represent the entire clinical picture in hospitals, and, fact, the total number of hospital patients in the national dataset was approximately two times of the total number hospitalized patients in our participating centers. This is because the NLB performs an on-site follow-up of all new patients in the Netherlands until date of hospital discharge in a specific hospital; then it reports the data on hospital discharge and new cases generico do citrato de tamoxifeno of Klebsiella pneumoniae or Salmonella.