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Background To promote effective education on challenges of antimicrobial resistance (AMR) and antimicrobial overuse, it is necessary to understand the current perception, attitude, knowledge and learning style preference on these issues among future general practitioners and subspecialists. Methods In 2014, we conducted a questionnaire-based survey in two participant groups: 1) first-year residents and fellows (doctor-in-training, DIT) of Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand and 2) final-year medical students (medical students, MS) of three medical schools in Thailand. Results A total of 225 DIT and 455 MS completed the questionnaire. Both groups had good perception of these problems. However, overall, only half of the participants answered that they can prescribe appropriate antibiotics to their patients (DIT 48.4% vs. MS 52.8%; p = 0.29). The DIT group had significantly higher mean knowledge scores on questions relating to antimicrobial use (64.0% vs. 56.0%; p

Many microbial species have been recognized as enteropathogens for humans. Here, we predicted the causative agents of acute diarrhea using data from multiplex quantitative PCR (qPCR) assays targeting 19 enteropathogens. For this, a case-control study was conducted at eight hospitals in Thailand. Stool samples and clinical data were collected from 370 hospitalized patients with acute diarrhea and 370 non-diarrheal controls. Multiple enteropathogens were detected in 75.7% and 13.0% of diarrheal stool samples using multiplex qPCR and bacterial culture methods, respectively. Asymptomatic carriers of enteropathogens were found among 87.8% and 45.7% of individuals by qPCR and culture methods, respectively. These results suggested the complexity of identifying causative agents of diarrhea. An analysis using the quantification cut-off values for clinical relevance drastically reduced pathogen-positive stool samples in control subjects from 87.8% to 0.5%, whereas 48.9% of the diarrheal stool samples were positive for any of the 11 pathogens. Among others, rotavirus, norovirus GII, Shigella/EIEC, and Campylobacter were strongly associated with acute diarrhea (P-value

Objectives Excessive use of antimicrobial agents for acute upper respiratory infections (URIs) is one of the most common problems in clinical practice. Interventions are required to reduce antimicrobial overuse in these common infections. Methods During a 9-month study period (June 2014–February 2015), a quasi-experimental (pre-/post-) study was conducted among internal medicine residents and fellows in an outpatient setting of Siriraj Hospital, Thailand. The aim of the study was to determine the effectiveness of individual feedback to reduce inappropriate antimicrobial prescriptions for treating URIs. The administrative ICD-10 database was used to identify index physicians with at least one outpatient experience of URI. Data on antimicrobial prescriptions were extracted from the hospital pharmacy database. A confidential letter and SMS were sent to all index physicians about the extent of antimicrobial therapy they prescribed for treating URIs during the pre-intervention period. Results The proportion of antimicrobial use among the index encounters showed a significant reduction from 34.7% in the pre-intervention period to 26.1% in the post-intervention period (P = 0.02). Segmented logistic regression analysis confirmed the significant impact of the intervention on reducing antimicrobial prescriptions (P = 0.02). Conclusion This integrated intervention is simple and non-labour intensive and may therefore be used sustainably in resource-limited settings.

BACKGROUND: Clinical effectiveness of previous regimens to treat Plasmodium vivax infection have been hampered by compliance. We aimed to assess the dose-response, safety, and tolerability of single-dose tafenoquine plus 3-day chloroquine for P vivax malaria radical cure. METHODS: In this double-blind, randomised, dose-ranging phase 2b study, men and women (aged >/=16 years) with microscopically confirmed P vivax monoinfection (parasite density >100 to 7500 per muL blood). The primary efficacy endpoint was relapse-free efficacy at 6 months from initial dose (ie, clearance of initial infection without subsequent microscopically confirmed infection), analysed by intention to treat. This study is registered with ClinicalTrials.gov, number NCT01376167. FINDINGS: Between Sept 19, 2011, and March 25, 2013, 329 patients were randomly assigned to a treatment group (chloroquine plus tafenoquine 50 mg [n=55], 100 mg [n=57], 300 mg [n=57], 600 mg [n=56]; or to chloroquine plus primaquine [n=50]; or chloroquine alone [n=54]). Relapse-free efficacy at 6 months was 57.7% (95% CI 43-70) with tafenoquine 50 mg, 54.1% (40-66) with tafenoquine 100 mg, 89.2% (77-95) with tafenoquine 300 mg, 91.9% (80-97) with tafenoquine 600 mg, 77.3% (63-87) with primaquine, and 37.5% (23-52) with chloroquine alone. Tafenoquine 300 mg and 600 mg had better efficacy than chloroquine alone (treatment differences 51.7% [95% CI 35-69], p

Background To promote effective education on antimicrobial resistance, appropriate antimicrobial use, and infection control, it is necessary to understand the current perception and knowledge of these issues among future medical subspecialties. Our study objective was to determine perception, attitude and knowledge of antimicrobial resistance, appropriate antimicrobial use, and infection control in first-year residents and fellows of a Thai University hospital. Methods An 8-page paper questionnaire was distributed to all first-year residents and fellows of Faculty of Medicine Siriraj Hospital, Mahidol University during their first orientation (June 2014). Results Two hundred and twenty-five residents and fellows completed the questionnaire. Majority of patients were female with a mean age of 26.71 ± 1.22 years. Nearly all of them (>90%) had good perception that prescribing broad-spectrum antimicrobial agents can harm the patient, can lead to the emergence of AMR and antimicrobial overuse is considered a national problem. Approximately half of them answered that they can prescribe appropriate antibiotic to their patients and more than half of them (54.8%) reported they feel anxious when they have to prescribe antimicrobial agents. Furthermore, internet search was voted as the most popular source of knowledge regarding appropriate antimicrobial use. Conclusion The problem of antimicrobial resistance and antimicrobial overuse in Thailand is well recognized by these future practitioners. However, their knowledge of antimicrobial resistance, appropriate antimicrobial use, and infection control is substantially limited. Additional efforts should be made to assure that these future specialists have a comprehensive knowledge and skills in the rational use of antimicrobials as well as the essential and appropriate infection control practices. Disclosures All authors: No reported disclosures.