Journal articles on the topic 'Antibiotic management'
To see the other types of publications on this topic, follow the link: Antibiotic management.
Create a spot-on reference in APA, MLA, Chicago, Harvard, and other styles
Consult the top 50 journal articles for your research on the topic 'Antibiotic management.'
Next to every source in the list of references, there is an 'Add to bibliography' button. Press on it, and we will generate automatically the bibliographic reference to the chosen work in the citation style you need: APA, MLA, Harvard, Chicago, Vancouver, etc.
You can also download the full text of the academic publication as pdf and read online its abstract whenever available in the metadata.
Browse journal articles on a wide variety of disciplines and organise your bibliography correctly.
1
Jaspers, Mark T., and James W. Little. "Antibiotic management." Journal of the American Dental Association 112, no. 1 (January 1986): 10–12. http://dx.doi.org/10.14219/jada.archive.1986.0027.
Full text
2
Pandya, Aarti, Emily Burgen, G. John Chen, Jessica Hobson, Mary Nguyen, Arman Pirzad, and Sadia Hayat Khan. "Comparison of management options for specific antibody deficiency." Allergy and Asthma Proceedings 42, no. 1 (January 1, 2021): 87–92. http://dx.doi.org/10.2500/aap.2021.42.200086.
Full textAbstract:
Background: Specific antibody deficiency is a primary immunodeficiency characterized by normal immunoglobulins with an inadequate response to polysaccharide antigen vaccination. This disease can result in recurrent infections, the most common being sinopulmonary infections. Treatment options include clinical observation, prophylactic antibiotic therapy, and immunoglobulin supplementation therapy, each with limited clinical data about their efficacy. Objective: This study aimed to identify whether there was a statistically significant difference in the rate of infections for patients who were managed with clinical observation, prophylactic antibiotics, or immunoglobulin supplementation therapy. Methods: A retrospective chart review was conducted. Patients were eligible for the study if they had normal immunoglobulin levels, an inadequate antibody response to polysaccharide antigen‐based vaccination, and no other known causes of immunodeficiency. Results: A total of 26 patients with specific antibody deficiency were identified. Eleven patients were managed with immunoglobulin supplementation, ten with clinical observation, and five with prophylactic antibiotic therapy. The frequency of antibiotic prescriptions was assessed for the first year after intervention. A statistically significant rate of decreased antibiotic prescriptions after intervention was found for patients treated with immunoglobulin supplementation (n = 11; p = 0.0004) and for patients on prophylactic antibiotics (n = 5; p = 0.01). There was no statistical difference in antibiotic prescriptions for those patients treated with immunoglobulin supplementation versus prophylactic antibiotics (p = 0.21). Conclusion: Prophylactic antibiotics seemed to be equally effective as immunoglobin supplementation therapy for the treatment of specific antibody deficiency. Further studies are needed in this area.
3
McLean-Tooke, Andrew, Catherine Aldridge, Catherine Stroud, and Gavin P. Spickett. "Practical management of antibiotic allergy in adults." Journal of Clinical Pathology 64, no. 3 (December 20, 2010): 192–99. http://dx.doi.org/10.1136/jcp.2010.077289.
Full textAbstract:
This review looks at the main issues around immediate hypersensitivity and the role and limitations of testing. The majority of literature on antibiotic hypersensitivity relates to β-lactam antibiotics, mainly because of the heavy usage of this class of drugs. Concerns around cross-reactivity always worry clinicians, particularly in the emergency situation. Reasonable data now exist in relation to β-lactam antibiotics and derivatives, which enable appropriate risk management to be undertaken. The available literature for other classes of antibiotics is also discussed.
4
Read, A. F., and R. J. Woods. "Antibiotic resistance management." Evolution, Medicine, and Public Health 2014, no. 1 (October 28, 2014): 147. http://dx.doi.org/10.1093/emph/eou024.
Full text
5
Akhtar, Khaleda, Rehana Begum Chowdhury, and Md Tauhidur Rahman. "Role of antibiotic in bronchiolitis management." Journal of Armed Forces Medical College, Bangladesh 9, no. 2 (February 2, 2015): 70–76. http://dx.doi.org/10.3329/jafmc.v9i2.21833.
Full textAbstract:
Introduction: Bronchiolitis is the most common illness among the patients attending the outpatient departments of CMH. It is predominantly a viral disease affecting the infants and young children. Though Antibiotic has little role, pediatricians frequently use them during bronchiolitis management. Very few randomized control trials without antibiotics in the management of bronchiolitis have so far been done. Objectives: To evaluate the outcome of bronchiolitis with or without antibiotics in a hospital setting. Methods: This prospective randomized control study was done in CMH Savar, during six months from October 2012 to March 2013. All the children below two years admitted in CMH Savar with first attack of Clinical Bronchiolitis were our study population. Exclusion criteria were: (i) atopic condition, (ii) congenital heart disease and/or (iii) known immunodeficiency. Study cases were randomly assigned into one of the two groups, AB group (Erythromycin/Amoxycilin) and NAB group (No Antibiotic).The NAB group was considered as control group. Supportive treatment was given according to the national guideline for management of bronchiolitis. Presenting symptoms and signs were followed-up twice daily while hospitalized and 7 days after discharge to determine the progress of disease. 70 JAFMC Bangladesh. Vol 9, No 2 (December) 2013 Outcome was determined by the progress of the variables in the structured follow-up format. Permission of commanding officer CMH Savar and verbal consent of the parents were taken before the study. Results: Fifty-four cases who could be followed up till after seven days of discharge were finally included in the study. Among them about half (25/54) received oral or intravenous antibiotic while rest (29/54) received only supportive therapy but no antibiotic (NAB group). Most of the cases were below six months of age. Male were about double of the female (37:17). The presenting features were cough, wheeze, fever and feeding difficulty. Clinical features of both groups progressed similarly in both the groups. With the given treatment 24 (96%) cases from AB group and 27 (93%) cases from NAB group improved and were discharged safely. 01 from AB and 02 from NAB group deteriorated and were then treated with broad spectrum antibiotics. There was no death. Mean hospital stay of AB group (5.6 days) was little longer than NAB group (4.2 days) and 16% (4/25) of them had respiratory symptoms at seven days follow up, but the difference of outcome between the two groups was not statistically significant. Conclusion: Antibiotics have no role in acute bronchiolitis management. DOI: http://dx.doi.org/10.3329/jafmc.v9i2.21833 Journal of Armed Forces Medical College Bangladesh Vol.9(2) 2013
6
Kitsos, Nikolaos, Dimitrios Cassimos, Ioannis Xinias, Charalampos Agakidis, and Antigoni Mavroudi. "Management of antibiotic allergy in children: a practical approach." Allergologia et Immunopathologia 50, no. 5 (September 1, 2022): 30–38. http://dx.doi.org/10.15586/aei.v50i5.607.
Full textAbstract:
Background: About 10% of children are declared as allergic to antibiotics, with beta(β)-lactams being the most common perpetrators. However, few of these are confirmed by allergy tests. This characteristic of being allergic follows a child well into adulthood, leading to alternative, usually more expensive broad-spectrum antibiotics, contributing to antibiotic resistance and increasing healthcare expenses. Objective: This review presents a practical approach to managing pediatric patients with antibiotic hypersensitivity reactions. Material and methods: We updated the guidelines on antibiotic allergy in children by conducting systematic literature research using the best available evidence from PubMed search by entering the keywords “antibiotic allergy” and “children.” The search output yielded 5165 citations. Results: Management of antibiotic allergy depends on the culprit antibiotic, and it includes confirmation of the diagnosis and finding a safe alternative to the culprit antibiotic. In particular patients with a history indicative of penicillin allergy can be treated with cephalosporins as an alternative to penicillin, especially with third-generation cephalosporins, except for those with similar R1 side chains. In patients with a history of immediate-type reactions to cephalosporins who require treatment with cephalosporins or penicillin, skin tests with cephalosporin or penicillin with different side chains should be performed. If allergy to macrolides is suspected, challenge tests are currently the only reliable diagnostic tool. The best strategy for managing patients with sulfonamide hypersensitivity is an alternative antibiotic. The skin prick tests and intradermal tests are not recommended for diagnosis of quinolone allergy, as they can activate dermal mast cells leading to false-positive results. Quinolone challenge test is the most appropriate test for diagnosing quinolone hypersensitivity. Conclusion: Although adverse drug reactions to antibiotics are frequently documented, immunologically mediated hypersensitivity is unusual. In the event of an reaction, an appropriate diagnostic workup is required to identify the drug’s causal role. It is critical to avoid “labeling” a child as allergic without first conducting a proper diagnostic workup.
7
Kaplan, Sheldon L. "Current Management of Common Bacterial Meningitides." Pediatrics In Review 7, no. 3 (September 1, 1985): 77–87. http://dx.doi.org/10.1542/pir.7.3.77.
Full textAbstract:
Bacterial meningitis is one of the most important, relatively frequent life-threatening infections encountered in children; thus physicians caring for children must be familiar with the current recommendations concerning its management. Newer antibiotics, especially third-generation cephalosporins, have provided satisfactory alternatives to the standard antibiotic treatment of bacterial meningitis in children but present the pediatrician with a baffling array of potential choices that can lead to confusion and indecision when selecting an agent to administer. At the present time, none of these newer agents has emerged as clearly superior to the others, and, therefore, a particular agent cannot be recommended as the single drug of choice for the treatment of bacterial meningitis in the pediatric age group. This review will focus on the antibiotic treatment and supportive care of the child with bacterial meningitis due to the most common pathogens ANTIMICROBIAL THERAPY OF BACTERIAL MENINGITIS IN CHILDREN The principles of the antibiotic therapy of bacterial meningitis have been derived from both clinical studies and animal models.1 It is clear that an antibiotic must be bactericidal in vitro against a particular microorganism in order to be most effective in vivo. Antibiotics that only inhibit growth of an organism frequently do not result in sterility of CSF in animal models or in the human host.
8
Balaji, Ragupathy Vikram. "Blood Culture Reports Utilization in Management of Blood Stream Infections in Tertiary Care Hospital, South India." International Journal of Current Microbiology and Applied Sciences 11, no. 5 (May 10, 2022): 8–11. http://dx.doi.org/10.20546/ijcmas.2022.1105.002.
Full textAbstract:
The choice of antimicrobial therapy for bloodstream infection is often empirical and based on the knowledge of local antimicrobial activity profiles of the most common bacteria causing infections. This study was conducted at Government Vellore Medical College Hospital to correlate the antibiotic sensitivity pattern with the empirically chosen antibiotics by the clinicians to treat blood stream infections and the change of antibiotic according to the sensitivity pattern. The aim of this work to assess whether antibiotics were changed after receiving blood culture reports by the clinicians. Out of 122 patients included in the study, antibiotics were changed in 107 patients (88%) after the issue of the sensitivity report. The clinical condition of the patient improved with the administration of antibiotics recommended as per the sensitivity report. Mortality was significantly reduced in strictly following the sensitivity pattern. Action plan to educate about Antibiotic choice of bloodstream infections as per Hospital Antibiotic policy of the Hospital, to implement change of antibiotics following reports as per Hospital policy and periodic surveillance regarding sustenance of the Antibiotic policy norms.
9
Osei Sekyere, John. "Antibiotic Types and Handling Practices in Disease Management among Pig Farms in Ashanti Region, Ghana." Journal of Veterinary Medicine 2014 (September 11, 2014): 1–8. http://dx.doi.org/10.1155/2014/531952.
Full textAbstract:
Antibiotic resistance in bacteria is affected by the type of antibiotics used and how they are handled. The types of antibiotics used by 110 pig farms in the Ashanti region and the handling practices of the farmers during disease management were assessed. Injectable tetracycline, sulphadimidine, benzylpenicillin, and dihydrostreptomycin containing antibiotics were overly used by the farmers especially in the management of diarrhea, rashes, and coughs. Unsafe storage and disposal practices observed among the farms reflected the abysmal knowledge on appropriate use of antibiotics. Misdiagnosis and inadequate protection during antibiotic handling in the farms increased the risk of antibiotic resistance development and spread. The factors affecting antibiotic resistance development and spread are rife in pig farms in Ashanti region and appropriate education and veterinary interventions are needed to prevent resistant bacteria from becoming endemic in pork and pig farm communities.
10
Sundin, George W., and Nian Wang. "Antibiotic Resistance in Plant-Pathogenic Bacteria." Annual Review of Phytopathology 56, no. 1 (August 25, 2018): 161–80. http://dx.doi.org/10.1146/annurev-phyto-080417-045946.
Full textAbstract:
Antibiotics have been used for the management of relatively few bacterial plant diseases and are largely restricted to high-value fruit crops because of the expense involved. Antibiotic resistance in plant-pathogenic bacteria has become a problem in pathosystems where these antibiotics have been used for many years. Where the genetic basis for resistance has been examined, antibiotic resistance in plant pathogens has most often evolved through the acquisition of a resistance determinant via horizontal gene transfer. For example, the strAB streptomycin-resistance genes occur in Erwinia amylovora, Pseudomonas syringae, and Xanthomonas campestris, and these genes have presumably been acquired from nonpathogenic epiphytic bacteria colocated on plant hosts under antibiotic selection. We currently lack knowledge of the effect of the microbiome of commensal organisms on the potential of plant pathogens to evolve antibiotic resistance. Such knowledge is critical to the development of robust resistance management strategies to ensure the safe and effective continued use of antibiotics in the management of critically important diseases.
11
Mundinger, Gerhard S., Daniel E. Borsuk, Zachary Okhah, Michael R. Christy, Branko Bojovic, Amir H. Dorafshar, and Eduardo D. Rodriguez. "Antibiotics and Facial Fractures: Evidence-Based Recommendations Compared with Experience-Based Practice." Craniomaxillofacial Trauma & Reconstruction 8, no. 1 (March 2015): 64–78. http://dx.doi.org/10.1055/s-0034-1378187.
Full textAbstract:
Efficacy of prophylactic antibiotics in craniofacial fracture management is controversial. The purpose of this study was to compare evidence-based literature recommendations regarding antibiotic prophylaxis in facial fracture management with expert-based practice. A systematic review of the literature was performed to identify published studies evaluating pre-, peri-, and postoperative efficacy of antibiotics in facial fracture management by facial third. Study level of evidence was assessed according to the American Society of Plastic Surgery criteria, and graded practice recommendations were made based on these assessments. Expert opinions were garnered during the Advanced Orbital Surgery Symposium in the form of surveys evaluating senior surgeon clinical antibiotic prescribing practices by time point and facial third. A total of 44 studies addressing antibiotic prophylaxis and facial fracture management were identified. Overall, studies were of poor quality, precluding formal quantitative analysis. Studies supported the use of perioperative antibiotics in all facial thirds, and preoperative antibiotics in comminuted mandible fractures. Postoperative antibiotics were not supported in any facial third. Survey respondents ( n = 17) cumulatively reported their antibiotic prescribing practices over 286 practice years and 24,012 facial fracture cases. Percentages of prescribers administering pre-, intra-, and postoperative antibiotics, respectively, by facial third were as follows: upper face 47.1, 94.1, 70.6; midface 47.1, 100, 70.6%; and mandible 68.8, 94.1, 64.7%. Preoperative but not postoperative antibiotic use is recommended for comminuted mandible fractures. Frequent use of pre- and postoperative antibiotics in upper and midface fractures is not supported by literature recommendations, but with low-level evidence. Higher level studies may better guide clinical antibiotic prescribing practices.
12
Khan, Habibullah, Iftikhar Ahmad, Hafsa Habib, Khizar Hayat, and Zafar Hayat. "ANTIBIOTICS IN THE MANAGEMENT OF BRUCELLOSIS." Gomal Journal of Medical Sciences 16, no. 4 (December 31, 2018): 114–16. http://dx.doi.org/10.46903/gjms/16.04.1988.
Full textAbstract:
Brucellosis is the most common zoonotic bacterial infection in the world. The causative organism is Brucella spp. and the incubation of period is 5 days to 5 months. Although immunological tests are widely used for the diagnosis but cultures of the blood or other clinical specimens is the gold standard for the diagnosis. Outbreaks of brucellosis occur from time to time. It spreads mostly in the communities having close contact with the sheep and cattle, like farmers, cattle grazers, veterinary workers, and butchers. In the urban situation the outbreaks usually occur due to consumption of unpasteurized milk or its products. The clinical features of brucellosis are protean but the major one is a prolonged fever. Infected animals are the reservoirs and the sources of infection. Antibiotics have a major role in the management of brucellosis. Although a single antibiotic may be effective but a combination is preferred to prevent the chances of development of resistance and recurrence of disease. Antibiotics commonly used in the management of brucellosis are doxycycline, rifampicin, streptomycin, fluoroquinolones, cotrimoxazole, and chloramphenicol. Resistance to one or the other antibiotic have been reported from time to time. Dual therapy is commonly prescribed and triple therapy is used in serious conditions like neuro-brucellosis, endocarditis, or recurrence. The objective of this review was to evaluate the effects of various antibiotic regimens in the management of brucellosis. Antibiotic resistance is a problem which can aggravate the situation in future. We suggest that antibiotics’ use should be rationalized to prevent future drug resistance. At least dual therapy should be used to prevent the chances of recurrence and triple therapy for complicated cases and in cases of relapse. There should be no compromise on the optimal doses and duration of therapy.
13
Teoh, Leanne, Monique C. Cheung, Stuart Dashper, Rodney James, and Michael J. McCullough. "Oral Antibiotic for Empirical Management of Acute Dentoalveolar Infections—A Systematic Review." Antibiotics 10, no. 3 (February 28, 2021): 240. http://dx.doi.org/10.3390/antibiotics10030240.
Full textAbstract:
Concerns regarding increasing antibiotic resistance raise the question of the most appropriate oral antibiotic for empirical therapy in dentistry. The aim of this systematic review was to investigate the antibiotic choices and regimens used to manage acute dentoalveolar infections and their clinical outcomes. A systematic review was undertaken across three databases. Two authors independently screened and quality-assessed the included studies and extracted the antibiotic regimens used and the clinical outcomes. Searches identified 2994 studies, and after screening and quality assessment, 8 studies were included. In addition to incision and drainage, the antibiotics used to manage dentoalveolar infections included amoxicillin, amoxicillin/clavulanic acid, cefalexin, clindamycin, erythromycin, metronidazole, moxifloxacin, ornidazole and phenoxymethylpenicillin. Regimens varied in dose, frequency and duration. The vast majority of regimens showed clinical success. One study showed that patients who did not receive any antibiotics had the same clinical outcomes as patients who received broad-spectrum antibiotics. The ideal choice, regimen and spectrum of empirical oral antibiotics as adjunctive management of acute dentoalveolar infections are unclear. Given that all regimens showed clinical success, broad-spectrum antibiotics as first-line empirical therapy are unnecessary. Narrow-spectrum agents appear to be as effective in an otherwise healthy individual. This review highlights the effectiveness of dental treatment to address the source of infection as being the primary factor in the successful management of dentoalveolar abscesses. Furthermore, the role of antibiotics is questioned in primary space odontogenic infections, if drainage can be established.
14
Russo, Carolyn Lucille, and Jennifer Morgan. "Post-antibiotic management of immunocompromised children with febrile neutropenia." Journal of Clinical Oncology 35, no. 8_suppl (March 10, 2017): 39. http://dx.doi.org/10.1200/jco.2017.35.8_suppl.39.
Full textAbstract:
39 Background: Febrile neutropenia in immunocompromised children is a medical emergency and requires prompt administration of antibiotics and supportive care management to prevent death from sepsis. We have previously shown that improvement in time to antibiotic administration from a baseline of 108 minutes was decreased to 64 minutes in 67 children in six St. Jude affiliate clinics. The improvement was achieved by designing a unique order set and process for prompt dispensing of antibiotics at each affiliate site. However, the clinical assessment of patients after antibiotic administration to provide early intervention for treatment of septic shock did not improve. Management of fluid status, oxygen therapy, and blood pressure support are critical for optimal outcome. The time from antibiotic administration to clinical assessment remained above the expected time of 15 minutes at an average of 60 minutes. To improve the post-antibiotic management, additional guidelines were established and monitored for compliance. Methods: Clinical guidelines were written. The guidelines included: patient assessed by nurse and vital signs checked within 15 minutes of arrival, patient assessed by a clinician within 30 minutes of arrival, antibiotic administrated within 60 minutes of arrival, nurse completed post-antibiotic assessment and vital signs rechecked within 15 minutes of administration, and clinician completed post antibiotic assessment within 30 minutes of administration. Results: After establishing guidelines, each site developed a process for implementation using a similar approach of automated order sets, time reminders, and staff education of the initial management of septic shock. Chart reviews were done at one year after implementation and all were in compliance. Conclusions: Clinical guidelines, automated order sets, and continued awareness and education in the management of immunocompromised children with febrile neutropenia improved compliance with this quality project. Continued monitoring is needed to ensure the results are sustained.
15
Asmar, Ghada, Dominique Cochelard, Jacques Mokhbat, Mohamed Lemdani, and Ahmed Haddadi. "Prophylactic and Therapeutic Antibiotic Patterns of Lebanese Dentists for the Management of Dentoalveolar Abscesses." Journal of Contemporary Dental Practice 17, no. 6 (2016): 425–33. http://dx.doi.org/10.5005/jp-journals-10024-1867.
Full textAbstract:
ABSTRACT Introduction General dentists issue approximately 10% of antibiotic prescriptions across the global medical community consummation. The use of antibiotics for the management of dentoalveolar infections should be considered only in the presence of an increased risk of a systemic involvement or to prevent metastatic infections. This study aimed to investigate the prophylactic and therapeutic antibiotic prescription patterns of Lebanese dentists for the management of dentoalveolar abscesses. The aim was to evaluate the influence of the patients’ medical condition and clinical signs data on the patterns of antibiotics prescription. Materials and methods Only patients with a dentoalveolar abscess were included in the study. Age, medical history, reason for consultation, clinical signs and symptoms, diagnosis, type of local treatment, and type of antibiotherapy were collected for each patient attending dental clinics in Beirut. The data were analyzed with chi-square test and multivariate regression. Results Out of the 563 initial patients, 127 were selected for the study and received a local treatment. The patient's medical condition and age did not affect the decision to prescribe antibiotics 36.2% patients with pain and 11.8% patients with swelling were prescribed antibiotics. Pain and swelling contributed to a higher level of antibiotic prescription compared to other signs and symptoms. Antibiotics were prescribed inappropriately to 51.76 and 38.10% among patients with an acute or chronic dentoalveolar abscess respectively. The main prescribed antibiotic was amoxicillin. Conclusion This study showed that dentists often did not follow the current prophylactic and therapeutic antibiotic prescription guidelines. Clinical significance Antibiotics prescriptions in dentistry will be more pertinent, leading to a decrease in inadequacy of prescriptions, microbial resistance, and the development of multiresistant germs against antibiotics. How to cite this article Asmar G, Cochelard D, Mokhbat J, Lemdani M, Haddadi A, Ayoub F. Prophylactic and Therapeutic Antibiotic Patterns of Lebanese Dentists for the Management of Dentoalveolar Abscesses. J Contemp Dent Pract 2016;17(6):425-433.
16
Ilieva, Nada, Milena Nikolova, Donka Pankov, Maja Simonoska Crcarevska, Kristina Mladenovska, Dushko Shalabalija, Ljubica Mihailova, Olga Gigopulu, and Marija Glavas Dodov. "Antibiotic consumption and management at Kocani General Hospital – Annual report." Macedonian Pharmaceutical Bulletin 65, no. 2 (2019): 11–21. http://dx.doi.org/10.33320/maced.pharm.bull.2019.65.02.002.
Full textAbstract:
The aim of the study was to get detailed insight into the antibiotic consumption trends in the three year period (2016-2018) in Kocani Hospital, to identify the most often prescribed antibiotics and to determine whether the treatment of given diagnosis was in accordance with the official guidelines. The survey covered all pediatric and infant patients admitted to the pediatric ward. Patients’ data included gender, age, diagnosis, antibiotic used and doses. The majority of admitted patients were in the age group of 0-1 (27.48%, 25.94% and 30.77% for 2016, 2017 and 2018, accordingly) followed by age group of 1-2 years (20.86%, 22,0% and 23.83% for 2016, 2017 and 2018, consequently) and 2-3 years (16.06%, 16.1% and 14.63% for 2016, 2017 and 2018, consequently) .The most frequent diagnosis was acute tonsillitis which was determined in ~21% of patients, pneumonia without complications in ~18% and acute bronchitis in ~16% of patients in the period 2016-2018. Results from conducted survey identified high prescription rate and use of antibiotics predominantly ceftriaxone (82.58%, 81.05% and 50.85% in 2016, 2017 and 2018, respectively) contrary to official recommendations and evidences based on clinical data for treatment of the diagnoses in question. So, it is foreseeable to conclude that there is urgent need for restrictive and educational measures i.e. to strength the surveillance and monitoring of antibiotic prescription and usage and hence to promote awareness for rational use of antibiotics on all health-care levels. Key words: antibiotic prescription, antibiotic consumption, pediatric wards, annual report
17
Giladi, A. M., S. Malay, and K. C. Chung. "A systematic review of the management of acute pyogenic flexor tenosynovitis." Journal of Hand Surgery (European Volume) 40, no. 7 (February 10, 2015): 720–28. http://dx.doi.org/10.1177/1753193415570248.
Full textAbstract:
Pyogenic flexor tenosynovitis (PFT) is an aggressive closed-space infection that can result in severe morbidity. Although surgical treatment of pyogenic flexor tenosynovitis has been widely described, the role of antibiotic therapy is inadequately understood. We conducted a literature review of studies reporting on acute pyogenic flexor tenosynovitis management. A total of 28 case series articles were obtained, all of which used surgical intervention with varied use of antibiotics. Inconsistencies among the studies limited summative statistical analysis. Our results showed that use of antibiotics as a component of therapy resulted in improved range of motion outcomes (54% excellent vs. 14% excellent), as did using catheter irrigation rather than open washout (71% excellent vs. 26% excellent). These studies showed benefits of early treatment of pyogenic flexor tenosynovitis and of systemic antibiotic use. As broad-spectrum antibiotics have changed the management of other infectious conditions, we must more closely evaluate consistent antibiotic use in pyogenic flexor tenosynovitis management. Level of Evidence: Therapeutic, Level III
18
Intravia, Jessica M., Meredith N. Osterman, and Rick Tosti. "Antibiotic Management and Antibiotic Resistance in Hand Infections." Hand Clinics 36, no. 3 (August 2020): 301–5. http://dx.doi.org/10.1016/j.hcl.2020.03.003.
Full text
19
Lee, Eugene, Jakrapun Pupaibool, and Laura Certain. "320. Does Guideline-Based Management of Diabetic Foot Osteomyelitis Reduce Risk of Further Proximal Amputations?" Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S232. http://dx.doi.org/10.1093/ofid/ofaa439.516.
Full textAbstract:
Abstract Background The antibiotic management of diabetic foot osteomyelitis involving surgical limb-sparing amputation is controversial. While there are several guidelines that provide recommendations regarding antibiotic therapy for diabetic foot osteomyelitis after amputation, we do not know of any studies that show that adherence to guidelines improves clinical outcomes. We assessed whether adherence to antibiotic choice and duration in accordance with our institution’s guidelines, which are based on IDSA guidelines, reduced risk of future amputations. Methods We conducted a retrospective cohort study of 110 patients with diabetic foot osteomyelitis treated with limb-sparing amputations at a VA hospital. We collected relevant clinical data such as patient comorbidities, antibiotic allergies, labs, imaging, culture data, histopathologic reports, pre-op and post-op antibiotics. We used our institutional guidelines, which are based on the 2012 IDSA Guidelines for the Diagnosis and Treatment of Diabetic Foot Infections, to assess antibiotic choice and duration for diabetic foot osteomyelitis therapy after amputation. We stratified cases as either adherent or non-adherent based on whether antibiotic choice and duration were both in accordance with our institutional guideline. For each case, we recorded the primary outcome of further proximal amputation occurring within six months or death from all causes within three months. Results We found a significant difference in primary outcomes between the groups that were treated with antibiotics adherent with guidelines and antibiotics non-adherent with guidelines. For patients who were treated with antibiotics that were non-adherent to guidelines, 15 of 36 (42%) patients needed further amputation or died. Of the patients treated according to guidelines, 12 of 74 (16%) patients needed further amputation or died. There was a statistically significant difference between these two groups (p=0.004). Conclusion Our study showed that guideline-based antibiotic therapy for diabetic foot osteomyelitis treated with amputation significantly lowered rates of further amputation compared to antibiotic therapies that were not adherent to guidelines. Disclosures All Authors: No reported disclosures
20
Udoh, Ekong E., and Martin M. Meremikwu. "Antibiotic prescriptions in the case management of acute watery diarrhea in under fives." International Journal of Contemporary Pediatrics 4, no. 3 (April 25, 2017): 691. http://dx.doi.org/10.18203/2349-3291.ijcp20171685.
Full textAbstract:
Background: Diarrhea disease is a leading cause of under-five mortality globally. The World Health Organization recommends low osmolality oral rehydration solution, zinc supplementation and adequate nutrition in the management. Antibiotic is indicated only in specific circumstances. This study was aimed at determining the antibiotic prescription in the management of under-fives with acute watery diarrhea.Methods: An audit of under-fives managed for acute watery diarrhea was conducted between January and February 2012. A multi-stage stratified random sampling technique was used to select 32 health facilities (21 primary and 11 secondary) from two local government areas of Cross River State. Case records of children managed for the condition six months prior to the audit were retrieved and evaluated. The appropriateness, types and frequency of antibiotic prescriptions were assessed.Results: A total of 370 case records were evaluated. Antibiotic was not indicated in any of the children but was prescribed for 291 (78.6%). Of this number, 169 (45.7%) received one antibiotic while 122 (33.0%) received two or more antibiotics. The difference in the prescription of multiple antibiotics between health workers in the primary and secondary facilities was statistically significant (p value = 0.00001). Metronidazole was the most prescribed antibiotic 228 (50.9%), followed by co-trimoxazole 88 (19.6%) and gentamicin 55 (11.8%).Conclusions: There is a high level of irrational antibiotic prescriptions in the State with oral metronidazole being the most prescribed. Periodic training of health workers on indications for antibiotic prescriptions in the management of diarrhea in under-fives is necessary.
21
Haworth, Charles S., and Roderigo Andres Floto. "Antibiotic Management in Bronchiectasis." Clinics in Chest Medicine 43, no. 1 (March 2022): 165–77. http://dx.doi.org/10.1016/j.ccm.2021.11.009.
Full text
22
OSBORNE, NEWTON G., and FERNANDO BONILLA-MUSOLES. "Pelvic Abscess: Antibiotic Management." Journal of Gynecologic Surgery 13, no. 3 (January 1997): 149–52. http://dx.doi.org/10.1089/gyn.1997.13.149.
Full text
23
OSBORNE, NEWTON G. "Mucopurulent Cervicitis: Antibiotic Management." Journal of Gynecologic Surgery 13, no. 4 (January 1997): 197–98. http://dx.doi.org/10.1089/gyn.1997.13.197.
Full text
24
Kim, Joo-Hee. "Diagnosis and Management of Antibiotic Allergies." Korean Journal of Medicine 96, no. 4 (August 1, 2021): 328–36. http://dx.doi.org/10.3904/kjm.2021.96.4.328.
Full textAbstract:
Drug allergies encompass a spectrum of immune-mediated hypersensitivity reactions with various mechanisms and clinical presentations. β-lactam drugs are common causes of drug allergies. A detailed clinical history as well as skin and drug provocation tests, are essential to diagnose drug allergies. The key to successful treatment is avoidance or discontinuation of the offending drug, and replacing it with a safe alternative. Cross-reactivities among β-lactam antibiotics should be considered when choosing alternative medications. Proper management of β-lactam allergies is important at the individual and population levels, to reduce the likelihood of drug allergies and prevent antibiotic-related adverse outcomes.
25
Zgliczyński, Wojciech Stefan, Jarosław Bartosiński, and Olga Maria Rostkowska. "Knowledge and Practice of Antibiotic Management and Prudent Prescribing among Polish Medical Doctors." International Journal of Environmental Research and Public Health 19, no. 6 (March 21, 2022): 3739. http://dx.doi.org/10.3390/ijerph19063739.
Full textAbstract:
Antimicrobial resistance (AMR) is an urgent public health issue. The role of medical doctors in proper antibiotic use is crucial. The aim of this study was to evaluate the knowledge and practices of Polish doctors of antimicrobial prescribing and antibiotic resistance. The study group consisted of 504 medical doctors with an average age 32.8 ± 5.9 years, mostly women (65%). The paper questionnaire was developed on the basis of a survey tool developed by the European Centre for Disease Prevention and Control (ECDC) and Public Health England (PHE). According to our study, physicians were aware that: taking antibiotics has side effects, antibiotics cannot be used against viruses, unnecessary use of antibiotics leads to AMR and that healthy people can carry resistant bacteria (each item ≥98% correct responses). Only 47% of respondents knew that the use of antibiotics as growth stimulants in livestock is illegal in the EU. Of the respondents, 98.61% saw the connection between prescribing antibiotics and AMR. However, 65.28% of the respondents reported a lack of appropriate materials on AMR counseling. Nearly 92.5% of participants “never” or “rarely” gave out resources on prudent antibiotic use. Physicians in Poland underestimate the role of hand hygiene in stimulating antibiotic resistance (ABR) (74.4%), while demonstrating satisfying knowledge about antimicrobial use, the clinical application of antimicrobial guidelines and prevention of ABR. However, educational interventions are needed to help lead challenging communication with assertive patients. Appropriate patient resources would be helpful in reaching this goal.
26
McIsaac, Warren J., Preeti Prakash, and Susan Ross. "The Management of Acute Uncomplicated Cystitis in Adult Women by Family Physicians in Canada." Canadian Journal of Infectious Diseases and Medical Microbiology 19, no. 4 (2008): 287–93. http://dx.doi.org/10.1155/2008/404939.
Full textAbstract:
INTRODUCTION: There are few Canadian studies that have assessed prescribing patterns and antibiotic preferences of physicians for acute uncomplicated cystitis. A cross-Canada study of adult women with symptoms of acute cystitis seen by primary care physicians was conducted to determine current management practices and first-line antibiotic choices.METHODS: A random sample of 2000 members of The College of Family Physicians of Canada were contacted in April 2002, and were asked to assess two women presenting with new urinary tract symptoms. Physicians completed a standardized checklist of symptoms and signs, indicated their diagnosis and antibiotics prescribed. A urine sample for culture was obtained.RESULTS: Of the 418 responding physicians, 246 (58.6%) completed the study and assessed 446 women between April 2002 and March 2003. Most women (412 of 420, for whom clinical information about antibiotic prescriptions was available) reported either frequency, urgency or painful urination. Physicians would have usually ordered a urine culture for 77.0% of the women (95% CI 72.7 to 80.8) and prescribed an antibiotic for 86.9% of the women (95% CI 83.3 to 90.0). The urine culture was negative for 32.8% of these prescriptions. The most commonly prescribed antibiotic was trimethoprim/sulfamethoxazole (40.8%; 95% CI 35.7 to 46.1), followed by fluoroquinolones (27.4%; 95% CI 22.9 to 32.3) and nitrofurantoin (26.6%; 95% CI 22.1 to 31.4).CONCLUSION: Empirical antibiotic prescribing is standard practice in the community, but is associated with high levels of unnecessary antibiotic use. While trimethoprim/sulfamethoxazole is the first-line empirical antibiotic choice, fluoroquinolone antibiotics have become the second most commonly prescribed empirical antibiotic for acute cystitis. The effect of current prescribing patterns on community levels of quinolone-resistantEscherichia colimay need to be monitored.
27
Mary Akpan, Richard, Emmanuel Imo Udoh, Samuel Emediong Akpan, and Chioma Cynthia Ozuluoha. "Community pharmacists’ management of self-limiting infections: a simulation study in Akwa Ibom State, South-South Nigeria." African Health Sciences 21, no. 2 (August 2, 2021): 576–84. http://dx.doi.org/10.4314/ahs.v21i2.12.
Full textAbstract:
Background: Inappropriate use of antibiotics, especially for treatment of self-limiting infections remains one of the major drivers of antibiotic resistance (ABR). Community pharmacists can contribute to reducing ABR by ensuring antibiotics are dispensed only when necessary.
Objective: To assess community pharmacists’ management of self-limiting infections.
Methods: A purposive sample of 75 pharmacies participated in the study. Each pharmacy was visited by an investigator and a trained simulated patient who mimicked symptoms of common cold and acute diarrhoea, respectively. Interactions between the simulated patient and pharmacist were recorded by the investigator in a data collection form after each visit. Descriptive statistical analysis was carried out. Ethics approval was obtained from the state Ministry of Health Research Ethics Committee.
Results: For common cold, 68% (51/75) of pharmacists recommended an antibiotic. Azithromycin, amoxicillin/clavulanic acid, and sulphamethoxazole/trimethoprim (43%, 24%, 20%, respectively) were the most frequently dispensed agents. For acute diarrhoea, 72% (54/75) of pharmacists dispensed one antibiotic, while 15% dispensed more than one antibiotic. The most frequently dispensed agent was metronidazole (82%), which was dispensed in addition to amoxicillin or tetracycline among pharmacists who dispensed more than one agent. In both infection scenarios, advice on dispensed antibiotics was ofered in 73% and 87% of the interactions, respectively.
Conclusion: This study shows high rate of inappropriate antibiotics dispensing among community pharmacists. There is need for improved awareness of antibiotic resistance through continuing education and training of community pharmacists. Furthermore, the inclusion of antibiotic resistance and stewardship in undergraduate pharmacy curriculum is needed.
Keywords: Antibiotics; pharmacists; common cold; acute diarrhoea; community pharmacy; patient simulation.
28
Cendron, Marc. "Antibiotic Prophylaxis in the Management of Vesicoureteral Reflux." Advances in Urology 2008 (2008): 1–6. http://dx.doi.org/10.1155/2008/825475.
Full textAbstract:
Antibiotic prophylaxis has been, since 1960s, one of the management options in treating vesicoureteral reflux. The purpose of this review article is to provide a concise overview of the rational for antiobiotic prophylaxis and to discuss the various agents used. Some of the current controversies regarding use of antibiotics for reflux will also be presented.
29
Ferdous, Jannatul, Sabbya Sachi, Zakaria Al Noman, S. M. Azizul Karim Hussani, Yousuf Ali Sarker, and Mahmudul Hasan Sikder. "Assessing farmers' perspective on antibiotic usage and management practices in small-scale layer farms of Mymensingh district, Bangladesh." Veterinary World 12, no. 9 (September 2019): 1441–47. http://dx.doi.org/10.14202/vetworld.2019.1441-1447.
Full textAbstract:
Background and Aim: Indiscriminate and injudicious use of antibiotics in layer farms is a common practice of Bangladesh for the compensation of Poor management practices and ignorance. Despite this scenario, there is no published documentation on antibiotic usage pattern and farm management practices in layer farms. This study was undertaken to understand the farmers' perspective in small-scale layer farms regarding antibiotics usage and farm management. Materials and Methods: A questionnaire survey was conducted in 120 small-scale layer farms of Mymensingh district during January-February 2017. We only considered farms in production. Data were analyzed on antibiotic usage, purpose, egg management, understanding of antibiotic residue, withdrawal period, and other issues. Results: Among 120 farmers, about 94.16% of farmers are using antibiotics without respecting the withdrawal period. Only 39.1% of farmers possess knowledge of residues. In our surveyed farms, 91.83% of farmers are not practicing egg washing before supplying to the market and 52.67% of farmers are unaware of cleaning and disinfection of egg tray. Ten different types of antibiotics of seven classes have found in the survey. Most antibiotics are in the Watch (49%) and Reserve (8%) groups according to the WHO AWaRe categorization and 73% antibiotics are critically important for human medicine and are considered as last resort. Conclusion: This study found that due to the lack of knowledge and poor management, farmers consider using antibiotics as the most effective practices to control disease and enhancement of egg production. These indiscriminate uses of antibiotics are responsible for antibiotic residual and resistance problem. Here, we also provide some suggestion and guidelines to improve management practices to minimize the emerging problems of antimicrobial resistance through small-scale layer farms.
30
Heal, Clare, Hilary Gorges, Mieke L. van Driel, Amanda Tapley, Josh Davis, Andrew Davey, L. Holliday, et al. "Antibiotic stewardship in skin infections: a cross-sectional analysis of early-career GP’s management of impetigo." BMJ Open 9, no. 10 (October 2019): e031527. http://dx.doi.org/10.1136/bmjopen-2019-031527.
Full textAbstract:
ObjectiveTo establish the prevalence and associations of systemic antibiotic prescription for impetigo by early-career general practitioners (GPs) (GP registrars in their first 18 months in general practice).DesignA cross-sectional analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) study.SettingReCEnT is an ongoing multisite cohort study of Australian registrars’ in-consultation clinical practice across five Australian states.ParticipantsRegistrars participating in ReCEnT from 2010 to 2017.Outcome measuresManagement of impetigo with systemic antibiotics.Results1741 registrars (response rate 96%) provided data from 384 731 problems identified in 246 434 consultations. Impetigo, on first presentation or follow-up, was managed in 930 (0.38%, 95% CI 0.35 to 0.40) consultations and comprised 0.24% (95% CI 0.23 to 0.26) of problems. 683 patients presented with a new diagnosis of impetigo of which 38/683 (5.6%) were not prescribed antibiotics; 239/683 (35.0%) were prescribed solely topical antibiotics; 306/683 (44.8%) solely systemic antibiotics and 100/683 (14.6%) both systemic and topical antibiotics. The most common systemic antibiotic prescribed was cephalexin (53.5%). Variables independently associated with prescription of systemic antibiotics were an inner regional (compared with major city) location (OR 1.82, 95% CI 1.06 to 3.13; p=0.028), seeking in-consultation information or advice (OR 2.17, 95% CI 1.47 to 3.23; p<0.001) and ordering pathology (OR 2.13, 95% CI 1.37 to 3.33; p=0.01).ConclusionsAustralian early-career GPs prescribe systemic antibiotics (the majority broad-spectrum) for a high proportion of initial impetigo presentations. Impetigo guidelines should clearly specify criteria for systemic antibiotic prescription and individual antibiotic choice. The role of non-antibiotic management and topical antiseptics needs to be explored further.
31
Schentag, Jerome J., Joseph A. Paladino, Mary C. Birmingham, Gabrial Zimmer, James R. Carr, and Stephen C. Hanson. "Use of Benchmarking Techniques to Justify the Evolution of Antibiotic Management Programs in Healthcare Systems." Journal of Pharmacy Technology 11, no. 5 (September 1995): 203–10. http://dx.doi.org/10.1177/875512259501100508.
Full textAbstract:
Objective: To apply basic benchmarking techniques to hospital antibiotic expenditures and clinical pharmacy personnel and their duties, to identify cost savings strategies for clinical pharmacy services. Design: Prospective survey of 18 hospitals ranging in size from 201 to 942 beds. Each was asked to provide antibiotic expenditures, an overview of their clinical pharmacy services, and to describe the duties of clinical pharmacists involved in antibiotic management activities. Specific information was sought on the use of pharmacokinetic dosing services, antibiotic streamlining, and oral switch in each of the hospitals. Results: Most smaller hospitals (<300 beds) did not employ clinical pharmacists with the specific duties of antibiotic management or streamlining. At these institutions, antibiotic management services consisted of formulary enforcement and aminoglycoside and/or vancomycin dosing services. The larger hospitals we surveyed employed clinical pharmacists designated as antibiotic management specialists, but their usual activities were aminoglycoside and/or vancomycin dosing services and formulary enforcement. In virtually all hospitals, the yearly expenses for antibiotics exceeded those of Millard Fillmore Hospitals by $2,000–3,000 per occupied bed. In a 500-bed hospital, this difference in expenditures would exceed $1.5 million yearly. Millard Fillmore Health System has similar types of patients, but employs clinical pharmacists to perform streamlining and/or switch functions at days 2–4, when cultures come back from the laboratory. Conclusions: The antibiotic streamlining and oral switch duties of clinical pharmacy specialists are associated with the majority of cost savings in hospital antibiotic management programs. The savings are considerable to the extent that most hospitals with 200–300 beds could readily cost-justify a full-time clinical pharmacist to perform these activities on a daily basis. Expenses of the program would be offset entirely by the reduction in the actual pharmacy expenditures on antibiotics.
32
Boccia, Giovanni, Federica Di Spirito, Francesco D’Ambrosio, Maria Pia Di Palo, Francesco Giordano, and Massimo Amato. "Local and Systemic Antibiotics in Peri-Implantitis Management: An Umbrella Review." Antibiotics 12, no. 1 (January 8, 2023): 114. http://dx.doi.org/10.3390/antibiotics12010114.
Full textAbstract:
The present umbrella review aimed to characterize the type and regimen of antibiotics administered locally and/or systemically, alone or in combination with surgical and nonsurgical treatments, for peri-implantitis and to evaluate and compare the associated clinical, radiographic, and crevicular peri-implant outcomes. The secondary objective was to determine the most effective antibiotic type, route of administration, regimen, and protocols (antibiotics alone or in combination with other approaches) for treating peri-implantitis. The study protocol, which was developed in advance under the PRISMA statement, was registered at PROSPERO (CRD42022373957). BioMed Central, Scopus, MEDLINE/PubMed, the Cochrane Library databases, and the PROSPERO registry were searched for systematic reviews through 15 November 2022. Of the 708 records found, seven reviews were included; three were judged of a critically low and four of low quality through the AMSTAR 2 tool. Locally administered antibiotics alone or as an adjunct to surgical or nonsurgical treatments for peri-implantitis showed favorable outcomes, albeit with limited evidence. The administration of systemically-delivered antibiotics in combination with nonsurgical or surgical treatments remained questionable. Local plus systemic antibiotics have not been shown to have durable efficacy. Due to the heterogeneity of reported antibiotic types, routes, regimens, and protocols, no definitive conclusions could be drawn regarding the most effective antibiotic use in treating peri-implantitis.
33
Foley, Kasey A., Erina L. MacGeorge, David L. Brinker, Yuwei Li, and Yanmengqian Zhou. "Health Providers’ Advising on Symptom Management for Upper Respiratory Tract Infections: Does Elaboration of Reasoning Influence Outcomes Relevant to Antibiotic Stewardship?" Journal of Language and Social Psychology 39, no. 3 (May 12, 2020): 349–74. http://dx.doi.org/10.1177/0261927x20912460.
Full textAbstract:
Antibiotic-resistant infections, fueled by unwarranted antibiotic prescribing, are an increasing threat to public health. Reducing overprescribing and promoting antibiotic stewardship requires managing patient expectations for and understanding about the utility of antibiotics. One hotspot for overprescribing is upper respiratory tract infections, for which the best treatment is often non-antibiotic symptom management behaviors. Guided by advice response theory, the current study examines how providers’ reason-giving for symptom management advice affected perceptions of advice quality, efficacy for symptom monitoring and management, and satisfaction with care for patients who were not prescribed antibiotics for their upper respiratory tract infections. Transcribed medical visits were coded for symptom management advice reason-giving and patients completed post-visit surveys. Greater provider elaboration about instruction was independently and positively associated with evaluations of advice quality. Results also indicate several significant interactions between types of reason-giving. Implications of these findings for advice theory and clinical practice are addressed in the discussion.
34
Carling, Philip, Teresa Fung, Ann Killion, Norma Terrin, and Michael Barza. "Favorable Impact of a Multidisciplinary Antibiotic Management Program Conducted During 7 Years." Infection Control & Hospital Epidemiology 24, no. 9 (September 2003): 699–706. http://dx.doi.org/10.1086/502278.
Full textAbstract:
AbstractObjective:To evaluate the impact of an interventional multidisciplinary antibiotic management program on expenditures for antibiotics and on the incidence of nosocomial infections caused by Clostridium difficile and antibiotic-resistant pathogens during 7 years.Design:Prospective study with comparison with preintervention trends.Setting:University-affiliated teaching hospital.Patients:All adult inpatients.Intervention:A multidisciplinary antibiotic management program to minimize the inappropriate use of third-generation cephalosporins was implemented in 1991. Its impact was evaluated prospectively. The incidence of nosocomial C. difficile and resistant Enterobacteriaceae infections as well as the rate of vancomycin-resistant enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) were compared with those of National Nosocomial Infections Surveillance System hospitals of similar size.Results:Following implementation of the program, there was a 22% decrease in the use of parenteral broad-spectrum antibiotics (P < .0001) despite a 15% increase in acuity of patient care during the following 7 years. Concomitantly, there was a significant (P= .002) decrease in nosocomial infections caused by C. difficile and a significant (P = .02) decrease in nosocomial infections caused by resistant Enterobacteriaceae. The program also appeared to have a favorable impact on VRE rates without a sustained impact on MRSA rates.Conclusion:These results suggest that an ongoing multidisciplinary antibiotic management program may have a sustained beneficial impact on both expenditures for antibiotics and the incidence of nosocomial infection by C. difficile and resistant bacterial pathogens.
35
Likopa, Zane, Anda Kivite-Urtane, and Jana Pavare. "Latvian Primary Care Management of Children with Acute Infections: Antibiotic-Prescribing Habits and Diagnostic Process Prior to Treatment." Medicina 57, no. 8 (August 17, 2021): 831. http://dx.doi.org/10.3390/medicina57080831.
Full textAbstract:
Background and Objectives: Primary care physicians frequently prescribe antibiotics for acutely ill children, even though they usually have self-limiting diseases of viral etiology. The aim of this research was to evaluate the routine antibiotic-prescribing habits of primary care in Latvia, in response to children presenting with infections. Materials and Methods: This cross-sectional study included acutely ill children who consulted eighty family physicians (FP) in Latvia, between November 2019 and May 2020. The data regarding patient demographics, diagnoses treated with antibiotics, the choice of antibiotics and the use of diagnostic tests were collected. Results: The study population comprised 2383 patients aged between one month and 17 years, presenting an acute infection episode, who had a face-to-face consultation with an FP. Overall, 29.2% of these patients received an antibiotic prescription. The diagnoses most often treated with antibiotics were otitis (45.8% of all antibiotic prescriptions), acute bronchitis (25.0%) and the common cold (14.8%). The most commonly prescribed antibiotics were amoxicillin (55.9% of prescriptions), amoxicillin/clavulanate (18.1%) and clarithromycin (11.8%). Diagnostic tests were carried out for 59.6% of children presenting with acute infections and preceded 66.4% of antibiotic prescriptions. Conclusion: Our data revealed that a high level of antibiotic prescribing for self-limiting viral infections in children continues to occur. The underuse of narrow-spectrum antibiotics and suboptimal use of diagnostic tests before treatment decision-making were also identified. To achieve a more rational use of antibiotics in primary care for children with a fever, professionals and parents need to be better educated on this subject, and diagnostic tests should be used more extensively, including the implementation of daily point-of-care testing.
36
Del Rosso DO, James. "Antibiotic Resistance Considerations of Importance to Clinical Dermatologists." SKIN The Journal of Cutaneous Medicine 1, no. 2 (August 31, 2017): 64. http://dx.doi.org/10.25251/10.25251/skin.1.2.2.
Full textAbstract:
Antibiotic resistance is a major health concern worldwide as the list of bacterial pathogens that are insensitive to available antibiotics continues to grow in both hospitals and outpatient communities. The slow development of newer antibiotics adds to the formidable challenge that clinicians face with treatment of infections caused by antibiotic-resistant bacteria. This article discusses important caveats related to antibiotic use in dermatology. These include understanding that both topical and oral antibiotics contribute to the emergence and spread of resistant bacteria, that antibiotic monotherapy is to be avoided for treatment of acne vulgaris, that effective treatment of rosacea does not require the use of an antibiotic, that antibiotic therapy in the management of atopic dermatitis is best limited to treatment of an active clinical infection, and that routine post-operative use of a topical antibiotic is not suggested after most office-based dermatologic procedures. By following principles of antibiotic stewardship, dermatologists are major players in the battle against antibiotic resistance.
37
Larsen, Jesper, Claire L. Raisen, Xiaoliang Ba, Nicholas J. Sadgrove, Guillermo F. Padilla-González, Monique S. J. Simmonds, Igor Loncaric, et al. "Emergence of methicillin resistance predates the clinical use of antibiotics." Nature 602, no. 7895 (January 5, 2022): 135–41. http://dx.doi.org/10.1038/s41586-021-04265-w.
Full textAbstract:
AbstractThe discovery of antibiotics more than 80 years ago has led to considerable improvements in human and animal health. Although antibiotic resistance in environmental bacteria is ancient, resistance in human pathogens is thought to be a modern phenomenon that is driven by the clinical use of antibiotics1. Here we show that particular lineages of methicillin-resistant Staphylococcus aureus—a notorious human pathogen—appeared in European hedgehogs in the pre-antibiotic era. Subsequently, these lineages spread within the local hedgehog populations and between hedgehogs and secondary hosts, including livestock and humans. We also demonstrate that the hedgehog dermatophyte Trichophyton erinacei produces two β-lactam antibiotics that provide a natural selective environment in which methicillin-resistant S. aureus isolates have an advantage over susceptible isolates. Together, these results suggest that methicillin resistance emerged in the pre-antibiotic era as a co-evolutionary adaptation of S. aureus to the colonization of dermatophyte-infected hedgehogs. The evolution of clinically relevant antibiotic-resistance genes in wild animals and the connectivity of natural, agricultural and human ecosystems demonstrate that the use of a One Health approach is critical for our understanding and management of antibiotic resistance, which is one of the biggest threats to global health, food security and development.
38
Islam, Mohammed Mansuri, Md Parwez Ahmad, Akhtar Alam Ansari, Tarannum Khatun, Mohammad Ashfaque Ansari, and Pramod Kumar Sarraf. "Acute Diarrhoea Management in Emergency; Influencing Antibiotic Prescribing Patterns." Med Phoenix 2, no. 1 (October 13, 2017): 12–17. http://dx.doi.org/10.3126/medphoenix.v2i1.18380.
Full textAbstract:
Background: Medical students are taught the internationally accepted approach to acute diarrhoea, viz. adequate fluid and electrolyte replacement is the fundamental management of acute diarrhoea. Antibiotics should be restricted to specific indications, such as acute dysentery. Despite the well known rationale, there has been a high rate of prescription of antibiotics for acute diarrhoea presenting to Emergency.Methods: The pre and post intervention data was collected in the following way. All Emergency case records were routinely scrutinized in the Dept of Family Medicine after discharge with the exception of cases that were admitted to the wards. All cases with a discharge diagnosis fitting the clinical criteria of acute diarrhoeal syndrome: diarrhoea, gastroenteritis, dysentery and cholera were separated, analysed and recorded sequentially.Results: Initially doctors were prescribing antibiotics for 52.8% of case of non-bloody diarrhoea. In the 2nd intervention period there were few cases, but it is remarkable how few were prescribed antibiotic (20%) while the survey of prescribing habits was underway. In the 3rd intervention period when an education event took place, it was the peak of the diarrhea season. Prescribing increased somewhat to 29%. In the 4th intervention a letter was sent out to the doctors describing the results so far, and pointing out the lower prescribing by “senior doctors”. The overall changes in prescribing behaviour after the educational interventions were statistically significant. The reduction in prescribing noted when comparing intervention 1 and intervention 4, is highly significant (antibiotic p < 0.0001, anti-protozoal p<0.0001). In the 5th intervention period when appropriate prescribing was no longer actively promoted, the rate of prescribing increased again to 41.4% of cases. A similar pattern is noted for antiprotozoal prescribing. The increase in prescribing noted in the 5th period was still less than in the 1st period (antibiotic p=0.041, anti-protozoal p=0.055). The increase in prescribing from periods 4 to 5 was significant. (Antibiotics p<0.0001, anti-protozoal p = 0.012).Med Phoenix Vol.2(1) July 2017, 12-17
39
Ahmed, Nehad, Mohamed Balaha, Abdul Haseeb, and Amer Khan. "Antibiotic Usage in Surgical Prophylaxis: A Retrospective Study in the Surgical Ward of a Governmental Hospital in Riyadh Region." Healthcare 10, no. 2 (February 18, 2022): 387. http://dx.doi.org/10.3390/healthcare10020387.
Full textAbstract:
Antibiotic prophylaxis is used to decrease the bacterial load in the wound to assist the natural host defenses in preventing the occurrence of surgical site infections. The present study aimed to investigate trends in using antibiotic prophylaxis in the surgical ward of a governmental hospital in the Riyadh Region and included collecting data concerning the use of antibiotic prophylaxis from medical electronic records. During 2020, most of the surgical patients received systemic antibiotics (82.40%). The most prescribed antibiotics were ceftriaxone (28.44%) and metronidazole (26.36%). The study also found that most of the patients received antibiotics for seven days or for five days, and only 1.08% of the patients received antibiotics appropriately for a maximum of one day. The present study showed that there was a major problem in selecting the correct antibiotic and in the duration of its use compared with the recommendations of the surgical prophylaxis guideline that was issued by the Saudi Ministry of Health. Thus, there is an urgent need to improve the adherence to the recommendations of surgical antibiotic prophylaxis guidelines in order to reduce the occurrence of negative consequences.
40
Scott, David M., John C. Rotschafer, and Fred Behrens. "Use of Vancomycin and Tobramycin Polymethylmethacrylate Impregnated Beads in the Management of Chronic Osteomyelitis." Drug Intelligence & Clinical Pharmacy 22, no. 6 (June 1988): 480–83. http://dx.doi.org/10.1177/106002808802200607.
Full textAbstract:
Over the past several years there has been a growing interest in the use of locally implanted beads containing antibiotics for the treatment of chronic osteomyelitis. This method has been popularized in Europe and, with few exceptions, gentamicin has been the only antibiotic used. There have been only a few reports from the U.S. and there is little information regarding the pharmacokinetics of antibiotics used in this fashion. To our knowledge this is the first report using vancomycin. Three patients with chronic osteomyelitis were treated with vancomycin and/or tobramycin polymethylmethacrylate beads. These beads were extemporaneously compounded and implanted for up to six weeks. From the site of bead implantation local fluid aliquots were collected for the measurement of antibiotic concentrations. In two patients, initial tobramycin concentrations exceeded 400 mg/L. In one patient receiving vancomycin, initial localized concentrations were approximately 100 mg/L. In all three patients therapeutic concentrations of localized antibiotic were maintained with immeasurable systemic concentrations throughout the period of bead placement. Localized antibiotic therapy for the management of chronic osteomyelitis represents a potential therapeutic alternative to long-term parenteral therapy. Data presented here suggest that other antibiotics, such as vancomycin and tobramycin, can be used successfully in polymethylmethacrylate beads and provide preliminary facts for future investigations of such applications.
41
Kaur, Amritpal, Rajan Bhagat, Navjot Kaur, Nusrat Shafiq, Vikas Gautam, Samir Malhotra, Vikas Suri, and Ashish Bhalla. "A study of antibiotic prescription pattern in patients referred to tertiary care center in Northern India." Therapeutic Advances in Infectious Disease 5, no. 4 (May 10, 2018): 63–68. http://dx.doi.org/10.1177/2049936118773216.
Full textAbstract:
Background: Tremendous infectious disease burden and rapid emergence of multidrug resistant pathogens continues to burden our healthcare system. Antibiotic stewardship program often implements antibiotic policies that help in preventing unnecessary use of antibiotics and in optimizing management. To develop such a policy for management of infections in the emergency unit, it is important to analyze the information regarding antibiotic prescription patterns in patients presenting to the emergency room referred from various healthcare settings. This study was conducted with the aforementioned background. Methods: We conducted a prospective observational study in triage area of emergency unit of a tertiary care hospital. All the referred patients were screened for antibiotic prescription. Data extraction form was used to capture information on patient demographics, diagnosis and antibiotics prescribed. Antibiotic prescription details with regard to dosage, duration and frequency of antimicrobial administration were also recorded. Data were summarized using descriptive statistics as appropriate. Results: Out of 517 screened patients, 300 were prescribed antimicrobials. Out of 29 antibiotics prescribed, 12 were prescribed in more than 90% of patients. Broad spectrum antibiotics accounted for 67.3% of prescriptions. In 129 out of 300 patients, no evidence of infectious etiology was found. Conclusion: Our study highlights some common but serious lapses in antibiotic prescription patterns in patients referred from various healthcare settings. This emphasizes the need to provide training for rational use of antibiotics across healthcare settings.
42
Karr, Jeffrey C. "Management in the Wound-care Center Outpatient Setting of a Diabetic Patient with Forefoot Osteomyelitis Using Cerament Bone Void Filler Impregnated with Vancomycin." Journal of the American Podiatric Medical Association 101, no. 3 (May 1, 2011): 259–64. http://dx.doi.org/10.7547/1010259.
Full textAbstract:
Several nonbiodegradable and biodegradable antibiotic cement delivery systems are available for the delivery of antibiotics for adjunctive therapy in the management of osteomyelitis. A major nonbiodegradable delivery system is polymethylmethacrylate beads. Antibiotics that can be incorporated into this delivery system are limited to the heat-stable antibiotics vancomycin and aminoglycosides, tobramycin being the most popular. Calcium sulfate and hydroxyapatite (Cerament Bone Void Filler) is a unique biocompatible and biodegradable ceramic bone void filler that can successfully deliver heat-stable and heat-unstable antibiotics in musculoskeletal infections. The use of Cerament as antibiotic beads has not been previously reported. An off-label case of diabetic foot osteomyelitis successfully managed with surgical bone resection and vancomycin Cerament antibiotic beads is presented. Subsequent surgery for the bone infection and staged removal of the antibiotic beads was not necessary. (J Am Podiatr Med Assoc 101(3): 259–264, 2011)
43
Stulberg, Eric, Alexander Zheutlin, Raymond Strobel, Katherine He, and Adelyn Beil. "2412 Cost effectiveness analysis of operative Versus antibiotic management for uncomplicated appendicitis." Journal of Clinical and Translational Science 2, S1 (June 2018): 79–80. http://dx.doi.org/10.1017/cts.2018.279.
Full textAbstract:
OBJECTIVES/SPECIFIC AIMS: (1) Evaluate the relative incremental cost-effectiveness [cost per quality-adjusted life year (QALY) gained] of antibiotics, laparotomy, and laparascopy for the initial treatment of uncomplicated appendicitis. (2) Detect if the relative incremental cost-effectiveness of each treatment differs by age, namely in pediatric patients, adult patients, and geriatric patients. (3) Use deterministic and probabilistic sensitivity analyses to assess the robustness of our findings when varying multiple model parameters. METHODS/STUDY POPULATION: Study Population and Analytic Approach: The population under analysis is a simulated population of those aged 1–90 diagnosed with uncomplicated appendicitis with computed tomography (CT) in the emergency department. Pregnant women and those younger than 1 year old were excluded from our analysis. We simulated our population through a Markov state-transition simulation model. Using this model, we estimated the lifelong costs and effects on QALYs from the use of antibiotics, laparoscopy, and laparotomy for a given hypothetical individual with uncomplicated appendicitis. This model allowed for the incorporation of both the short-term and long-term effects of each respective treatment option. The primary outcome of the model was the cost per additional QALY gained. The analysis was conducted using a healthcare perspective. A 100 age-year time horizon was used. A 3% discount rate was applied to both the costs and effects in the model. Transition states are depicted. Surgical state rates were derived from HCUP. Treatment failure of antibiotics was defined as recurrent appendicitis within one year of antibiotic treatment. This was determined using results from prior RCTs and a Cochrane review of antibiotic management for uncomplicated appendicitis. Recurrent appendicitis was defined as recurrent appendicitis after 1 year of antibiotic treatment, using rates of appendicitis applied to the general population by age group. National age-adjusted mortality rates were applied to account for death due to causes unrelated to appendicitis. To assess differential results by age, different acute and long-term outcome, cost, and state transition rates were applied to 3 age groups: a pediatric group (1–17 years old), an adult group (18–64 years old), and a geriatric group (65+ years old). As an individual progressed through the model until age 100, the respective parameters would change to adjust for the transitions between the 3 life stages. Outcomes After Appendicitis: Lifetime QALYs were incorporated throughout the study for short-term and long-term health states. There is limited availability of QALY data in the literature pertaining to the health states specific to appendicitis. Due to this limitation, however, calculated quality of life (QoL) indices for 2015 created by Wu et al. were utilized for this study. QALYs were subsequently derived by multiplying QoL by the appropriate duration of time spent in a respective health status. Transition rates between health states were abstracted from the existing literature. Costs: Direct medical costs were obtained from HCUP statistics from the 2014 fiscal year for all age groups in the nationwide network. This database contains all costs of care related to surgical appendicitis intervention, however it lacks costs associated with antibiotic-only management. To account for these costs, data was extracted from current available literature, and the resulting average was applied to our model. Sensitivity Analysis: One-way analyses by cost of procedure and effectiveness of antibiotic protocol were undertaken to account for regional variation in costs and improvements in antibiotic therapy, respectively. For cost of procedure sensitivity analysis, costs were varied by 1 standard deviation below and above the mean cost per treatment group per age. These costs were then compared to a designated reference group. Antibiotic sensitivity analysis was conducted by reducing the effectiveness of antibiotics from the maximum reported effectiveness down to 0, with the goal of obtaining a level of effectiveness at which antibiotics were no longer cost-effective. A probabilistic Monte-Carlo sensitivity analysis was then employed to determine the percent likelihood of each treatment arm being cost-effective at a level of $100,000 per additional QALY. The probabilistic sensitivity analysis was then repeated to determine the percent likelihood of each treatment arm being the dominant option, in that it lowers costs and adds QALYs. RESULTS/ANTICIPATED RESULTS: Our model examined the cost-effectiveness of 3 different treatment options for patients with acute uncomplicated appendicitis: laparoscopic appendectomy, laparotomy appendectomy, and an antibiotic regimen. We first examined the cost-effectiveness of each of these strategies in comparison to laparotomy. Laparoscopic appendectomy was shown to be superior to laparotomy in regards to costs and QALYs for patients ages 18 to 65+, while there was very little difference for patients ages 1–17. For those aged 1–17, laparoscopy had an additional cost of $90.00 with an associated gain of 0.1 QALYs compared with laparotomy. For those aged 18–64, laparoscopy had a net cost-savings of $3437.03 with an associated gain of 0.13 QALYs compared with laparotomy. For those aged 65+, laparoscopy had a net cost-savings of $5713.55 with an associated gain of 0.13 QALYs compared to laparotomy. Antibiotic management was superior to laparotomy as it relates to both costs and QALYs for all 3 age cohorts. For those aged 1–17, antibiotic management had a net cost-savings of $5972.55, with an associated gain of 0.6 QALYs compared with laparotomy. For those aged 18–64, antibiotic management had a net cost-savings of $6621.00 with an associated gain of 0.5 QALYs compared with laparotomy. For those aged 65+, antibiotic management had a net cost-savings of $11,953.00 with an associated gain of 0.21 QALYs compared with laparotomy. We then assessed the cost-effectiveness of antibiotics relative to laparoscopy. In all 3 age groups, antibiotics added QALYs and were cost-saving. For those aged 1–17, antibiotic management had a net cost-savings of $6062.55, with an associated gain of 0.6 QALYs compared with laparotomy. For those aged 18–64, antibiotic management had a net cost-savings of $3183.97 with an associated gain of 0.5 QALYs compared with laparotomy. For those aged 65+, antibiotic management had a net cost-savings of $6239.45 with an associated gain of 0.21 QALYs compared with laparotomy. Sensitivity Analysis: We first examined the effect of varying costs on our results. Costs for all interventions were varied by 1 standard deviation above and below the average costs used in our original model, yielding 3 cost estimate levels: high cost (1 standard deviation above), middle cost (average cost reported in model), low cost (1 standard deviation below). For all 3 cost estimate levels of antibiotics, antibiotics persistently dominated laparotomy for all 3 age groups. Laparoscopy dominated at all cost levels in age groups 18–64 and 65+ but had a positive ICER for both high and medium cost levels in the 1–17 age group. We then varied effectiveness (one minus the failure rate) of antibiotic treatment in each age group to assess at what level of effectiveness to antibiotics become dominant relative to laparotomy. In ages 1–17, antibiotic treatment became dominant at 43.8%; in ages 18–64, antibiotic treatment became dominant at 33%; and in ages 65+, there was no level of antibiotic effectiveness that did not result in this therapy being dominant over laparotomy. Probabilistic Monte-Carlo sensitivity analysis is pending, but we anticipate antibiotics having a high likelihood of being both cost-effective and dominant relative to the other 2 treatment options. DISCUSSION/SIGNIFICANCE OF IMPACT: We performed a cost-effective analysis comparing surgery versus antibiotic management for uncomplicated appendicitis. Our study found that antibiotic therapy was the dominant strategy in all age groups as it yielded lower costs and additional QALYs gained compared with laparotomy and laparoscopy. Appendicitis is the most common surgical emergencies worldwide, with a lifetime risk of 6.9% in females and 8.6% in males (Körner 1997). For over 100 years, open appendectomy had been the established treatment for appendicitis, but current management has evolved with the advent of laparoscopy and now growing use of antibiotics for treatment of appendicitis. There is growing interest in nonoperative management of uncomplicated appendicitis, given both an aging population that is increasingly frail and vulnerable to surgical complications and concerns over skyrocketing medical costs. Our model showed that antibiotic-only management was cost-effective in all age groups. This has important implications for management of appendicitis, where current management is to offer antibiotic-only management only in the “rare cases” where the patient is unfit for surgery or refuses surgery. Our data show that medical management of appendicitis not only is cheaper, but also provides more QALYs in all age groups. Our study has several limitations. First, we conducted our analysis under the assumption that all patients will be cured of appendicitis following surgical intervention. Some patients following appendectomy will develop symptoms of appendicitis and be diagnosed with “stump appendicitis,” which can occur in stumps as short as 0.5cm and can present as late as 50 years following initial surgery (Kanona, 2012). Additionally, any intraperitoneal surgery can lead to late complications such as small bowel obstruction from adhesions following surgery. Thus, our assumption that patients following appendectomy will return to the general population’s QALYs and mortality rate is not necessarily an accurate reflection of all clinical courses. However, the overwhelming majority of appendectomy patients recover fully post-surgery and we do not believe the above complications would significantly change our analysis. We also assumed that all patients with recurrent appendicitis following medical management would undergo surgery. However, patients who underwent nonoperative management at initial appendicitis may be more likely to be ineligible for surgery or refuse surgery during this second case of appendicitis. In addition, data were sparse for QALYs for the complications of open and laparoscopic surgery. We estimated these numbers from the EQ-5D, which while perhaps not accurate, we believe to be the best approximation given the available data. The next steps in evaluating the use of nonoperative management in uncomplicated appendicitis would be to validate the use of nonoperative management in elderly populations and to develop more accurate diagnostic criteria for uncomplicated Versus complicated appendicitis. Additionally, with increasing attention on antibiotic-resistant micro-organisms, policy decisions on the use of nonoperative management must also consider antibiotic stewardship. While one dose of perioperative antibiotics is indicated for appendectomy, treatment strategies from trial protocols for antibiotic-only management require significantly more antibiotics—some protocols require 1–3 days of IV antibiotics followed by up to 10 days of oral antibiotics. This study provides a cost-effectiveness analysis of treatment options for acute uncomplicated appendicitis among varying age groups. Our analysis demonstrates the benefit of antibiotics for initial therapy in the management of acute uncomplicated appendicitis. While the historic gold standard of laparotomy still is present as the first line treatment option in many physicians’ minds, new evidence indicates that the advancement of other methods, whether surgical via laparoscopic removal of the appendix or medical via improved antibiotic regimens, suggests better alternatives exist. Our study builds upon a growing body of literature supporting initial treatment of acute uncomplicated appendicitis with antibiotics, before surgical intervention.
44
Ramasamy, Roshan, Louise Willis, Seilesh Kadambari, Dominic F. Kelly, Paul T. Heath, Simon Nadel, Andrew J. Pollard, and Manish Sadarangani. "Management of suspected paediatric meningitis: a multicentre prospective cohort study." Archives of Disease in Childhood 103, no. 12 (February 7, 2018): 1114–18. http://dx.doi.org/10.1136/archdischild-2017-313913.
Full textAbstract:
ObjectiveTo quantify delays during management of children with suspected meningitis.DesignMulticentre prospective cohort study.SettingThree UK tertiary paediatric centres; June 2011–June 2012Patients388 children aged <16 years hospitalised with suspected meningitis or undergoing lumbar puncture (LP) during sepsis evaluation.Main outcome measuresTime of prehospital and in-hospital assessments, LP, antibiotic treatment and discharge; types of prehospital medical assessment and microbiological results. Data collected from hospital records and parental interview.Results220/388 (57%) children were seen by a medical professional prehospitalisation (143 by a general practitioner). Median times from initial hospital assessment to LP and antibiotic administration were 4.8 hours and 3.1 hours, respectively; 62% of children had their LP after antibiotic treatment. Median time to LP was shorter for children aged <3 months (3.0 hours) than those aged 3–23 months (6.2 hours, P<0.001) or age ≥2 years (20.3 hours, P<0.001). In meningitis of unknown cause, cerebrospinal fluid (CSF) PCR was performed for meningococcus in 7%, pneumococcus in 10% and enterovirus in 76%. When no pathogen was identified, hospital stay was longer if LP was performed after antibiotics (median 12.5 days vs 5.0 days, P=0.037).ConclusionsMost children had LP after antibiotics were administered, reducing yield from CSF culture, and PCRs were underused despite national recommendations. These deficiencies reduce the ability to exclude bacterial meningitis, increasing unnecessary hospital stay and antibiotic treatment.
45
Long, Michelle, Deepti N. Reddy, Salwa Akiki, Nicholas J. Barrowman, and Roger Zemek. "Paediatric acute lymphadenitis: Emergency department management and clinical course." Paediatrics & Child Health 25, no. 8 (September 21, 2019): 534–42. http://dx.doi.org/10.1093/pch/pxz125.
Full textAbstract:
Abstract Objectives To describe clinical characteristics and management of acute lymphadenitis and to identify risk factors for complications. Methods Health record review of children ≤17 years with acute lymphadenitis (≤2 weeks) in a tertiary paediatric emergency department (2009–2014); 10% of charts were reviewed by a blinded second reviewer. Multivariate logistic regression identified factors associated with intravenous antibiotic treatment, unplanned return visits warranting intervention, and surgical drainage. Results Of 1,023 health records, 567 participants with acute lymphadenitis were analyzed. The median age = 4 years (interquartile range [IQR]: 2 to 8 years), and median duration of symptoms = 1.0 day (IQR: 0.5 to 3.0 days). Cervical lymphadenitis was most common. Antibiotics were prescribed in 73.5% of initial visits; 86.9% of participants were discharged home. 29.0% received intravenous antibiotics, 19.3% had unplanned emergency department return visits, and 7.4% underwent surgical drainage. On multivariate analysis, factors associated with intravenous antibiotic use included history of fever (odds ratio [OR]=2.07, 95% confidence interval [CI]: 1.11 to 3.92), size (OR=1.74 per cm, 95% CI: 1.44 to 2.14), age (OR=0.84 per year, 95% CI: 0.76 to 0.92), and prior antibiotic use (OR=4.45, 95% CI: 2.03 to 9.88). The factors associated with unplanned return visit warranting intervention was size (OR=1.30 per cm, 95% CI: 1.06 to 1.59) and age (OR=0.89, 95% CI: 0.80 to 0.97). Factors associated with surgical drainage were age (OR=0.68 per year, 95% CI: 0.53 to 0.83) and size (OR=1.80 per cm, 95% CI: 1.41 to 2.36). Conclusions The vast majority of children with acute lymphadenitis were managed with outpatient oral antibiotics and did not require return emergency department visits or surgical drainage. Larger lymph node size and younger age were associated with increased intravenous antibiotic initiation, unplanned return visits warranting intervention and surgical drainage.
46
Moon, A., R. Veeratterapillay, M. Garthwaite, and C. Harding. "Urinary tract infection management – do the guidelines agree?" Journal of Clinical Urology 11, no. 2 (March 2018): 81–87. http://dx.doi.org/10.1177/2051415816681248.
Full textAbstract:
Urinary tract infection (UTI) is defined as the inflammatory response of the urothelium to bacterial invasion. UTI in adults is one of the most prevalent infectious diseases worldwide with a substantial financial burden on society. There is mounting concern surrounding the ongoing development of microbial resistance. In addition, the increasing resistance of organisms to broad-spectrum antibiotics is worrying. There is a continuing drive for antibiotic stewardship and more prudent prescribing of antimicrobial agents. There is currently no national UK guideline on the management of UTI in adults but the EAU, AUA and SIGN all have their separate recommendations. In this review, we discuss the existing guideline recommendations particularly relating to lower UTIs (cystitis and epididymo-orchitis), upper UTIs (pyelonephritis) and catheter-associated infections (due to their large healthcare burden). The aims are to identify common recommendations and assess how they may apply for the UK setting. This review has highlighted considerable differences in practice recommendations between the major UK, European and American guidelines. Discrepancy exists in the choice of antibiotics and for some types of infection, whether or not any guidance for treatment is offered. Antibiotic avoidance and prudent antibiotic prescribing will be key components of future strategies in reducing antimicrobial resistance.
47
James, Hector E., and John S. Bradley. "Management of complicated shunt infections: a clinical report." Journal of Neurosurgery: Pediatrics 1, no. 3 (March 2008): 223–28. http://dx.doi.org/10.3171/ped/2008/1/3/223.
Full textAbstract:
Object The authors present their experience with a protocol for the treatment of patients with complicated shunt infections. Methods Complicated shunt infections are defined for the purpose of this protocol as multiple compartment hydrocephalus, multiple organism shunt infection, severe peritonitis, or infections in other sites of the body. The initial treatment protocol for these patients was 3 weeks of intravenous antibiotic therapy and 2 weeks of twice daily intraventricular/intrashunt antibiotic therapy. Cerebrospinal fluid (CSF) cultures were monitored during therapy and obtained again 48 hours after completion. The shunt was completely replaced. Additionally, follow-up cultures were obtained in all patients 3–6 months after therapy was completed. Results A cure of the infection was achieved in all patients as defined by negative cultures obtained at completion of antibiotic therapy and in follow-up studies. The follow-up period was 2–11 years (mean 4.4 ± 2.5 years). The treatment protocol was modified in the patients treated after 1991, and 18 patients were treated with this modified treatment regime. In these patients, intraventricular antibiotics were administered only once daily for 14 days, and the CSF was cultured 24 hours after antibiotic therapy had been stopped instead of after 48 hours. The results were similar to those obtained with the initial protocol. Conclusions Based on their prospective nonrandomized series, the authors believe that patients with complicated shunt infections can be successfully treated with 2 weeks of intraventricular antibiotic therapy administered once daily, concurrent with 3 weeks of intravenous antibiotic therapy. This protocol reduces length of treatment and hospital stay, and avoids recurrence of infection.
48
McFall, Cory, Alexandra D. Beier, Kelsey Hayward, Emily C. Alberto, Randall S. Burd, Bethany J. Farr, David P. Mooney, et al. "Contemporary management of pediatric open skull fractures: a multicenter pediatric trauma center study." Journal of Neurosurgery: Pediatrics 27, no. 5 (May 2021): 533–37. http://dx.doi.org/10.3171/2020.10.peds20486.
Full textAbstract:
OBJECTIVE The authors sought to evaluate the contemporary management of pediatric open skull fractures and assess the impact of variations in antibiotic and operative management on the incidence of infectious complications. METHODS The records of children who presented from 2009 to 2017 to 6 pediatric trauma centers with an open calvarial skull fracture were reviewed. Data collected included mechanism and anatomical site of injury; presence and depth of fracture depression; antibiotic choice, route, and duration; operative management; and infectious complications. RESULTS Of the fractures among the 138 patients included in the study, 48.6% were frontal and 80.4% were depressed; 58.7% of patients underwent fragment elevation. The average duration of intravenous antibiotics was 4.6 (range 0–21) days. Only 53 patients (38.4%) received a single intravenous antibiotic for fewer than 4 days. and 56 (40.6%) received oral antibiotics for an average of 7.3 (range 1–20) days. Wounds were managed exclusively in the emergency department in 28.3% of patients. Two children had infectious complications, including a late-presenting hardware infection and a superficial wound infection. There were no cases of meningitis or intracranial abscess. Neither antibiotic spectrum or duration nor bedside irrigation was associated with the development of infection. CONCLUSIONS The incidence of infectious complications in this population of children with open skull fractures was low and was not associated with the antibiotic strategy or site of wound care. Most minimally contaminated open skull fractures are probably best managed with a short duration of a single antibiotic, and emergency department closure is appropriate unless there is significant contamination or fragment elevation is necessary.
49
Feldman, Charles, and Guy Richards. "Appropriate antibiotic management of bacterial lower respiratory tract infections." F1000Research 7 (July 23, 2018): 1121. http://dx.doi.org/10.12688/f1000research.14226.1.
Full textAbstract:
Lower respiratory tract infections are the leading cause of infectious disease deaths worldwide and are the fifth leading cause of death overall. This is despite conditions such as pneumococcal infections and influenza being largely preventable with the use of appropriate vaccines. The mainstay of treatment for the most important bacterial lower respiratory tract infections, namely acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and community-acquired pneumonia (CAP), is the use of antibiotics. Yet despite a number of recent publications, including clinical studies as well as several systematic literature reviews and meta-analyses, there is considerable ongoing controversy as to what the most appropriate antibiotics are for the empiric therapy of CAP in the different settings (outpatient, inpatient, and intensive care unit). Furthermore, in the case of AECOPD, there is a need for consideration of which of these exacerbations actually need antibiotic treatment. This article describes these issues and makes suggestions for appropriately managing these conditions, in the setting of the need for antimicrobial stewardship initiatives designed to slow current emerging rates of antibiotic resistance, while improving patient outcomes.
50
Zimmer, Andrea J., and Alison G. Freifeld. "Optimal Management of Neutropenic Fever in Patients With Cancer." Journal of Oncology Practice 15, no. 1 (January 2019): 19–24. http://dx.doi.org/10.1200/jop.18.00269.
Full textAbstract:
Febrile neutropenia remains an important complication of treatment with cytotoxic chemotherapy. It is often the first and sometimes the only sign or symptom of infection in this vulnerable patient population. Urgent and appropriate evaluation and treatment are imperative because delay in initiating appropriate antibiotic therapy may be life threatening. Selection of antibiotics should be based on the patient's symptoms, previous culture data, and institutional antibiograms. Ongoing therapy should be guided by culture and clinical data. Antimicrobial resistance is of great concern, particularly in this population, so careful attention to antibiotic selection and duration is needed.