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1
Yau, Marina. A home intravenous antibiotic program for cystic fibrosis patients. London: Victoria Hospital, 1987.
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2
Milkovich, Natalie Christine. An economic evaluation of hospital-based and home-based intravenous antibiotic therapy for individuals with cellulitis. Ottawa: National Library of Canada, 2002.
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3
Gilchrist, Francis J., and Alex Horsley. Management of respiratory exacerbations. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780198702948.003.0005.
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Cystic fibrosis lung disease is characterized by chronic infection, inflammation and a progressive loss of lung function. Patients are also affected by recurrent episodes of increased respiratory symptoms, called exacerbations which have a detrimental effect on quality of life, the rate of lung function decline, and mortality. Early diagnosis and treatment is vital. Diagnosis relies on a combination of symptoms, examination findings, the results of laboratory tests, and lung function. Antibiotics are the mainstay of treatment but airway clearance, nutrition, and glucose homeostasis must also be optimized. Mild exacerbations are usually treated with oral antibiotics and more severe exacerbations with intravenous antibiotics. The choice of antibiotic is guided by the patient’s chronic pulmonary infections, the in-vitro antibiotic sensitivities, known antibiotic allergies, and the previous response to treatment. In patients with chronic Pseudomonas aeruginosa infection, antibiotic monotherapy is thought to increase the risk of resistance and treatment with 2 antibiotics is therefore suggested (usually a β-lactam and an aminoglycoside). Although there is a lack of evidence on the duration of treatment, most patients receive around 14 days. This can be altered according to the time taken for symptoms and lung function to return to pre-exacerbation levels. If patients are carefully selected and receive appropriate monitoring, home intravenous antibiotics can be as effective as in-patient treatment. They are also associated with decreased disruption to patients / family life, decreased risk of cross infection and decreased costs.
4
Gertz, Alida. Tularemia. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199976805.003.0067.
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Tularemia, caused by the gram-negative coccobacillus Francisella tularensis, is an extremely infectious bacterial zoonosis. Symptoms depend on site of exposure; they can be nonspecific and may include fever, lymphadenopathy, ulcer or papule, and nausea/vomiting. Natural transmission occurs via small mammals, such as rabbits, or arthropod bites. IV or IM antibiotics are preferred over oral forms. Supportive care is also critical; some patients may require respiratory support. If used as a biological weapon, aerosolized F. tularensis would be the most likely route of transmission. Clinical symptoms would include those of pneumonic tularemia. In the event of a bioterrorist attack, oral administration antibiotics can be used, as the health care system may not be able to accommodate intravenous or intramuscular treatment. Antibiotic resistance should also be considered if patients deteriorate despite use of recommended antibiotics.
5
Saha, Sudip. Septic Thrombophlebitis. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199976805.003.0021.
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Septic (suppurative) thrombophlebitis is venous thrombosis in the setting of bacteremia. There is usually a degree of perivascular inflammation seen on histology. Septic thrombophlebitis occurs most commonly with intravenous catheters. However, most cases of infection related to intravenous catheters are not complicated by septic thrombophlebitis. Catheter-related septic thrombophlebitis includes erythema, tenderness, and/or drainage at the site of an intravenous catheter. Jugular vein septic thrombophlebitis, also known as Lemierre’s syndrome, is a subset of septic thrombophlebitis. This condition can affect otherwise young, healthy adults and is often preceded by pharyngitis with tonsillar and peritonsillar involvement, dental infections, or infectious mononucleosis. Presentation of jugular vein septic thrombophlebitis includes high fevers, rigors, respiratory distress, ulceration or erythema of the oropharynx, and tenderness and swelling of the neck. Primary treatment of thrombophlebitis includes removal of infected materials, intravenous antibiotics, and possible anticoagulation.
6
Sevransky, Jon. Management of sepsis in the critically ill. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0296.
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Sepsis is triggered by an infection, and treatment of sepsis requires timely identification of the patient, and rapid treatment with antibiotics, source control, and fluids. The site of infection, patient’s phenotype, and location of the patient will help drive decisions about initial antibiotic therapy. Patients with sepsis should be treated to ensure adequate cardiac output and organ perfusion, which usually requires infusion of intravenous fluids. In addition to haemodynamic and fluid support, some patients require infection source control. Many sepsis patients require additional supportive therapy with vasoactive agents, mechanical ventilation, renal replacement therapy, and nutritional therapy.. When using these supportive therapies, the clinician should attempt to minimize the complications of the therapies, including withdrawal of therapies that are no longer necessary.. Patients who do not respond to initial therapy should be evaluated for resistant organisms, persistent sources, or alternate diagnoses.
7
P, Davey, and Clinical Resource and Audit Group., eds. Audit of intravenous antibiotic administration. (Edinburgh): Scottish Office, 1992.
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8
McGregor, Laura, Monica N. Gupta, and Max Field. Septic arthritis in adults. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199642489.003.0098.
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Septic arthritis (SA) is a medical emergency with mortality of around 15%. Presentation is usually monoarticular but in more than 10% SA affects two or more joints. Symptoms include rapid-onset joint inflammation with systemic inflammatory responses but fever and leucocytosis may be absent at presentation. Treatment according to British Society of Rheumatology/British Orthopaedic Association (BSR/BOA) guidelines should be commenced if there is a suspicion of SA. At-risk patients include those with primary joint disease, previous SA, recent intra-articular surgery, exogenous sources of infection (leg ulceration, respiratory and urinary tract), and immunosupression because of medical disorders, intravenous drug use or therapy including tumour necrosis factor (TNF) inhibitors. Synovial fluid should be examined for organisms and crystals with repeat aspiration as required. Most SA results from haematogenous spread-sources of infection should be sought and blood and appropriate cultures taken prior to antibiotic treatment. Causative organisms include staphylococcus (including meticillin-resistant Staphylococcus aureus, MRSA), streptococcus, and Gram-negative organisms (in elderly patients), but no organism is identified in 43%, often after antibiotic use before diagnosis. Antibiotics should be prescribed according to local protocols, but BSR/BOA guidelines suggest initial intravenous and subsequent oral therapy. Medical treatment may be as effective as surgical in uncomplicated native SA, and can be cost-effective, but orthopaedic advice should be sought if necessary and always in cases of infected joint prostheses. In addition to high mortality, around 40% of survivors following SA develop limitation of joint function. Guidelines provide physicians with treatment advice aiming to limit mortality and morbidity and assist future research.
9
Spevetz, Antoinette, and Joseph E. Parrillo. Diagnosis and management of shock in the ICU. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0150.
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Sepsis is triggered by an infection and treatment of sepsis requires timely identification of the patient, and rapid treatment with antibiotics, source control, and fluids. In the absence of a true biomarker for sepsis, the clinician needs to recognize which patients are at risk, as well as the common signs and symptoms of infection. The site of infection, the patient’s phenotype, and the location of the patient will help drive decisions about initial antibiotic therapy. Patients with sepsis should be treated to ensure adequate cardiac output and organ perfusion, which usually requires infusion of intravenous fluids. Crystalloid fluids are most frequently infused, and patients will often require large doses in the first 6–24 hours of treatment. In addition to haemodynamic and fluid support, some patients require infection source control. Many sepsis patients require additional supportive therapy with vasoactive agents, mechanical ventilation, renal replacement therapy, and nutritional therapy. The use of these supportive therapies allows for a patients host defence system to work in conjunction with antibiotics to fight off the infection. When using these supportive therapies, the clinician should attempt to minimize the complications of the therapies and the causative infection. Once a patient starts to clinically improve, it is essential that therapies that are no longer necessary are withdrawn. Patients who do not respond to initial therapy should be evaluated for either resistant organisms, persistent sources, or alternate diagnoses.
10
Wijdicks, Eelco F. M., and Sarah L. Clark. Drugs Used to Prevent Complications. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190684747.003.0017.
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Comprehensive neurosciences nursing care goes far in providing optimal support, but the acute immobilization and anticipated prolonged bed rest requires the use of prophylactic drugs. Many options relate to failure to move limbs, failure to breathe adequately and placement of intravenous catheters This chapter covers the more critical preventive measures.Prevention of deep venous thrombosis, hyperglycemia, stress ulcers, ventilator-associated pneumonia, urinary tract infections, vascular access infections, ventriculitis, and post-craniotomy infections are discussed in this chapter. Pharmacists assist in effective stewardship and surveillance of critically ill patients by helping select the appropriate antibiotics, determining the need for drug levels, and initiating or stopping preventative medications.
11
Mallows, Vaughan. Implementation of an intravenous to oral antibiotic stepdown program. 1993.
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12
Dillon, Carla. A pharmacist initiated sequential intravenous to oral antibiotic therapy. 1999.
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13
Scordino, David. Infectious Colitis. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199976805.003.0031.
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Infectious colitis is diarrhea with evidence of colonic inflammation by visualization (colonoscopy), history (blood or mucus in the stool), or laboratory evidence (high lactoferrin). Infectious colitis is associated with direct bacterial or indirect bacterial toxin invasion of the colonic mucosa, leading to toxicity, volume loss, hemorrhage, and colonic inflammation. The most important treatment is adequate hydration, but treatment also may include loperamide (useful in patients without fever or bloody stools) and antibiotics in individuals with evidence of colitis (although not for mild to moderate diarrhea without colitis). In any individual with diarrhea, address recent travel history, possible immunosuppression, the presence of blood or mucus in the stool, and any history of vomiting or severe abdominal pain. Therapy should be focused on maintaining adequate hydration and not missing potentially dangerous etiologies. Intravenous hydration can be used for those with moderate to severe dehydration with supplemental oral hydration solutions if discharge is possible.
14
Zanchetta, Cristina. An antibiotic intravenous to oral stepdown program: a preliminary study. 1993.
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15
Beattie, R. Mark, Anil Dhawan, and John W.L. Puntis. Necrotizing enterocolitis. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780198569862.003.0005.
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Necrotizing enterocolitis 46Necrotizing enterocolitis (NEC) is the most common gastroenterological emergency in the neonatal intensive care unit (NICU) and the major cause of death for all newborns undergoing surgery. The mortality is greater than that from all the congenital disorders of the gastrointestinal tract combined. Survivors may be left with short-bowel syndrome as well as other long-term gastrointestinal, growth and neurodevelopmental sequelae. NEC frequently presents as feed intolerance with bile-stained gastric residuals, abdominal distension, blood in the stools, apnoea, and acidosis. It may develop insidiously, or be a rapidly progressive illness culminating in shock followed by death. The characteristic finding on abdominal radiograph is intramural gas (pneumatosis), produced by bacteria that have invaded the bowel wall. Other radiographic findings include portal gas, persistently dilated loops of bowel and pneumoperitoneum. Immediate management involves stopping enteral feeding, and giving intravenous fluids with broad-spectrum antibiotics. Blood and platelet transfusion may be required. Hypotheses regarding aetiology include the possibility that enteric bacteria ferment maldigested carbohyhdrate creating an acidic intraluminal environment that adversely affects mucosal blood flow. Immaturity of gastrointestinal motor function, digestion, immunity, and circulation are all implicated in the pathogenesis....
16
Seow, Sharon Mei Leen. Levofloxacin use in hospitalized patients with community acquired pneumonia: impact on the use and duration of intravenous antibiotic. 2001.
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17
Sukhtankar, Priya, Julia Clark, and Saul N. Faust. Bone and joint infections in children. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199642489.003.0099.
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Bone and joint infections in children are uncommon, but they affect all ages and there is a wide range of disease. The mode of infection may be haematogenous or by direct inoculation from a wound. The child may present acutely unwell or with a chronic infection. Clinical features include fever, reluctance to move the affected limb, pain, and swelling. Laboratory tests and medical imaging are used to confirm diagnosis. Medical treatment is with initial intravenous antibiotic therapy, usually followed by oral treatment. Surgical treatment may be necessary if abscess or joint collection is present. In general prognosis is good with timely initiation of treatment, although complications such as pathological fracture are occasionally seen.
18
Donaghy, Michael. Focal peripheral neuropathy. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780198569381.003.0487.
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Some causes of focal peripheral nerve damage are self-evident, such as involvement at sites of trauma, tissue necrosis, infiltration by tumour, or damage by radiotherapy. Focal compressive and entrapment neuropathies are particularly valuable to identify in civilian practice, since recovery may follow relief of the compression. Leprosy is a common global cause of focal neuropathy, which involves prominent loss of pain sensation with secondary acromutilation, and requires early antibiotic treatment. Mononeuritis multiplex due to vasculitis requires prompt diagnosis and immunosuppressive treatment to limit the severity and extent of peripheral nerve damage. Various other medical conditions, both inherited and acquired, can present with focal neuropathy rather than polyneuropathy, the most common of which are diabetes mellitus and hereditary liability to pressure palsies. A purely motor focal presentation should raise the question of multifocal motor neuropathy with conduction block, which usually responds well to high-dose intravenous immunoglobulin infusions.
19
Grisoli, Dominique, and Didier Raoult. Prevention and treatment of endocarditis. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0161.
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Initially always lethal, the prognosis of infective endocarditis (IE) has been revolutionized by antibacterial therapy and valve surgery. Nevertheless, it remains one of the deadliest infectious diseases, with ≥30% of patients dying within a year of diagnosis. Its incidence has also remained stable at 25–50 cases per million per year, and results predominantly from a combination of bacteraemia and a predisposing cardiac condition, including endocardial lesions and/or intracardiac foreign material. While antibiotic prophylaxis is recommended by various learned societies to cover healthcare procedures with the potential of causing bacteraemia in at-risk patients, there is no evidence to support this strategy. Even though the benefits are hypothetical, national guidelines should still be followed to avoid medico-legal issues. General preventive measures, such as education of clinicians and at-risk patients appear to be more crucial. Invasive procedures, especially intravenous catheterization, should be kept to the minimum possible. The severity of IE mandates a multidisciplinary and standardized approach to treatment, with involvement of dedicated surgeons within specialist centres. Standardized antibiotic protocols have produced dramatic reductions in hospital and 1-year mortality in reference centres. Most deaths now result from complications that constitute definite surgical indications, so optimization of surgical management and avoidance of delay will clearly improve prognosis. This disease has now entered an ‘early surgery’ era, with a more aggressive surgical approach showing promising results. Conditions such as septic shock, sudden death, and vancomycin-resistant staphylococcal endocarditis still constitute therapeutic and research challenges, and justify an important role for specialist centres.