For patients at high surgical risk, placement of a sonographically guided, percutaneous, transhepatic cholecystostomy drainage tube coupled with the administration of antibiotics may provide definitive therapy. [47] Results of studies suggest that most patients with acute acalculous cholecystitis can be treated with percutaneous drainage alone, [48, 49] but the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) guideline describes radiographically guided percutaneous cholecystostomy as a temporizing measure until the patient can undergo cholecystectomy. [41]
Azithromycin and fluoroquinolones (e.g., ciprofloxacin) are commonly used for treatment, but resistance to fluoroquinolones is common. Antimicrobial susceptibility testing can help guide appropriate therapy.
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Lane Library recently upgraded its Sanford Guide Web Edition subscription to include Stewardship Assist, an antimicrobial stewardship app. SHC antibiotic guidelines are now integrated with information on antimicrobial therapy, HIV/AIDS therapy, and hepatitis therapy into a single searchable website and mobile device app. With interactive calculators, algorithms, and tables, Sanford Guide can inform and support the clinical decision-making process and promote the optimal use of antibiotics.
Convenient access to the SHC antibiotic guidelines empowers SHC users to support the mission of the Stanford Antimicrobial Safety & Sustainability Program to improve patient outcomes and safety and promote the optimal use and sustainability of antimicrobials.
Investigators with Oregon Health and Science University surveyed 106 residents, 69% of them in internal medicine and the rest in family medicine (18%) and pediatrics (13%). The response rate was 87%. The respondents were asked questions about two prescribing vignettes, one involving post-appendectomy fever, chills, purulent drainage, and other symptoms and one involving recurrent urinary tract infection. Respondents were asked to identify pathogens to cover with antimicrobial therapy, name resources they would use for clinical decision-making, and recommend specific empiric antibiotics.
Android: Open your old Sanford Guide app/s, select "Account" from the drop-down menu, and then tap "Manage Subscriptions in Google Play." Then tap the "Cancel" button.If you have any questions about your subscription or need technical assistance, please contact Technical Support below.Technical Supporttechsupport@sanfordguide.com1-540-987-9480 Office Hours: Monday-Friday, 9am-5pm, US Eastern Time
In this context, the guide for the development of a program to rationalize the use of antimicrobials in hospitals, developed by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America, indicates the prospective audit of antibiotics with interaction, intervention and feedback to the physician who prescribed the drug as an important strategy to promote adequate use5.
The International Classification of Diseases (ICD) was the parameter used for the grouping of diagnoses. The therapeutic rationality of the prescribed medications was compared with treatment recommendations from an antimicrobial reference guide6 therapy, based on patient diagnosis.
The main indications for the use of antimicrobials were lower respiratory tract infections in 55 (41.0%), prophylaxis in 31 (23.1%), surgical therapy in 14 (10.4%) and upper airway diseases in 12 (8.9%) patients, totaling 83.4% of the causes. Prophylaxis was used in 12 (38.7%) orthopedic procedures, 10 (32.2%) surgical and 9 (29.0%) gynecological/obstetric procedures. Of the 64 patients for whom there was indication of microbiological examination, only 37 (57.5%) underwent the assessment. The clinical diagnosis was confirmed by the laboratory in 54 (40.3%) cases. Only 6 (4.5%) patients had acquired the infection in hospital environments, and it was possible to associate it with urinary catheter use in 89 (66.4%) cases.
When antibiotic prescriptions were confronted with the antimicrobial therapy guide suggestions6, it was observed that 100 (74.6%) of patients received the recommended treatment of choice. Monotherapy was prescribed in 110 (82.1%) cases; however, 20 (14.9%) patients received treatment adjustment regarding drug class. Of these, 7 cases (35.0%) were due to inadequate indication and in 13 (65.0%) the adjustment was made according to the cultures. It was observed that 4 (3.0%) patients had therapy indicated with disregard of the pharmacodynamics/kinetics of the drug. The medical infection control assessment was requested for 6.0% of the sample.
This study demonstrates that most hospitalizations occur due to complications of non-infectious chronic diseases. We found a antimicrobial drugs prescription frequency of 15.8%, lower than that expected and reported by Vlahovic-Palcevski et al.7, which ranged from 20% to 50% It was observed that the pediatric age group, as well as the population older than 50 years, had a higher indication for antimicrobial therapy, resulting from the immunological status and associated comorbidities. No significant difference was found between the use of these drugs between the genders. However, length of hospital stay was longer in the subgroup that used antimicrobials.
The prescription of antibiotics to treat respiratory tract infections and their use in surgical procedures is the main indication in the hospital environment. The practice of the prophylactic use is extensive, and it is observed in more than 90% of surgical procedures8. However, the success of surgical prophylaxis is directly related to compliance with the pre-established principles and indications9. In this context, it was observed that all patients taking prophylactic antibiotics had received the first-choice drug, according to the reference guide and the adopted audit program5. Monotherapy was used in most cases, being the antimicrobial control program goal. The antimicrobial association is related to false protection. The simultaneous use of drugs is recommended in specific situations, in order to increase the antimicrobial spectrum. However, when used inappropriately, it is associated with the risk of toxicity, resistant pathogen selection and increase in institutional costs10.
We emphasize the importance of developing programs that promote the rationalization of antibiotic therapy, influencing the decrease in hospital costs. Strategies depend directly on the care profile, investment in human and technological resources and the expertise of the team responsible for the program. The educational rationalization program implemented by the institution, coordinated by the infection control committee and supported by the institutional board can prioritize an effective strategy favoring antimicrobial consumption control and interventions with pro-active interventions with interaction, intervention and feedback to the prescribing physician5. The prospective audit reduces inappropriate antimicrobial use3. It is essential that the developed control activities be not understood as restrictive, but as responsible for the professional qualifications and must be conducted in an integrated manner with the other members of the clinical team 15,16.
Metronidazole has been used to provide coverage for anaerobic microorganisms in the treatment of aspiration pneumonia since the 1970s.1,2 Its exclusively anaerobic spectrum of activity provides a means to introduce or expand anti-anaerobic therapy of an existing empiric antimicrobial regimen. 3 Theoretical benefits of metronidazole include its low cost, availability as intravenous and oral formulations, generally mild adverse effect profile, and extremely low levels of resistance.4 Despite this, limited information is available to fully define its effect when added to empiric regimens for treatment of aspiration pneumonia.
Preferred antimicrobials for aspiration pneumonia discussed in the IDSA-ATS guidelines include clindamycin and -lactam/-lactamase inhibitors (ampicillin/sulbactam, amoxicillin/clavulanic acid, and piperacillin/tazobactam), while alternative antimicrobials include carbapenems.8 Recently, moxifloxacin also has been recommended as a treatment option because of its good in vitro activity against anaerobes and data from clinical trials demonstrating safety and efficacy similar to ampicillin/sulbactam.14
For over half a century, beta-blocker therapy has been an important component of cardiovascular disease management.1 Initially, this medication class was developed as a treatment for hypertension and angina.2 With continued study, beta-blocker prescribing expanded into other cardiovascular indications including acute myocardial infarction, tachyarrhythmias, and heart failure. Widespread utilization of beta-blocker therapy in patients with heart failure did not occur rapidly. Historically, heart failure was considered to be due to a decline in systolic function only; therefore, any medication with negative inotropic effects was contraindicated for use. This conventional wisdom changed with the publication of several large, randomized, placebo-controlled trials such as the Metoprolol in Dilated Cardiomyopathy (MDC), Metoprolol CR/XL Randomized Intervention Trial in Heart Failure (MERIT-HF), Cardiac Insufficiency Bisoprolol Studies (CIBIS I and II), and Carvedilol Prospective Randomized Cumulative Survival (COPERNICUS) studies.3-7 Results of these studies definitively proved that beta-blocker therapy decreases morbidity and mortality among symptomatic patients with class II through IV heart failure and reduced left ventricular ejection fraction.2 Current guidelines from both the American College of Cardiology and the Heart Failure Society of America recommend beta-blockers as an essential treatment for patients with current or prior symptoms of heart failure with reduced ejection fraction unless contraindications exist.8,9 589ccfa754
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