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EpiPen in leg
Published in Alisa McQueen, S. Margaret Paik, Pediatric Emergency Medicine: Illustrated Clinical Cases, 2018
All of these suggestions are to create a more controlled environment so that there is a lower risk of injury and bent or embedded needles. In the case of embedded needles, the bone usually heals well and there are no complications. The most severe complication from this situation would be osteomyelitis. If the needle penetrates a digit, other concerns can be whitlow and impaired nail growth (if the needle goes through the nail bed). In a case study, amoxicillin-clavulanic acid was prescribed as a prophylactic antibiotic.
Amoxicillin–Clavulanic Acid
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Amoxicillin–clavulanic acid is a combination product consisting of the semisynthetic antibiotic amoxicillin with the beta-lactamase-inhibitor clavulanic acid as a potassium salt. Clavulanic acid is a naturally occurring beta-lactamase inhibitor isolated from Streptomyces clavuligerus (Brown et al., 1976; Reading and Cole, 1977; see Chapter 13, Beta-Lactamase inhibitors). It contains a beta-lactam ring, and the sulfur of the penicillin thiazolidine ring is replaced with oxygen to form an oxazolidine ring (see Figure 14.1). Clavulanic acid has weak intrinsic beta-lactam activity, but its clinical utility relates to its potent inhibition of many beta-lactamases (Reading et al., 1983) and its ability to protect substrate drugs from hydrolysis (Bush, 1988). The molecular formula of clavulanic acid is C8H8KNO5. Chemically, clavulanate potassium is potassium –(2R,5R)-3-(2-hydroxyethylidine)-7-oxo-4-oxa-1-azabicyclo[3.2.0]-heptane-2-carboxylate and has a molecular weight of 237.25.
Safety of treating acute liver injury and failure
Published in Expert Opinion on Drug Safety, 2022
Miren García-Cortés, Aida Ortega-Alonso, Raúl J. Andrade
Although an increased risk of DILI in patients with ALI or ALF has not been proved, the development of such complication could be fatal in patients with impaired liver function. The incidence and risk of antibiotic-related DILI is variable. Among currently available antimicrobials, amoxicillin/clavulanic acid, co-trimoxazole, and flucloxacillin appear as the most frequently involved drugs [58]. Amoxicillin/clavulanic acid is the drug most frequently implicated in the hepatic reactions reported to the Spanish DILI Registry and in the DILI network in the United States [59,60]. Thus, caution is recommended when this antibiotic is used in patients with liver disease. Apparently, macrolides, tetracyclines, or fluoroquinolones have a lower rate of liver toxicity. Exceptions to the latter are trovafloxacin, a quinolone withdrawn from the market, and telithromycin, a macrolide with restrictions due to liver toxicity [58].
Appropriateness of empirical antibiotic therapy and added value of adjunctive gentamicin in patients with septic shock: a prospective cohort study in the ICU
Published in Infectious Diseases, 2021
Rob G. H. Driessen, Rald V. M. Groven, Johan van Koll, Guy J. Oudhuis, Dirk Posthouwer, Iwan C. C. van der Horst, Dennis C. J. J. Bergmans, Ronny M. Schnabel
Patients receiving gentamicin were more often treated with amoxicillin/clavulanic acid than patients receiving monotherapy in this study (44 vs 24%, p = .002). We believe this can be explained by the fact that in the gentamicin group, more patients are admitted directly from the emergency department (40 vs 21%). Amoxicillin/clavulanic acid is the first choice antibiotic therapy for patients admitted from out-of-hospital according to the antibiotic treatment protocol in our centre. Although more patients in the monotherapy group received meropenem, this difference was not statistically different between both groups (10 vs 5%, p = .175). The fact that less patients in the combination group received broad spectrum antibiotics, could also be explained as an advantage of gentamicin combination therapies.
Unilateral granulomatous mastitis in a pregnant woman as a first manifestation of sarcoidosis
Published in Scandinavian Journal of Rheumatology, 2021
A Aldea-Parés, AS Alves, C Vasconcelo Barros, MT Boncoraglio, MJ Redondo-Urda, E Sanfeliu, S Prieto-González, G Espinosa
A 34-year-old woman, 24 weeks pregnant, with no previous medical history presented an indurated, red, and painful plaque on her left breast. Oral treatment with amoxicillin/clavulanic acid was prescribed. Two weeks later, despite antibiotic therapy, the inflammatory signs worsened and she was admitted to the hospital. Breast ultrasound revealed a hypoechoic and heterogeneous area. The patient received different oral and intravenous antibiotics and two surgical drainages were performed, without microbiological isolation or clinical improvement. Afterwards, she developed tender nodules on her extremities and painless left red eye, with no vision disturbance. With the suspicion of a systemic inflammatory disease, the patient was finally transferred to our Autoimmune Diseases Department.