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Acinetobacter Infections — Overview of Clinical Features
Published in E. Bergogne-Bénézin, M.L. Joly-Guillou, K.J. Towner, Acinetobacter, 2020
Itzchak Levi, Ethan Rubinstein
Appropriate antimicrobial treatment of community-acquired pneumonia includes an aminoglycoside, an extended spectrum penicillin or third-generation cephalosporin, or imipenem. If the differential microbiological diagnosis includes Acinetobacter as a possible pathogen, either because of an underlying disorder or the presence of the patient in a high-risk area, then appropriate antibiotic therapy should be started pending laboratory results. Subsequent treatment can be tailored according to the results of sensitivity tests.
Oncological emergencies
Published in Peter Hoskin, Peter Ostler, Clinical Oncology, 2020
Intravenous antibiotics should be instigated as a matter of urgency – a target of administration of intravenous antibiotic within 1 hour of a patient presenting with symptoms is a recognized standard. The results of cultures should not be awaited as life-threatening septicaemia can develop if there is any delay. The precise antibiotic combination to be used will be guided by individual hospital antibiotic policies but will take the form of broad-spectrum cover against both Gram-negative and -positive organisms. Typical combinations are an aminoglycoside with an extended spectrum penicillin, e.g. gentamicin or amikacin and carbenicillin, ticarcillin or piperacillin. Alternatively, a single-agent cephalosporin, such as ceftazidime or cefotaxime, can be used. If the fever does not settle after 48 hours and there have been no positive results from culture, then it might be necessary to add metronidazole for anaerobic organisms or amphotericin for fungi. If there is clinical evidence for Pneumocystis then treatment with high-dose co-trimoxazole will be required.
Genital injuries in children and adolescents
Published in Joseph S. Sanfilippo, Eduardo Lara-Torre, Veronica Gomez-Lobo, Sanfilippo's Textbook of Pediatric and Adolescent GynecologySecond Edition, 2019
Bindu N. Patel, Diane F. Merritt
Initial management of all types of bite injuries involves extensive irrigation and debridement. Whether to repair a wound with primary closure or to allow healing by secondary intent is controversial and depends on the type of bite. Old literature regarding management of animal bites speaks of delayed closure or healing by secondary intent due to concerns about infection. However, some recent guidelines now advocate primary definitive repair of injuries, because rates of infection can be higher with delayed closure.2 Antibiotic prophylaxis should be given for large wounds and hematomas; puncture wounds; cat and human bites (which are at higher risk of infection than dog bites); bites older than 6 hours; and bites in babies, infants, and immunocompromised patients. Prophylaxis in such cases is a combination of extended-spectrum penicillin with β-lactamase inhibitors for 5–7 days.2 Furthermore, evaluation for tetanus and rabies immunization should be performed as appropriate. Patients with simple scrapes and abrasions are unlikely to benefit from antibiotic treatment.
Encouraging rational antibiotic prescribing behaviour in primary care – prescribing practice among children aged 0–4 years 2016–2018: an observational study
Published in Scandinavian Journal of Primary Health Care, 2021
Maria Run Gunnlaugsdottir, Kristjan Linnet, Jon Steinar Jonsson, Anna Bryndis Blondal
The children’s antibiotic prescriptions were classified into 11 ATC groups. Extended-spectrum penicillin (J01CA), almost solely amoxicillin, comprised more than half of all the antibiotic prescriptions and increased significantly over the three years (p = 2.2*10−16). Their number increased from 40.0% of the total antibiotic prescriptions in 2016 to 64.0% in 2018 (Figure 1), that is, from 111 to 168 prescriptions per 1000 inhabitants per year (Figure 2). Co-amoxiclav which belongs to the ATC class J01CR was the second most prescribed antibiotic, followed by the first-generation cephalosporins (J01DB) (Figures 1–2). The number of macrolide (J01FA) prescriptions, mostly comprising azithromycin, decreased significantly over the study period (p = 1.6*10−7) or about 40.7% in 2018, compared to 2017 after the implementation of the new guidance, as well as the prescriptions of co-amoxiclav which decreased by 52.3% (p = 2.2*10−16) at the same time.
Point prevalence surveys of antimicrobial use: a systematic review and the implications
Published in Expert Review of Anti-infective Therapy, 2020
Zikria Saleem, Mohamed Azmi Hassali, Brian Godman, Ann Versporten, Furqan Khurshid Hashmi, Hamid Saeed, Fahad Saleem, Muhammad Salman, Inayat Ur Rehman, Tahir Mehmood Khan
Among children, India was the country where the highest use of antimicrobials was seen in two published studies reaching 98.4% [35,64]. Ghana was the second-highest country at 70.6%, China the third (67.8%), and Turkey the fourth-highest country at 54.6%, respectively [65–67]. Among 31 hospitals in the USA, the reported use of antimicrobials was 54.4% with gentamicin was the most commonly used antibiotic followed by ampicillin and vancomycin [68]. The antimicrobial use rate was 46.0% in a survey conducted in Australia [69]. Among European countries, the highest prevalence of antimicrobial use was found in hospitals in the UK followed by Italy. In the 2008 ESAC survey, which was based on pediatric antimicrobial prescribing in 32 hospitals among 21 European countries, the antimicrobial use rate was 32.4% with the most commonly used antibiotics for therapeutic use being the third-generation cephalosporins (18%), aminoglycosides (14%), and extended-spectrum penicillin (10%) [70]. Data from two hospitals of Germany and Croatia in 2005 showed antibiotic use at 17.4% among the pediatric population [71], which is also the lowest use compared to other regions of the world.
A review of post-caesarean infectious morbidity: how to prevent and treat
Published in Journal of Obstetrics and Gynaecology, 2018
Rebecca C. Pierson, Nicole P. Scott, Kristin E. Briscoe, David M. Haas
In the modern medical world, antibiotics have become an essential tool for the reduction of puerperal infections and prophylactic antibiotics are used routinely to reduce morbidity in obstetrics. A Cochrane review in 2014 explored the effect of antibiotic prophylaxis in all caesarean sections, including elective and non-elective, repeat and primary, as well as preoperative and intraoperative delivery of antibiotics. Wound infection was found to be decreased (RR 0.40; 95% CI 0.35–0.46) with use of prophylactic antibiotics. Subgroup analyses demonstrated that the most effective antibiotic prophylaxis agents for wound infection prevention were the extended-spectrum penicillin class (RR 0.18, 95% CI 0.09–0.39) and aminoglycoside class (RR 0.17 95% CI 0.08–0.34) (Smaill and Grivell 2014). Presently, the American College of Obstetricians and Gynecologists (ACOG) recommends administration of antimicrobial prophylaxis within 60 minutes of the start of CD. In the case of emergent CD, antibiotics should be administered as soon as possible after the incision is made. Regimens that provide appropriate coverage are a first generation cephalosporin or a combination of aminoglycosides and clindamycin for women with a history of severe reactions to cephalosporins (ACOG 2011). A recent Cochrane review demonstrated that penicillins and cephalosporins are equivalent in prophylactic activity (Gyte et al. 2014). Choice of antibiotic therapy should be based on patient history, physician preference, local epidemiologic data regarding pathogen prevalence and hospital data regarding antibiotic resistance.