Items in AFP with MESH term: Anti-Bacterial Agents
IDSA Updates Guideline for Managing Group A Streptococcal Pharyngitis - Practice Guidelines
ABSTRACT: Clostridium difficile infection is a common cause of antibiotic-associated diarrhea. It causes no symptoms in more than one-half of infected patients, but can also cause a wide spectrum of illnesses and death. The incidence and severity have increased in recent years. The most important modifiable risk factor for C. difficile infection is antibiotic exposure; this risk is dose-related and higher with longer courses and combination therapy. C. difficile infection is also associated with older age, recent hospitalization, multiple comorbidities, use of gastric acid blockers, inflammatory bowel disease, and immunosuppression. It has become more common in younger, healthier patients in community settings. The most practical testing options are rapid testing with nucleic acid amplification or enzyme immunoassays to detect toxin, or a two-step strategy. Treatment includes discontinuing the contributing antibiotic, if possible. Mild C. difficile infection should be treated with oral metronidazole; severe infection should be treated with oral vancomycin. Fidaxomicin may be an effective alternative. Recurrences of the infection should be treated based on severity. Tapering and the pulsed-dose method of oral vancomycin therapy for second recurrences are effective. Prevention includes responsible antibiotic prescribing and vigilant handwashing. Probiotics prevent antibiotic-associated diarrhea, but are not recommended specifically for preventing C. difficile infection.
ABSTRACT: Postexposure prophylaxis (PEP) is effective in preventing illness after potential or documented exposure to a variety of microbial pathogens and in reducing the risk of secondary spread of infection. Guidelines have been published by the Centers for Disease Control and Prevention and the Advisory Committee on Immunization Practices for proper use of PEP for bloodborne pathogens, for microorganisms transmitted by either airborne or droplet spread or through direct contact, and for infections acquired after traumatic injuries. Depending on the type of exposure, different forms of PEP are available, including vaccines, immune globulins, antibiotics, and antiviral medications. Physicians should assess a patient’s potential need for PEP based on several factors, including the type of exposure, the timing and severity of illness in the source patient, the exposed person’s susceptibility to infectious diseases of concern, and the relative risks and benefits of the PEP regimen in an individual situation. Immunity to certain infectious diseases can be ensured with prior infection or vaccination, and by serologic testing in patients with a negative or uncertain history. PEP should be given to persons exposed to index cases of pertussis and invasive meningococcal infection regardless of immunization history, and should be given following rabies and tetanus exposure regardless of the length of delay. In general, PEP should be given as soon as possible following a high-risk exposure. Persons exposed to bloodborne pathogens should have baseline testing for human immunodeficiency virus, hepatitis B virus, and hepatitis C virus antibodies, and follow-up testing at six weeks, three months, and six months postexposure.
Minocycline for Acne Vulgaris - Cochrane for Clinicians
Otitis Media: Diagnosis and Treatment - Article
ABSTRACT: Acute otitis media is diagnosed in patients with acute onset, presence of middle ear effusion, physical evidence of middle ear inflammation, and symptoms such as pain, irritability, or fever. Acute otitis media is usually a complication of eustachian tube dysfunction that occurs during a viral upper respiratory tract infection. Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis are the most common organisms isolated from middle ear fluid. Management of acute otitis media should begin with adequate analgesia. Antibiotic therapy can be deferred in children two years or older with mild symptoms. High-dose amoxicillin (80 to 90 mg per kg per day) is the antibiotic of choice for treating acute otitis media in patients who are not allergic to penicillin. Children with persistent symptoms despite 48 to 72 hours of antibiotic therapy should be reexamined, and a second-line agent, such as amoxicillin/clavulanate, should be used if appropriate. Otitis media with effusion is defined as middle ear effusion in the absence of acute symptoms. Antibiotics, decongestants, or nasal steroids do not hasten the clearance of middle ear fluid and are not recommended. Children with evidence of anatomic damage, hearing loss, or language delay should be referred to an otolaryngologist.
Persistent Skin Furuncle - Photo Quiz
Corticosteroids for the Treatment of Sore Throat - Cochrane for Clinicians