ITEMS IN AFP WITH MESH TERM:
Interventions to Improve Antibiotic Prescribing Practices for Hospital Inpatients - Cochrane for Clinicians
Should We Prescribe Antibiotics for Acute Conjunctivitis? - Cochrane for Clinicians
Rhinosinusitis: What Is the Desired Outcome? - Editorials
ABSTRACT: Although most cases of acute rhinosinusitis are caused by viruses, acute bacterial rhinosinusitis is a fairly common complication. Even though most patients with acute rhinosinusitis recover promptly without it, antibiotic therapy should be considered in patients with prolonged or more severe symptoms. To avoid the emergence and spread of antibiotic-resistant bacteria, narrow-spectrum antibiotics such as amoxicillin should be used for 10 to 14 days. In patients with mild disease who have beta-lactam allergy, trimethoprim/sulfamethoxazole or doxycycline are options. Second-line antibiotics should be considered if the patient has moderate disease, recent antibiotic use (past six weeks), or no response to treatment within 72 hours. Amoxicillin-clavulanate potassium and fluoroquinolones have the best coverage for Haemophilus influenzae and Streptococcus pneumoniae. In patients with beta-lactam hypersensitivity who have moderate disease, a fluoroquinolone should be prescribed. The evidence supporting the use of ancillary treatments is limited. Decongestants often are recommended, and there is some evidence to support their use, although topical decongestants should not be used for more than three days to avoid rebound congestion. Topical ipratropium and the sedating antihistamines have anticholinergic effects that maybe beneficial, but there are no clinical studies supporting this possibility. Nasal irrigation with hypertonic and normal saline has been beneficial in chronic sinusitis and has no serious adverse effects. Nasal corticosteroids also may be beneficial in treating chronic sinusitis. Mist, zinc salt lozenges, echinacea extract, and vitamin C have no proven benefit in the treatment of acute bacterial rhinosinusitis.
Conjunctivitis - Article
ABSTRACT: Conjunctivitis refers to any inflammatory condition of the membrane that lines the eyelids and covers the exposed surface of the sclera. It is the most common cause of "red eye". The etiology can usually be determined by a careful history and an ocular examination, but culture is occasionally necessary to establish the diagnosis or to guide therapy. Conjunctivitis is commonly caused by bacteria and viruses. Neisseria infection should be suspected when severe, bilateral, purulent conjunctivitis is present in a sexually active adult or in a neonate three to five days postpartum. Conjunctivitis caused by Chlamydia trachomatis or Neisseria gonorrhoeae requires aggressive antibiotic therapy, but conjunctivitis due to other bacteria is usually self-limited. Chronic conjunctivitis is usually associated with blepharitis, recurrent styes or meibomianitis. Treatment requires good eyelid hygiene and the application of topical antibiotics as determined by culture. Allergic conjunctivitis is distinguished by severe itching and allergen exposure. This condition is generally treated with topical antihistamines, mast-cell stabilizers or anti-inflammatory agents.
The Woman with Dysuria - Article
ABSTRACT: Bacterial cystitis is the most common bacterial infection occurring in women. Thirty percent of women will experience at least one episode of cystitis during their lifetime. About one third of patients presenting with symptoms of cystitis have upper urinary tract infection. A careful history to identify risk factors for subclinical pyelonephritis is important. Symptoms of chronic cystitis accompanied by sterile urine without pyuria may represent interstitial cystitis. Dysuria may also be the principal complaint of women with vaginitis (infectious, atrophic or chemical) or urethritis. A stepwise diagnostic approach, accompanied by inexpensive office laboratory testing, is usually sufficient to determine the cause of dysuria.
Aminoglycosides: A Practical Review - Article
ABSTRACT: Aminoglycosides are potent bactericidal antibiotics that act by creating fissures in the outer membrane of the bacterial cell. They are particularly active against aerobic, gram-negative bacteria and act synergistically against certain gram-positive organisms. Gentamicin is the most commonly used aminoglycoside, but amikacin may be particularly effective against resistant organisms. Aminoglycosides are used in the treatment of severe infections of the abdomen and urinary tract, as well as bacteremia and endocarditis. They are also used for prophylaxis, especially against endocarditis. Resistance is rare but increasing in frequency. Avoiding prolonged use, volume depletion and concomitant administration of other potentially nephrotoxic agents decreases the risk of toxicity. Single daily dosing of aminoglycosides is possible because of their rapid concentration-dependent killing and post-antibiotic effect and has the potential for decreased toxicity. Single daily dosing of aminoglycosides appears to be safe, efficacious and cost effective. In certain clinical situations, such as patients with endocarditis or pediatric patients, traditional multiple dosing is still usually recommended.
ABSTRACT: Endogenous endophthalmitis is a potentially blinding ocular infection resulting from hematogenous spread from a remote primary source. The condition is relatively rare but may become more common as the number of chronically debilitated patients and the use of invasive procedures increase. Many etiologic organisms (gram-positive, gram-negative and fungal) have been reported to cause endogenous endophthalmitis. Risk factors are well defined and include most reasons for immune suppression. A high clinical suspicion is needed for early diagnosis and treatment. Early intravenous antibiotic therapy remains the cornerstone of treatment. The roles of intravitreal antibiotics and vitrectomy are evolving and may become more widely accepted as therapeutic modalities. The authors report a case of endogenous endophthalmitis and provide a brief review of the literature.