Anti-bacterial Agents / therapeutic use

Approach to otitis externa

Alex Haga — Wed, 23 Oct 2024 15:28:25 +0000

Date Added:

October 23, 2024

Journal/Publication:

Canadian Family Physician

Publication Date:

October 1, 2024

Issue:

Volume:

Pages:

617-623

URL:

Approach to otitis externa

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.46747/cfp.7010617

Keywords

otitis externa

PMID (1):

39406431

MeSH

Anti-bacterial Agents / therapeutic use

Otitis Externa* / diagnosis

Otitis Externa* / drug therapy

Otitis Externa* / therapy

A concise evidence-based review of the diagnosis and management of patients with otitis externa. James W. Mold, MD, MPH

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Objective: To provide family physicians with a practical evidence-based approach to management of otitis externa.

Sources of information: The approach described is based on MEDLINE and PubMed literature published between 1993 and 2023.

Main message: Otitis externa is diffuse inflammation of the external auditory canal and typically occurs from moisture exposure and trauma. Management focuses on eliminating infection, pain management, education, and preventing recurrence. The primary treatment of uncomplicated otitis externa is topical. Complicated presentations may require additional systemic therapy.

Conclusion: History taking and physical examination can help differentiate among acute, chronic, and necrotizing otitis externa. At-risk populations, typically those who are immunosuppressed, are more likely to develop necrotizing otitis externa and should be carefully monitored.

Author/s:

Janjulee Ellis, Allison De La Lis, Emily Rosen

Bacterial vaginosis

Alex Haga — Thu, 13 Jun 2024 21:25:55 +0000

Date Added:

June 13, 2024

Journal/Publication:

Canadian Medical Association Journal

Publication Date:

June 3, 2024

URL:

Bacterial vaginosis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1503/cmaj.231688

Keywords

vaginosis

bacterial vaginosis

PMID (1):

38830679

MeSH

Anti-bacterial Agents / therapeutic use

female

Vaginosis

Bacterial* / diagnosis

Bacterial* / drug therapy

Bacterial* / microbiology

A very concise summary of the diagnosis and treatment of bacterial vaginosis. James W. Mold, MD, MPH

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Bacterial vaginosis is the most common cause of abnormal vaginal discharge, affecting 23%–30% of reproductive-aged people
Bacterial vaginosis is caused by a disrupted vaginal microbiome balance. Symptoms include itch, dysuria, and a thin, grey discharge with a “fishy” odour, particularly after coitus. Risk factors include smoking and unprotected intercourse, including oral sex.

Author/s:

Michal Braunstein, Amanda Selk

Amoxicillin Versus Other Antibiotic Agents for the Treatment of Acute Otitis Media in Children

Aubrey Delammermore — Sun, 11 Dec 2022 06:00:00 +0000

Date Added:

December 11, 2022

Journal/Publication:

The Journal of Pediatrics

Publisher:

Elsevier

Publication Date:

August 6, 2022

Volume:

251

Pages:

98-105

URL:

Amoxicillin Versus Other Antibiotic Agents for the Treatment of Acute Otitis Media in Children

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1016/j.jpeds.2022.07.053

Keywords

Amoxicillin-Potassium Clavulanate Combination

PMID (1):

35944719

MeSH

Otitis Media* / drug therapy

Amoxicillin* / therapeutic use

Anti-bacterial Agents / therapeutic use

Cefdinir

Azithromycin / therapeutic use

This retrospective cohort study reaffirms that acute otitis almost always resolves and that amoxicillin is as good or better than other antibiotics for treatment, when treatment is deemed necessary. James W. Mold, MD, MPH

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Objectives: The objective of the study was to compare the antibiotic treatment failure and recurrence rates between antibiotic agents (amoxicillin, amoxicillin-clavulanate, cefdinir, and azithromycin) for children with uncomplicated acute otitis media (AOM).

Study design: We completed a retrospective cohort study of children 6 months-12 years of age with uncomplicated AOM identified in a nationwide claims database. The primary exposure was the antibiotic agent, and the primary outcomes were treatment failure and recurrence. Logistic regression was used to estimate ORs, and analyses were stratified by primary exposure, patient age, and antibiotic duration.

Results: Among the 1 051 007 children included in the analysis, 56.6% were prescribed amoxicillin, 13.5% were prescribed amoxicillin-clavulanate, 20.6% were prescribed cefdinir, and 9.3% were prescribed azithromycin. Most prescriptions (93%) were for 10 days, and 98% were filled within 1 day of the medical encounter. Treatment failure and recurrence occurred in 2.2% (95% CI: 2.1, 2.2) and 3.3% (3.2, 3.3) of children, respectively. Combined failure and recurrence rates were low for all agents including amoxicillin (1.7%; 1.7, 1.8), amoxicillin-clavulanate (11.3%; 11.1, 11.5), cefdinir (10.0%; 9.8, 10.1), and azithromycin (9.8%; 9.6, 10.0).

Conclusions: Despite microbiologic changes in AOM etiology, treatment failure and recurrence were uncommon for all antibiotic agents and were lower for amoxicillin than for other agents. These findings support the continued use of amoxicillin as a first-line agent for AOM when antibiotics are prescribed.

Author/s:

Frost, H. M., Bizune, D., Gerber, J. S., Hersh, A. L., Hicks, L. A., Tsay, S. V.

Optimal Urine Culture Diagnostic Stewardship Practice-Results from an Expert Modified-Delphi Procedure

Aubrey Delammermore — Thu, 08 Sep 2022 05:00:00 +0000

Date Added:

September 8, 2022

Journal/Publication:

Clinical Infectious Diseases

Publisher:

Infectious Diseases Society of America

Publication Date:

August 1, 2022

Issue:

Volume:

Pages:

382-389

URL:

Optimal Urine Culture Diagnostic Stewardship Practice-Results from an Expert Modified-Delphi Procedure

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1093/cid/ciab987

Keywords

Diagnostic Stewardship

Expert consensus

modified Delphi

urinary tract infections

urine cultures

PMID (1):

34849637

MeSH

Anti-bacterial Agents / therapeutic use

Delphi Technique

anti-bacterial agents

urinalysis

Urinary Tract Infections* / diagnosis

A useful summary of practical recommendations for the appropriate ordering and interpretation of urine cultures. James W. Mold, MD, MPH

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Background: Urine cultures are nonspecific and often lead to misdiagnosis of urinary tract infection and unnecessary antibiotics. Diagnostic stewardship is a set of procedures that modifies test ordering, processing, and reporting in order to optimize diagnosis and downstream treatment. In this study, we aimed to develop expert guidance on best practices for urine culture diagnostic stewardship.

Methods: A RAND-modified Delphi approach with a multidisciplinary expert panel was used to ascertain diagnostic stewardship best practices. Clinical questions to guide recommendations were grouped into three thematic areas (ordering, processing, reporting) in practice settings of emergency department, inpatient, ambulatory, and long-term care. Fifteen experts ranked recommendations on a 9-point Likert scale. Recommendations on which the panel did not reach agreement were discussed during a virtual meeting, then a second round of ranking by email was completed. After secondary review of results and panel discussion, a series of guidance statements was developed.

Results: One hundred and sixty-five questions were reviewed. The panel reaching agreement on 104, leading to 18 overarching guidance statements. The following strategies were recommended to optimize ordering urine cultures: requiring documentation of symptoms, sending alerts to discourage ordering in the absence of symptoms, and cancelling repeat cultures. For urine culture processing, conditional urine cultures and urine white blood cell count as criteria were supported. For urine culture reporting, appropriate practices included nudges to discourage treatment under specific conditions and selective reporting of antibiotics to guide therapy decisions.

Conclusions: These 18 guidance statements can optimize use of urine cultures for better patient outcomes.

Keywords: diagnostic stewardship; expert consensus; modified Delphi; urinary tract infection; urine cultures.

Author/s:

Claeys, K. C., Trautner, B. W., Leekha, S., Coffey, K. C., Crnich, C. J., Diekema, D. J., Fakih, M. G., Goetz, M. B., Gupta, K., Jones, M. M., Leykum, L., Liang, S. Y., Pineles, L., Pleiss, A., Spivak, E. S., Suda, K. J., Taylor, J. M., Rhee, C., Morgan, D. J.