A Randomized Trial Comparing #Antibiotics with Appendectomy for #Appendicitis

..In total, 1552 adults (414 with an appendicolith) underwent randomization; 776 were assigned to receive antibiotics (47% of whom were not hospitalized for the index treatment) and 776 to undergo appendectomy (96% of whom underwent a laparoscopic procedure). Antibiotics were noninferior to appendectomy on the basis of 30-day EQ-5D scores (mean difference, 0.01 points; 95% confidence interval [CI], −0.001 to 0.03). In the antibiotics group, … Continue reading A Randomized Trial Comparing #Antibiotics with Appendectomy for #Appendicitis

Co‐occurrence of #antibiotic, biocide, and heavy #metal resistance genes in bacteria from metal and radionuclide contaminated soils at the Savannah River Site

Contaminants such as heavy metals may contribute to the dissemination of antimicrobial resistance (AMR) by enriching resistance gene determinants via co‐selection mechanisms. In the present study, a survey was performed on soils collected from four areas at the Savannah River Site (SRS), South Carolina, USA, with varying contaminant profiles: relatively pristine (Upper Three Runs), heavy metals (Ash Basins), radionuclides (Pond B) and heavy metal and … Continue reading Co‐occurrence of #antibiotic, biocide, and heavy #metal resistance genes in bacteria from metal and radionuclide contaminated soils at the Savannah River Site

Reducing #Antibiotic Prescribing in Primary Care for #Respiratory Illness

One-third of outpatient antibiotic prescriptions for pediatric acute respiratory tract infections (ARTIs) are inappropriate. We evaluated a distance learning program’s effectiveness for reducing outpatient antibiotic prescribing for ARTI visits.. In this stepped-wedge clinical trial run from November 2015 to June 2018, we randomly assigned 19 pediatric practices belonging to the Pediatric Research in Office Settings Network or the NorthShore University HealthSystem to 4 wedges. Visits … Continue reading Reducing #Antibiotic Prescribing in Primary Care for #Respiratory Illness

Association of Nonoperative Management Using Antibiotic Therapy vs Laparoscopic #Appendectomy With Treatment Success and Disability Days in Children With Uncomplicated #Appendicitis

Nonoperative management with antibiotics alone has the potential to treat uncomplicated pediatric appendicitis with fewer disability days than surgery.. ..Patient and family selection of nonoperative management with antibiotics alone (nonoperative group, n = 370) or urgent (≤12 hours of admission) laparoscopic appendectomy (surgery group, n = 698). Main Outcomes and Measures The 2 primary outcomes assessed at 1 year were disability days, defined as the total number of days … Continue reading Association of Nonoperative Management Using Antibiotic Therapy vs Laparoscopic #Appendectomy With Treatment Success and Disability Days in Children With Uncomplicated #Appendicitis

High-Fat Diet and Antibiotics Cooperatively Impair Mitochondrial Bioenergetics to Trigger #Dysbiosis that Exacerbates Pre-inflammatory Bowel Disease

The clinical spectra of irritable bowel syndrome (#IBS) and inflammatory bowel disease (#IBD) intersect to form a scantily defined overlap syndrome, termed pre-IBD. We show that increased Enterobacteriaceae and reduced Clostridia abundance distinguish the fecal microbiota of pre-IBD patients from IBS patients. A history of antibiotics in individuals consuming a high-fat diet was associated with the greatest risk for pre-IBD. Exposing mice to these risk … Continue reading High-Fat Diet and Antibiotics Cooperatively Impair Mitochondrial Bioenergetics to Trigger #Dysbiosis that Exacerbates Pre-inflammatory Bowel Disease

Antibiotic Use and Outcomes in Children in the Emergency Department With Suspected #Pneumonia

Antibiotic therapy is often prescribed for suspected community-acquired pneumonia (CAP) in children despite a lack of knowledge of causative pathogen. Our objective in this study was to investigate the association between antibiotic prescription and treatment failure in children with suspected CAP who are discharged from the hospital emergency department (ED).. ..Of 337 eligible children, 294 were matched on the basis of propensity score. There was … Continue reading Antibiotic Use and Outcomes in Children in the Emergency Department With Suspected #Pneumonia

Pharmacologic Therapies in Patients With Exacerbation of Chronic #Obstructive #Pulmonary Disease: A Systematic Review With Meta-analysis

..Compared with placebo or management without antibiotics, antibiotics given for 3 to 14 days were associated with increased exacerbation resolution at the end of the intervention (odds ratio [OR], 2.03 [95% CI, 1.47 to 2.80]; moderate SOE) and less treatment failure at the end of the intervention (OR, 0.54 [CI, 0.34 to 0.86]; moderate SOE), independent of severity of exacerbations in out- and inpatients. Compared … Continue reading Pharmacologic Therapies in Patients With Exacerbation of Chronic #Obstructive #Pulmonary Disease: A Systematic Review With Meta-analysis

Antibiotic prescribing without documented indication in ambulatory care clinics: national cross sectional study

… According to the criteria, 57% (52% to 62%) of the 130.5 million prescriptions were for appropriate indications, 25% (21% to 29%) were inappropriate, and 18% (15% to 22%) had no documented indication. This corresponds to an estimated 24 million prescriptions without a documented indication. Being an adult male, spending more time with the provider, and seeing a non-primary care specialist were significantly positively associated … Continue reading Antibiotic prescribing without documented indication in ambulatory care clinics: national cross sectional study

Evidence-based clinical practice guideline on #antibiotic use for the urgent management of pulpal- and periapical-related #dental pain and intraoral swelling

..systematic review and formulated clinical recommendations for the urgent management of symptomatic irreversible pulpitis with or without symptomatic apical #periodontitis, pulp necrosis and symptomatic apical periodontitis, or pulp necrosis and localized acute apical abscess using antibiotics, either alone or as adjuncts to definitive, conservative dental treatment (DCDT) in immunocompetent adults. The panel formulated 5 clinical recommendations and 2 good practice statements, each specific to the … Continue reading Evidence-based clinical practice guideline on #antibiotic use for the urgent management of pulpal- and periapical-related #dental pain and intraoral swelling

C-Reactive Protein Testing to Guide Antibiotic Prescribing for #COPD Exacerbations

Point-of-care testing of C-reactive protein (#CRP) may be a way to reduce unnecessary use of antibiotics without harming patients who have acute exacerbations of chronic obstructive pulmonary disease (COPD). A lower percentage of patients in the CRP-guided group than in the usual-care group received an antibiotic prescription at the initial consultation (47.7% vs. 69.7%, for a difference of 22.0 percentage points; adjusted odds ratio, 0.31; … Continue reading C-Reactive Protein Testing to Guide Antibiotic Prescribing for #COPD Exacerbations