scholarly journals 161 Current Practice of Antibiotic Prescription in Acute Uncomplicated Diverticulitis

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
M Patel ◽  
N Darwish ◽  
N Kirmani
Keyword(s):  
Current Practice ◽  
Antibiotic Prescription ◽  
Lower Abdominal Pain ◽  
Complicated Diverticulitis ◽  
Antibiotic Prescribing ◽  
Antibiotic Administration ◽  
Nice Guidelines ◽  
Uncomplicated Diverticulitis ◽  
Prescribing Practice ◽  
Acute Uncomplicated Diverticulitis

Abstract Aim To review the current antibiotic prescribing practice for patients with acute uncomplicated diverticulitis against the NICE guidelines November 2019, to avoid unnecessary/overuse of antibiotics. Method A retrospective review of patients presenting with lower abdominal pain between 1/11/2019 -31/1/2020. All patients with suspected diverticulitis were included. Patients who were subsequently diagnosed with complicated diverticulitis/alternate diagnosis were excluded from the analysis. Results 22/27 (81.5%) of the patients were admitted. 26 out of 27 (96.3%) patients with acute uncomplicated diverticulitis were administered antibiotics. Antibiotics were indicated as per NICE guidelines in 17 patients (62.97%) and not indicated in 9 patients (33.34%). Admission was not indicated in 20 patients (90.91%) according to NICE guidelines. Conclusions Our adherence to NICE guidelines is 66.67% in terms of antibiotic administration, however the drug and duration of antibiotic administration needs to be reviewed. NICE guidelines recommend that acute uncomplicated diverticulitis can be managed as an outpatient. Antibiotics should be administered only if patient is systemically unwell, is immunosupressed or has significant co morbidities

Diagnosis and Management of Acute Diverticulitis

2019 ◽  
Author(s):  
Tiffany K Weidner ◽  
John T Kidwell ◽  
David A Etzioni
Keyword(s):  
United States ◽  
Acute Diverticulitis ◽  
The United States ◽  
Complicated Diverticulitis ◽  
Perforated Diverticulitis ◽  
Uncomplicated Diverticulitis ◽  
Urgent Surgery ◽  
Colonic Fistula ◽  
Surgical Evaluation ◽  
Acute Uncomplicated Diverticulitis

Diverticulitis is the cause of 300,000 inpatient admissions in the United States each year. Surgical evaluation and treatment are commonly required for the treatment of diverticulitis. This chapter discusses the diagnosis, triage, and treatment of acute diverticulitis. Medical treatment, as well as the indications for surgical treatment for diverticulitis, is discussed. Current controversies, including the need for antibiotics for a patient with acute uncomplicated diverticulitis, necessity of colonoscopy after resolution of an acute episode, and indications for urgent surgery, are reviewed.  This review contains 10 figures, 3 tables, and 67 references. keywords: acute diverticulitis, colonic fistula, complicated diverticulitis, diverticular abscess, diverticular disease, diverticulitis, diverticulosis, perforated diverticulitis, uncomplicated diverticulitis

1069 Diverticular Disease: An Audit of Adherence to NICE Guidelines

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
O Lesi ◽  
M R Iqbal ◽  
L Khan
Keyword(s):  
Diverticular Disease ◽  
Complicated Diverticulitis ◽  
University Hospital ◽  
Full Blood Count ◽  
C Reactive Protein ◽  
Nice Guidelines ◽  
Reactive Protein ◽  
Presenting Symptoms ◽  
Uncomplicated Diverticulitis ◽  
Retrospective Audit

Abstract Introduction Diverticular disease is a common surgical problem ranging from diverticulosis to uncomplicated diverticulitis to complicated diverticulitis. The NICE Guidelines for diverticular disease recommended that antibiotics should only be given in patients who are systemically unwell, background of immunosuppression or have complicated diverticulitis. We aimed to access the compliance to these guidelines with regards to the use of antibiotics at our local institute. Method This was a retrospective audit reviewing the management of patients with Computed Tomography Scan findings of uncomplicated acute diverticulitis (Hinchey Ia) at the surgical emergency unit at Basildon University Hospital between August 2018 and May 2020. Data obtained included demographic data, presenting symptoms (fever, abdominal pain), haematological investigations (full blood count and c-reactive protein) and use of intravenous/oral antibiotics. Results Twenty patients were included, the M:F ratio was 1:1.9, the age range was between 36-80 years. 13 patients (65%) had left iliac fossa pain as part of their presenting symptom while only three (15%) had pyrexia. Seventeen patients(85%) had NEWS score between 0-1 with 60% of the patients presenting with elevated white blood cell count and 75% with c-reactive protein >5. All our patients were prescribed antibiotics. Conclusions There was no discrimination in the use of antibiotics/admission for uncomplicated diverticulitis as all patients had antibiotics and as such there is need for increased awareness about the guidelines among the surgical team and adherence to the protocol to prevent indiscriminate use of antibiotics.

scholarly journals Performance associated effect variations of public reporting in promoting antibiotic prescribing practice: a cluster randomized-controlled trial in primary healthcare settings

2017 ◽  
Vol 18 (05) ◽  
pp. 482-491 ◽  
Author(s):  
Yuqing Tang ◽  
Chenxi Liu ◽  
Xinping Zhang
Keyword(s):  
Randomized Controlled Trial ◽  
Primary Healthcare ◽  
Antibiotic Prescription ◽  
Controlled Trial ◽  
Public Reporting ◽  
Antibiotic Prescribing ◽  
Randomized Controlled ◽  
Healthcare Settings ◽  
Prescribing Practice ◽  
Cluster Randomized

Aim To evaluate the variations in effect of public reporting in antibiotic prescribing practice among physicians with different performance in primary healthcare settings. Background Overprovision of antibiotics is a major public health concern. Public reporting has been adopted to encourage good antibiotic prescribing practices. However, which group, for instance, high, average or low antibiotic prescribers, accounted for antibiotic prescription reduction has not been fully understood. Methods A cluster randomized-controlled trial was conducted. In total, 20 primary healthcare institutions in Qianjiang city were paired through a six indicators-synthesized score. Coin flipping was used to assign control–intervention status; 10 were then subjected to intervention where prescription indicators were publicly reported monthly over a one-year period. Prescriptions for upper respiratory tract infections (URTIs) before and after the intervention were collected. Physicians were divided into high, average and low antibiotic prescribers based on their antibiotic prescribing rates last month, which were publicly reported in intervention arm. Multilevel difference-in-differences logit regressions were performed to estimate intervention effect in each physician group on three outcome indicators: prescriptions containing antibiotics, two or more antibiotics and antibiotic injections. Findings In total, 31 460 URTI prescriptions were collected (16 170 in intervention arm and 15 290 in control arm). Reduction in antibiotic prescription attributed to intervention was 2.82% [95% confidence intervals (CI): −4.09, −1.54%, P<0.001], least significant in low prescribers (−1.41%, 95% CI: −3.81, 0.99%, P=0.249) and most significant in average prescribers (−5.01%, 95% CI: −6.94, −3.07%, P<0.001). Reduction in combined antibiotics prescriptions attributed to intervention was 3.81% (95% CI: −5.23, −2.39%, P<0.001), least significant in low prescribers (−2.42%, 95% CI: −4.39, −0.45%, P=0.016) and most significant in average prescribers (−5.01%, 95% CI: −7.47, −2.56%, P<0.001). Conclusion Public reporting can positively influence antibiotic prescribing patterns of physicians for URTIs in primary care settings, with reduction in antibiotic and combined antibiotic prescriptions. The reduction was mainly attributed to average and high antibiotic prescribers.

scholarly journals Medical Management of Diverticular Disease

2018 ◽  
Vol 31 (04) ◽  
pp. 214-216
Author(s):  
Liam Knott ◽  
Craig Reickert
Keyword(s):  
Diverticular Disease ◽  
Current Literature ◽  
Medical Management ◽  
Complicated Diverticulitis ◽  
Uncomplicated Diverticulitis ◽  
Recurrent Diverticulitis ◽  
Surgical Options ◽  
Acute Uncomplicated Diverticulitis

AbstractThis article reviews the current literature supporting the non-surgical options for treatment in acute uncomplicated diverticulitis, complicated diverticulitis, and options for prevention of recurrent diverticulitis.

scholarly journals 229 Uncomplicated Diverticulitis: A Proposed Diagnostic Algorithm

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
B Kerr ◽  
O Ahmed ◽  
C Byrnes
Keyword(s):  
Parametric Analysis ◽  
Clinical Presentation ◽  
Lower Abdominal Pain ◽  
Diagnostic Algorithm ◽  
Infection Risk ◽  
Complicated Diverticulitis ◽  
Bowel Habit ◽  
Symptom Duration ◽  
Single Centre ◽  
Uncomplicated Diverticulitis

Abstract Introduction Covid-19 has changed surgical practice. Infection risk and hospital pressures means appropriate patient ambulation is paramount. Uncomplicated diverticulitis can be managed as an outpatient. Clinical differentiation of uncomplicated and complicated diverticulitis remains challenging. This study aims to develop a diagnostic algorithm to differentiate complicated from uncomplicated disease prior to imaging. Method A single-centre retrospective review of 177 patients referred as diverticulitis between Sept-Dec 2018, was performed. Data collected included clinical presentation, biochemistry and imaging. Complicated diverticulitis was defined as occlusion, perforation, abscess formation, fistula and/or bleeding. Inferential parametric analysis was performed to ensure predictive value. Results Of 177 patients referred, 71 received a consultant diagnosis of diverticulitis. 60 were confirmed and differentiated on CT scan. LIF/lower abdominal pain (P < 0.01) and bowel habit change (P < 0.05) was significantly higher in patients with diverticulitis compared to other pathology. In complicated diverticulitis, symptoms occurred < 4days (P < 0.05), fever was present (P < 0.001) and CRP was > 75. Conclusions Once diverticulitis diagnosis is made based on pain localisation and change in bowel habit, complicated disease can be predicted by symptom duration (< 4 days), presence of fever and a CRP > 75. Plans to assess these findings prospectively in a Surgical Admissions Unit are currently in development.

scholarly journals Antibiotic prescription for febrile outpatients: a health facility-based secondary data analysis for the Greater Accra region of Ghana

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Michael Mireku Opoku ◽  
Harriet Affran Bonful ◽  
Kwadwo Ansah Koram
Keyword(s):  
Antibiotic Prescription ◽  
Secondary Data ◽  
Health Facilities ◽  
Full Blood Count ◽  
Baseline Survey ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Factors Associated ◽  
Laboratory Investigations ◽  
Greater Accra Region

Abstract Background Misguided prescription of antibiotics is an important contributor towards the emergence and spread of antibiotic resistance. The absence of effective interventions to control antibiotic use leads to increased consumption beyond the needed requirements. Antibiotic stewardship interventions must be appropriately targeted and assessed to enhance the controlled use of antibiotics. The objective of this study was to determine the factors associated with antibiotic prescription to febrile outpatients who seek care in health facilities within the Greater Accra region of Ghana. Methods Secondary data obtained from the medical records of 2519 febrile outpatients, consecutively sampled at the outpatient department of 6 health facilities in 3 municipalities during the baseline survey of a quasi-experiment in 2015 was used. The primary outcome was prescription of any antibiotic. Independent variables included patients’ demographics, symptoms, laboratory investigations (blood film microscopy, malaria rapid diagnostic test, full blood count, urine and stool routine examinations), diagnoses, and prescribers’ demographics. Crude and adjusted logistic regression analyses were used to determine the factors associated with antibiotic prescription. Results The prevalence of antibiotic prescription was 70.1% (95% CI: 67.7–72.4). Prescribers with more years of practice (> 5 years) were more likely to prescribe antibiotics compared to those with less than 3 years of practice (p <  0.001). Integrated Management of Neonatal and Childhood Illnesses (IMNCI) training was associated with a 2.3 (95% CI: 1.54, 3.53, p <  0.001) fold odds of antibiotic prescribing. Patients aged 5 years or more were 60% less likely to receive antibiotics compared with those under 5 years (AOR = 0.40, 95% CI: 0.32, 0.51; p <  0.001). Patients referred for laboratory investigations were 29% less likely to be prescribed antibiotics than those not referred. The presence of cough as a presenting symptom was associated with a 3.5 (95% CI: 2.54, 4.92) fold odds of antibiotic prescription. Conclusion Prescription of antibiotics to febrile outpatients was high. Promoting laboratory testing can potentially reduce irrational antibiotic prescription. Prescribing antibiotics for children under five and the prescribing practices of prescribers with longer years of practice should be targeted with interventions to reduce high use of antibiotics.

scholarly journals Patterns of dental antibiotic prescribing in 2017: Australia, England, United States, and British Columbia (Canada)

2021 ◽  
pp. 1-8
Author(s):  
Wendy Thompson ◽  
Leanne Teoh ◽  
Colin C. Hubbard ◽  
Fawziah Marra ◽  
David M. Patrick ◽  
...  
Keyword(s):  
United States ◽  
British Columbia ◽  
Broad Spectrum ◽  
Antibiotic Prescription ◽  
Population Level ◽  
The United States ◽  
Antibiotic Prescribing ◽  
Prescribing Behavior ◽  
The Us ◽  
Amoxicillin Clavulanic Acid

Abstract Objective: Our objective was to compare patterns of dental antibiotic prescribing in Australia, England, and North America (United States and British Columbia, Canada). Design: Population-level analysis of antibiotic prescription. Setting: Outpatient prescribing by dentists in 2017. Participants: Patients receiving an antibiotic dispensed by an outpatient pharmacy. Methods: Prescription-based rates adjusted by population were compared overall and by antibiotic class. Contingency tables assessed differences in the proportion of antibiotic class by country. Results: In 2017, dentists in the United States had the highest antibiotic prescribing rate per 1,000 population and Australia had the lowest rate. The penicillin class, particularly amoxicillin, was the most frequently prescribed for all countries. The second most common agents prescribed were clindamycin in the United States and British Columbia (Canada) and metronidazole in Australia and England. Broad-spectrum agents, amoxicillin-clavulanic acid, and azithromycin were the highest in Australia and the United States, respectively. Conclusion: Extreme differences exist in antibiotics prescribed by dentists in Australia, England, the United States, and British Columbia. The United States had twice the antibiotic prescription rate of Australia and the most frequently prescribed antibiotic in the US was clindamycin. Significant opportunities exist for the global dental community to update their prescribing behavior relating to second-line agents for penicillin allergic patients and to contribute to international efforts addressing antibiotic resistance. Patient safety improvements will result from optimizing dental antibiotic prescribing, especially for antibiotics associated with resistance (broad-spectrum agents) or C. difficile (clindamycin). Dental antibiotic stewardship programs are urgently needed worldwide.

scholarly journals 321 Role of Antibiotics in Acute uncomplicated diverticulitis, A Systematic Review and Meta-Analysis

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
A A Tahir ◽  
K M Ali ◽  
A U Khan ◽  
S Kamal ◽  
A Hussain ◽  
...  
Keyword(s):  
Systematic Review ◽  
Statistical Analysis ◽  
Treatment Failure ◽  
Hospital Stay ◽  
Meta Analysis ◽  
Dietary Advice ◽  
Duration Of Hospital Stay ◽  
Uncomplicated Diverticulitis ◽  
Acute Uncomplicated Diverticulitis

Abstract Introduction Diverticular disease is a common health problem with a wide clinical spectrum. About 75% of the patients would have uncomplicated diverticulitis. Cornerstones of treatment are antibiotics, analgesia, and dietary advice. Recent evidence has shown that its treatment is controversial, questioning the use of antibiotics. Aim is to assess the role of antibiotics in the treatment of acute uncomplicated diverticulitis. Method This is a systematic review and Meta-analysis. Literature review of the available studies was conducted using search engines like Pubmed, Medline, Embase, Google Scholar, and Cochrane databases. Statistical analysis was conducted using RevMan5.4. Results Out of 1754 records 1324 were duplicates, 430 studies were screened. 395 were further excluded.35 full text articles were assessed and in the final review 10 studies were included. PRISMA guidelines were used. Pooled OR for recurrence = 0.92 (95% CI = 0.74 to 1.13). Pooled OR for Hospital stay= -0.66 (95% CI= -1.12 to -0.21). Pooled OR for complications = 1.06 (95% CI = 0.69 to 1.64). Pooled OR for treatment failure= 1.24 (95% CI = 0.90-1.69). Conclusions We conclude that from the available evidence antibiotics have no role in reducing recurrence, complications, treatment failure, and duration of hospital stay in acute uncomplicated diverticulitis.

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