Cost and Risk Analysis of Lifelong Penicillin Allergy

2019 ◽  
Vol 58 (11-12) ◽  
pp. 1309-1314 ◽  
Author(s):  
Lauren Y. C. Au ◽  
Andrea M. Siu ◽  
Loren G. Yamamoto
Keyword(s):  
Clostridium Difficile ◽  
Risk Analysis ◽  
Adverse Effects ◽  
Penicillin Allergy ◽  
Antibiotic Utilization ◽  
Mean Lifetime ◽  
Antibiotic Cost

Patients labeled as being penicillin-allergic require the use of alternative antibiotics. The objective of this study was to estimate the lifetime antibiotic costs of patients labeled as being penicillin allergic prior to age 10 compared with those who were not penicillin allergic and to compare antibiotic utilization between these 2 groups with regard to risks of adverse effects. Using the low end of the antibiotic cost range, penicillin-allergic patients had a mean lifetime antibiotic cost of $8171 per patient, compared with $6278 for non–penicillin-allergic patients, a difference of $1893. Penicillin-allergic patients utilized more moderate-spectrum antibiotics, more fluoroquinolones, and had a higher estimated Clostridium difficile risk.

scholarly journals The evolution of Risk from Landslides: Concepts and Applications for Communities in New Zealand

2021 ◽  
Author(s):  
◽  
Gabriele Hufschmidt
Keyword(s):  
At Risk ◽  
New Zealand ◽  
Risk Analysis ◽  
Adverse Effects ◽  
Social Vulnerability ◽  
Landslide Hazard ◽  
Social Resilience ◽  
Absolute Level ◽  
Risk Levels ◽  
Elements At Risk

<p>The aim of this research is to identify temporal changes of risk from landsliding for several locations in New Zealand (the Western Hutt Hills, close to Wellington; Te Arai, close to Gisborne; Mt.Cook/Aoraki Village, South Island). While risk analysis usually targets a particular point in time, this research includes several five-year intervals (based on census years) starting in 1981 until 2006. The scale of this analysis is the community level. Risk is not expressed as an absolute level of loss, for example a dollar value or the number of fatalities. Risk is rather considered as the probability and extent of adverse effects on a community inferred from landsliding. As such, risk is relative: the aim is to quantify risk for a community relative to another point in time, and relative to other communities. In addition, the degree to which risk levels vary between communities is quantified. The objectives of the risk analysis are to: 1. establish landslide hazard, i.e. the frequency and magnitude of landsliding for each location, 2. develop an index of social vulnerability per census year and community, 3. develop an index of social resilience per census year and community, 4. combine 1.-3. and, together with exposure ('elements at risk'), determine risk from landsliding for each community through time.</p>

Resources Assessment for Penicillin Allergy Testing Performed by Pharmacists at the Patient’s Bedside

2021 ◽  
pp. 106002802110024
Author(s):  
Sophie Gaudreau ◽  
Geneviève Bourque ◽  
Kevin Côté ◽  
Clément Nutu ◽  
Marie-France Beauchesne ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Antibiotic Therapy ◽  
Provocation Test ◽  
Hospitalized Patients ◽  
Penicillin Allergy ◽  
Full Time ◽  
Allergy Testing ◽  
Oral Provocation ◽  
Allergy Test ◽  
Oral Provocation Test

Background: False penicillin allergies lead to increased antimicrobial resistance, adverse effects, and health care costs by promoting the use of broad-spectrum antibiotics. The Infectious Diseases Society of America recommends the implementation of allergy testing. Objectives: The primary objective of this research was to estimate the number of pharmacist full-time equivalents (FTEs) required for an intervention aimed at determining penicillin allergy in hospitalized patients. Acceptance of pharmacists’ suggestions on antibiotic therapy are described. Methods: A quasi-experimental study was conducted in a 712-bed university hospital involving hospitalized patients with a suspected penicillin allergy and an infection treatable with penicillin. The time required for the intervention, which included a questionnaire, penicillin allergy testing (skin-prick test, intradermal injection, and oral provocation test), and recommendations on antibiotic therapy were measured to calculate the number of pharmacist FTEs. Results: A total of 55 patients were included. Scarification allergy testing was performed on 37, intradermal allergy test on 33, and oral provocation test on 26 patients. The intervention ruled out penicillin allergy in 26 patients, with no serious adverse effects. The intervention was associated with a median weekly pharmacist FTE of 0.15 (interquartile range = 0.12-0.25). The acceptance of pharmacists’ suggestions was high and led to 9 patients being switched to an antibiotic with a narrower spectrum of activity. Conclusions and Relevance: This study describes penicillin allergy testing and the number of median weekly hospital pharmacist FTEs required, which was approximately 0.15. These data may aid in the implementation of this safe intervention that promotes narrower-spectrum antibiotherapy.

scholarly journals The evolution of Risk from Landslides: Concepts and Applications for Communities in New Zealand

2021 ◽  
Author(s):  
◽  
Gabriele Hufschmidt
Keyword(s):  
At Risk ◽  
New Zealand ◽  
Risk Analysis ◽  
Adverse Effects ◽  
Social Vulnerability ◽  
Landslide Hazard ◽  
Social Resilience ◽  
Absolute Level ◽  
Risk Levels ◽  
Elements At Risk

<p>The aim of this research is to identify temporal changes of risk from landsliding for several locations in New Zealand (the Western Hutt Hills, close to Wellington; Te Arai, close to Gisborne; Mt.Cook/Aoraki Village, South Island). While risk analysis usually targets a particular point in time, this research includes several five-year intervals (based on census years) starting in 1981 until 2006. The scale of this analysis is the community level. Risk is not expressed as an absolute level of loss, for example a dollar value or the number of fatalities. Risk is rather considered as the probability and extent of adverse effects on a community inferred from landsliding. As such, risk is relative: the aim is to quantify risk for a community relative to another point in time, and relative to other communities. In addition, the degree to which risk levels vary between communities is quantified. The objectives of the risk analysis are to: 1. establish landslide hazard, i.e. the frequency and magnitude of landsliding for each location, 2. develop an index of social vulnerability per census year and community, 3. develop an index of social resilience per census year and community, 4. combine 1.-3. and, together with exposure ('elements at risk'), determine risk from landsliding for each community through time.</p>

scholarly journals Applying fecal microbiota transplantation (FMT) to treat recurrent Clostridium difficile infections (rCDI) in children

PeerJ ◽  
2018 ◽  
Vol 6 ◽  
pp. e4663 ◽  
Author(s):  
Shaaz Fareed ◽  
Neha Sarode ◽  
Frank J. Stewart ◽  
Aneeq Malik ◽  
Elham Laghaie ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Adverse Effects ◽  
Gut Microbiome ◽  
Pediatric Patients ◽  
Fecal Microbiota Transplantation ◽  
Diversity Index ◽  
Microbial Community Composition ◽  
Fecal Microbiota ◽  
Rrna Gene ◽  
Significant Difference

Background Fecal Microbiota Transplantation (FMT) is an innovative means of treating recurrent Clostridium difficile infection (rCDI), through restoration of gut floral balance. However, there is a lack of data concerning the efficacy of FMT and its impact on the gut microbiome among pediatric patients. This study analyzes clinical outcomes and microbial community composition among 15 pediatric patients treated for rCDI via FMT. Methods This is a prospective, observational, pilot study of 15 children ≤18 years, who presented for rCDI and who met inclusion criteria for FMT at a pediatric hospital and pediatric gastroenterology clinic. Past medical history and demographics were recorded at enrollment and subsequent follow-up. Specimens of the donors’ and the patients’ pre-FMT and post-FMT fecal specimen were collected and used to assess microbiome composition via 16S rRNA gene sequencing. Results FMT successfully prevented rCDI episodes for minimum of 3 months post-FMT in all patients, with no major adverse effects. Three patients reported continued GI bleeding; however, all three also had underlying Inflammatory Bowel Disease (IBD). Our analyses confirm a significant difference between pre-and post-FMT gut microbiome profiles (Shannon diversity index), whereas no significant difference was observed between post-FMT and donor microbiome profiles. At the phyla level, post-FMT profiles showed significantly increased levels of Bacteroidetes and significantly decreased levels of Proteobacteria. Subjects with underlying IBD showed no difference in their pre-and post-FMT profiles. Conclusion The low rate of recurrence or re-infection by C. difficile, coupled with minimal adverse effects post-FMT, suggests that FMT is a viable therapeutic means to treat pediatric rCDI. Post-FMT microbiomes are different from pre-FMT microbiomes, and similar to those of healthy donors, suggesting successful establishment of a healthier microbiome.

scholarly journals A hosszú távú protonpumpagátló kezelés következményei felnőtteken

2018 ◽  
Vol 159 (19) ◽  
pp. 735-740 ◽  
Author(s):  
Iván Igaz ◽  
Gábor Simonyi ◽  
Sándor Balogh ◽  
Miklós Szathmári
Keyword(s):  
Clostridium Difficile ◽  
Adverse Effects ◽  
General Practitioners ◽  
Proton Pump ◽  
Bone Fractures ◽  
Vitamin B ◽  
Strong Indication ◽  
The World ◽  
Long Term Adverse Effects

Abstract: In the last few decades, proton-pump inhibitors have become the mainstay of the treatment of acid-related disorders. Despite their efficacy, these drugs are not without risks. Recently several articles have been published on their long-term adverse effects. Among these adverse effects, the higher risk of bone fractures, the vitamin B12 and magnesium deficiencies and the higher risk of Clostridium difficile infection may be relevant. As these drugs are prescribed more and more frequently all over the world, the knowledge of the long-term adverse effects is very important not only for the specialists but for the general practitioners as well. In this review, the authors discuss the recent findings in this field, emphasising that the long-term use of these drugs must be based on an adequate and strong indication. Orv Hetil. 2018; 159(19): 735–740.

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