scholarly journals Efficacy and safety of decamethoxin in complex treatment of patients with group III viral-bacterial community-acquired pneumonia

2021 ◽  
pp. 15-21
Author(s):  
O.L. Bororova
Keyword(s):  
Antibiotic Therapy ◽  
Antibiotic Use ◽  
Generation Cephalosporin ◽  
Infectious Complications ◽  
Community Acquired Pneumonia ◽  
Main Group ◽  
Control Group ◽  
Complex Treatment ◽  
Medical Problems ◽  
Group Iii

BACKGROUND. There are many unsolved medical problems and, of course, pneumonia is one of them. Communityacquired pneumonia (CAP) is a multifactorial disease, but the role of viruses as causative agents is constantly growing. Specific antiviral therapy for CAP is limited. Therefore, the search for drugs with virucidal activity remains relevant. An antimicrobial agent with a broad spectrum of action – decamethoxin – is successfully used today for treatment of patients with infectious exacerbations of bronchial asthma and chronic bronchitis. At the same time efficacy of decamethoxin in CAP patients was not studied. OBJECTIVE. To evaluate the effectiveness and safety of the inhaled antimicrobial drug decamethoxin in the complex treatment of patients with group III viral-bacterial CAP. MATERIALS AND METHODS. There was enrolled 62 patients with group III viral-bacterial CAP. All patients received the same sequential antibiotic therapy: protected aminopenicillin with macrolide or III generation cephalosporin with macrolide. Patients of the main group were prescribed inhalations through a nebulizer of the antiseptic drug decamethoxin in addition to antibacterial therapy from the first day of treatment for 5-7 days. RESULTS AND DISCUSSION. No adverse events were detected in any of the patients during treatment. In all cases, recovery was diagnosed. At the same time, the term of achieving positive results in the main group was 12.2±0.7 days, and in the control – 17.2±0.7 (р <0,05). The average duration of antibiotic use was different in main and control groups: respectively 9.4±0.4 and 10.7±0.4 days (р <0,05). There were no infectious complications in the patients of the main group, while 24 (72 %) patients of the control group were diagnosed with acute rhinopharyngitis (47.0 % of cases), lateral pharyngitis (13 %) and sinusitis (9 %), other complications (otitis, infectious exudative pericarditis). In 22 (66 %) cases there was one complication and in 2 (6 %) cases there were two complications. CONCLUSIONS. For patients with group III viral-bacterial CAP additional inclusion in the empirical sequential antibiotic therapy of inhaled decamethoxin can significantly reduce the frequency of infectious complications, duration of antibiotic therapy, as well as the duration of positive treatment results.

scholarly journals Effect of dynamic electroneurostimulation in treatment of community-acquired pneumonia in preschool children

2014 ◽  
Vol 95 (3) ◽  
pp. 370-374
Author(s):  
Zh R Ibragimova ◽  
O I Pikuza ◽  
Kh M Vahitov
Keyword(s):  
Preschool Children ◽  
Clinical Symptoms ◽  
Day Treatment ◽  
White Blood Cells ◽  
Community Acquired Pneumonia ◽  
Main Group ◽  
Control Group ◽  
Complex Treatment ◽  
X Ray ◽  
Inflammatory Changes

Aim. To assess the effect of dynamic electroneurostimulation in treatment of community-acquired pneumonia in preschool children. Methods. The main group consisted of 45 preschool children with community-acquired pneumonia, in whom 7-day treatment course of dynamic electroneurostimulation was included as the component of the complex treatment. The control group included 55 children in whom conventional tactics was applied. Results. General intoxication syndrome was resolved at 3.2±1.1 day in children of the main group compared to 7.7±1.4 day in the control group. The use of dynamic electroneurostimulation reduced the duration of respiratory distress by more than 1.5 times (6.8±1.3 day), regression of physical lung changes was observed at 10.3±1.4 on average, compared to the end of the second week at the control group. Resolving of the clinical symptoms in children of the main group was accompanied by statistically significant (p 0.05) reduction of basic parameters of systemic inflammation (increased white blood cells count, high neutrophil count, left shift) by 7th day of treatment. The level of C-reactive protein reduced by 7 times in children of the main group, compared to 2.3 times in comparison group (p 0.05). Chest X-ray on the 7th day showed complete resolving of inflammatory changes in 20 (44.4%) patients of the main group, while no such cases were observed in control group (p 0.001). At the same time, no positive change of X-ray picture was revealed in 25 (45.5%) children of the control group, while there were no such cases in the main group (p 0.001). On the 11th day of treatment complete resolving of inflammatory changes was found in 43 (95.6%) children of the main group, compared to 34 (61.8%) children of the control group (p 0.05). Conclusion. Including of dynamic electroneurostimulation in complex treatment of community-acquired pneumonia in children reduces the recovery time, hospital stay and treatment cost.

Clinical efficacy of osteopathic correction in the complex treatment of patients with unoperated open-angle glaucoma

2020 ◽  
pp. 97-105
Author(s):  
E. N. Simakova ◽  
O. V. Stenkova
Keyword(s):  
Intraocular Pressure ◽  
Drug Therapy ◽  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Randomized Study ◽  
Main Group ◽  
Control Group ◽  
Open Angle ◽  
Complex Treatment ◽  
Hypotensive Drug

Introduction. Glaucoma is one of the most significant eye diseases. It is often diagnosed, not always amenable to therapy, and can lead to a complete loss of visual functions. In recent years, the method of osteopathic correction has become widespread as one of the effective methods of treatment and rehabilitation of patients with pathologies of various body systems. In the pathogenesis of glaucoma, it is customary to distinguish a dystrophic concept, which considers primary open-angle glaucoma as a result of dystrophic changes in the connective tissue, as well as in the endothelial lining of the trabeculae and Schlemm′s canal, especially destructive changes in mitochondria and the alteration of their functional activity. A vascular concept is also distinguished. According to this concept, the central link in the pathogenesis of glaucoma is circulatory disorder in the ciliary vessels, ocular artery, and major vessels of the head and neck, it can be assumed that osteopathic correction in the treatment of patients with open-angle glaucoma will be pathogenetically substantiated and will have a positive effect on intraocular pressure and trophicity of the optic nerve. The goal of research — to study the influence of in osteopathic correction on the nature of unoperated glaucoma (stage IIA) and to substantiate the possibility of using osteopathic correction in the complex treatment of patients with this pathology.Materials and methods. A prospective controlled randomized study was conducted at 52 city polyclinics, branch 3, Moscow, from January 2018 to January 2019. 40 patients (70 eyes) aged 50 to 75 years with primary open-angle glaucoma IIA stage were examined. At this stage of the disease, patients most often seek medical care and the issue of conservative management is primarily considered. All patients were divided into two groups of 20 people: the main group and the control group. The treatment in the main group included hypotensive drug therapy and osteopathic correction. Patients of the control group received only drug therapy. All patients underwent ophthalmic (visometry, tonometry, perimetry) and osteopathic examination twice: before the treatment and after 3 months.Results. For patients with primary open-angle IIA non-operated glaucoma, regional (most often regions of the head, neck, dura mater) and local (abdominal diaphragm, iliac bones, hip and knee joints) somatic dysfunctions were the most typical. In the main group a statistically significant decrease in the frequency and severity of dysfunctions at all levels was stated. Also, in patients receiving osteopathic correction, a significant decrease in the level of intraocular pressure and perimetric indices was noted. In patients of the control group, no reliable changes in these indicators were obtained.Conclusion. The results obtained indicate that osteopathic correction is clinically effective in the complex treatment of patients with primary open-angle II A glaucoma.

scholarly journals Clinical Factors Associated with a Shorter or Longer Course of Antibiotic Treatment in Patients with Exacerbations of Bronchiectasis: A Prospective Cohort Study

2019 ◽  
Vol 8 (11) ◽  
pp. 1950
Author(s):  
Giulia Scioscia ◽  
Rosanel Amaro ◽  
Victoria Alcaraz-Serrano ◽  
Albert Gabarrús ◽  
Patricia Oscanoa ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Antibiotic Treatment ◽  
Prospective Observational Study ◽  
Antibiotic Use ◽  
Community Acquired Pneumonia ◽  
Clinical Factors ◽  
Treatment Results ◽  
Factors Associated ◽  
Long Term Oxygen Therapy

Background: Bronchiectasis exacerbations are often treated with prolonged antibiotic use, even though there is limited evidence for this approach. We therefore aimed to investigate the baseline clinical and microbiological findings associated with long courses of antibiotic treatment in exacerbated bronchiectasis patients. Methods: This was a bi-centric prospective observational study of bronchiectasis exacerbated adults. We compared groups receiving short (≤14 days) and long (15–21 days) courses of antibiotic treatment. Results: We enrolled 191 patients (mean age 72 (63, 79) years; 108 (56.5%) females), of whom 132 (69%) and 59 (31%) received short and long courses of antibiotics, respectively. Multivariable logistic regression of the baseline variables showed that long-term oxygen therapy (LTOT), moderate–severe exacerbations, and microbiological isolation of Pseudomonas aeruginosa were associated with long courses of antibiotic therapy. When we excluded patients with a diagnosis of community-acquired pneumonia (n = 49), in the model we found that an etiology of P. aeruginosa remained as factor associated with longer antibiotic treatment, with a moderate and a severe FACED score and the presence of arrhythmia as comorbidity at baseline. Conclusions: Decisions about the duration of antibiotic therapy should be guided by clinical and microbiological assessments of patients with infective exacerbations.

Aspects of the Wound Process in the Choice of Surgical Treatment of the Ventral Hernias

10.12737/5900 ◽  
2014 ◽  
Vol 21 (3) ◽  
pp. 62-65
Author(s):  
Агаларян ◽  
A. Agalaryan ◽  
Ротькин ◽  
E. Rotkin ◽  
Хохлова ◽  
...  
Keyword(s):  
Standard Method ◽  
Infectious Complications ◽  
Main Group ◽  
Control Group ◽  
Macrophage Activity ◽  
Hernial Sac ◽  
Effective Activity ◽  
Bed Days ◽  
The Mean ◽  
Ventral Hernias

The examination of the wound process in 140 patients after the alloplasty, according to the standard method «on-lay» and developed method with the use of the flaps of the hernial sac was carried out. All patients were divided into 2 groups. The main group was consisted of the patients treated by the developed method using the flaps of the hernial sac, the control group of patients – by means of the standard method «on-lay». According to the data of the cytological study of the exudates in the both groups it has been found that the flaps of the hernial sac situated in the subprosthetic space contribute to the high content of the cells having the macrophage activity (neutrophils, macrophagocytes) in the surgical intervention field. In the main group, the mean volume of the secretion was 113ml, it was in 2 times less than the volume of the serous drainage in the patients of the control group. Decrease of the exudates volume in the main group influenced to the drainage terms (3 days average) and to the hospital stay (as many as 8 bed-days average). The absence of the infectious complications in the patients treated by method with the use of the hernial sac flaps is explained by the effective activity of the cells immunity factors in the wound.

Tumor expression of hypoxia-inducible factor and antimicrobial peptides in oral fluid for prediction of after-surgery suppurative complications in patients with oral mucosa cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e17530-e17530
Author(s):  
Ekaterina Komarova ◽  
Oleg Ivanovich Kit ◽  
Vladimir Kononenko ◽  
Aleksey Yurievich Maksimov ◽  
Victoria V. Pozdnyakova ◽  
...  
Keyword(s):  
Oral Mucosa ◽  
Protein A ◽  
Hypoxia Inducible Factor ◽  
Infectious Complications ◽  
Main Group ◽  
Control Group ◽  
Comprehensive Treatment ◽  
Microbial Infection ◽  
Tumor Tissues ◽  
Tumor Expression

e17530 Background: It is believed that hypoxia-inducible factor (HIF-1α) hyperactivity promotes synthesis of protective factors and increases bacterial growth-inhibitory activity, provides enhancement methods of the congenital immune response to microbial infection. Methods: Lactoferrin and α-defensin were detected in saliva of 41 patients with oral mucosa (OM) cancer (T2N0-2M0) before a comprehensive treatment; enzyme immunoassay (EIA) method was used. A level of hypoxia-inducible factor (HIF-1α) was evaluated by EIA method in tumor tissues after surgical treatment. The patients were divided into two groups according to an after-surgery period: the main group (n = 16) had after-surgery suppurative complications. An after-surgery period proceeded without infectious complications in patients of a control group (n = 25). Results: It was found that Lactoferrin content in saliva statistically was significantly higher by 36,4% (p < 0,05) (3,0±0,24 µg/ml against 2,2±0,19 µg/ml) if to draw a comparison between the main group and the control group with respect to development of suppurative complications and absence of a inter-group difference according to α-defensin concentration (4,1±0,35 pg/ml against 3,8±0,19 pg/ml). HIF-1α expression index in the main group (8,4±0,79 CU/mg protein in a well) exceeded this index by 18,3% (p < 0,05) in the control group (7,1±0,79 CU/mg protein). A positive correlation between HIF-1α expression and Lactoferrin content (R = 0,53 at р = 0,0001) was detected in patients with OM cancer. Conclusions: Detected HIF-1α hyperexpression in tumor tissues and Lactoferrin content in saliva, as well as their interaction allows suggesting significance of these factors for their progression prediction in patients with OM cancer in case of after-surgery suppurative complications.

scholarly journals A preoperatív antibiotikus és antiszeptikus kezelés hatása a műtéti úton eltávolított alsó bölcsességfogak sebgyógyulására – prospektív randomizált vizsgálat

2017 ◽  
Vol 158 (1) ◽  
pp. 13-19 ◽  
Author(s):  
István Kaposvári ◽  
Kinga Körmöczi ◽  
Zsuzsa Beáta László ◽  
Ferenc Oberna ◽  
Ferenc Horváth ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Third Molar ◽  
Control Group ◽  
Surgical Removal ◽  
Group Iii ◽  
Prophylactic Dose ◽  
Group I ◽  
Mandibular Third Molar ◽  
Amoxicillin Clavulanate ◽  
Group 2

Abstract: Introduction and aim: The study compares the antibiotic prophylaxis combined with postoperative antibiotic therapy to preoperative chlorhexidine rinse combined with postoperative antibiotic therapy in preventing complications after surgical removal of a mandibular third molar. Method: 71 healthy patients in four groups were enrolled in the study: I. prophylactic dose of 2000 mg of amoxicillin clavulanate, continued with amoxicillin clavulanate postoperatively; II. prophylactic dose of 600 mg of clindamycin, continued with clindamycin postoperatively; III. prophylactic chlorhexidin rinsing, continued randomized amoxicillin clavulanate or clindamycin postoperatively; IV. control, with clindamycin postoperatively. Results: The pain was smaller in the prophylaxis groups. Alveolitis occurred only in the control group: 2 patients. Wound opening occurred in 22,2 % in group IV., 14,2 % in group II, 10 % in group I., 5 % in group III. Conclusion: We consider completing the indicated postoperative antibiotic prescription with antibiotic or antiseptic prophylaxis. Chlorhexidin prophylaxis could have the same positive effect. Orv. Hetil., 2017, 158(1), 13–19.

scholarly journals ДЕСТРУКТИВНИЙ УСКЛАДНЕНИЙ ПОЛІОНІХОМІКОЗ І ВРОСТАННЯ НІГТІВ: КЛІНІКО-БІОХІМІЧНІ ПАРАЛЕЛІ (КЛІНІЧНІ СПОСТЕРЕЖЕННЯ)

2018 ◽  
Author(s):  
A. R. Vergun ◽  
B. M. Parashchuk ◽  
M. R. Krasnyi ◽  
O. M. Vergun ◽  
Z. M. Kit ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Metabolic Syndrome ◽  
Conservative Treatment ◽  
Nail Plate ◽  
Main Group ◽  
Control Group ◽  
Homa Index ◽  
Complex Treatment ◽  
System Therapy ◽  
Ingrown Nail

Causes of unsatisfactory outcomes of ingrown nail and mycotical pathology complex treatment were insufficiently studied for approaches to preventing relapses. The need for complex research on surgical nail pathology is primarly determined by a large number of clinical observations of uncomplicated and complicated cases, especially relapses. The mycotic paronychia and the chronic subungual abscess are compressed along the nail edge. Not all surgical procedures that have been successfully treated paronychia you can apply for the correction of ingrown nail. Late compression relapses with monoonychocryptosis are 5–18 %, and with ingrown nail combined with onychomycosis – 30–70 %, which is also confirmed by our previous studies. Fungal infections of the nails (onychomycosis) in combination with ingrowth remain one of the most serious problems of dermatology and dermatological surgery. In domestic literature there is a significant number of works devoted to pathology of the nail plate, however, the surgical aspects of the onychology are assigned a minimal, secondary role.The aim of the study – optimal sequence of surgical treatment, local and system antimycotic therapy, clinical and biochemical parallels after moving away of the incarnated nails at trichophytosis and destructive polyonychomycosis, complicated by the secondary ingrown nail for some patients with the complicated defeat of nails.Materials and Methods. Over a five-year period 436 unguis incarnates diagnosis (among them 325 cases of incarnated multifocal mycotical-assotiated nail pathology – the main group, included sub-selections of patients with diabetes mellitus and metabolic syndrome) in 259 men and 177 women 28–86 years old were performed. Adequate system therapy of patients with comorbid diabetes mellitus and metabolic syndrome was carried out. In 182 patients late relapses of onychocryptosis were confirmed after previous surgeries at other clinics. Conservative treatment was recommended only at early stages of ingrowth. Removal of the affected nails was performed in patients with mycotic lesions (local and systemic fungicide therapies were used). Investigation of the morphogenesis of destructive aspect of the mycotic lesions was carried out. The analysis justifies the feasibility of establishing predictive relationships between clinical variants of chronic purulent necrotic infections and combined comorbidity.Results and Discussion. 363 cases of destructive purulent-necrotic superficial chronic, combined and combined lesions of the distal phalange of the toes with nail plate ingrowth were studied in patients aged 12–75 years, 236 men and 127 women operated in surgical departments were investigated. All surgical procedures are performed correctly according to local protocols. Nosological forms of lesions are associated with some degree of onychocryptosis, according to the dominant clinical manifestations of ICD 10 were divided into sub-samples – actually onychocryptosis, dermatophytosis and candidal onychomycosis with incarnation of the nail. Other 73 patients with uncomplicated mycosis some conservative treatment were performed correctly according to local protocols. Analysis of subonychial scraping allowed stating the prevalence of red trichophytia, where in 74 % of cases it was associated with mold, in 26 % cases it was associated with yeast fungi; and in 31 % cases – with the bacterial flora; applied 4 "pulses" of itraconazole 400 mg/day. We studied some indicators in the lipid profile, which were significantly higher in both groups of patients, p <0.01 for both groups; noted the positive correlation between the level of total cholesterol and leptin (p <0.01). The concentration of high-density lipoprotein cholesterol in patients of the main group – (5.2±0.1) mmol/L compared with patients in control group – (2.8±0.2) mmol/L. The average content of nitrogen oxide in the study group (metabolic syndrome) was higher than that in healthy patients – (15.1±0.9) mcmol/L, p <0.05. Patients of the main and the comparison groups with type 2 diabetes mellitus with ingrown polyonychomycosisexperienced considerable decreasing HOMA -index of β-cells function and increasing HOMA -index of insulin resistance (8.11±1.1) in the main group and (2.2±1.2) in the control group). The late unsatisfactory results of the complex treatment of destructive onychomycosis associated with incarnation (occurrence of compression relapses) are determined by the technical errors of the operation interventions (inadequate selection of the method and volume of resection, traumatic performance of onychectomy, failure to perform partial matrixectomy), disregard of pathogenetic and morphogenetic factors of destructive onychomycosis, the refusal to perform simultaneous surgical interventions on deeply placed structures in case of combined mycotic-associated lesions, ineffective pre- and intraoperative prophylactic actions to prevent spreading mycotic infection to deeply placed structures.Conclusions. In all cases of mycotic onychocryptosis (secondary ingrown toenail) underwent a comprehensive treatment of comorbid pathology, system therapy of itraconazole to operative treatment (basic onychial defeats sanation) and in a postoperative period was carried out, some patients with combined pathology got 4 seven-day system "pulses" of 400 mg/day itraconazole therapy. Sanation of other nails for prevention of mycotic reinfection was carried out by ciclopirox or amorolfine lacquer. We recommend using more radical and effective three-component surgical methods: nail resection or removal of the nail plate, supplemented by excision of pathologically altered eponycheal tissues and partial marginal matrixectomy in the area of ingrowth. In patients, the low-impact methods of excision of the nail and partial marginal matricectomy by mechanical carving and coagulation with the further dermatophytoma scraping off with the Volkmann spoon were embedded and applied.

Possibilities of osteopathic correction of somatic dysfunctions in children with chronic adenoiditis

2020 ◽  
pp. 62-71
Author(s):  
E. V. Chaiko ◽  
O. I. Kurbatov
Keyword(s):  
Neck Region ◽  
Endoscopic Examination ◽  
Main Group ◽  
Control Group ◽  
Complex Treatment ◽  
Structural Components ◽  
Thoracic Region ◽  
Head Region ◽  
Complex Therapy ◽  
Chronic Adenoiditis

Introduction. Chronic adenoiditis is one of the most frequent ENT diseases. It is comparatively resistant, and in advanced cases, the pathological process is hardly reversible. Despite the big number of publications on chronic adenoiditis, in a high percentage of cases specialists still encounter frequent recurrence of the disease. That is why issues of standard treatment, especially conservative, the search for adequate and effective methods of medical rehabilitation of patients with chronic inflammatory diseases, including in frequently ill children, are timely and relevant. Osteopathic methods of correction can potentially improve blood circulation and the innervation of adenoids, which will increase the clinical effectiveness of conservative treatment, reduce medication period and achieve a longer remission. However, studies on the influence of osteopathic correction on the course of chronic adenoiditis have not been found in the literature available to us. That is why it was necessary to conduct this study. The goal of research — to justify the possibility of using osteopathic correction in the complex treatment of frequently ill children with chronic adenoiditis.Materials and methods. From January 2018 to March 2019, a prospective controlled randomized study was performed at the MEDSI Clinic (Moscow). Thirty patients with chronic adenoiditis at the age of 4 to 10 years were examined. Patients were divided by the method of simple randomization using a random number generator into two equal groups of 15 people: the main group and the control group. Children of the main group received osteopathic correction along with drug and irrigation therapy for 2 months. In total, 3 osteopathic sessions were conducted with a frequency of 1 time in 14 days. Children in the control group received only pharmacological and irrigation therapy. All patients before the start of treatment and 2 months after the start of treatment were examined by an otorhinolaryngologist with an endoscopic examination, and by an osteopath with the assessment of the main somatic dysfunctions. Otorhinolaryngological examination included history taking and collecting of complaints with fi lling out a special questionnaire, anterior and posterior rhinoscopy, as well as an endoscopic examination of the nasopharynx with the assessment of the revealed changes in points.Results. After the treatment, the number of complaints and the main symptoms of the disease, the number of changes in the nasopharynx and oropharynx, revealed by the results of endoscopic examination, decreased statistically significantly in patients of both groups. The study showed that regional biomechanical disorders are common for children with chronic adenoiditis. Dysfunctions of head region, neck region (visceral component), thoracic region (structural component) were the most frequent. Against the background of the treatment, patients of the main group presented a decrease in the number of regional somatic dysfunctions. Statistically significant differences were obtained in the frequency of occurrence of somatic dysfunctions: head region, neck region (visceral and structural components), thoracic region (visceral and structural components) (p<0,05). In patients of the control group, a statistically significant decrease in the number of somatic dysfunctions was detected only in the head region (p<0,05). A follow-up assessment of the results of the treatment showed that the inclusion of osteopathic correction in the complex therapy of children with chronic adenoiditis contributes to a longer remission (p<0,05).Conclusion. Based on the study, it can be concluded that the direct results of osteopathic correction in the complex treatment of frequently ill children with chronic adenoiditis are comparable with the results of isolated pharmacological and irrigation therapy (reduction in the number of complaints and positive changes in the results of endoscopic examination of the nasopharynx). However, the inclusion of osteopathic correction in the complex therapy of such children contributes to a longer remission, which is of great importance for this group of patients. The results of the research suggest a further study of the possibilities of osteopathic correction of somatic dysfunctions in frequently ill children with chronic adenoiditis.

scholarly journals Procalcitonin-Guided Antibiotic Therapy Reduces Antibiotic Use for Lower Respiratory Tract Infections in a United States Medical Center: Results of a Clinical Trial

2018 ◽  
Vol 5 (12) ◽  
Author(s):  
Jennifer Townsend ◽  
Victoria Adams ◽  
Panagis Galiatsatos ◽  
David Pearse ◽  
Hardin Pantle ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Antibiotic Therapy ◽  
Respiratory Tract Infections ◽  
Antibiotic Use ◽  
Adverse Outcomes ◽  
Control Group ◽  
Lower Respiratory Tract Infections ◽  
Antibiotic Duration ◽  
Tract Infections

Abstract Background European trials using procalcitonin (PCT)-guided antibiotic therapy for patients with lower respiratory tract infections (LRTIs) have demonstrated significant reductions in antibiotic use without increasing adverse outcomes. Few studies have examined PCT for LRTIs in the United States. Methods In this study, we evaluated whether a PCT algorithm would reduce antibiotic exposure in patients with LRTI in a US hospital. We conducted a controlled pre-post trial comparing an intervention group of PCT-guided antibiotic therapy to a control group of usual care. Consecutive patients admitted to medicine services and receiving antibiotics for LRTI were enrolled in the intervention. Providers were encouraged to discontinue antibiotics according to a PCT algorithm. Control patients were similar patients admitted before the intervention. Results The primary endpoint was median antibiotic duration. Overall adverse outcomes at 30 days comprised death, transfer to an intensive care unit, antibiotic side effects, Clostridium difficile infection, disease-specific complications, and post-discharge antibiotic prescription for LRTI. One hundred seventy-four intervention patients and 200 controls were enrolled. Providers complied with the PCT algorithm in 75% of encounters. Procalcitonin-guided therapy reduced median antibiotic duration for pneumonia from 7 days to 6 (P = .045) and acute exacerbation of chronic obstructive pulmonary disease (AECOPD) from 4 days to 3 (P = .01). There was no difference in the rate of adverse outcomes in the PCT and control groups. Conclusions A PCT-guided algorithm safely reduced the duration of antibiotics for treating LRTI. Utilization of a PCT algorithm may aid antibiotic stewardship efforts. This clinical trial was a single-center, controlled, pre-post study of PCT-guided antibiotic therapy for LRTI. The intervention (incorporation of PCT-guided algorithms) started on April 1, 2017: the preintervention (control group) comprised patients admitted from November 1, 2016 to April 16, 2017, and the postintervention group comprised patients admitted from April 17, 2017 to November 29, 2017 (Supplementary Figure 1). The study comprised patients admitted to the internal medicine services to a medical ward, the Medical Intensive Care Unit (MICU), the Cardiac Intensive Care Unit (CICU), or the Progressive Care Unit (PCU) “step down unit”. The registration data for the trails are in the ClinicalTrials.gov database, number NCT0310910.

scholarly journals ANTIBACTERIAL THERAPY OF PYOGENIC LIVER ABSCESSES

2021 ◽  
Vol 48 (1) ◽  
Author(s):  
V. V. Novak ◽  
V. O. Belinska
Keyword(s):  
Body Temperature ◽  
Antibiotic Therapy ◽  
Antibacterial Therapy ◽  
Anaerobic Bacteria ◽  
Main Group ◽  
Diagnostic Methods ◽  
Control Group ◽  
Liver Abscesses ◽  
Microbiological Examination ◽  
Facultative Anaerobic Bacteria

Abstract Purpose of the study. To study the features of the microbial landscape, to develop an algorithm for antibacterial therapy in patients with pyogenic liver abscesses. Prove the effectiveness of the developed algorithm in the treatment of such patients. Materials and methods. The results of treatment of 79 patients with pyogenic liver abscesses were analyzed. The mean age of patients was 48,4 ± 4,7 years, with men predominating (62,9%). The inclusion criterion was the presence of pyogenic liver abscesses, the exclusion criteria were cholangiogenic and specific abscesses. The main group consisted of 44 patients operated on minimally invasive technologies based on modern diagnostic methods. They received a comprehensive conservative therapy, which took into account antibacterial treatment according to the developed algorithm. The tactics of surgical treatment of 35 patients in the control group did not differ from the main one. The groups did not differ significantly in age, sex, comorbidity, severity of the disease and the results of microbiological examination. Results. The number of inoculations of microorganisms from the purulent center was dominated by monoinfection – 86,4–88,6% of cases, which was mostly aerobic. Most of them were facultative anaerobic bacteria of the genus Enterobacteriaceae, namely Kl. pneumoniae – 34,1–40,1%. Less than a quarter of patients (11,4–13,6%) isolated cultures are represented by microbial associations – aerobic-anaerobic and aerobicaerobic. However, aerobic-aerobic infection prevailed – 75,0–83,3%. MRSA strains of staphylococci were isolated in 5,7–6,8% of patients. Treatment began on the first day of hospitalization. Empirical treatment was immediately prescribed, followed by antibiotic replacement, if necessary, based on the results of microbiological examination and determination of the sensitivity of the isolated cultures. According to microbiological studies, in patients with AP most of the isolated microorganisms (71,4–90,9%) were sensitive to linezalide and taigecycline. These antibacterial drugs were reserve drugs and were prescribed in extremely severe cases in the absence of sensitivity to other drugs. The effectiveness of treatment was evaluated by clinical data and improvement of laboratory parameters (normalization of body temperature and leukocyte formula). Conclusion. Carrying out adequate combined antibiotic therapy for patients with AP according to the developed algorithms, along with surgery, allowed to reduce the recovery time of patients: for 2–3 days normalization of body temperature (t = 5,66176; P < 0,000001) and leukocyte formula (t = 8, 56860; P < 0,000001) patients of the main group in comparison with control patients. In turn, this contributed to a probable reduction in the length of stay of the patient in the hospital for 3 days (t = 3,95561; P = 0,000116). Keywords: liver abscess, ultrasound semiotics, sonography intervention, classification of abscesses, antibiotic therapy.

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