1148. Duration of Antibiotic Therapy in the Treatment of Bacterial Meningitis in Young Infants: A Systematic Review and Narrative Synthesis

Background IDSA recommendations of 14-21 days of parenteral therapy for bacterial meningitis are based predominantly on expert consensus. Parenteral durations consistent with these recommendations are sometimes provided even when meningitis is suspected but not confirmed. We aimed to systematically review the literature on duration of parenteral antibiotic therapy and outcomes in bacterial meningitis in infants < 3 months of age. Methods We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials for publications up until May 11, 2021. Eligible studies were published in English and included infants < 3 months of age with bacterial meningitis for which route and duration of antibiotic therapy and outcomes were reported. We excluded case reports and infants with birth weight < 1500g, major congenital malformations, or neurosurgical conditions. We assessed bias using published tools specific to study type. A meta-analysis was not conducted due to insufficient data on outcomes by duration of therapy. PROSPERO registration: CRD42020201667. Results A total of 2195 studies were identified; 280 were selected for full text review and 32 were included for narrative synthesis. There was 1 randomized-controlled trial (RCT), 25 cohort studies, and 6 case series. The RCT found no difference in treatment failure rates between 10 and 14 days of therapy, but only included 2 cerebrospinal fluid (CSF) culture-positive cases. A single cohort study including only CSF culture-negative cases presented outcomes by duration of therapy and concluded that courses >21 days had no impact on prognosis. Twenty-one studies had data on duration of therapy and outcomes by patient, most with small samples (median 4 patients). No conclusions on efficacy of shortened antibiotic courses could be drawn due to small sample sizes and lack of stratification of outcomes by short versus long courses. Conclusion Data on parenteral treatment duration in bacterial meningitis in infants < 3 months are primarily observational, and larger studies rarely report outcomes by duration of therapy. Given the associated risks and costs of prolonged parenteral therapy, there is a pressing need for comparative effectiveness research to determine the optimal parenteral treatment duration. Disclosures All Authors: No reported disclosures

EXPRESS: Survival and Drug Persistence in Patients Receiving Inhaled Treprostinil at Doses Greater than 54 Mcg (9 Breaths) 4 Times Daily

Treprostinil is a prostacyclin analogue approved for the treatment of pulmonary arterial hypertension (PAH). Commercial data sets indicate that approximately 20-25% of patients are prescribed a higher dose than the maximum recommended dosage of 9 breaths per treatment session (bps) (54 Ï g), four times a day (QID) and numerous studies have demonstrated the safety of doses >9 bps QID. This phase 4, retrospective analysis of specialty pharmacy records assessed the effects of inhaled treprostinil at doses >9 bps QID. Patients receiving inhaled treprostinil between September 2009 and June 2018 were included, and a random sampling of 5,000 patients were selected for further analysis. Subjects were grouped based on the highest dose reached for ≥2 months within a rolling 6-month window and were followed for up to three years. Of the total of 5,000 patients analyzed, 28.5% received >9 bps QID. Survival rates were significantly higher in the >9 bps QID dosing group for years one, two, and three (P < 0.001). The time to transition to parenteral therapy was significantly longer for those at doses >9 bps (17.5 months) compared to doses ≤9 bps (9.5 moths; P < 0.0001). Drug persistence was also significantly higher for those taking >9 bps at years 1, 2, and 3 (P < 0.0001). Patients receiving inhaled treprostinil at doses >9 bps QID had a higher rate of survival and drug persistence over a three-year period, suggesting that higher doses may provide clinically relevant benefits while remaining tolerable.

The TOPAZ study: a home-based trial of zoledronic acid to prevent fractures in neurodegenerative parkinsonism

The Trial of Parkinson’s And Zoledronic acid (TOPAZ, https://clinicaltrials.gov/ct2/show/NCT03924414) is a unique collaboration between experts in movement disorders and osteoporosis to test the efficacy of zoledronic acid, an FDA-approved parenteral treatment for osteoporosis, for fracture prevention in people with neurodegenerative parkinsonism. Aiming to enroll 3,500 participants age 65 years or older, TOPAZ is one of the largest randomized, placebo-controlled clinical trials ever attempted in parkinsonism. The feasibility of TOPAZ is enhanced by its design as a U.S.- wide home-based trial without geographical limits. Participants receive information from multiple sources, including specialty practices, support groups and websites. Conducting TOPAZ in participants’ homes takes advantage of online consent technology, the capacity to confirm diagnosis using telemedicine and the availability of research nursing to provide screening and parenteral therapy in homes. Home-based clinical research may provide an efficient, convenient, less expensive method that opens participation in clinical trials to almost anyone with parkinsonism.

Una febbre che… soffia

The paper describes the case of a 7-year-old child with a ventricular septal defect and a story of 10 weeks of non-periodic recurrent fever repeatedly treated with short course of antimicrobial therapy. All the echocardiographies were negative for valve vegetation, but all the cultural blood exams were positive for Streptococcus sanguinis. Infective endocarditis was diagnosed using the modified Duke’s criteria and treated with a long course of adequate antimicrobial parenteral therapy.

Medication Error Incidence (Parenteral Therapy) at Government Hospital in Magelang

Patient safety is the key to maintain the quality of health services. One of the most important things to achieve patient safety is to identify medication errors and its causes. Most cases of medication errors are reported by nurses, because nurses are the therapeutic team. The purpose of this study is to determine factors affecting medication error by nurse in giving parenteral therapy at Government Hospital in Magelang. A cross-sectional analytic study was carried out on 67 nurses working in hospital wards. The data were collected using a questionnaire filled by respondents to see medication errors within 3 months. The final number of medication errors were 91 incidents in 3 months. The most frequent errors were wrong time (51.7%), wrong dose (14.2%), wrong document and wrong drug (9.9%), wrong route (8.8%), and the least was wrong patient (5%). Although the medication error incidences were not sentinel events and didn’t affect to SNARs criteria, but it still affecting on the quality of health services in the hospital. The significant independent determinant of medication errors is working experience at Government Hospital in Magelang (p 0,001), while the other determinants are not. Conclusion in this study was significant correlation between work experience in hospital and medication error, where respondents with work experience at Government Hospital in Magelangless than 5 years tend to be at higher risk doing medication errors than those who having worked more or equivalent to 5 years.