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

On the question of parenteral treatment of "acute and chronic urticaria"

In this brief and incomplete communication, I feel it necessary to share the very satisfactory results I have obtained in the treatment of urticaria by injecting a combination of two substances: absolute alcohol and ichthyol.

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.

P89 Can we manage osteoporosis without patients ever seeing a consultant?

Background Specialist services are heavily reliant on a consultant reviewing a patient and discussing management options. We designed an innovative proof-of-concept osteoporosis service with patients only consulting a metabolic bone CNS and a consultant providing remote oversight. The aim of the project was to improve the efficiency of the service by eliminating consultant appointments and reducing unnecessary hospital visits whilst continuing to deliver a high-quality and safe service. Methods All stakeholders involved in the management of osteoporosis at our unit were engaged. Following extensive discussions, a new pathway was implemented where a consultant rheumatologist and a CNS virtually triaged post menopausal women over the age of 65 into the service. A dedicated proforma provided the template for the CNS to undertake new patient telephone consultation and assess the suitability of parenteral treatment. Relevant investigations were requested during the telephone clinic and treatment related information was despatched to help with shared decision making. All patients were then reviewed in a consultant-CNS virtual MDT. Appropriate parenteral treatment option was agreed and confirmed to everyone. The CNS worked through a safety checklist and provided further advice and support to the patient as necessary. If all checks were satisfactory, the treatment was commenced, and individuals advised to contact the advice line for any concerns. There was no face-to-face appointment in the service unless explicitly requested by the users. Results In the proof-of-concept phase, 38 patients were triaged into the new service. It was a combination of sixteen new referrals and 22 patients pulled from the consultants’ waiting list. Mean age of participants was 77.2 years (65-92). Referral to virtual triage took median 20 days (0-62). Median time for triage to new patient CNS telephone consultation was 18 days (6-87). Time to virtual MDT for treatment authorisation was median zero days (0-76 days). 17 patients had anabolic therapy commenced via home care. Remaining had anti resorptive therapy. No patient requested face-to-face review. Only one patient fed back that they would’ve preferred to see the consultant once. 38 new patient consultant appointments were saved and median delay in treatment commencement was reduced from 84 to 38 days. Conclusion To our knowledge, this is the first successful example of an innovative service wholly provided by CNSs for commencing parenteral anti-osteoporotic therapy with only remote consultant supervision. Our service redesign has significantly improved the efficiency of the parenteral osteoporosis pathway with reduction in treatment delay and a more streamlined patient journey. A nurse-delivered osteoporosis treatment pathway is highly effective, safe and provides an innovative solution to thinly stretched health care needs of people with chronic conditions. Disclosures J. Fourmy None. J. Begum None. M.K. Nisar None.

Efficacy of NEMO-binding domain peptide used to treat experimental osteomyelitis caused by methicillin-resistant Staphylococcus aureus: an in-vivo study

Purpose Treatment of chronic osteomyelitis (bone infection) remains a clinical challenge. Our previous study had demonstrated that NEMO-binding domain (NBD) peptide effectively ameliorates the inhibition of osteoblast differentiation by TNF-α in vitro. In this work, NBD peptide was evaluated in vivo for treating chronic osteomyelitis induced by methicillin-resistant Staphylococcus aureus (MRSA) in a rabbit model. Methods Tibial osteomyelitis was induced in 50 New Zealand white rabbits by tibial canal inoculation of MRSA strain. After 3 weeks, 45 rabbits with osteomyelitis were randomly divided into four groups that correspondingly received the following interventions: 1) Control group (9 rabbits, no treatment); 2) Van group (12 rabbits, debridement and parenteral treatment with vancomycin); 3) NBD + Van group (12 rabbits, debridement and local NBD peptide injection, plus parenteral treatment with vancomycin); 4) NBD group (12 rabbits, debridement and local NBD peptide injection). Blood samples were collected weekly for the measurement of leucocyte count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) levels. The rabbits in all four groups were sacrificed 6 weeks after debridement; the anti-infective efficacy was evaluated by radiological, histological, and microbiological examination, and promotion of bone remodeling was quantified by micro-CT using the newly formed bone. Results Except two rabbits in the Control group and one in the NBD group that died from severe infection before the end point, the remaining 42 animals (7, 12, 12, 11 in the Control, Van, NBD + Van, and NBD group respectively) were sacrificed 6 weeks after debridement. In general, there was no significant difference in the leucocyte count, and ESR and CRP levels, although there were fluctuations throughout the follow-up period after debridement. MRSA was still detectable in bone tissue samples of all animals. Interestingly, treatment with NBD peptide plus vancomycin significantly reduced radiological and histological severity scores compared to that in other groups. The best therapeutic efficacy in bone defect repair was observed in the NBD peptide + Van group. Conclusions In a model of osteomyelitis induced by MRSA, despite the failure in demonstrating antibacterial effectiveness of NBD peptide in vivo, the results suggest antibiotics in conjunction with NBD peptide to possibly have promising therapeutic potential in osteomyelitis.

Antibiotic treatment of acute gastroenteritis in children

Antibiotic therapy is not necessary for acute diarrhea in children, as rehydration is the key treatment and symptoms resolve generally without specific therapy. Searching for the etiology of gastroenteritis is not usually needed; however, it may be necessary if antimicrobial treatment is considered. The latter is left to the physician evaluation in the absence of clear indications. Antimicrobial treatment should be considered in severely sick children, in those who have chronic conditions or specific risk factors or in specific settings. Traveler’s diarrhea, prolonged diarrhea, and antibiotic-associated diarrhea may also require antibiotic therapy. Depending on the severity of symptoms or based on risk of spreading, empiric therapy may be started while awaiting the results of microbiological investigations. The choice of antibiotic depends on suspected agents, host conditions, and local epidemiology. In most cases, empiric therapy should be started while awaiting such results. Empiric therapy may be started with oral co-trimoxazole or metronidazole, but in severe cases parenteral treatment with ceftriaxone or ciprofloxacin might be considered.