Does This Patient Have Pertussis? Bedside Clues to Diagnosis

Does This Patient Have Pertussis? Bedside Clues to Diagnosis

Adults with cough <3weeks or 3-8 weeks with post-tussive vomiting or whooping should be treated for pertussis; those with fever or without paroxysmal cough should be considered to have an alternate diagnosis. Children with <4 weeks of cough and post-tussive vomiting may have pertussis, but it was much less clear than in adults.

Do We Write Antibiotic Rx Because It's Just Easier?

Do We Write Antibiotic Rx Because It's Just Easier?

It took an extra 67 seconds when not prescribing an antibiotic to patients with acute respiratory infection compared to visits in which an antibiotic was prescribed.

Dealing With the ESBL Threat - Extended Spectrum β-lactamase Enterobacteriaceae

Dealing With the ESBL Threat - Extended Spectrum β-lactamase Enterobacteriaceae

Highly resistant, extended spectrum β-lactamase (ESBL) producing Enterobacteriaceae in the urine are becoming increasingly common in unexpected patients in the ED.

Vancomycin/Piperacillin-Tazobactam and AKI

Vancomycin/Piperacillin-Tazobactam and AKI

The combination of vancomycin plus piperacillin-tazobactam (VPT) was associated with increased risk of acute kidney injury (AKI) compared to either drug as monotherapy or other vancomycin - β-lactam combinations, NNH = 11.

Initial Parenteral then Oral Antibiotic vs Oral Alone in Pediatric UTI

Initial Parenteral then Oral Antibiotic vs Oral Alone in Pediatric UTI

There was no reduction in children 29 days - 2 months in 72-hour repeat ED visit with subsequent admission for those given a single parenteral dose of antibiotic in the ED and then outpatient oral treatment vs simply starting on oral therapy.

LRINEC Score, Physical Exam, or Imaging for Necrotizing Infection?

LRINEC Score, Physical Exam, or Imaging for Necrotizing Infection?

In this systematic review and meta-analysis, no single aspect of the physical examination, imaging, or LRINEC score had high enough sensitivity to exclude necrotizing soft tissue infections. Contrast CT performed the best, but it was only 94.3% sensitive at best. If you have a high clinical suspicion, early surgical consultation is necessary for definitive diagnosis and management.

Outpatient Antibiotic for Pyelonephritis - Ciprofloxacin, TMP/SMX, or Cephalosporins?

Outpatient Antibiotic for Pyelonephritis - Ciprofloxacin, TMP/SMX, or Cephalosporins?

Outpatient treatment failure for pyelonephritis occurred more often in patients treated with fluoroquinolones or trimethoprim-sulfamethoxazole (TMP-SMX) than in patient treated with cephalosporins.

Antibiotic Harms - 70,000 PED Visits a Year

Antibiotic Harms - 70,000 PED Visits a Year

Adverse drug events related to antibiotics led to nearly 70,000 ED visits a year in children ≤19 years.  One out of every 330 children ≤2 years given amoxicillin will end up in the ED with an ADE.

Do Steroids Benefit Influenza Pneumonia?

Do Steroids Benefit Influenza Pneumonia?

Unless there is compelling alternative reason to do so (i.e. asthma), giving a glucocorticoid to treat influenza pneumonia was associated with increased risk of mortality.

Why SEP-1 CMS "Quality" Metrics Are Dumb

Why SEP-1 CMS "Quality" Metrics Are Dumb

Sepsis bundles like the CMS SEP-1 guidelines are too restrictive, requiring an all-or-nothing approach to achieve compliance. These bundles fail to prioritize the most important bundle components while penalizing providers for meaningless omissions that have no impact on mortality.

Antibiotic Resistance - The Problem and Solution

Antibiotic Resistance - The Problem and Solution

Most doctors and clinicians think someone else is the problem when it comes to antibiotic resistance and stewardship.  We are the problem.  And we are the solution.

Who's Giving Inappropriate Antibiotics - Urgent Care, Retail, Emergency, or Medical Office?

Who's Giving Inappropriate Antibiotics - Urgent Care, Retail, Emergency, or Medical Office?

Urgent care centers wrote the most inappropriate antibiotic prescriptions for viral respiratory illnesses.  They were followed by the ED, medical offices, and finally by retail health clinics.

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