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301. Covid-19: New data on the cardiac adverse effects of the combination of hydroxychloroquine (Plaquenil) with azithromycin (Zithromax or other brands) Full Text available with Trip Pro

(Zithromax° or other brands) carries a risk of serious cardiac adverse effects: prolongation of the QT interval with a high risk of cardiac arrhythmia and torsade de pointes, and cardiovascular mortality, which is increased by the addition of azithromycin. Several cases of cardiac arrest have been reported. The combination of hydroxychloroquine, an anti-malarial drug with immunosuppressant activity, and azithromycin, a macrolide antibiotic, is a treatment under evaluation for patients with covid-19 (...) involved patients with rheumatoid arthritis, which is sometimes treated with hydroxychloroquine. About 956 000 patients treated with hydroxychloroquine were compared to 310 000 patients treated with sulfasalazine (Salazopyrine°), another weak immunosuppressant used in rheumatoid arthritis. The authors analysed cardiovascular events occurring within 30 days of starting concomitant administration of an antibiotic, azithromycin or amoxicillin. There was no statistically significant difference

2020 Prescrire

302. Covid-19 drug vignettes: Azithromycin

to Description of the drug, including regulatory status Azithromycin is a macrolide antibacterial drug, derived from erythromycin, licensed in the and in the , and used to treat bacterial infections. It has been used in combination with hydroxychloroquine in the treatment of COVID-19. However, there is an adverse drug–drug interaction between the two, which contraindicates their combined use. Mechanism of action Azithromycin exerts its antibacterial action by binding to the RNA of susceptible organisms (...) c prolongation (499 milliseconds) developed torsade de pointes 3 days later. Experience in other viral infections In a retrospective of 349 critically ill patients with MERS, azithromycin and other macrolide antibacterial drugs had no effect on 90-day mortality or improvement in MERS-CoV RNA clearance; patients who received macrolides were more likely to be admitted with community-acquired MERS. A protocol for a trial in Ebola of antiviral drugs, which included azithromycin, was , but no results

2020 Oxford COVID-19 Evidence Service

303. COVID-19: ‘Fever Hospitals’

walls, glass partitions, and rituals of barrier nursing created a further “isolation within isolation”. According to ,1929 Edition, there were 635 fever hospitals of less than 100 beds in England and Wales. Many remained closed except during epidemic outbreaks. Clearly our forebears had grasped the need for a flexible response in times of uncertainty and surge. The development of immunisations and availability of antibiotics made infectious diseases less common, less serious, and the need

2020 Oxford COVID-19 Evidence Service

304. JBI Evidence Summary: Infection Transmission (Healthcare Workers): Aprons and Gowns

contacts; the control arm undertook usual standard of care which required healthcare workers to follow CDC guidelines for contact precautions (i.e. gloves and gowns) when caring for patients known to have infection or colonization with antibiotic-resistant bacteria, such as vancomycin- resistant enterococci (VRE) or MRSA. Although the RCT had found that universal glove and gown use had no effect on VRE in ICU settings, a significant effect on MRSA acquisition rates was observed (40.2% relative

2020 Covid-19 Ad hoc papers

305. JBI Evidence Summary: Hand Hygiene in Hospitals - Alcohol-based Solutions

-tolerated by participants. When compared to ethanol only, the ethanol plus CHG was associated with significantly lower aerobic CFU counts immediately after use, and after the time spent in the ICU common area. Moreover, a trend toward less frequent acquisition of antibiotic-resistant pathogens on hands was observed in the ethanol plus CHG group. Authors reported that the addition of CHG to alcohol-based hand sanitizers may be beneficial in reducing bacterial contamination on hands for up to several (...) hours after application due to a cumulative efficacy (after use, CHG accumulates on the skin). Therefore, the addition of CHG to hand sanitizers could be an effective approach to enhancing and extending the duration of antimicrobial activity. 2 (Level 1) • An RCT compared the effectiveness of three hand hygiene protocols during routine inpatient care: protocol 1 (P1) hand-rubbing with alcohol covering all hand surfaces (in no particular order); protocol 2 (P2) hand-rubbing with alcohol using

2020 Covid-19 Ad hoc papers

306. Are there risk factors and preventative interventions for acute respiratory distress syndrome (ARDS) in COVID-19?

was not stated in this paper, but ~300 patients received NIV or invasive ventilation so it likely represents a reasonable ARDS cohort. Liu(7) found no statistically significant association between inpatient or fever clinic treatments, such as antibiotics or antivirals, and ARDS. In the case of antivirals and antibiotics this may have been because 96.3% of the sample were prescribed these drugs, making it difficult to detect differences between the groups. Wu(3) found that ARDS patients were more likely

2020 Oxford COVID-19 Evidence Service

307. JBI Evidence Summary: Respiratory Infection: Reuse, or Extended Use, of Disposable Masks and Respirators

available wipe products, of deposited contaminants from three types of N95 FFRs (cup [FFR A], flat-fold [FFR B], and duck bill [FFR C]) contaminated with either infectious or non-infectious aerosols; mucin or viable Staphylococcus aureus (S. aureus). FFRs were cleaned with hypochlorite, benzalkonium chloride, or non-antimicrobial wipes and incubated for 15 minutes at room temperature; contaminants were then extracted and quantified. Specifically, selected wipes were Hype-Wipes (Current Technologies, Inc (...) , Crawfordsville, IN), which contain 0.9% hypochlorite (OCL); 504/07065 Respirator Cleaning Wipes (3M Company, St Paul, MN), which contain benzalkonium chloride (BAC); and Pampers wipes (Proctor & Gamble, Cincinnati, OH), which contain no active antimicrobial ingredients (inert). Filter performance was evaluated after three cleaning cycles, and any physical degradation of FFRs after cleaning appeared to be negligible. Authors concluded that their preliminary evaluation had shown that FFRs can be successfully

2020 Covid-19 Ad hoc papers

308. Covid-19: More about chloroquine and hydroxychloroquine

be increased in patients who are acutely ill with severe COVID-19, in many of whom high doses are being used. Macrolide antibacterial drugs, such as azithromycin, clarithromycin, erythromycin, and telithromycin, interact adversely with the 4-aminoquinolines, since both types of drug prolong the electrocardiographic QT interval. The combination increases the risk of the serious ventricular tachycardia called torsades de pointes, which is often fatal. Macrolide antibacterial drugs should be avoided (...) of benefit, based on poor mechanistic reasoning, is small. The high doses of the 4-aminoquinolines that are being used in COVID-19 increase the risk of adverse drug reactions. Drug–drug interactions can occur, for example between the 4-aminoquinolines and the macrolide antibacterial drug azithromycin, with which the drugs have often been used in combination. 1. Weak evidence for the hypothesis of efficacy In cell cultures and animal studies, the effects of 4-aminoquinolines on viruses from avian

2020 Oxford COVID-19 Evidence Service

309. UK SMI B 62: abdominal organ transport fluid testing

considerations 6 6. Investigation 6 7. Antimicrobial susceptibly testing 9 8. Referral for incident investigations 9 9. Referral to reference laboratories 9 Appendix: ODT rapid alert form 11 References 12 Abdominal organ transport fluid testing Technical | B 62 | Issue no: 1 | Issue date: 29.01.20 | Page: 4 of 12 UK Standards for Microbiology Investigations | Issued by the Standards Unit, Public Health England Amendment table Each UK SMI method has an individual record of amendments. The current amendments (...) -laboratory processes (reporting procedures) Routine local laboratory reporting Report: • Clinically significant organisms with antimicrobial susceptibility results • No growth of clinically significant organisms* • No growth * Identification should not be reported for organisms of no clinical significance. Communicating results to ODT The communication process below is in addition to the routine reporting and communication of results between the laboratory and clinical teams, according to local protocols

2020 Public Health England

310. Transforming health through innovation: Integrating the NHS and academia - supporting case studies

contributions to the advancement of patient care since the inception of the NHS. The list is not exhaustive, and additional examples can be found in the resources listed in Reference 1. 1 1940s Development of penicillin as a drug The antibiotic properties of the Penicillium mould were first discovered by Sir Alexander Fleming FRS FRSE in 1928 in his laboratory in St Mary’s Hospital in London. Ground-breaking work by Sir Ernst Chain FRS and Lord Florey OM FRS in the 1940s to purify and extract penicillin (...) then enabled it to be mass produced as a life-saving drug. 2 Penicillin antibiotics became the first effective treatments against many bacterial infections and are still widely used today. 3,4 Intraocular lens for cataract patients Cataracts form when the eye’s lens becomes cloudy leading to blurry vision and eventually blindness. 5 The first successful implantation of an intraocular lens was performed by Sir Harold Ridley FRS at St Thomas’s Hospital in 1949 following the extraction of a patient’s cataract

2020 Academy of Medical Sciences

311. Hydroxychloroquine for COVID-19: What do the clinical trials tell us?

as young as 12 to as old as 76 years. The measured outcomes cannot have been normally distributed. This has been thoroughly discussed by in their statistical review of this trial. The standard treatment included “antiviral agents, antibacterial agents, and immunoglobulin with or without corticosteroids.” The antiviral and antibacterial agents were unspecified, and the proportions of individuals in each group who received any agent were not reported. This could have introduced bias. Although the trial

2020 Oxford COVID-19 Evidence Service

312. Hydroxychloroquine or Chloroquine for treating COVID-19 – a PROTOCOL for a systematic review of IPD

pharmacological interventions such as antimalarial drugs, antiviral drugs, biologics, and interferon. The number of trial registrations for hydroxychloroquine/cholorquine as a COVID-19 therapeutic rises each day and on April 5 th 2020 we found three published trials and 100 ongoing studies. A first published report from Gautret et al. (1) suggested a positive effect of hydroxychloroquine (plus azithromycin, an antibiotic, in some cases) on the disappearance of COVID-19, attracting intense media coverage

2020 Oxford COVID-19 Evidence Service

313. What is the role of imaging and biomarkers within the current testing strategy for diagnosing COVID-19?

leads to uncertainty regarding the diagnosis and can mean that antibiotics are not reviewed and stopped in patients with initial negative RT-PCR. CURRENT EVIDENCE We described the approaches to clinical investigations following a negative RT-PCR results as described in guidelines from China, Italy, Spain, UK and US. Then we looked at possible strategies to understand how to increase the accuracy of the current testing pathway to identify patients with COVID -19, while focusing on the role of imaging

2020 Oxford COVID-19 Evidence Service

314. How can pandemic spreads be contained in care homes?

, Legislation, Practice guidelines 2. Respiratory including influenza, gastrointestinal and viral infections including norovirus Exclusion: 1. Animal studies 2. Papers not in English or Persian 3. Opinion pieces 4. Schools, childcare and paediatric facilities 5. Antibiotic resistance studies 6. Influenza and pneumococcal vaccine studies 7. Disease/conditions: UTI, Clostridium difficile, scabies, general bacterial infections 8. No abstract or full text availability Search terms: Search 1 (((((facilities

2020 Oxford COVID-19 Evidence Service

315. Effectiveness and safety of antiviral or antibody treatments for coronavirus: A rapid review

patients with severe acute respiratory syndrome (SARs, n=33), middle east respiratory syndrome (MERS, n=16), COVID-19 (n=3), and unspecified coronavirus (n=2). The most common treatment was ribavirin (n=41), followed by oseltamivir (n=10) and the combination of lopinavir/ritonavir (n=7). Additional therapies included broad spectrum antibiotics (n=30), steroids (n=39) or various interferons (n=12). No eligible studies examining monoclonal antibodies for COVID-19 were identified. One trial found

2020 Covid-19 Ad hoc papers

316. The effectiveness of Virtual Hospital models of care

, exacerbations in COPD requiring treatment with systemic steroid and/or antibiotics but not admission to hospital, length of stay, and all- cause mortality. Nurses, respiratory nurses. No difference in drop-out rate between groups. No difference in hospital admissions for COPD between groups. Telemonitor ing patients had more moderate exacerbatio ns (i.e. some treatment without hospital admission); whereas the control group had more visits to outpatient clinics. No difference in mortality between groups

2020 Sax Institute Evidence Check

317. Covid-19 and hydroxychloroquine: caution

and arrhythmia, circulatory collapse, seizures, hypokalaemia, cardiac arrest, coma, and death. A great many other drugs increase the risk of QT prolongation, which can lead to potentially fatal torsade de pointes. They include neuroleptics, antihistamines used for allergies, some angina treatments, and macrolide antibiotics, including azithromycin. Hypokalaemia increases the risk of torsade de pointes; it is caused in particular by drugs such as diuretics, laxatives, and beta-2 agonists used in asthma

2020 Prescrire

318. Covid-19: Effectiveness and safety of antiviral or antibody treatments for coronavirus

respiratory syndrome (MERS, n=16), COVID-19 (n=3), and unspecified coronavirus (n=2). The most common treatment was ribavirin (n=41), followed by oseltamivir (n=10) and the combination of lopinavir/ritonavir (n=7). Additional therapies included broad spectrum antibiotics (n=30), steroids (n=39) or various interferons (n=12). No eligible studies examining monoclonal antibodies for COVID-19 were identified. One trial found that ribavirin prophylactic treatment statistically significantly reduced risk (...) included a variety of broad spectrum antibiotics (n=30), steroids including hyrdcortisone, methylprednisone, or prednisolone (n=39) or various interferons (n=12; Appendix 3). No animal or human trials investigating monoclonal antibodies for the treatment of COVID-19 were found in this rapid review. All of the studies recruited from or reported on hospitalized populations and the most commonly reported outcome was mortality (n=40), followed by ICU admission (n=21) and adverse events (n=18). Table 2

2020 Covid-19 Ad hoc papers

319. Rapid tests for group A streptococcal infections in people with a sore throat

This guidance covers using rapid tests for group A streptococcal (strep A) infections in people aged 5 and over with a sore throat. For children under 5, assessment is described in NICE's guideline on fever in under 5s: assessment and initial management. People who are at higher risk of complications, for example women who are pregnant or who have just had a baby, or people who are immunocompromised, should be offered antibiotics in line with NICE's guideline on antimicrobial prescribing for acute sore (...) throat. This is because their effect on improving antimicrobial prescribing and stewardship, and on patient outcomes, as compared with clinical scoring tools alone, is likely to be limited. Therefore, they are unlikely to be a cost-effective use of NHS resources. Wh Why the committee made these recommendations y the committee made these recommendations Unnecessary use of antibiotics can contribute to antimicrobial resistance, which is a public health concern. NICE's guideline on antimicrobial

2019 National Institute for Health and Clinical Excellence - Diagnostics Guidance

320. Inactivated influenza vaccine: information for healthcare practitioners

influenza vaccine: information for healthcare practitioners Guidance for healthcare practitioners about the inactivated influenza vaccine. Published 19 October 2016 Last updated 26 November 2019 — From: Documents Ref: PHE publications gateway number 2019081 . Published 19 October 2016 Last updated 26 November 2019 26 November 2019 Updated antibiotic section and reference to gelatin. 22 October 2019 Revised the guidance to include information on checkpoint inhibitors. 20 August 2019 Added new version

2020 Public Health England

Evidence-based Synopses

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