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181. Spondyloarthritis in over 16s: diagnosis and management

NICE's technology appraisal guidance on ustekinumab for treating active psoriatic arthritis.] Reactiv Reactive arthritis e arthritis Antibiotics Antibiotics 1.4.30 After treating the initial infection, do not offer long-term (4 weeks or longer) treatment with antibiotics solely to manage reactive arthritis caused by a gastrointestinal or genitourinary infection. 1.5 Non-pharmacological management of spondyloarthritis 1.5.1 Refer people with axial spondyloarthritis to a specialist physiotherapist

2017 National Institute for Health and Clinical Excellence - Clinical Guidelines

182. Cataracts in adults: management

. Endophthalmitis Endophthalmitis 1.8.4 Use preoperative antiseptics in line with standard surgical practice. 1.8.5 Use intracameral cefuroxime during cataract surgery to prevent endophthalmitis. 1.8.6 Use commercially prepared or pharmacy-prepared intracameral antibiotic solutions to prevent dilution errors. Cystoid macular oedema Cystoid macular oedema 1.8.7 Consider topical steroids in combination with non-steroidal anti-inflammatory Cataracts in adults: management (NG77) © NICE 2019. All rights reserved (...) #notice-of-rights). Page 22 of 235 Interventions to prevent endophthalmitis What is the effectiveness of postoperative antibiotic drops to reduce rates of endophthalmitis after cataract surgery? Wh Why this is important y this is important There is a lack of evidence on postoperative antibiotics to reduce rates of endophthalmitis, which may be because they are provided as part of standard good clinical practice in the UK. In addition, it is recognised that patients are invariably receiving other drops

2017 National Institute for Health and Clinical Excellence - Clinical Guidelines

183. Cystic fibrosis: diagnosis and management

visits and if the person with cystic fibrosis Cystic fibrosis: diagnosis and management (NG78) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 9 of 43prefers it. 1.3.7 Make arrangements (including providing equipment and expert support) for people to have intravenous antibiotic therapy at home, when this is appropriate. Multidisciplinary team Multidisciplinary team 1.3.8 The specialist cystic fibrosis (...) intravenous antibiotic services, including intravenous access. 1.3.13 Specialist physiotherapists should assess and advise people with cystic fibrosis at clinic, at inpatient admissions, during pulmonary exacerbations and at their annual review. Assessment and advice could cover airway clearance, nebuliser use, musculoskeletal disorders, exercise, physical activity and urinary incontinence. 1.3.14 Specialist dietitians should assess and advise people with cystic fibrosis about all aspects of nutrition

2017 National Institute for Health and Clinical Excellence - Clinical Guidelines

184. Pregnancy and Renal Disease

? KDIGO Guideline for the Care of Kidney Transplant Recipients, 2009. ? KDIGO Clinical Practice Guidelines for Nutrition in Chronic Renal Failure, 2008. ? NICE: Intrapartum Care for Women with Existing Medical Conditions or Obstetric Complications and their Babies [NG121], 2019. ? NICE: Urinary Tract Infection (Lower) Antimicrobial Prescribing [NG109], 2018 ? NICE: Urinary Tract Infection (Recurrent) Antimicrobial Prescribing [NG112], 2018. ? NICE: Antenatal Care for Uncomplicated Pregnancies [CG62

2019 Renal Association

185. Management of glucocorticoids during the peri-operative period for patients with adrenal insufficiency

,butnotalways,low.C-reactive proteinmayberaised,butthistestisoflimitedvaluein thepostoperativeperiod. ©2020TheAuthors.AnaesthesiapublishedbyJohnWiley&SonsLtdonbehalfofAssociationofAnaesthetists 7 Woodcocket al. | Peri-operativemanagementofglucocorticoids Anaesthesia20204 Persistentpyrexiamaybeduetoadrenalinsuf?ciency, but is usually attributed to postoperative sepsis and treated with antimicrobial chemotherapy. Steroid supplementationshouldnotbereducedorwithdrawn whilethepatientispyrexial. It is clear

2020 Association of Anaesthetists of GB and Ireland

187. Laboratory diagnosis of G6PD deficiency Full Text available with Trip Pro

haemolysis in G6PD‐deficient subjects. Category of drug Predictable haemolysis Possible haemolysis Antimalarials Dapsone Chloroquine Primaquine Quinine Pamaquin * Not on UK market. Tafenoquine Methylene blue Analgesics/antipyretic Phenazopyridine Aspirin (high doses) † Acceptable up to a dose of at least 1 g daily in most G6PD‐deficient individuals. Paracetamol (Acetaminophen) Antibacterials Cotrimoxazole Sulfasalazine Sulfadiazine Quinolones ‡ Including ciprofloxacin, moxifloxacin, nalidixic acid

2020 British Committee for Standards in Haematology

188. 2019 EHRA International Consensus Document on How to Prevent, Diagnose, and Treat Cardiac Implantable Electronic Device Infections

. Device-related infection is, however, one of the most serious complications of cardiac implantable electronic device (CIED) therapy associated with significant morbidity, mortality, and financial health care burden. Although many preventive strategies such as administration of intravenous antibiotic therapy before implantation are well recognized, uncertainties still exist about other regimens. Questions still remain such as the use of CIED alternatives expected to be less prone to infections and how

2020 Heart Rhythm Society

189. ASGE review of adverse events in colonoscopy

therapeutic colon procedures such as colonic stent insertion. 73 Although individual cases of infection after colonoscopy have been reported, there is no de?nite causal link with the endoscopic procedure and no proven bene?t for antibiotic prophylaxis. 74 Therefore, current guidelines from the American Heart Association and ASGE recommend against antibiotic prophylaxis for patients undergoing colonoscopy. 75 The 2016 update of the multisociety guideline on reprocessing ?exible GI endoscopes reported cases (...) options include a conservative approach, splenic artery emboliza- tion, and surgery. The treatment option chosen is based on the presentation, underlying comorbidities, and imag- ing ?ndings. Hemodynamically stable patients can be managed conservatively with close monitoring, intrave- nous ?uids, blood transfusion, and antibiotics. However, some patientsmay failaconservativeapproachandrequire surgery or splenic artery embolization. For hemodynami- cally stable patients with grades I to IV lacerations

2020 American Society for Gastrointestinal Endoscopy

190. Management of Poisoning

reaction of massive envenomation, careful monitoring for: rhabdomyolysis, thrombocytopenia, cardiac arrhythmias, renal failure and possible dialysis should be instituted (pg 195). Grade D, Level 3 D In cases of corneal bee stings, pain relief should be provided. An urgent referral to the ophthalmologist should be done to rule out infection, uveitis and in? ammatory glaucoma. Broad-spectrum topical antibiotics could be given to prevent secondary infection. Surgical removal of the embedded stinger (...) to address the local lesion. Grade D, Level 4 D Secondary infection, chronic ulcer and osteomyelitis can occur. Prophylactic antibiotic should be given in contaminated wounds (pg 198). Grade D, Level 4 B First aid for stingray and stone? sh stings is hot, non-scalding (not higher than 45°C) water immersion as the venom is heat labile (pg 198). Grade B, Level 2++ A Hot water immersion may be useful for pain relief following jelly? sh stings after the tentacles have been removed (pg 198). Grade A, Level 1

2020 Ministry of Health, Singapore

191. Use of Bowel Preparation in Elective Colon and Rectal Surgery

. Lancet. 1973;2:735. 15. Clarke JS, Condon RE, Bartlett JG, Gorbach SL, Nich- ols RL, Ochi S. Preoperative oral antibiotics reduce septic complications of colon operations: results of pro- spective, randomized, double-blind clinical study. Ann Surg. 1977;186:251–259. 16. Matheson DM, Arabi Y, Baxter-Smith D, Alexander-Williams J, Keighley MR. Randomized multicentre trial of oral bowel prep- aration and antimicrobials for elective colorectal operations. Br J Surg. 1978;65:597–600. 17. Guglielmo BJ (...) and readmissions after colorectal surgery. J Am Coll Surg. 2013;216:756–762. 22. Oshima T, Takesue Y, Ikeuchi H, et al. Preoperative oral antibiotics and intravenous antimicrobial prophylaxis re- duce the incidence of surgical site infections in patients with ulcerative colitis undergoing IPAA. Dis Colon Rectum. 2013;56:1149–1155. 23. Scarborough JE, Mantyh CR, Sun Z, Migaly J. Combined me- chanical and oral antibiotic bowel preparation reduces inci- sional surgical site infection and anastomotic leak rates

2020 American Society of Colon and Rectal Surgeons

192. Management of Pilonidal Disease

factor analysis to improve patient selec- tion. World J Surg. 2011;35:206–211. 43. Chaudhuri A, Bekdash BA, Taylor AL. Single-dose metroni- dazole vs 5-day multi-drug antibiotic regimen in excision of pilonidal sinuses with primary closure: a prospective, ran- domized, double-blinded pilot study. Int J Colorectal Dis. 2006;21:688–692. 44. Lundhus E, Gjøde P, Gottrup F, Holm CN, Terpling S. Bacteri- cidal antimicrobial cover in primary suture of perianal or pilo- nidal abscess: a prospective (...) , randomized, double-blind clinical trial. Acta Chir Scand. 1989;155:351–354. 45. Kronborg O, Christensen K, Zimmermann-Nielsen C. Chronic pilonidal disease: a randomized trial with a complete 3-year follow-up. Br J Surg. 1985;72:303–304. 46. Marks J, Harding KG, Hughes LE, Ribeiro CD. Pilonidal sinus ex- cision–healing by open granulation. Br J Surg. 1985;72:637–640. 47. Mavros MN, Mitsikostas PK, Alexiou VG, Peppas G, Falagas ME. Antimicrobials as an adjunct to pilonidal disease surgery: a systematic

2020 American Society of Colon and Rectal Surgeons

193. Cirrhosis

patients with ascites, as SBP can be asymptomatic) - Do not delay for elevated INR or thrombocytopenia - Send for cell count/gram stain, culture, albumin, and total protein 1. Start antibiotics promptly (See Table, "Spontaneous Bacterial Peritonitis") 2. Give 1.5 g/kg 25% albumin on day 1 (Max 100 g) 3. Give additional 1 g/kg 25% albumin on day 3 (Max 100 g) 4. Hold diuretics and large volume paracentesis in patients with SBP or AKI 5. Prescribe antibiotics on discharge for secondary prophylaxis (see (...) Table, "Prophylaxis in Patients at High Risk for Spontaneous Bacterial Peritonitis") - Start antibiotics per ID guidelines (See Table, "Prophylaxis in Patients with Cirrhosis and GI Bleeds") - Start Octreotide infusion - Consult Hepatology for EGD (discuss the use of blood product such as PRBCs, platelets, FFP, etc. with Hepatology) - For all upper GI bleeds in cirrhotic patients, continue antibiotics for 5-7 days (see Table for oral options) 1. Continue octreotide drip for 72 hours (unless patient

2020 University of Michigan Health System

194. Diabetic Foot Infections

depth of infection. [I-C] If a patient does not have a current A1c result available, obtain upon hospital admission. Cultures. Obtain post-debridement soft tissue cultures rather than superficial swabs for evaluation of infected diabetic foot ulcers. [I-C] If wound swab is the only available method of obtaining a culture, perform it after debriding and cleaning the wound. [II-E] If osteomyelitis is suspected, obtain bone culture to guide antibiotic therapy rather than soft tissue culture (...) , or if additional imaging is needed to evaluate the extent of osteomyelitis, perform an MRI as the next imaging test. [I-C] Obtain a triple-phase bone scan in combination with a tagged WBC scan if MRI cannot be obtained but further evaluation of osteomyelitis is needed. [I-C] Treatment. Delay antibiotic initiation until after soft tissue cultures are obtained in patients with mild and moderate wound infections and without evidence of active cellulitis (Table 1). [II-E] Consult the appropriate surgical service

2020 University of Michigan Health System

195. Management of Chronic Kidney Disease

Potassium-sparing diuretics (amiloride, eplenerone, spironolactone, triamterene) Sulfonamide antibiotics Acetazolamide Antacids Corticosteroids Fluconazole Insulin Loop diuretics Salicylates Stimulant laxatives (senna) Sodium polystyrene sulfonate Theophylline Thiazide diuretics 9 UMHS Chronic Kidney Disease Guideline, July 2019 Table 14. Key Elements of Patient Education for CKD Elements • Ensure patient awareness of CKD diagnosis • “Know your numbers”- make patients aware of their kidney function (...) ? Hydantoins ? Lovastatin ? Macrolide antibiotics ? Metoclopramide ? Nefazodone ? Nifedipine ? Orlistat ? Probucol ? Protease inhibitors ? Quinolones ? Rifamycins ? Serotonin reuptake inhibitors ? Sulfonamides ? Terbinafine ? Verapamil ? Grapefruit juice ? St. John’s wort ? Red wine ? Berberine ? Chaparral ? European Barberry ? Tree Turmeric ? Echinacea ? ? * ? indicates that the agent generally increases the effect of immunosuppression medications; ? indicates a decreased effect Table 20. Select Herbs

2020 University of Michigan Health System

196. Prenatal Care

for high-risk women, including those with initial hemoglobin 100,000 CFU/mL, treatment at the time of diagnosis is recommended. Evidence is insufficient to recommend a test of cure after completion of antibiotic therapy, except in the case of GBS bacteriuria, for which a test of cure is recommended. Cervical cancer screening. Women who are current with routine screening for cervical cancer do not need to undergo additional testing. Rates of false positive cervical cytology increase in pregnancy

2020 University of Michigan Health System

197. Clinical Practice Guideline on the Diagnosis and Prevention of Periprosthetic Joint Infections

to Arthroplasty 7 Blood Tests for Preoperative Diagnosis 7 Diagnosis of Infected Joint Replacements 8 Diagnostic Imaging 9 Gram Stain 9 Avoiding antimicrobials two weeks prior to obtaining intra-articular culture to identify a pathogen for the diagnosis of PJI 9 Avoiding Initiating Antimicrobials prior to Obtaining Intra-Articular culture in patients suspected of having PJI 10 Antibiotics with low preoperative suspicion of PJI or established PJI with a known pathogen 10 Perioperative Antibiotic Selection 10 (...) 31 Blood Tests for Preoperative Diagnosis 32 Diagnosis of Infected Joint Replacements 34 Diagnostic Imaging 39 Gram Stain 42 Avoiding Antimicrobials Two Weeks Prior to Obtaining Intra-Articular Culture to Identify a Pathogen for the Diagnosis of PJI 43 Avoiding Initiating Antimicrobials Prior to Obtaining Intra-Articular Culture in Patients Suspected of Having PJI 44 Antibiotics with low preoperative suspicion of PJI or established PJI with a known pathogen 45 Perioperative Antibiotic Selection

2020 American Academy of Orthopaedic Surgeons

198. Special Topics in Venous Thromboembolism

liver insufficiency with jaundice or those receiving antibiotics at risk for vitamin K deficiency. There are also evolving data on the use of direct acting oral anticoagulants in highly selected patients, but further studies of are needed. 81-83 Six months of anticoagulation therapy has a higher rate of recanalization, but no specific duration has been established. Chronic PVT in a cirrhotic patient (Figure 4). Systemic anticoagulation is not recommended for cirrhotic patients found to have

2020 University of Michigan Health System

199. Clostridioides difficile Infection in Adults and Children

to overclassify pediatric disease as severe, hence the need for 2 or more abnormal lab criteria required to make a severe diagnosis (or the presence of a high-risk condition). The frequency of pediatric CDI patients meeting criteria for severe disease is low (~8%), with similar proportions of severe disease noted across all pediatric age groups. 63 Prevention Antibiotics and Prevention Nearly all antimicrobial classes have been associated with CDI. However, clindamycin and cephalosporins (especially third (...) The use of >14 Defined Daily Doses (DDDs) of antibiotics in the 3 months prior to CDI had the strongest association with CDI (OR 8.50;95% CI 4.56–15.9). Another study found the risk of CDI increases with cumulative dose and number of antibiotics, as well as days of antibiotic exposure. 68 Poor clinical outcomes in patients with CDI were independently associated with concomitant use of non-CDI-related antimicrobials, 69 and are associated with a doubling in risk of failure of CDI therapy. 70

2020 University of Michigan Health System

200. Care of Women Presenting with Suspected Preterm Prelabour Rupture of Membranes from 24+0 Weeks of Gestation Full Text available with Trip Pro

Should antibiotics be given? Recommendation Evidence Level Strength Rationale for the recommendation Erythromycin should be given for 10 days following the diagnosis of PPROM, or until the woman is in established labour (whichever is sooner) 1++ A A Cochrane review found benefits when antibiotics were administered: reduced chorioamnionitis, prolonged latency and improved neonatal outcomes Recommended by NG 25 A Cochrane review investigating the role of antibiotics for women with confirmed PPROM found (...) that the use of antibiotics is associated with a statistically significant reduction in chorioamnionitis (RR 0.66, 95% CI 0.46–0.96). There was a significant reduction in the numbers of babies born within 48 hours (RR 0.71, 95% CI 0.58–0.87) and 7 days (RR 0.79, 95% CI 0.71–0.89). Neonatal infection, use of surfactant, oxygen therapy and abnormal cerebral ultrasound prior to discharge from hospital was also reduced. There was no significant reduction in perinatal mortality or on the health of the children

2019 Royal College of Obstetricians and Gynaecologists

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