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2021. Management of bacterial vaginosis

)(11), but it is unclear whether this is a problem in UK practice where many units administer perioperative antibiotics. There are no studies investigating the possible role of BV in the onset of PID following insertion of an intrauterine contraceptive device (IUCD). In one study BV was associated with NGU in male partners(12). Diagnosis Two approaches are available • Amsel criteria(13).At least three of the four criteria are present for the diagnosis to be confirmed. (1) Thin, white, homogeneous (...) to recommend routine treatment of asymptomatic pregnant women who attend a G-U clinic and are found to have BV. • Metronidazole enters breast milk and may affect its taste. The manufacturers recommend avoiding high doses if breast feeding. Small amounts of clindamycin enter breast milk. It is prudent therefore to use an intravaginal treatment for lactating women (C). Termination of pregnancy (TOP) Three studies have investigated whether antibiotics can reduce the rate of infectious morbidity in women

2006 British Association for Sexual Health and HIV

2022. Management of PID

page 2 Signs • lower abdominal tenderness which is usually bilateral • adnexal tenderness on bimanual vaginal examination • cervical motion tenderness on bimanual vaginal examination • fever (>38°C) Complications • Women with HIV may have more severe symptoms associated with PID but respond well to standard antibiotic therapy 6 . No change in treatment recommendations compared to HIV uninfected patients is required 7-9 . (Grade B [III]) • The Fitz-Hugh-Curtis syndrome comprises right upper quadrant (...) of definitive diagnostic criteria, a low threshold for empiric treatment of PID is recommended. Broad spectrum antibiotic therapy is required to cover pid_v4_0205 page 4 N. gonorrhoeae, C. trachomatis and a variety of aerobic and anaerobic bacteria commonly isolated from the upper genital tract in women with PID 1;2;5 . The best evidence for the effectiveness of antibiotic treatment in preventing the long term complications of PID comes from the PEACH study where women were treated with cefoxitin followed

2005 British Association for Sexual Health and HIV

2023. UK National STI Screening and Testing Guideline

-specific (poor positive predictive value – 17%). Because of the serious long term sequelae of PID and the low risk associated with antibiotic use, a low threshold for making a clinical diagnosis of PID is appropriate i.e. any sexually active woman with lower abdominal pain plus either adnexal tenderness or cervical motion tenderness. Window Period The minimum time gap between exposure to a sexually transmitted infection and its successful detection will vary depending on a number of factors, including (...) : 13• the organism • the size of inoculum • the type of test utilised The evidence base for specific recommendations on how long to wait before testing for different STIs is limited. In general: • for serological testing (e.g. HIV, syphilis, hepatitis), an interval of 3-6 months is required with the interval reflecting the timing of potential exposure to infection (level IIb) • for bacterial STIs, many clinicians would wait 3-7 days before testing (level IV) Recent Antibiotic Use Patients taking

2006 British Association for Sexual Health and HIV

2024. Management of gonorrhoea in adults

available, specific, sensitive and cheap diagnostic test that readily allows confirmatory identification and antimicrobial susceptibility testing. It is currently the method of first choice for use in genitourinary medicine clinics in the UK. Selective culture media containing antimicrobials are recommended to reduce contamination 5 (recommendation level B). • Alternative tests include nucleic amplification tests (NAATs) and nucleic acid hybridization tests. NAATs are more sensitive than culture and can (...) is lacking on the sensitivity of a single set of tests from anogenital sites to identify infection with N. gonorrhoeae. To confidently exclude infection in patients who attend within three days of sexual contact with a confirmed case of gonorrhoea, a second set of tests should be considered if epidemiological treatment with effective antimicrobial therapy is not given 12 (evidence level IV, recommendation level C). Management. General Advice. • Referral to a GU Medicine Department for management

2005 British Association for Sexual Health and HIV

2025. Infection control in anaesthesia

in the transfer of potential pathogens and a decrease in the incidence of preventable HCAI [4]. Despiteconsistentadvice,staffoftenneglecthandhygiene when caring for patients. At the start of every session, and when visibly soiled or potentially contaminated, hands must be washed with liquid soap and water. When there is no soiling, the Hand Hygiene Liaison Group advocates that staff should use an antimicrobial hand rub between patients or activities [5] as this is effective and quicker. It is vital to ensure (...) that the whole hand and ?ngers (particularly the tips), are exposed to the hand rub. Antimicrobial hand rub is not effective in preventing cross infection with Clostridium dif?cile. Trusts must ensure that sinks, soap and antimicrobial hand rubs are conveniently placed to encourage regular use. Watches and jewellery (including dress rings and wrist adornments) must be removed at the beginning of each clinical session, before regular hand decontamina- tion begins. Cuts and abrasions must be covered

2008 Association of Anaesthetists of GB and Ireland

2026. Specific Treatment Options - meningococcal septicaemia

of patient. Repeat assessment and further management of ABCs as necessary en route. RISK OF INFECTION TO AMBULANCE PERSONNEL Meningococcal bacteria are very fragile and do not survive outside the nose and throat. Public health guidelines recommend preventative antibiotics only for health workers whose mouth or nose is directly exposed to large particle droplets / secretions from the respiratory tract of a patient with meningococcal disease. This type of exposure is unlikely to occur unless Ambulance (...) Clinicians are in close proximity to patients, for example, when undertaking airway management or inhaling droplets when patients cough or sneeze. When a case of meningococcal disease is con?rmed, the public health Doctor will ensure that antibiotics are offered to any contacts of the case whose exposure puts them at increased risk of infection. Key Points – Meningococcal septicaemia ? Meningococcal disease is the leading infectious cause of death in children and young adults and can kill a healthy

2007 Joint Royal Colleges Ambulance Liaison Committee

2027. Specific Treatment Options - chronic obstructive pulmonary disease

adjusted accordingly. In the short time that a patient is in ambulance care hypoxia presents a much greater risk than hypercapnia in most cases. Whilst blood gas levels are important to continuing long term care of the patient, a lack of oxygen will prove fatal far more rapidly in the acute setting than changes in CO2 levels which alter more slowly. Use of systemic corticosteroids as advocated in asthma is of no proven bene?t in acute exacerbations of COPD. A course of oral steroids and/or antibiotics

2007 Joint Royal Colleges Ambulance Liaison Committee

2028. Drugs - Benzylpenicillin (Penicillin g)

Drugs - Benzylpenicillin (Penicillin g) Benzylpenicillin (Penicillin G) BPN Drugs October 2006 Page 1 of 2 Drugs PRESENTATION Ampoule containing 600 milligrams of benzylpenicillin as powder. ACTIONS Antibiotic active against a range of bacteria. DOSAGE AND ADMINISTRATION Administer en-route to hospital (unless already administered by GP etc). Administer by slow IV injection. If it is not possible to gain rapid vascular access, the drug should be given by the IM route, as detailed below (...) VOLUME <1 year 300 milligrams 5.0ml 1-<9 years 600 milligrams 10.0ml 9 years – adult 1.2 grams (2 vials) 20.0ml Concentration – 600 milligrams dissolved in 9.6ml water for injections. AGE DOSE VOLUME <1 year 300 milligrams 1.0ml 1-<9 years 600 milligrams 2.0ml 9 years – adult 1.2 grams (2 vials) 4.0ml Concentration – 600 milligrams dissolved in 1.6ml water for injections.ADDITIONAL INFORMATION Penicillin Allergy Antibiotic allergy – This will be a very dif?cult judgement for ambulance staff as many

2007 Joint Royal Colleges Ambulance Liaison Committee

2029. Prevention of group B streptococcal infection in newborns

given on the basis of risk factors only Potential benefits • Prevention of GBS colonization and early-onset infection in neonates Potential harms • Increased incidence of GBS strains resistant to erythromycin (reported rates ranging from 3.2% to 16.0%) and clindamycin (reported rates ranging from 2.5% to 15%) , , • Increased incidence of neonatal sepsis due to ampicillin-resistant organisms other than GBS (possibly related to widespread use of antepartum and intrapartum antibiotics (...) of early-onset infection in the control groups were 7% and 0.1% respectively). (In view of statistically significant heterogeneity [ p = 0.0062], the results of the 2 studies were not combined.) Thus, a much larger proportion of pregnant women will receive antibiotics if universal screening for GBS colonization and IPC is adopted as a preventive strategy than if universal screening and selective IPC given on the basis of risk factors is adopted. The point estimates for effectiveness for the different

2002 CPG Infobase

2030. Inhalation devices and propellants

deposition of nebulised pentamidine in children. Thorax 1993 ; 48 : 220 -6. 32. Mukhopadhyay S, Staddon GE, Estman C, Palmer M, Rhys Davies E, Carswell F. The quantitative distribution of nebulized antibiotics in the lung in cystic fibrosis. Respir Med 1994 ; 88 : 203 -11. 33. Finlay WH, Stapleton KW, Zuberbuhler P. Errors in regional lung deposition predictions of nebulized salbutamol sulphate due to neglect or partial inclusion of hygroscopic effects. Int J Pharm 1997 ; 149 : 63 -72. 34. Phipps PR

1999 CPG Infobase

2033. Guidelines for the Management of Colorectal Cancer

-disciplinary team 26 iii) Surgical specialisation 27 Process 28 i) Preparation for surgery 28 a) Informed consent 29 b) Preparation for stoma formation 30 c) Cross-matching 30 d) Bowel preparation 30 e) Thrombo-embolism prophylaxis 31 f) Antibiotic prophylaxis 31 g) Enhanced recovery 32 ii) Rates of curative resection 32 iii) Definition of Rectal Tumour 32 iv) Surgical technique 33 a) Resection 33 b) Anastomosis 34 v) Rates of permanent stoma formation 35 vi) Local excision 35 vii) Laparoscopic surgery 36

2007 Association of Coloproctology of Great Britain and Ireland

2034. Helicobacter pylori. The latest in diagnosis and treatment

attempts – 10 or 14 days treatment may have a higher chance of success. However, the risk of adverse effects increases • After two failed eradication attempts, current guidelines advocate antimicrobial sensitivity testing. Culture should be performed in specialised laboratories, as the procedure is technically demanding. Several studies have shown that higher eradication rates are obtained when antibiotics are chosen based on susceptibility testing, and this seems to be a cost effective approach • T (...) based therapy, bismuth based quadruple therapy is the favoured second line therapy. Preparing the patient for possible side effects is important as poor compliance and antibiotic resistance are the main reasons for eradication failure. helicobacter pylori The latest in diagnosis and treatment Barry marshall FRACP , FAA, FRS, Nobel Laureate, is Clinical Professor of Microbiology, The University of Western Australia. Aruni mendis PhD, DIC, is Manager, Scientific & Regulatory Affairs, Tri-Med Australia

2008 The Royal Australian College of General Practitioners

2035. Cholesteatoma - diagnosing the unsafe ear

to toxins or direct invasion. Water within the ear can precipitate an acute infection of the cholesteatoma and results in otorrhea. In any patient with otitis media that fails to settle with appropriate antibiotic treatment, a cholesteatoma should be suspected. A cholesteatoma is rarely associated with pain. Pain however reflects extensive disease with the possibility of intracranial invasion and dural irritation. 7 Vertigo is also associated with an extensive cholesteatoma and requires urgent attention (...) nerve. Antibiotic-steroid eardrops can be instilled on a daily basis over 1 week to treat any polyp occluding the ear canal and obstructing the view of the underlying tympanic membrane. If a cholesteatoma is suspected the patient’s facial nerve should be examined. The patient should also be examined for dizziness using the fistula test. A fistula test involves applying positive pressure to the affected ear. It can be performed by placing a finger to the external auditory meatus and creating

2008 The Royal Australian College of General Practitioners

2036. Ocular Emergencies

not specific to a penetrating injury, hyphaema and dislocation of the natural lens may also be seen. It is imperative that the eye is not touched or manipulated. If the object is present it should be left in situ as its removal may cause further herniation of the eye contents. Topical anaesthetic and antibiotics can be given to aid comfort and reduce the risk of infection. Nausea or vomiting should be suppressed with the use of antiemetics as violent head movements can aggravate the condition. 2,4 Tetanus

2008 The Royal Australian College of General Practitioners

2037. Vertigo part 2 - management in general practice

(125 mg) is given and the dosage is slowly tapered down over 18 days. Antiviral medication has not been shown to be of any benefit. 13 In patients with suppurative labyrinthitis, usually following a bacterial otitis media infection, hospitalisation with intravenous antibiotic treatment is required. Early mobilisation as tolerated in a safe environment will encourage the brainstem compensatory mechanism. Vestibular rehabilitation exercises can also be introduced to allow a more rapid and complete

2008 The Royal Australian College of General Practitioners

2039. Guidelines for the Management of Inflammatory Bowel Disease (IBD) in Children in the United Kingdom

, Daum F, Fisher SE et al. Peripheral neuropathy in Crohn’s disease patients treated with metronidazole. Gastroenterology 1985; 88: 681–4. [44] Sartor RB. Antibiotics as therapeutic agents in Crohn’s disease. In: Bayless TM, Hanauer SB eds. Advanced Therapy of Inflammatory Bowel Disease. Lewiston, NY: BC Decker, 2001: 359–62. [45] Singleton J. Second trial of mesalamine therapy in the treatment of active Crohn’s disease. Gastroenterology 1994;107:632–3. [46] Barden L, Lipson A, Pert P et al

2008 British Society of Paediatric Gastroenterology Hepatology and Nutrition

2040. Guideline to Regulations for Radiopharmaceuticals in Early Phase Clinical Trials in the EU

materials present in a radiopharmaceutical preparation as excipients (solvents, buffers, stabilisers, additives, antimicrobial agents, …) must be of pharma- copoeial quality (as indicated on the label), or be accompanied by a certificate of analysis, or be analysed using validated methods and in accordance with national regulations. Requirements for radiopharmaceuticals in early phase clinical trials Radiopharmaceuticals can be used for different purposes in early phase clinical trials. They may be used

2008 European Association of Nuclear Medicine

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