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2041. Assessment and Management of Venous Leg Ulcers

pain; increasing erythema of surrounding skin; purulent exudate; rapid increase in ulcer size). 31. Do not use topical antiseptics to reduce bacteria in wound tissue, B e.g., povidone iodine, iodophor, sodium hypochlorite, hydrogen peroxide, or acetic acid. 32. Topical antibiotics and antibacterial agents are frequent sensitizers and B should be avoided. F. COMPRESSION 33. The treatment of choice for clinical venous ulceration uncomplicated A by other factors, is graduated compression bandaging (...) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .101 Appendix G – Pain Assessment Tools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .103 Appendix H – Cleansing Agents and Their Associated Toxicities . . . . . . . . . . . . . . . . . .106 Appendix I – Potential Allergens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .107 Appendix J – Topical Antimicrobial Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .108 Appendix K – Classes of Compression Bandages

2004 Registered Nurses' Association of Ontario

2042. Evidence-Based Guidelines for the Classification and Management of Drug Induced Phototoxicity

of phototoxicity in dark-skinned individuals. 8. Susceptibility to photosensitivity can persist for several months after cessation of a photoactive drug. Table 1. Major patterns of cutaneous phototoxicity Skin reactions Photosensitisers Prickling or burning during exposure immediate erythema; oedema or urticaria with higher doses; sometimes delayed erythema or hyperpigmentation Photofrin; amiodarone; chlorpromazine Exaggerated sunburn Fluoroquinolone antibiotics; chlorpromazine; amiodarone; thiazide diuretics (...) ; quinine; demethylchlortetracycline and other tetracyclines Late onset erythema; blisters with slightly higher doses; hyperpigmentation only with low doses Psoralens Increased skin fragility with blisters from trauma (pseudoporphyria) Nalidixic acid; frusemide; tetracycline; naproxen; amiodarone; fluoroquinolone antibiotics Photoexposed site telangiectasia Calcium channel antagonists From: Ferguson J. Photosensitivity due to drugs. Photoderm Photoimmunol Photomed 2002, 18, 262-269. Diagnostic

2007 European Dermatology Forum

2043. Guidelines for evaluation and management of urticaria in adults and children

of evidence III). A meta-analysis of therapeutic trials for Helicobacter pylori found that resolution of chronic urticaria was more likely when antibiotic therapy was successful than when it was not (Quality of evidence I, Strength of recommendation B). 6 There is no stat- istical association between malignancy and urticaria 7 (Quality of evidence II-ii) although individual case reports have been published. Appropriate investigations The diagnosis of urticaria is primarily clinical. 8 Any investi- gations (...) there is prolongation of the Q-T interval. It should not be taken concurrently with drugs that inhibit hepatic metabolism via cytochrome P450 (includ- ing macrolide antibiotics and imidazole antifungals) and with drugs that have potential arrythmic properties (including tricy- clic antidepressants, such as doxepin). Cetirizine has the short- est time to attain maximum concentration, which may be an advantage where rapid availability is clinically important. Des- loratadine has the longest elimination T½ at 27 h

2007 British Association of Dermatologists

2044. Treatment and recommendations for homeless people with with Otitis Media

/ behavior – Inquire about child’s interaction with family members and behavior at daycare/school. Explore possible causes of behavior problems besides hearing loss (stress, feeling ostracized, family violence). • Missed school – Ask about missed school days due to ear discomfort or other illness. • Prior ear infections/ treatment – Ask about number and treatment of past ear infections, symptoms and duration of current complaint, and whether child has received full course of any antibiotic treatments (...) , transportation, geographical, limited time off from work, behavioral health problems, family stressors). Assist in resolution of identified barriers and weigh these factors in deciding whether to “wait and observe” or prescribe antibiotics for AOM in a homeless child. Assess parent/caregiver’s ability and resources to participate in the plan of care. • Risks of delayed/ interrupted treatment – Explain risks to hearing, speech, emotional development, school performance from chronic, serious ear infections

2008 National Health Care for the Homeless Council

2045. Treatment and recommendations for homeless people with asthma

members or shelter residents to sell on the street or to enhance cocaine effects. Associated problems, complications • Antibiotic use – Recognize possible increased risk of asthma for infants treated with antibiotics; assure antibiotic treatment is warranted. • Financial barriers – Lack of health coverage can present barrier to treatment; provide assistance with Medicaid/ SCHIP applications. Use pharmaceutical discount programs, manufacturer-sponsored patient assistance programs, and gift cards

2008 National Health Care for the Homeless Council

2046. Clinical Guideline on the Treatment of Carpal Tunnel Syndrome

carpal tunnel release: skin nerve preservation (Grade B, Level I) epineurotomy (Grade C, Level II) The following procedures carry no recommendation for or against use: flexor retinaculum lengthening, internal neurolysis, tenosynovectomy, ulnar bursa preservation (Inconclusive, Level II and V). Recommendation 7 The physician has the option of prescribing pre-operative antibiotics for carpal tunnel surgery. (Grade C, Level III) vi Recommendation 8 We suggest that the wrist not be immobilized (...) as the outcome measures at 8 weeks, also had too little power to allow for meaningful statistical comparisons. The study was therefore inconclusive. See Evidence Tables 23-37 and Evidence Report pages 88-95, figures 82-88. 9,15 18 RECOMMENDATION 7 The physician has the option of prescribing pre-operative antibiotics for carpal tunnel surgery. (Grade C, Level III) Rationale Our searches indicated that the current literature rarely reports whether pre-operative antibiotic treatment was used in carpal tunnel

2008 Congress of Neurological Surgeons

2047. Therapies for essential tremor

to 750 mg/day use did not result in significant tremor reduction. Another class IV, open-label study found that acetazolamide (in doses up to 500 mg/day) reduced tremor severity, but did not improve patient self-assessment or motor task scale. Isoniazid (Laniazid, Nydrazid). Isoniazid is an antibacterial agent that is used to treat tuberculosis. One class II study randomized 11 patients with ET to isoniazid (doses up to 1,200 mg/day) or placebo over a 4-week period. Only 2 of 11 patients had

2005 American Academy of Neurology

2048. Guideline for the Screening and Treatment of Retinopathy of Prematurity

the treatment? After treatment your baby may need to be given some antibiotic and steroid eye drops to prevent infection and reduce swelling. An appointment will be made for an eye examination about a week later when the ophthalmologist will check if the treatment has stopped the abnormal blood vessels developing. In most babies one treatment is effective but sometimes a second treatment will be needed around 2 to 3 weeks later. Are there any side-effects from the treatment? ROP treatment is a surgical

2008 British Association of Perinatal Medicine

2049. Intermediate care - Hospital at Home in COPD

there is impairment of consciousness, confusion, acidosis, serious co-morbidity or inadequate social support. 2. After suitability for HaH is confirmed by assessment in hospital, a treatment package is prescribed which includes antibiotics, steroids, nebulised bronchodilators and oxy- gen if necessary. 3. Home care should be delivered by specialist respiratory nurses/physiotherapists or in generic teams by district nurses. 4. For most hospitals the preferred model of HaH should be early supported discharge (ESD (...) that the airways of a proportion of patients with stable COPD are chronically colonised with bacteria and consequently an organism cultured during an exacerbation may not be causal. 29 30 Similarly, the spectrum of antibiotic-responsive organisms commonly causing exacerbations is well known without the need for culture. 18 Consequently, the NICE guide- line 2 recommends routine sputum culture only for patients admitted to hospital and when the sputum is purulent. Recommendation N (R10) Routine sputum culture

2007 British Thoracic Society

2050. Guidelines for the prevention of sepsis in asplenic and hyposplenic patients (Abstract)

Guidelines for the prevention of sepsis in asplenic and hyposplenic patients Asplenic or hyposplenic patients are at risk of fulminant sepsis. This entity has a mortality of up to 50%. The spectrum of causative organisms is evolving as are recommended preventive strategies, which include education, prophylactic and standby antibiotics, preventive immunizations, optimal antimalarial advice when visiting endemic countries and early management of animal bites. However, there is evidence

2008 Clinical Practice Guidelines Portal

2051. Consensus guidelines for dosing of amoxicillin-clavulanate in melioidosis Full Text available with Trip Pro

exposure to Burkholderia pseudomallei—Los Angeles, California, 2003. MMWR Morb Mortal Wkly Rep 53 : 988 –990. Gilbert D, Moellering R, Eliopolous G, Sande M, 2006 . The Sanford Guide to Antimicrobial Therapy 2006. Sperryville, VA: Antimicrobial Therapy. Arzola JM, Hawley JS, Oakman C, Mora RV, 2007 . A case of prostatitis due to Burkholderia pseudomallei. Nat Clin Pract Urol 4 : 111 –114. Lee YL, Lee SS, Tsai HC, Chen YS, Wann SR, Kao CH, Liu YC, 2006 . Pyogenic liver abscess caused by Burkholderia

2008 Clinical Practice Guidelines Portal

2052. Diagnostic and therapeutic approach to persistent or recurrent fevers of unknown origin in adult stem cell transplantation and haematological malignancy Full Text available with Trip Pro

to share full-text version of article. I have read and accept the Wiley Online Library Terms and Conditions of Use. Shareable Link Use the link below to share a full-text version of this article with your friends and colleagues. Copy URL Share a link - Based on these observations, two prospective, randomised controlled‐trials (RCT) were performed to compare the efficacy of AmB‐D versus continuing antibiotics alone and/or discontinuing all antimicrobial therapy for the treatment of PFUO. , In both (...) of administering AmB‐D empirically to treat possible IFI in patients who develop PFUO while receiving broad‐spectrum antibiotics, as the standard of care. Empirical antifungal therapy trials and newer antifungal agents AmB‐D was the first agent used as empirical antifungal therapy (EAFT). Many experts attribute the lack of overall survival advantage observed with AmB‐D, when used as EAFT, to its well‐known toxicities. Several RCTs have since explored the efficacy and safety of newer but more expensive agents

2008 Clinical Practice Guidelines Portal

2053. Benzylpenicillin (Penicillin g)

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, into the antero (...) 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

2006 Joint Royal Colleges Ambulance Liaison Committee

2054. Meningococcal septicaemia

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 person of any age within hours of their ?rst symptoms

2006 Joint Royal Colleges Ambulance Liaison Committee

2055. Chronic obstructive pulmonary disease (COPD)

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 may be appropriate based on the judgement

2006 Joint Royal Colleges Ambulance Liaison Committee

2056. 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

2057. 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

2058. 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

2059. 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

2060. 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

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