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1761. Dyspepsia - unidentified cause: How should I assess a person?

, anticholinergics, aspirin, benzodiazepines, beta-blockers, bisphosphonates, calcium-channel blockers, corticosteroids, nitrates, nonsteroidal anti-inflammatory drugs (NSAIDs), theophyllines, and tricyclic antidepressants. The number and duration of any previous courses of antibiotics, which may affect the choice of Helicobacter pylori eradication regimen used (if needed). Consider clinical features that may suggest an , and manage appropriately. Examine the person, to assess for: Weight loss by checking serial

2016 NICE Clinical Knowledge Summaries

1762. Dermatitis - contact

. Allergic contact dermatitis is a type IV (delayed) hypersensitivity reaction that occurs after sensitization and subsequent re-exposure to a specific allergen or allergens. Common allergens include personal care products (such as cosmetics, skin care products, nail varnish, fragrances, and hair dye), metals (such as nickel), topical medications (including antibiotics and corticosteroids) and certain plants (such as sunflower and primula). Irritant contact dermatitis is a non-immunological inflammatory

2016 NICE Clinical Knowledge Summaries

1763. Dental abscess

, with tenderness, warmth, and a purulent exudate. Differential diagnoses include: infections (such as mumps, sinusitis, acute otitis media, or facial cellulitis); salivary gland problems; neoplasm; and unerupted teeth. Definitive treatment for a dental abscess should be provided by a dentist. Interim treatment (whilst waiting to see a dentist) consists of: Self-care advice to reduce the pressure and pain of the dental abscess. Analgesia (ibuprofen or paracetamol) to relieve symptoms. Antibiotics are generally (...) not indicated for otherwise healthy people at low risk of complications when there are no signs of spreading infection. Antibiotics should be prescribed for: People who are systemically unwell or with signs of severe infection (such as fever, lymphadenopathy, cellulitis, diffuse swelling). People with a high risk of complications (for example people who are immunocompromised or have diabetes). A person should be admitted to hospital as an emergency if they have a dental abscess and: Signs of airway

2016 NICE Clinical Knowledge Summaries

1764. Otitis media - acute

or ibuprofen. Many people with AOM will not need antibiotic treatment as symptoms usually resolve spontaneously within a few days. However, antibiotics are necessary in a number of situations, including for: People who are systemically very unwell. People who have symptoms and signs of a more serious illness or condition. People who have a high risk of complications. If an antibiotic is required, a 5–7 day course of amoxicillin is recommended first-line. Clarithromycin or erythromycin are alternatives (...) . Considering the need for paediatric or ENT referral or admission, depending on the clinical situation. Considering a first-line antibiotic (if not already prescribed) or a second-line antibiotic if the initial treatment was ineffective. Measures to prevent recurrent AOM include: In children — avoiding exposure to passive smoking, use of dummies, and flat, supine feeding; and ensuring that children have had a complete course of pneumococcal vaccinations as part of the routine childhood immunization

2016 NICE Clinical Knowledge Summaries

1765. Otitis externa: Topical ear preparations

acid 2% spray (Earcalm®) † Corticosteroid preparations Corticosteroid: lower potency Prednisolone sodium phosphate 0.5% drops (Predsol®) Corticosteroid: higher potency Betamethasone sodium phosphate 0.1% drops (Betnesol®, Vista-methasone®) Antibiotic preparations Aminoglycoside Gentamicin 0.3% drops (Genticin®) Non-aminoglycoside Chloramphenicol 5% drops Antifungal preparations Antifungal Clotrimazole 1% solution (Canesten®) Combined corticosteroid and antibiotic preparations Quinolone (...) Hydrocortisone acetate 1%, gentamicin 0.3% (drops: Gentisone HC®) Framycetin Dexamethasone 0.05%, framycetin sulphate 0.5%, gramicidin 0.005% (drops: Sofradex®) Combined corticosteroid and antibiotic/antifungal preparations Clioquinol with corticosteroid Flumetasone pivalate 0.02%, clioquinol 1% * Aluminium acetate 13% is available from manufacturers of 'special order' products. Aluminium acetate 8% can be made by diluting 8 parts aluminium acetate ear drops (13%) with 5 parts purified water (must be freshly

2016 NICE Clinical Knowledge Summaries

1766. Multi-disciplinary Guidelines for the Oral Management of Patients following Oncology Treatment

are not due to malignancy. Following a 11 diagnosis of ORN it is recommended that: 2.7.2. Oral trauma is minimised, and a high standard of oral hygiene is established. 2.7.3. Local measures are employed to relieve symptoms including topical/systemic analgesia. 2.7.4. New therapeutic use of Antioxidant medications may be beneficial in ORN lesions identified early. 2.7.5. High dose systemic antibiotics are prescribed. 2.7.6. Localised surgical excision of exposed necrosed bone with primary mucosal closure (...) to clean the mouth with oral sponges/gauze, as a temporary measure. The sponge/gauze should be moistened with water or an antimicrobial agent such as diluted alcohol-free chlorhexidine. - Additional aids, such as flossing and fluoride supplements should only be prescribed according to risk assessment by a member of the dental team. The need to restrict sugary food and drink to meal times only should be emphasised. ? For adults, the following factors should additionally be considered: - Adults

2012 British Society for Disability and Oral Health

1768. Management of chemotherapy extravasation

Melphalan Cytarabine Daunorubicin Anthracyclines (other): Etoposide phosphate Epirubicin Liposomal doxorubicin Gemcitabine Idarubicin Liposomal Daunorubicin Fludarabine Others (antibiotics) Mitoxantrone Interferons Dactinomycin Topoisomerase II inhibitors Interleukin-2 Mitomycin C Etoposide Methotrexate Mitoxantrone a Teniposide Monoclonal antibodies Non-DNA-binding compounds Antimetabolites Pemetrexed Vinka alkaloids Fluorouracil Raltitrexed Vincristine Platin salts Temsirolimus Vinblastine Carboplatin (...) on non-biopsy con?rmed data and in many cases, simultaneous treatment with antibiotics was initiated. It should be also considered that many of the recommendations date back to a drug’s original registration, which can be several decades ago when requirements for approval were less strict. general measures Regardless of the chemotherapy drug, early initiation of treatment is considered mandatory. In this context, patient education is crucial for a prompt identi?cation of the extravasation.The

2012 European Society for Medical Oncology

1769. Sinusitis: Scenario: Acute sinusitis

requiring antibiotics a year). Treatment failure after extended courses of antibiotics. Unusual or resistant bacteria. Anatomic defect(s) causing obstruction. Immunocompromise. A suspected allergic or immunological cause. Comorbidities complicating management such as nasal polyps. Basis for recommendation The recommendations on management of a person with acute sinusitis are based largely on the National Institute for Health and Care Excellence (NICE) guidance on Sinusitis (acute): antimicrobial (...) sinusitis in adults and children emphasise the need for imaging (CT or MRI) if orbital or central nervous system complications are suspected [ ; ]. When to prescribe an antibiotic The recommendations on when to prescribe an antibiotic are based on the NICE guidance on Sinusitis (acute): antimicrobial prescribing [ ]. Acute sinusitis usually follows a common cold, and symptoms for less than around 10 days are more commonly associated with a cold rather than viral or bacterial acute sinusitis. Prolonged

2015 NICE Clinical Knowledge Summaries

1770. Sinusitis: How should I diagnose acute sinusitis?

discharge). Basis for recommendation Symptoms and signs Information on diagnostic criteria for acute sinusitis is based on expert opinion published in the European position paper on rhinosinusitis and nasal polyps [ ] and the National Institute for Health and Care Excellence (NICE) guideline Sinusitis (acute): antimicrobial prescribing [ ]. Features suggestive, but not diagnostic, of acute sinusitis are consistent with expert opinion in a US clinical practice guideline [ ] and a practice parameter (...) by experts of the European Position Statement 2012 group (EPOS 2012), published in the European guidance European position paper on rhinosinusitis and nasal polyps [ ] and the NICE guideline Sinusitis (acute): antimicrobial prescribing [ ]. The NICE committee acknowledged that it is challenging to differentiate between viral and bacterial acute sinusitis and listed several features indicating a likely bacterial cause [ ]. A Royal College of General Practitioners guide to the management of acute

2015 NICE Clinical Knowledge Summaries

1771. Vaginal discharge

, for example in women with PID who are pregnant (urgent admission); if a gynaecological cancer is suspected (suspected cancer pathway referral); and for partner notification (if there is microbiologically-confirmed gonorrhoea, chlamydia, or trichomoniasis). Prescribing appropriate antibiotics for infective causes. Managing non-infective causes, where possible. Reassuring women with features suggestive of physiological discharge. Giving general healthcare advice (such as on personal hygiene). Providing

2015 NICE Clinical Knowledge Summaries

1772. Candida - oral: How should I diagnose oral candidal infection?

are immunocompromised (especially people with AIDS, diabetes, cancer, or taking broad spectrum antibiotics), and people with xerostomia. Acute erythematous oral candidiasis (acute atrophic oral candidiasis) presents with marked soreness and erythema, particularly on the palate and dorsum of the tongue. The filiform papillae disappear, and the dorsal surface of the tongue appears smooth. It is usually asymptomatic or is accompanied by a mild burning and itching sensation. It is the most common presentation in both (...) immune depressed and immunocompetent people, and commonly occurs after treatment with oral antibiotics. Denture stomatitis (chronic erythematous candidiasis or chronic atrophic oral candidiasis) presents with redness, and rarely soreness, in the denture-bearing area. It affects about 50–70% of denture wearers. Angular cheilitis presents with redness, fissuring, and soreness at the angle of the mouth. It may be caused by bacterial infection (mainly Staphylococcus aureus ) as well as yeast ( Candida

2015 NICE Clinical Knowledge Summaries

1773. Candida - oral

plaque-like candidiasis (which commonly occurs in men older than 30 years of age, and smokers). Comorbidities that increase the risk of candidal infections include diabetes mellitus, severe anaemia, and immunocompromise (such as due to chemotherapy, radiotherapy, HIV infection, and AIDS). Other risk factors include poor dental hygiene; local trauma; smoking; the use of broad spectrum antibiotics, or inhaled or oral corticosteroids; and malnutrition. Admission to hospital should be arranged

2015 NICE Clinical Knowledge Summaries

1774. Candida - oral: Scenario: Adults and young people (not immunocompromised)

information. Excluding risk factors Oral candidiasis is common in infants, but in adults and older children, it may signify immune deficiency or other illness [ ; ; ; ]. CKS, therefore recommends excluding risk factors in an otherwise healthy person with oral candidiasis. Expert opinion in a review article is that the treatment of oral candidiasis should include recognizing and eliminating the underlying causes, such as ill-fitting oral appliances, history of medications (such as antibiotics

2015 NICE Clinical Knowledge Summaries

1775. Diarrhoea and vomiting caused by gastroenteritis in under 5s: diagnosis and management

reserved. Subject to Notice of rights ( conditions#notice-of-rights). Page 2 of 26Contents Contents Introduction 4 Key priorities for implementation 5 Diagnosis 5 Assessing dehydration and shock 5 Fluid management 5 Nutritional management 6 Information and advice for parents and carers 7 1 Guidance 8 1.1 Diagnosis 8 1.2 Assessing dehydration and shock 10 1.3 Fluid management 13 1.4 Nutritional management 16 1.5 Antibiotic therapy 16 1.6 Other therapies 17 1.7 (...) in children is multifaceted. There is evidence of variation in clinical practice, which may have a major impact on the use of healthcare resources. This guideline applies to children younger than 5 years who present to a healthcare professional for advice in any setting. It covers diagnosis, assessment of dehydration, fluid management, nutritional management and the role of antibiotics and other therapies. It provides recommendations on the advice to be given to parents and carers, and also considers when

2009 National Institute for Health and Clinical Excellence - Clinical Guidelines

1777. Canadian consensus guidelines for the management of testicular germ cell cancer

. 114 Prophylactic antibiotic treatment has been shown to reduce febrile neutropenia during chemother- apy with no change in mortality and may be considered in some patients. 115,116 In patients with life-threatening “poor” prognosis disease, orchiectomy should not delay the initiation of curative ther- apy and can be performed at the end of therapy. 117-120 It is recommended that these patients be referred to special- ized centres for optimal multidisciplinary management and supportive care

2010 CPG Infobase

1780. Quality Improvement Guidelines for the Performance of Inferior Vena Cava Filter Placement for the Prevention of Pulmonary Embolism

signi?cant history, including indications for the procedure; b. Clinically signi?cant physical or diagnostic examination ?ndings, including clinical or medical conditions that may necessitate speci?c care, such as preprocedure antibiotics and other measures; c. Clinically indicated laboratory evaluation including, but not limited to, coagulation factors, creatinine, white blood cell count, and previously obtained cultures; and d. Preprocedure documentation should conform to the requirements

2011 Society of Interventional Radiology


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