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161. Beta-lactam allergy in the paediatric population

Beta-lactam allergy in the paediatric population Beta-lactam allergy is commonly diagnosed in paediatric patients, but over 90% of individuals reporting this allergy are able to tolerate the medications prescribed after evaluation by an allergist. Beta-lactam allergy labels are associated with negative clinical and administrative outcomes, including use of less desirable alternative antibiotics, longer hospitalizations, increasing antibiotic-resistant infections, and greater medical costs. Also (...) , children with true IgE-mediated allergy to penicillin medications are often advised to avoid all beta-lactam antibiotics, including cephalosporins, which is likely unnecessary in greater than 97% of those reporting penicillin allergies. Most patients can be safely treated with penicillin or amoxicillin if they do not have a history compatible with IgE-mediated or systemic, delayed reactions such as Stevens-Johnson syndrome (SJS), serum sickness-like reactions, drug reaction with eosinophilia

2020 Canadian Paediatric Society

162. Sepsis and the Emergency Department

of rapid antibiotic treatment, and benefit of care bundles [3,4], however these are the mainstay of management 6. Ensuring audit of these processes, and sepsis care. 7. Ensuring compliance with minimisation of inappropriate antibiotic use* 8. Ensuring staff compliance with Infection Control (including hand hygiene and procedural) policies, and regular audit of this 9. Ensure compliance with Public Health requirements for epidemic and imported disease Those patients being discharged home (e.g. with oral (...) antibiotics, or with a diagnosis of a viral infection (where antibiotics will not help)) should receive clear advice with regards what to do if their condition deteriorates and what specific signs to look out for. *Whilst time to antibiotic for patients with Sepsis is an important measure; for those patients who do not have Sepsis it is important that merely having an abnormal early warning score is not used as an indication to give IV antibiotics ‘just in case’ or for a poorly chosen antibiotic

2020 Royal College of Emergency Medicine

163. Current epidemiology and guidance for COVID-19 caused by SARS-CoV-2 virus, in children: March 2020

-be-used-in-children-when-covid-19-is-suspected March 2020. Korean Society of Infectious Diseases; Korean Society of Pediatric Infectious Diseases; Korean Society of Epidemiology; Korean Society for Antimicrobial Therapy; Korean Society for Healthcare-associated Infection Control and Prevention; Korea Centers for Disease Control and Prevention. Report on the epidemiological features of coronavirus disease 2019 (COVID-19) outbreak in the Republic of Korea from January 19 to March 2, 2020. J Korean Med

2020 Canadian Paediatric Society

164. Assessing the infection prevention and control measures for the prevention and management of COVID-19 in healthcare settings

. 7. Lai CC, Shih TP, Ko WC, et al. Severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges. International Journal of Antimicrobial Agents 2020; (no pagination). Review. 8. Jin YH, Cai L, Cheng ZS, et al. A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version). Military Medical Research 2020; 7 (1) (no pagination). Review. 9. Wax RS

2020 Covid-19 Ad hoc guidelines

165. Clinical management of severe acute respiratory infection when COVID-19 is suspected

assessment for patients with sepsis. Remark 1: Although the patient may be suspected to have COVID-19, administer appropriate empiric antimicrobials within 1 hour of identification of sepsis (5). Empiric antibiotic treatment should be based on the clinical diagnosis (community- acquired pneumonia, health care-associated pneumonia [if infection was acquired in health care setting] or sepsis), local epidemiology and susceptibility data, and national treatment guidelines. Remark 2: When there is ongoing (...) - detail/laboratory-testing-for-2019-novel-coronavirus-in-suspected-human-cases-20200117). Additionally, guidance on related biosafety procedures is available (https://apps.who.int/iris/bitstream/handle/10665/331138/WHO-WPE-GIH-2020.1-eng.pdf). Collect blood cultures for bacteria that cause pneumonia and sepsis, ideally before antimicrobial therapy. DO NOT delay antimicrobial therapy to collect blood cultures. Collect specimens from the upper respiratory tract (URT; nasopharyngeal and oropharyngeal

2020 WHO Coronavirus disease (COVID-19) Pandemic

166. Management of patients with severe to critical COVID-19

antibacterial agents, over no antibacterials. If the treating team initiates empiric antibacterials, they should assess for de-escalation daily, and re-evaluate the duration of therapy and spectrum of coverage based on the microbiology results and the patient’s clinical status. [Adapted from SSC] 33.36 For mechanically ventilated adults with COVID-19 and moderate to severe ARDS: We suggest using, as needed, intermittent boluses of neuromuscular blocking agents (NMBA), over continuous NMBA infusion

2020 National COVID-19 Clinical Evidence Taskforce

167. Management of patients with moderate to severe COVID-19

) if O2 saturations =92% or significantly below baseline. [Adapted from ASID] FLUID MANAGEMENT 1.9 A restrictive fluid management strategy is recommended. The aim is to reduce extravascular lung water. Where possible avoid ‘maintenance’ intravenous fluids, high volume enteral nutrition, and fluid bolus for hypotension. [ANZICS] SUPPORTIVE ANTI-INFECTIOUS THERAPY 49.7 Prescribe antibiotics for bacterial pneumonia if hypoxaemic ( 72h, as per eTG or local institutional pneumonia guidelines). [ASID] 49.8

2020 National COVID-19 Clinical Evidence Taskforce

168. Covid-19: Guidance on adaptations to standard UK critical care medication prescribing and administration practices during pandemic emergency pressures

sparing agents. However, beware that these are less titratable. Antibiotics ? Consider not commencing antibiotics empirically at presentation. ? Continue to follow local antimicrobial policies unless specific shortages occur. ? Continue to practice good antimicrobial stewardship with regular review to stop, de- escalate or switch to oral/ enteral route. Stress ulcer prophylaxis ? If standard practice is intravenous ranitidine consider switching to PPI if unavailable or stopping once enteral feed (...) . ? Consider the local implementation of teams to administer IV medicines (e.g. roles for doctors who are re-deployed from other clinical areas). ? Consider bolus dosing / administration of medicines where possible (e.g. magnesium, certain antibiotics). ? Administration (i.e. if a person in PPE already, doctor or nurse, to check which other professional group role needs to be done in any given timeline). 2 Alternative techniques First line drugs / priority clinical indications Alternative drugs Sedation

2020 ICM Anaesthesia COVID-19

170. Respiratory support for adults with severe to critical COVID-19

workers and infrastructure, ECMO should only be considered in selected patients with COVID-19 and severe ARDS. PP [Taskforce] Mechanical ventilation (cont.) ADDITIONAL MEASURES TRACHEOSTOMY In mechanically ventilated patients with COVID-19 and respiratory failure, use empiric antibacterial agents when clinically indicated. Re-evaluate the duration of therapy and spectrum of coverage based on the microbiology results and the individual’s clinical status. PP [Taskforce] In mechanically ventilated

2020 National COVID-19 Clinical Evidence Taskforce

171. Management of adults with mild COVID-19

SUPPORTIVE CARE Manage mild COVID-19 in a similar way to seasonal flu and advise patients to rest. PP [BMJ] An antipyretic is generally not required for mild COVID-19, but paracetamol or ibuprofen as appropriate can be considered for symptomatic relief. PP [ACSQHC] COVID-19 THERAPIES ANTIBIOTICS Do not prescribe antibiotics for mild COVID-19 unless indicated for other reasons, such as community acquired pneumonia. PP [Taskforce] DISEASE-MODIFYING TREATMENTS Hydroxychloroquine NOT RECOMMENDED Lopinavir

2020 National COVID-19 Clinical Evidence Taskforce

172. Management of adults with moderate to severe COVID-19

on room air = 92%) or have pleural effusion or purulent sputum, prescribe antibiotics according to local pneumonia guidelines. If the onset of bacterial pneumonia symptoms occurs within 72 hours of hospital admission, choose antibiotics according to local CAP guidelines. If the onset of bacterial pneumonia symptoms occurs more than 72 hours after admission, choose antibiotics according to local HAP guidelines. PP [Taskforce/ASID] In people with suspected or confirmed COVID-19 with onset of symptoms

2020 National COVID-19 Clinical Evidence Taskforce

173. COVID-19 Recovery: Implications for cancer care

to minimise the risk of drug interactions. 35 o Adopting a lower threshold for use of more aggressive supportive care interventions such as anti-emetics, use of granulocyte colony stimulating factor (G-CSF) with chemotherapy regimens to reduce risk of febrile neutropenia, and outpatient treatment of low-risk patients with febrile neutropenia with oral antibiotics to reduce hospital admission rates. 36-38 4.2 Impact of change • The adoption of value-based healthcare practices increases effective, patient (...) neutropenia, and outpatient treatment of low-risk patients with febrile neutropenia with oral antibiotics helped to reduce hospital admission rates. 7,78,79 • Some health practitioners across Australia moved towards e-prescribing and e- ordering of investigations, enabled through the availability of telehealth and home delivery of medications. 80 8.2 Impact of change • Implementation of innovative hospital and infrastructure models aiming to minimise potential overloading of acute care facilities

2020 Cancer Australia

174. Guidance on Competencies for Spinal Cord Stimulation

as part of wider rehabilitative intervention 4 Interactions of SCS systems with a. medical/electrical/magnetic equipment e.g. diathermy, physiotherapy equipment b. MRI scanners c. other implanted devices e.g. cardiac pacemakers 5 Indications for trial of SCS and evaluation of trial outcome 6 Indications for percutaneous/surgical electrodes and choice of pulse generator 7 Basic skills in a. patient positioning b. asepsis and infection control (hand hygiene, MRSA screening, antibiotic prophylaxis

2020 Faculty of Pain Medicine

175. Best Practice in the Management of Epidural Analgesia in the Hospital Setting

be aware of, and adhere to, local infection guidelines (including use of prophylactic antibiotics in special circumstances). 5.5 Duration of catheter placement should be determined after weighing up the associated risks and benefits. Epidural catheters should not remain in situ for longer than clinically necessary and should be removed as soon as it is safe to do so (including taking into account anti-coagulation). 6. ANTI-COAGULATION AND EPIDURALS 6.1 Dose, timings and therapeutic effect of all anti

2020 Faculty of Pain Medicine

176. Prostate cancer screening with prostate-specific antigen (PSA) test Full Text available with Trip Pro

guided by ultrasound Takes about 5-10 minutes Antibiotics given before procedure Local anaesthesia or sedation given before procedure May have to stop blood thinners before procedure Screening If biopsy is required Slow stream Sensation of incomplete emptying Increased urinary frequency Family history of prostate cancer African descent Poorer socio-economic groups ©BMJ Publishing Group Limited. Disclaimer: This infographic is not a validated clinical decision aid. This information is provided without

2018 BMJ Rapid Recommendations

178. Choosing Wisely Canada recommendation - Don’t routinely do screening mammography for average risk women aged 40 – 49. Individual assessment of each woman’s preferences and risk should guide the discussion and decision regarding mammography screening in th

of the lower spine before six weeks does not improve outcomes. Don’t use antibiotics for upper respiratory infections that are likely viral in origin, such as influenza-like illness, or self-limiting, such as sinus infections of less than seven days of duration. Bacterial infections of the respiratory tract, when they do occur, are generally a secondary problem caused by complications from viral infections such as influenza. While it is often difficult to distinguish bacterial from viral sinusitis, nearly (...) all cases are viral. Though cases of bacterial sinusitis can benefit from antibiotics, evidence of such cases does not typically surface until after at least seven days of illness. Not only are antibiotics rarely indicated for upper respiratory illnesses, but some patients experience adverse effects from such medications. Don’t order screening chest X-rays and ECGs for asymptomatic or low risk outpatients. There is little evidence that detection of coronary artery stenosis in asymptomatic patients

2019 CPG Infobase

180. Developmental follow-up of children and young people born preterm

aspects of daily life. In the ICD-10 this is defined as an IQ score more than 2 standard deviations below the mean. Developmental follow-up of children and young people born preterm (NG72) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 22 of 29Neonatal sepsis Neonatal sepsis Blood culture-positive sepsis that is treated with antibiotics for more than 5 days. Small for gestational age Small for gestational age Birth

2017 National Institute for Health and Clinical Excellence - Clinical Guidelines

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