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201. Performance associated effect variations of public reporting in promoting antibiotic prescribing practice: a cluster randomized-controlled trial in primary healthcare settings. Full Text available with Trip Pro

Performance associated effect variations of public reporting in promoting antibiotic prescribing practice: a cluster randomized-controlled trial in primary healthcare settings. Aim To evaluate the variations in effect of public reporting in antibiotic prescribing practice among physicians with different performance in primary healthcare settings.Overprovision of antibiotics is a major public health concern. Public reporting has been adopted to encourage good antibiotic prescribing practices (...) . However, which group, for instance, high, average or low antibiotic prescribers, accounted for antibiotic prescription reduction has not been fully understood.A cluster randomized-controlled trial was conducted. In total, 20 primary healthcare institutions in Qianjiang city were paired through a six indicators-synthesized score. Coin flipping was used to assign control-intervention status; 10 were then subjected to intervention where prescription indicators were publicly reported monthly over a one

2018 Primary health care research & development Controlled trial quality: uncertain

202. Should antibiotics be administered after endoscopic mucosalresection in patients with colon polyps? Full Text available with Trip Pro

Should antibiotics be administered after endoscopic mucosalresection in patients with colon polyps? Endoscopic mucosal resection (EMR) is widely used for treating gastrointestinal polypoid lesions. However, it is currently unclear whether antibiotic administration is necessary after EMR of colon polyps to prevent infection. We aimed to assess whether antibiotic administration is essential in such conditions.In total, 115 patients with colon polyps were randomly assigned to 3 groups based (...) on the treatment given after EMR: Group A, no antibiotics treatment after EMR (n = 38); Group B, administration of levofloxacin after EMR (n = 38); and Group C, administration of ceftazidime after EMR (n = 39).The colon polyps were completely removed by EMR in all cases without any serious complications. Although infection developed in 2 cases in Group A, it was resolved via levofloxacin injection over 3 days; infection did not develop in any cases in Group B and C. The postoperative infection rate

2018 Turkish Journal of Medical Sciences Controlled trial quality: uncertain

203. Is there a real role of postoperative antibiotic administration for mildmoderate acute cholecystitis? A prospective randomized controlled trial. Full Text available with Trip Pro

Is there a real role of postoperative antibiotic administration for mildmoderate acute cholecystitis? A prospective randomized controlled trial. In cases of acute cholecystitis (AC), postoperative antibiotic prophylaxis is generally used for the purpose of preventing subsequent infections. However, there is still no standardized guideline regarding antibiotic administration after cholecystectomy.A total of 200 patients at five participating hospitals who were admitted for cholecystectomy (...) to treat grade I or II AC were enrolled and randomly allocated to a group given a placebo (group A) or a group given postoperative antibiotics (group B). Surgical outcomes and incidence of postoperative infectious morbidities were reviewed.A total of 188 patients (95 patients in group A and 93 patients in group B) were finally analyzed. The incidence rate of infectious complications (seven cases, 7.4%, in group A and eight cases, 8.6%, in group B, P = 0.794) and overall non-infectious complications

2018 Journal of hepato-biliary-pancreatic sciences Controlled trial quality: uncertain

204. Optimising the antibiotic treatment of uncomplicated acute appendicitis: a protocol for a multicentre randomised clinical trial (APPAC II trial). Full Text available with Trip Pro

Optimising the antibiotic treatment of uncomplicated acute appendicitis: a protocol for a multicentre randomised clinical trial (APPAC II trial). Based on epidemiological and clinical data acute appendicitis can present either as uncomplicated (70-80%) or complicated (20-30%) disease. Recent studies have shown that antibiotic therapy is both safe and cost-effective for a CT-scan confirmed uncomplicated acute appendicitis. However, based on the study protocols to ensure patient safety (...) , these randomised studies used mainly broad-spectrum intravenous antibiotics requiring additional hospital resources and prolonged hospital stay. As we now know that antibiotic therapy for uncomplicated acute appendicitis is feasible and safe, further studies evaluating optimisation of the antibiotic treatment regarding both antibiotic spectrum and shorter hospital stay are needed to evaluate antibiotics as the first-line treatment for uncomplicated acute appendicitis.APPAC II trial is a multicentre, open-label

2018 BMC Surgery Controlled trial quality: predicted high

205. Efficacy of Antibiotic Prophylaxis against ventilator-associated pneumonia. (Abstract)

Efficacy of Antibiotic Prophylaxis against ventilator-associated pneumonia. Ventilator-associated pneumonia (VAP) is one of the most important problems of intensive care units. Eighty-four neurologic patients with acute stroke (Glasgow Coma Score ≤8) were entered into a double-blind clinical trial. Patients in the intervention group received piperacillin-tazobactam 4 g/0.5 g at the time of intubation and 12 h later. The incidences of early-onset (within four days of intubation) and late-onset

2018 Journal of Hospital Infection Controlled trial quality: predicted high

206. A randomized controlled trial comparing the efficacy of topical antibiotic steroid combination versus no treatment after fornix-incision strabismus surgery. (Abstract)

A randomized controlled trial comparing the efficacy of topical antibiotic steroid combination versus no treatment after fornix-incision strabismus surgery. To compare comfort and inflammation in patients treated with postoperative topical antibiotic steroids in one eye versus no treatment in the other eye.This prospective, randomized single-masked study included all patients with planned symmetrical strabismus surgery via fornix incision. One eye was randomly assigned to topical postoperative (...) tobramycin-dexamethasone and the other eye was not treated. Patient and parent questionnaires were administered, and two masked observers assessed conjunctival injection over the muscle and wound site.A total of 70 patients completed at least 1 postoperative visit and were included. There was no statistically significant difference between the treatment eye and the no treatment eye in any of the studied parameters.Postoperative topical antibiotic steroid did not prove to be superior to no treatment

2018 JAAPOS - Journal of the American Association for Pediatric Ophthalmology and Strabismus Controlled trial quality: uncertain

207. Cost-effectiveness of internet-based training for primary care clinicians on antibiotic prescribing for acute respiratory tract infections in Europe. Full Text available with Trip Pro

Cost-effectiveness of internet-based training for primary care clinicians on antibiotic prescribing for acute respiratory tract infections in Europe. Overprescribing of antibiotics by general practitioners (GPs) is seen as a major driver of antibiotic resistance. Training in communication skills and C-reactive protein (CRP) testing both appear effective in reducing such prescribing. This study assesses the cost-effectiveness (compared with usual care) of: (i) training GPs in the use of CRP (...) testing; (ii) training GPs in communication skills; and (iii) training GPs in both CRP testing and communication skills.Economic analyses [cost-utility analysis (CUA) accounting for the cost of antibiotic resistance and cost-effectiveness analysis (CEA)] were both conducted from a healthcare perspective with a time horizon of 28 days alongside a multinational, cluster, randomized, factorial controlled trial in patients with respiratory tract infections in five European countries. The primary outcome

2018 Journal of Antimicrobial Chemotherapy Controlled trial quality: uncertain

208. Shared decision making and antibiotic benefit-harm conversations: an observational study of consultations between general practitioners and patients with acute respiratory infections. Full Text available with Trip Pro

Shared decision making and antibiotic benefit-harm conversations: an observational study of consultations between general practitioners and patients with acute respiratory infections. Little research has examined whether shared decision making (SDM) occurs in consultations for acute respiratory infections (ARIs), including what, and how, antibiotic benefits and harms are discussed. We aimed to analyse the extent and nature of SDM in consultations between GPs and patients with ARIs, and explore (...) was used (15, 42%), compared to the 21 usual care consultations, mean observer-assessed SDM scores (OPTION-12, ACEPP scores) were higher and antibiotic harms mentioned in all (compared to only 1) consultations. Patients generally reported high decision involvement and self-efficacy, and low decisional conflict.The extent of observer-assessed SDM between GPs and patients with ARIs was generally low. Balanced discussion of antibiotic benefits and harms occurred more often when decision aids were used.

2018 BMC Family Practice Controlled trial quality: uncertain

209. Lactobacillus reuteri DSM 17938 in the prevention of antibiotic-associated diarrhea in children: a randomized clinical trial. (Abstract)

Lactobacillus reuteri DSM 17938 in the prevention of antibiotic-associated diarrhea in children: a randomized clinical trial. To assess the effectiveness of Lactobacillus reuteri DSM 17938 for the prevention of diarrhoea and antibiotic-associated diarrhoea (AAD) in children.Hospitalized children who received antibiotics were assigned by a computer-generated list to receive L. reuteri (at 2 × 108 CFU) or placebo, twice daily, for the duration of antibiotic treatment. Follow up was for 1 week (...) after antibiotic cessation. The primary outcome measures were diarrhoea and AAD. Both were defined according to one of three definitions (i) three or more loose or watery stools per day for ≥48 h; (ii) three or more loose or watery stools per day for ≥24 h; or (iii) two or more loose or watery stools per day for ≥24 h. For AAD, it had to be diarrhoea caused by Clostridium difficile or otherwise unexplained diarrhoea.A total of 250 children were randomized and 247 were analysed (L. reuteri n = 123

2018 Clinical Microbiology and Infection Controlled trial quality: predicted high

210. Infection Control in Teeth with Apical Periodontitis Using a Triple Antibiotic Solution or Calcium Hydroxide with Chlorhexidine: A Randomized Clinical Trial. (Abstract)

Infection Control in Teeth with Apical Periodontitis Using a Triple Antibiotic Solution or Calcium Hydroxide with Chlorhexidine: A Randomized Clinical Trial. This randomized clinical study compared the antibacterial effectiveness of treatment protocols using either a triple antibiotic solution (1 mg/mL) or calcium hydroxide/chlorhexidine paste as interappointment medication in infected canals of teeth with primary apical periodontitis.The root canals of single-rooted teeth with apical (...) periodontitis were prepared by using a reciprocating single-instrument technique with 2.5% sodium hypochlorite irrigation and then medicated for 1 week with either a triple antibiotic solution (minocycline, metronidazole, and ciprofloxacin) at 1 mg/mL (n = 24) or a calcium hydroxide paste in 2% chlorhexidine gluconate (n = 23). Samples were taken from the canal at the baseline (S1), after chemomechanical preparation (S2), and after intracanal medication (S3). DNA extracts from clinical samples were

2018 Journal of Endodontics Controlled trial quality: uncertain

211. Ileum terminal antibiotic infusion affects jejunal and colonic specific microbial population and immune status in growing pigs Full Text available with Trip Pro

Ileum terminal antibiotic infusion affects jejunal and colonic specific microbial population and immune status in growing pigs Compared with oral antibiotics (primarily disrupt foregut microbiota), the present study used antibiotics with ileum terminal infusion to disrupt the hindgut microbiota, and investigated the changes in specific bacterial composition and immune indexes in the jejunum and colon, and serum of growing pigs. Twelve barrows (45 d of age, 12.08 ± 0.28 kg) fitted with a T (...) -cannula at the terminal ileum, were randomly assigned to two groups and infused either saline without antibiotics (Control) or with antibiotics (Antibiotic) at the terminal ileum. After 25 d experiment, all pigs were euthanized for analyzing bacterial composition and immune status.Ileum terminal antibiotic infusion (ITAI) altered dominant bacteria counts, with a decrease in Bifidobacterium, Clostridium cluster IV and Clostridium cluster IV in the colon (P < 0.05), and an increase in Escherichia coli

2018 Journal of animal science and biotechnology Controlled trial quality: uncertain

212. Pharmaceutical analysis of different antibiotic regimens in the treatment of lower respiratory tract infection Full Text available with Trip Pro

Pharmaceutical analysis of different antibiotic regimens in the treatment of lower respiratory tract infection The present study aimed to discuss and compare the effects and expenses of different antibiotic regimens in the treatment of lower respiratory tract infection (LRTI). A retrospective analysis was performed on 200 patients diagnosed with LRTI and treated at the Department of Respiratory Medicine of Dongying People's Hospital from February 2015 to May 2017. The patients were randomly (...) divided into Group A, Group B, Group C and Group D, with 50 cases in each group, and were treated with ceftriaxone sodium, ceftizoxime sodium, levofloxacin and azithromycin, respectively. Venous blood of patients was collected. White blood cells (WBC) of venous blood were detected using a hematology analyzer and C-reactive protein (CRP) was tested with latex immunoturbidimetry. Moreover, therapeutic effects and drug costs of four different antibiotics were compared. No adverse reactions occurred

2018 Experimental and therapeutic medicine Controlled trial quality: uncertain

213. Simplified antibiotic regimens for treating neonates and young infants with severe infections in the Democratic Republic of Congo: a comparative efficacy trial Full Text available with Trip Pro

Simplified antibiotic regimens for treating neonates and young infants with severe infections in the Democratic Republic of Congo: a comparative efficacy trial One-quarter of neonatal and infant deaths are due to infection, and the majority of these deaths occur in developing countries. Standard treatment for infection, which includes parenteral treatment only, is often not available in low-resource settings. Infant mortality will not be reduced in developing countries without a reduction (...) in deaths due to infection. We participated in a multi-site trial that demonstrated the effectiveness of three simplified antibiotic regimens compared to standard treatment (The AFRINEST Trial: parent study). For this report, we examined the site-specific data for the Democratic Republic Congo (DRC), the most impoverished of the countries that participated in the study, to determine if outcomes in the DRC were similar to outcomes across all sites.The parent study was an individually randomized, open

2018 Maternal health, neonatology and perinatology Controlled trial quality: uncertain

214. The effect of antibiotic stewardship interventions with stakeholder involvement in hospital settings: a multicentre, cluster randomized controlled intervention study Full Text available with Trip Pro

The effect of antibiotic stewardship interventions with stakeholder involvement in hospital settings: a multicentre, cluster randomized controlled intervention study There is limited evidence from multicenter, randomized controlled studies to inform planning and implementation of antibiotic stewardship interventions in hospitals.A cluster randomized, controlled, intervention study was performed in selected specialities (infectious diseases, pulmonary medicine and gastroenterology) at three (...) emergency care hospitals in Western Norway. Interventions applied were audit with feedback and academic detailing. Implementation strategies included co-design of interventions with stakeholders in local intervention teams and prescribers setting local targets for change in antibiotic prescribing behaviour. Primary outcome measures were adherence to national guidelines, use of broad-spectrum antibiotics and change in locally defined targets of change in prescribing behaviour. Secondary outcome measures

2018 Antimicrobial resistance and infection control Controlled trial quality: uncertain

215. Probiotic supplementation restores normal microbiota composition and function in antibiotic-treated and in caesarean-born infants Full Text available with Trip Pro

Probiotic supplementation restores normal microbiota composition and function in antibiotic-treated and in caesarean-born infants Infants born by caesarean section or receiving antibiotics are at increased risk of developing metabolic, inflammatory and immunological diseases, potentially due to disruption of normal gut microbiota at a critical developmental time window. We investigated whether probiotic supplementation could ameliorate the effects of antibiotic use or caesarean birth on infant (...) . Faecal samples of the infants were collected at 3 months and analyzed using taxonomic, metagenomic and metaproteomic approaches.The probiotic supplement had a strong overall impact on the microbiota composition, but the effect depended on the infant's diet. Only breastfed infants showed the expected increase in bifidobacteria and reduction in Proteobacteria and Clostridia. In the placebo group, both birth mode and antibiotic use were significantly associated with altered microbiota composition

2018 Microbiome Controlled trial quality: predicted high

216. Carriage of antibiotic-resistant Gram-negative bacteria after discontinuation of selective decontamination of the digestive tract (SDD) or selective oropharyngeal decontamination (SOD) Full Text available with Trip Pro

Carriage of antibiotic-resistant Gram-negative bacteria after discontinuation of selective decontamination of the digestive tract (SDD) or selective oropharyngeal decontamination (SOD) Selective decontamination of the digestive tract (SDD) and selective oropharyngeal decontamination (SOD) reduce colonization with antibiotic-resistant Gram-negative bacteria (ARGNB), incidence of nosocomial infections and improve survival in ICU patients. The effect on bacterial gut colonization might be caused (...) by growth suppression by antibiotics during SDD/SOD. We investigated intestinal colonization with ARGNB after discharge from ICU and discontinuation of SDD or SOD.We performed a prospective, observational follow-up study in regular hospital wards of three teaching hospitals in the Netherlands in patients discharged from the ICU, who were participating in a cluster randomized trial comparing SDD with SOD. We determined rectal carriage with ARGNB at ICU discharge (time (T) = 0) and 3, 6 and 10 days after

2018 Critical Care Controlled trial quality: uncertain

217. Prophylactic Antibiotics After Stented, Distal Hypospadias Repair: Randomized Pilot Study Full Text available with Trip Pro

Prophylactic Antibiotics After Stented, Distal Hypospadias Repair: Randomized Pilot Study The usage of prophylactic oral antibiotics following distal hypospadias repair with stenting has been recently challenged. This study evaluated the incidence of symptomatic urinary tract infections (UTIs) following stented, distal hypospadias repair and the impact of prophylactic antibiotic therapy. Subjects 0 to 5 years of age with distal hypospadias were randomized to either Group 1 (antibiotics (...) ) or Group 2 (no prophylactic therapy). Urinalysis/urine culture was obtained intraoperatively with no preoperative antibiotics given. Phone interviews at 1 month and 3 months after surgery were done. Forty-eight patients were successfully randomized to either Group 1 (24) or Group 2 (24). The incidence of symptomatic UTI in this pilot study is low, and prophylactic antibiotic therapy does not appear to lower the incidence of symptomatic UTI. A larger, randomized, multicenter trial is needed to determine

2018 Global pediatric health Controlled trial quality: uncertain

218. Continuous low-dose antibiotic prophylaxis to prevent urinary tract infection in adults who perform clean intermittent self-catheterisation: the AnTIC RCT. Full Text available with Trip Pro

by cost per UTI avoided. The secondary measures were microbiologically proven UTI, antimicrobial resistance, health status and participants' attitudes to antibiotic use.The frequency of symptomatic antibiotic-treated UTI was reduced by 48% using prophylaxis [incidence rate ratio (IRR) 0.52, 95% confidence interval (CI) 0.44 to 0.61; n = 361]. Reduction in microbiologically proven UTI was similar (IRR 0.49, 95% CI 0.39 to 0.60; n = 361). Absolute reduction in UTI episodes over 12 months was from (...) a median (interquartile range) of 2 (1-4) in the no-prophylaxis group (n = 180) to 1 (0-2) in the prophylaxis group (n = 181). The results were unchanged by adjustment for days at risk of UTI and the presence of factors giving higher risk of UTI. Development of antimicrobial resistance was seen more frequently in pathogens isolated from urine and Escherichia coli from perianal swabs in participants allocated to antibiotic prophylaxis. The use of prophylaxis incurred an extra cost of £99 to prevent one

2018 Health technology assessment (Winchester, England) Controlled trial quality: predicted high

219. Postoperative prophylactic antibiotics in total joint arthroplasty Full Text available with Trip Pro

Postoperative prophylactic antibiotics in total joint arthroplasty The Center for Disease Control and Prevention recently released their 2017 Guideline for the Prevention of Surgical Site Infection. One of their recommendations is the ordering of a single dose of preoperative prophylactic antibiotics with no subsequent postoperative dosing; this recommendation includes perioperative antibiotics for patients undergoing total joint arthroplasty. At this time, the American Association of Hip (...) and Knee Surgeons (AAHKS) does not agree with this recommendation vis-a-vis total joint arthroplasty because it contradicts current international standards of care with limited evidence and study. AAHKS still recommends postoperative antibiotics and recommends further research. Both the Board of Counselors and Board of Specialty Societies of the American Academy of Orthopaedic Surgeons have endorsed this AAHKS recommendation through an advisory opinion; the American Academy of Orthopaedic Surgeons

2018 Arthroplasty today Controlled trial quality: uncertain

220. Prehospital recognition and antibiotics for 999 patients with sepsis: protocol for a feasibility study Full Text available with Trip Pro

Prehospital recognition and antibiotics for 999 patients with sepsis: protocol for a feasibility study Sepsis is a common condition which kills between 36,000 and 64,000 people every year in the UK. Early recognition and management of sepsis has been shown to reduce mortality and improve the health and well-being of people with sepsis. Paramedics frequently come into contact with patients with sepsis and are well placed to provide early diagnosis and treatment.We aim to determine (...) the feasibility of undertaking a fully powered randomised controlled trial (RCT) to test the clinical and cost-effectiveness of paramedics obtaining blood cultures from and administering IV antibiotics to patients with sepsis, so we can make a decision about whether to proceed to a fully powered randomised controlled trial, which will answer questions regarding safety and effectiveness for patients and benefit to the National Health Service (NHS).This is an individually randomised, two-arm feasibility study

2018 Pilot and feasibility studies Controlled trial quality: uncertain

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