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21. Partial Oral versus Intravenous Antibiotic Treatment of Endocarditis. Full Text available with Trip Pro

Partial Oral versus Intravenous Antibiotic Treatment of Endocarditis. Patients with infective endocarditis on the left side of the heart are typically treated with intravenous antibiotic agents for up to 6 weeks. Whether a shift from intravenous to oral antibiotics once the patient is in stable condition would result in efficacy and safety similar to those with continued intravenous treatment is unknown.In a randomized, noninferiority, multicenter trial, we assigned 400 adults in stable (...) condition who had endocarditis on the left side of the heart caused by streptococcus, Enterococcus faecalis, Staphylococcus aureus, or coagulase-negative staphylococci and who were being treated with intravenous antibiotics to continue intravenous treatment (199 patients) or to switch to oral antibiotic treatment (201 patients). In all patients, antibiotic treatment was administered intravenously for at least 10 days. If feasible, patients in the orally treated group were discharged to outpatient

2018 NEJM Controlled trial quality: predicted high

22. Preventive Antibiotics in Stroke Study (PASS): A cost-effectiveness study (Abstract)

Preventive Antibiotics in Stroke Study (PASS): A cost-effectiveness study To evaluate the cost-effectiveness of preventive ceftriaxone vs standard stroke unit care without preventive antimicrobial therapy in acute stroke patients.In this multicenter, randomized, open-label trial with masked endpoint assessment, 2,550 patients with acute stroke were included between 2010 and 2014. Economic evaluation was performed from a societal perspective with a time horizon of 3 months. Volumes and costs

2018 EvidenceUpdates

23. Procalcitonin-Guided Use of Antibiotics for Lower Respiratory Tract Infection. Full Text available with Trip Pro

Procalcitonin-Guided Use of Antibiotics for Lower Respiratory Tract Infection. The effect of procalcitonin-guided use of antibiotics on treatment for suspected lower respiratory tract infection is unclear.In 14 U.S. hospitals with high adherence to quality measures for the treatment of pneumonia, we provided guidance for clinicians about national clinical practice recommendations for the treatment of lower respiratory tract infections and the interpretation of procalcitonin assays. We (...) then randomly assigned patients who presented to the emergency department with a suspected lower respiratory tract infection and for whom the treating physician was uncertain whether antibiotic therapy was indicated to one of two groups: the procalcitonin group, in which the treating clinicians were provided with real-time initial (and serial, if the patient was hospitalized) procalcitonin assay results and an antibiotic use guideline with graded recommendations based on four tiers of procalcitonin levels

2018 NEJM Controlled trial quality: predicted high

24. Five-Year Follow-up of Antibiotic Therapy for Uncomplicated Acute Appendicitis in the APPAC Randomized Clinical Trial. Full Text available with Trip Pro

Five-Year Follow-up of Antibiotic Therapy for Uncomplicated Acute Appendicitis in the APPAC Randomized Clinical Trial. Short-term results support antibiotics as an alternative to surgery for treating uncomplicated acute appendicitis, but long-term outcomes are not known.To determine the late recurrence rate of appendicitis after antibiotic therapy for the treatment of uncomplicated acute appendicitis.Five-year observational follow-up of patients in the Appendicitis Acuta (APPAC) multicenter (...) randomized clinical trial comparing appendectomy with antibiotic therapy, in which 530 patients aged 18 to 60 years with computed tomography-confirmed uncomplicated acute appendicitis were randomized to undergo an appendectomy (n = 273) or receive antibiotic therapy (n = 257). The initial trial was conducted from November 2009 to June 2012 in Finland; last follow-up was September 6, 2017. This current analysis focused on assessing the 5-year outcomes for the group of patients treated with antibiotics

2018 JAMA Controlled trial quality: predicted high

25. Decontamination Strategies and Bloodstream Infections With Antibiotic-Resistant Microorganisms in Ventilated Patients: A Randomized Clinical Trial. Full Text available with Trip Pro

Decontamination Strategies and Bloodstream Infections With Antibiotic-Resistant Microorganisms in Ventilated Patients: A Randomized Clinical Trial. The effects of chlorhexidine (CHX) mouthwash, selective oropharyngeal decontamination (SOD), and selective digestive tract decontamination (SDD) on patient outcomes in ICUs with moderate to high levels of antibiotic resistance are unknown.To determine associations between CHX 2%, SOD, and SDD and the occurrence of ICU-acquired bloodstream infections (...) with multidrug-resistant gram-negative bacteria (MDRGNB) and 28-day mortality in ICUs with moderate to high levels of antibiotic resistance.Randomized trial conducted from December 1, 2013, to May 31, 2017, in 13 European ICUs where at least 5% of bloodstream infections are caused by extended-spectrum β-lactamase-producing Enterobacteriaceae. Patients with anticipated mechanical ventilation of more than 24 hours were eligible. The final date of follow-up was September 20, 2017.Standard care was daily CHX 2

2018 JAMA Controlled trial quality: predicted high

26. The effect of an antibiotic checklist on length of hospital stay and appropriate antibiotic use in adult patients treated with intravenous antibiotics: a stepped wedge cluster randomised trial. Full Text available with Trip Pro

The effect of an antibiotic checklist on length of hospital stay and appropriate antibiotic use in adult patients treated with intravenous antibiotics: a stepped wedge cluster randomised trial. Quality indicators (QIs) have been developed to define appropriate antibiotic use in hospitalized patients. We evaluated whether a checklist based on these QIs affects appropriate antibiotic use and length of hospital stay.An antibiotic checklist for patients treated with intravenous antibiotics (...) associated with shorter LOS. Discordance existed between checklist-answers and actual performance.Use of an antibiotic checklist resulted in a significant increase in appropriateness of antibiotic use, but not in a reduction of LOS. Low overall checklist completion rates and discordance between checklist-answers and actual provided care might have attenuated the impact of the checklist.Copyright © 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All

2017 Clinical Microbiology and Infection Controlled trial quality: uncertain

27. Antimicrobial efficacy of clindamycin and triple antibiotic paste as root canal medicaments on tubular infection: An in vitro study. Full Text available with Trip Pro

Antimicrobial efficacy of clindamycin and triple antibiotic paste as root canal medicaments on tubular infection: An in vitro study. This study compared the antibacterial effect of 2% clindamycin and 2% and 100% concentration of triple antibiotic paste (TAP) on an Enterococcus faecalis biofilm. Dentinal tubules of 100 root specimens were infected and randomly assigned to five groups. A total of 1000 mg mL-1 of TAP, 20 mg mL-1 of TAP and clindamycin, calcium hydroxide or methylcellulose (...) (control) were placed in the root canal for 1 week. After treatment, dentine shavings were collected from 200 and 400 μm dentine depth and the number of colony-forming units (CFU) per mg was determined. Reduction in viable bacteria in first three groups was significantly better than calcium hydroxide and control groups. However, the antimicrobial effectiveness among these three groups was not significantly different from each other. There was no significant difference between data at 200 and 400 μm

2018 Australian endodontic journal : the journal of the Australian Society of Endodontology Inc Controlled trial quality: uncertain

28. Treatment of periodontitis in smokers with multiple sessions of antimicrobial photodynamic therapy or systemic antibiotics: A randomized clinical trial. Full Text available with Trip Pro

Treatment of periodontitis in smokers with multiple sessions of antimicrobial photodynamic therapy or systemic antibiotics: A randomized clinical trial. The aim of this study was to evaluate the effects of non-surgical periodontal therapies on smokers with chronic periodontitis, involving multiple adjunctive applications of antimicrobial photodynamic therapy (aPDT), and systemic metronidazole (MTZ) with amoxicillin (AMX).All participants were treated with scaling and root planing (SRP

2018 Photodiagnosis and Photodynamic Therapy Controlled trial quality: uncertain

29. Clinical and histological evaluation of the efficacy of antimicrobial photodynamic therapy used in addition to antibiotic therapy in pericoronitis treatment. (Abstract)

Clinical and histological evaluation of the efficacy of antimicrobial photodynamic therapy used in addition to antibiotic therapy in pericoronitis treatment. Although antimicrobial efficacy of photodynamic therapy has been studied several times, there is no study investigating its efficacy on pericoronitis. This study aimed to determine whether antimicrobial photodynamic therapy combined with antibiotic therapy is clinically and histologically superior to antibiotic therapy alone (...) in pericoronitis treatment.Patients (n = 40) with pericoronitis were divided into two groups (20 patients for each) to receive either antibiotic + indocyanine green + 810 nm wavelength diode laser (antimicrobial photodynamic therapy group) or antibiotic alone. Initial biopsy samples were obtained from the affected tissue of the patients at their first presentation to the clinic before any intervention. The second biopsy samples were obtained on the 3rd day of treatment in both groups from the tissue part

2018 Photodiagnosis and Photodynamic Therapy Controlled trial quality: uncertain

30. Sustainable reduction of antibiotic-induced antimicrobial resistance (ARena) in German ambulatory care: study protocol of a cluster randomised trial. Full Text available with Trip Pro

Sustainable reduction of antibiotic-induced antimicrobial resistance (ARena) in German ambulatory care: study protocol of a cluster randomised trial. Despite many initiatives to enhance the rational use of antibiotics, there remains substantial room for improvement. The overall aim of this study is to optimise the appropriate use of antibiotics in German ambulatory care in patients with acute non-complicated infections (respiratory tract infections, such as bronchitis, sinusitis, tonsillitis (...) set as well as a computerised decision support system and quality circles in local multidisciplinary groups. The study aims to recruit 193 practices which will provide data on 23,934 patients each year (47,867 patients in total). The outcome evaluation is based on claims data and refers to established indicators of the European Surveillance of Antimicrobial Consumption Network (ESAC-Net). Primary and secondary outcomes relate to prescribing of antibiotics, which will be analysed in multivariate

2018 Implementation Science Controlled trial quality: uncertain

31. Do we treat our patients or rather periodontal microbes with adjunctive antibiotics in periodontal therapy? A 16S rDNA microbial community analysis. Full Text available with Trip Pro

Do we treat our patients or rather periodontal microbes with adjunctive antibiotics in periodontal therapy? A 16S rDNA microbial community analysis. Empiric antibiotics are often used in combination with mechanical debridement to treat patients suffering from periodontitis and to eliminate disease-associated pathogens. Until now, only a few next generation sequencing 16S rDNA amplicon based publications with rather small sample sizes studied the effect of those interventions on the subgingival (...) richness, and increased dissimilarity in the antibiotic, but not in the placebo group after therapy. The PCoA revealed a clear compositional separation of microbiomes after therapy in the antibiotic group, which could not be seen in the group receiving mechanical therapy only. This difference was even more pronounced on aRSV level. Here, adjunctive antibiotics were able to induce a microbiome shift by statistically noticeably reducing aRSVs belonging to genera containing disease-associated species, e.g

2018 PLoS ONE Controlled trial quality: uncertain

32. Cost-effectiveness of longer-term versus shorter-term provision of antibiotics in patients with persistent symptoms attributed to Lyme disease. Full Text available with Trip Pro

Cost-effectiveness of longer-term versus shorter-term provision of antibiotics in patients with persistent symptoms attributed to Lyme disease. The treatment of persistent symptoms attributed to Lyme disease remains controversial. Recently, the PLEASE study did not demonstrate any additional clinical benefit of longer-term versus shorter-term antibiotic treatment. However, the economic impact of the antibiotic strategies has not been investigated.This prospective economic evaluation, adhering (...) a societal perspective, was performed alongside the PLEASE study, a multicenter, placebo-controlled, double-blind 1:1:1 randomized clinical trial in which all patients received open-label intravenous ceftriaxone for two weeks before the 12-week randomized blinded oral antibiotic regimen (doxycycline, clarithromycin plus hydroxychloroquine, or placebo). Between 2010 and 2013, patients (n = 271) with borreliosis-attributed persistent symptoms were enrolled and followed for one year. Main outcomes were

2018 PLoS ONE Controlled trial quality: predicted high

33. Enhanced preservation of the human intestinal microbiota by ridinilazole, a novel Clostridium difficile-targeting antibacterial, compared to vancomycin. Full Text available with Trip Pro

Enhanced preservation of the human intestinal microbiota by ridinilazole, a novel Clostridium difficile-targeting antibacterial, compared to vancomycin. Ridinilazole, a novel targeted antibacterial being developed for the treatment of C. difficile infection (CDI) and prevention of recurrence, was shown in a recent Phase 2 study to be superior to vancomycin with regard to the primary efficacy measure, sustained clinical response (SCR), with the superiority being driven primarily by marked (...) -of-study [EOS; Day 40], and at CDI recurrence). qPCR analyses showed profound losses of Bacteroides, C. coccoides, C. leptum, and Prevotella groups at EOT with vancomycin treatment, while ridinilazole-treated participants had a modest decrease in C. leptum group levels at EOT, with levels recovering by Day 25. Vancomycin-treated participants had a significant increase in the Enterobacteriaceae group, with this increase persisting beyond EOT. At EOT, alpha diversity decreased with both antibiotics

2018 PLoS ONE Controlled trial quality: uncertain

34. Clinical score and rapid antigen detection test to guide antibiotic use for sore throats: randomised controlled trial of PRISM (primary care streptococcal management) Full Text available with Trip Pro

Clinical score and rapid antigen detection test to guide antibiotic use for sore throats: randomised controlled trial of PRISM (primary care streptococcal management) 29506977 2018 10 23 1756-1833 360 2018 03 05 BMJ (Clinical research ed.) BMJ Clinical score and rapid antigen detection test to guide antibiotic use for sore throats: randomised controlled trial of PRISM (primary care streptococcal management). k1068 10.1136/bmj.k1068 eng Journal Article Published Erratum 2018 03 05 England BMJ

2018 The BMJ Controlled trial quality: uncertain

35. Antibiotics for amniotic-fluid colonization by Ureaplasma and/or Mycoplasma spp. to prevent preterm birth: A randomized trial. Full Text available with Trip Pro

Antibiotics for amniotic-fluid colonization by Ureaplasma and/or Mycoplasma spp. to prevent preterm birth: A randomized trial. To assess whether antibiotics used for treatment in asymptomatic second-trimester women positive for Mycoplasma or Ureaplasma spp. detected by amniotic-fluid PCR prevents preterm delivery.A randomized, double-blind, placebo-controlled trial.10 maternal fetal medicine centers in France.Women with a singleton pregnancy who underwent amniocentesis between 16 and 20 weeks

2018 PLoS ONE Controlled trial quality: predicted high

36. Use of PNA FISH for blood cultures growing Gram-positive cocci in chains without a concomitant antibiotic stewardship intervention does not improve time to appropriate antibiotic therapy. (Abstract)

Use of PNA FISH for blood cultures growing Gram-positive cocci in chains without a concomitant antibiotic stewardship intervention does not improve time to appropriate antibiotic therapy. Peptide nucleic acid fluorescence in situ hybridization (PNA FISH) is a rapid diagnostic assay that can identify certain organisms growing in blood cultures 30-90 min from the time of positive Gram-stain. Existing studies have demonstrated a clinical utility with this assay when antibiotic stewardship programs (...) assist clinicians with interpreting the results. However, the benefit of these rapid assays in the absence of concomitant antibiotic stewardship involvement is unclear. In this randomized study of 220 patients with enterococcal or streptococcal bacteremia, we found that PNA FISH, in the absence of concomitant input from an antibiotic stewardship program, had no impact on time to effective or optimal therapy, length of hospital stay, or in-hospital mortality. Our results suggest that in the absence

2017 Diagnostic microbiology and infectious disease Controlled trial quality: uncertain

37. Evaluation of Residual Antibacterial Effect of Human Radicular Dentin Treated with Triple and Double Antibiotic Pastes. (Abstract)

Evaluation of Residual Antibacterial Effect of Human Radicular Dentin Treated with Triple and Double Antibiotic Pastes. The aim of this study was to investigate the residual antibacterial effect of human radicular dentin treated with various concentrations of triple antibiotic paste and double antibiotic paste (DAP).Sterilized dentin specimens were randomly assigned to 6 treatment groups and a no-treatment control group (n = 45 per group). For treatment groups, specimens were treated (...) using an automated counting machine.Dentin specimens treated with 1000 mg/mL TAP or DAP had a significant residual antibacterial effect up to 14 days and 30 days, respectively. No significant difference was observed between 1000 and 1 mg/mL TAP and DAP at all time points. Dentin treated with all concentrations of DAP has a significantly longer residual antibacterial effect compared with dentin treated with TAP at the same concentrations.Radicular dentin treated with TAP and DAP showed a significant

2017 Journal of Endodontics Controlled trial quality: uncertain

38. Gut Microbial Diversity in Antibiotic-Naive Children After Systemic Antibiotic Exposure: A Randomized Controlled Trial. Full Text available with Trip Pro

Gut Microbial Diversity in Antibiotic-Naive Children After Systemic Antibiotic Exposure: A Randomized Controlled Trial. Antibiotic exposure can alter the gut microbiome. We evaluate the effects of azithromycin on the gut microbiome diversity of children from an antibiotic-naive community in Niger.A population-based sample of 80 children aged 1-60 months in the Dosso region of Niger was randomized to receive a single dose of either oral azithromycin or placebo. Fecal samples were collected (...) -2.51; P = .26).Oral administration of azithromycin definitively decreases the diversity of the gut microbiome of children in an antibiotic-naive community.NCT02048007.Published by Oxford University Press for the Infectious Diseases Society of America 2017. This work is written by (a) US Government employee(s) and is in the public domain in the US.

2017 Clinical Infectious Diseases Controlled trial quality: predicted high

39. A Randomized Control Trial of Preoperative Oral Antibiotics as Adjunct Therapy to Systemic Antibiotics for Preventing Surgical Site Infection in Clean Contaminated, Contaminated, and Dirty Type of Colorectal Surgeries. (Abstract)

A Randomized Control Trial of Preoperative Oral Antibiotics as Adjunct Therapy to Systemic Antibiotics for Preventing Surgical Site Infection in Clean Contaminated, Contaminated, and Dirty Type of Colorectal Surgeries. Preoperative bowel preparation with or without oral antibiotics is controversial in terms of postoperative surgical site infections.This study aimed to evaluate the efficacy of oral antibiotics as adjunct therapy to systemic antibiotics with mechanical bowel preparation (...) preparation or mechanical bowel preparation with oral antibiotics.The primary outcome was the rate of surgical site infections. The secondary outcomes were extra-abdominal complications, duration of postoperative ileus, and readmission rate.Ninety-five patients were allocated to each group. Eight and 26 surgical site infections (8.42% vs 27.3 %, p = 0.004) occurred in the mechanical bowel preparation with oral antibiotics and mechanical bowel preparation groups. Thirteen extra-abdominal complications were

2017 Diseases of the Colon & Rectum Controlled trial quality: predicted high

40. Design and rationale of the Procalcitonin Antibiotic Consensus Trial (ProACT), a multicenter randomized trial of procalcitonin antibiotic guidance in lower respiratory tract infection. Full Text available with Trip Pro

Design and rationale of the Procalcitonin Antibiotic Consensus Trial (ProACT), a multicenter randomized trial of procalcitonin antibiotic guidance in lower respiratory tract infection. Overuse of antibiotics is a major public health problem, contributing to growing antibiotic resistance. Procalcitonin has been reported to be commonly elevated in bacterial, but not viral infection. Multiple European trials found procalcitonin-guided care reduced antibiotic use in lower respiratory tract (...) infection, with no apparent harm. However, applicability to US practice is limited due to trial design features impractical in the US, between-country differences, and residual safety concerns.The Procalcitonin Antibiotic Consensus Trial (ProACT) is a multicenter randomized trial to determine the impact of a procalcitonin antibiotic prescribing guideline, implemented with basic reproducible strategies, in US patients with lower respiratory tract infection.We describe the trial methods using

2017 BMC Emergency Medicine Controlled trial quality: uncertain

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