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Clindamycin Topical

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141. There?s Pus About, So Are Antibiotics In or Out? Adding antibiotics for abscess management

25% of patients will experience adverse effects, with gastrointestinal adverse effects occurring for an additional one in 11 on clindamycin and one in 50 on trimethoprim-sulfamethoxazole, compared to placebo. Evidence: • Two recent systematic reviews, including four and 14 randomized controlled trials (RCTs), 2,406 and 4,198 patients, respectively. 1,2 Results statistically significant unless mentioned. o Both relied heavily on two new high-quality RCTs (2,051 patients) of clindamycin (...) with antibiotics that cover MRSA, but not those without (example: cephalexin). 2 o Total adverse effects: 1 25% versus 22% (placebo), Number Needed to Harm (NNH)=38. ? Gastrointestinal adverse effects: 2 • Clindamycin: ~10% more than placebo, NNH=11. • Trimethoprim-sulfamethoxazole: 2% more than placebo, NNH=47. o Limitations: One systematic review only included studies of antibiotics that have activity against MRSA; 1 only two studies included patients with diabetes (2.4% and 11% of study populations

2019 Tools for Practice

142. Fecal Microbiota Transplantation for Recurrent Clostridium difficile Infection and Other Conditions in Children: A Joint Position Paper From the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for

, including neurologic, neuropsychiat- ric, metabolic, immune diseases, GI disorders, obesity, chronic PPI use, malignancy, and recent antibiotic use. Screening Laboratory Tests Recommended testing from the JSCR to the FDA (102) can be found in Table 2. Other authorities have made additional recommendations for donor testing. A useful review on the topic was published in 2017 (106). Universal Donors and Stool Banks The FDA and the 2013 JSCR have suggested that fecal donors should be known to the recipient

2019 North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition

143. Adult and Pediatric Antibiotic Prophylaxis during Vascular and IR Procedures: A Society of Interventional Radiology Practice Parameter Update Endorsed by the Cardiovascular and Interventional Radological Society of Europe and the Canadian Association for

recommendation with categories used by other guideline developers (2,3). This aligns with recommendations promoted by the Institute of Medicine in 2011 (4,5). METHODOLOGY SIR produces its Standards of Practice documents by using the following process. Topics of relevance and timeliness are conceptualized by the StandardsofPracticeCommitteemembers,ServiceLines,SIRmembers,or theExecutiveCouncil.Arecognizedexpertorgroupofexpertsisidenti?ed to serve as the principal author or writing group for the document. Addi (...) /sulbactam, and trimethoprim/sulfamethoxazole, can be given safely, but subsequent doses may need dose or timing adjustment (19,20). Ceftriaxone, clindamycin, and moxi?oxacin do not requiredose adjustment inrenaldysfunction(19).Vancomycinshouldalwaysbedosedaccordingto pharmacy protocol, and aminoglycosides (eg, gentamycin) should be avoided in patients with renal dysfunction (20). General Pediatric Antibiotic Dosing In adult patients, drug doses are standardized. However, in children, drugs

2019 Society of Interventional Radiology

145. Dental Management of Pediatric Patients Receiving Chemotherapy, Hematopoietic Cell Transplantation, and/or Radiation Therapy

Fluoride: Preventive measures include the use of fluoridated toothpaste, fluoride supplements if indicated, neutral fluoride gels/rinses, or applications of fluoride varnish for patients at risk for caries and/or xerostomia. 6,8 A brush-on technique is convenient and may increase the likelihood of patient com- pliance with topical fluoride therapy. 8 Lip care: Lanolin-based creams and ointments are more effective in moisturizing and protecting against damage than petrolatum-based products. 8 Trismus (...) ., microfibrillar col- lagen, topical thrombin) and additional medications as recommended by the hematologist/oncologist (e.g., aminocaproic acid, tranexamic acid) may help control bleeding. 1 • Other coagulation tests may be in order for individual patients. Dental procedures: • Ideally, all dental care should be completed before im- munosuppressive therapy is initiated. When that is not feasible, temporary restorations may be placed and non- acute dental treatment may be delayed until the patient’s

2018 American Academy of Pediatric Dentistry

146. Management of Diabetic Foot

(Second Edition) smaller number demonstrating efficacy against gram-negative bacteria (e.g. neomycin, silver sulphadiazine). Some antibiotics that are used systemically (e.g. gentamicin, metronidazole, clindamycin) have also been formulated for topical use. 47, level I In a Cochrane systematic review, topical antimicrobial dressing was more effective than non-antimicrobial dressing in wound healing of diabetic foot (RR=1.28, 95% CI 1.12 to 1.45). However, there was no significant difference in adverse (...) be considered in moderate pain. Strong opioids (e.g. morphine) should be offered to patients with moderate to severe pain. 44 In neuropathic pain, adjuvants are used at all steps of the analgesic ladder. 44 Examples of the adjuvants are antidepressant (e.g. amitriptyline or duloxetine) and anticonvulsant (e.g. gabapentin or pregabalin). 45 Refer to Appendix 8 on T reatment of Neuropathic Pain in Diabetic Foot. b. Topical antimicrobial Wound treatments aim to alleviate symptoms, promote healing and avoid

2018 Ministry of Health, Malaysia

147. Screening and Management of Bacterial Vaginosis in Pregnancy

is undertaken, it should be with metronidazole 500 mg orally twice daily for seven days or clindamycin 300 mg orally twice daily for seven days. Topical (vaginal) therapy is not recommended for this indication (I-B). 6. Testing should be repeated one month after treatment to ensure that cure was achieved (III-L). Key Words: , , , To access this article, please choose from the options below Log In Register Purchase access to this article Claim Access If you are a current subscriber with Society Membership (...) in formulating the guideline. Outcomes Outcomes evaluated include antibiotic treatment efficacy and cure rates, and the influence of the treatment of bacterial vaginosis on the rates of adverse pregnancy outcomes such as preterm labour and delivery and preterm premature rupture of membranes. Evidence Medline, EMBASE, CINAHL, and Cochrane databases were searched for articles, published in English before the end of June 2007 on the topic of bacterial vaginosis in pregnancy. Values The evidence obtained

2017 Society of Obstetricians and Gynaecologists of Canada

148. Antibiotic Prophylaxis in Obstetric Procedures

text on ScienceDirect. Abstract Objective To review the evidence and provide recommendations on antibiotic prophylaxis for obstetrical procedures. Outcomes Outcomes evaluated include need and effectiveness of antibiotics to prevent infections in obstetrical procedures. Evidence Published literature was retrieved through searches of Medline and The Cochrane Library on the topic of antibiotic prophylaxis in obstetrical procedures. Results were restricted to systematic reviews, randomized controlled (...) for Caesarean section should be a single dose of a first-generation cephalosporin. If the patient has a penicillin allergy, clindamycin or erythromycin can be used (I-A). 3. The timing of prophylactic antibiotics for Caesarean section should be 15 to 60 minutes prior to skin incision. No additional doses are recommended (I-A). 4. If an open abdominal procedure is lengthy (>3 hours) or estimated blood loss is greater than 1500 mL, an additional dose of the prophylactic antibiotic may be given 3 to 4 hours

2017 Society of Obstetricians and Gynaecologists of Canada

150. Perioperative Pathways: Enhanced Recovery After Surgery

a combination of clindamycin and gentamycin or a quinolone such as ciprofloxacin (23). Health care providers should consult their institutional antibiograms to confirm local susceptibility rates to the chosen coverage regimen. For lengthy procedures, additional intraoperative doses of the chosen antibiotic, given at intervals of two times the half-life of the drug (measured from the initiation of the preoperative dose, not from the onset of surgery), are recommended to maintain adequate levels throughout (...) , recommended scrub time can be as long as 5 minutes ( ). The solution should then be removed with a towel and the surgical site painted with a topical povidone-iodine solution, which should be allowed to dry for 2 minutes before draping (47). Vaginal cleansing with either 4% chlorhexidine gluconate or povidone-iodine should be performed before hysterectomy or vaginal surgery (44). Although currently only povidone-iodine preparations are U.S. Food and Drug Administration-approved for vaginal surgical-site

2018 American College of Obstetricians and Gynecologists

151. Surveillance of healthcare-associated infections and prevention indicators in European intensive care units: HAI-Net ICU protocol, version 2.2

two weeks, depending on the size of the ICU. The following priority topics and indicators were selected for the HAI-Net ICU protocol. Methods and data sources differ according to the indicator. ? Hand hygiene: alcohol hand rub consumption during the previous year in the ICU. The consumption of alcohol-based hand rubs in intensive care units is collected from the hospital pharmacy records for the year prior to the surveillance year. ? ICU staffing: registered nurse-to-patient ratio and nursing

2017 European Centre for Disease Prevention and Control - Technical Guidance

152. 2018 United Kingdom National Guideline for the Management of Pelvic Inflammatory Disease

and, if possible, use should be restricted to women who are known to be M. genitalium negative. Inpatient Regimens i.v. ceftriaxone 2g daily plus i.v. doxycycline 100mg twice daily (oral doxycycline may be used if tolerated) followed by oral doxycycline 100mg twice daily plus oral metronidazole 400mg twice daily for a total of 14 days Grade 1A 37,38 i.v. clindamycin 900mg 3 times daily plus i.v. gentamicin (2mg/kg loading dose) followed by 1.5mg/kg 3 times daily [a single daily dose of 7mg/kg may (...) be substituted]) followed by either oral clindamycin 450mg 4 times daily or oral doxycycline 100mg twice daily plus oral metronidazole 400mg twice daily to complete 14 days Grade 1A 37 Gentamicin levels should be monitored if this regimen is used. Intravenous therapy should be continued until 24 hours after clinical improvement and then switched to oral (Grade 2D). Intravenous doxycycline is not currently licensed in the UK but is available from IDIS world medicines (tel. 01932 824100). 14 Alternative

2018 British Association for Sexual Health and HIV

153. CRACKCast E177 – Acute Complications of Pregnancy

with a hydatidiform mole and usually resolves with evacuation of the mole. Patients may present with signs of thyroid storm, including altered mental status, severe tachycardia, and signs of high-output heart failure (eg, edema, dyspnea, orthopnea). Rosen’s in Perspective Topics to be covered: Ectopic pregnancy Bleeding in late pregnancy Hypertension in pregnancy AFE Rh immunization Abd pain in pregnancy N/V in pregnancy VTE in pregnancy Vaginal and UTIs Thyroid disease (shownotes) 1) List 6 causes of first (...) oral tocolytic therapy with beta adrenergic agonists 8) How are BV, vaginal yeast infections and trichomonas infections managed during pregnancy? BV: BV associated with morbidity – so treat! 7-day course of metronidazole or 7-day course of clindamycin. Intravaginal treatment is not recommended in pregnant patients. Vaginal yeast infections: There is no association of Candida colonization with adverse pregnancy outcomes, and treatment is for relief of symptoms only. Oral azoles are contraindicated

2018 CandiEM

154. Outpatient Management of Fever and Neutropenia in Adults Treated for Malignancy Full Text available with Trip Pro

and logistic considerations are outlined within the guideline. The panel continued to endorse consensus recommendations from the previous version of this guideline that patients with febrile neutropenia receive initial doses of empirical antibacterial therapy within 1 hour of triage and be monitored for ≥ 4 hours before discharge. An oral fluoroquinolone plus amoxicillin/clavulanate (or clindamycin, if penicillin allergic) is recommended as empirical outpatient therapy, unless fluoroquinolone prophylaxis (...) as clinical judgment, were recommended. , This update includes new evidence on risk stratification of patients who are seemingly stable and at lower risk for FN, a population that has been difficult to assess accurately in the past. Antimicrobial prophylaxis recommendations are not included in this guideline update; they will be updated in a forthcoming separate ASCO/IDSA guidance document. The decision to address these two topics in separate guidelines was made to make the recommendations clearer

2018 Infectious Diseases Society of America

155. CRACKCast E171 – Pediatric Cardiac Disorders

potentially save the lives of more young athletes who suddenly collapse secondary to hypertrophic cardiomyopathy, prolonged QT syndromes, and commotio cordis. Rosen’s in Perspective We hope you’re listening to this podcast while you’re well rested, caffeinated, or have time to listen to it at ½ speed. It’s a big one. There is more content in this episode then we can cover in the podcast, so there will be a few questions that are in the shownotes only. Today we’re hoping to cover these topics in less than (...) %), changing murmur (21%), dental caries (14%), and hepatosplenomegaly (14%). Less common signs are CHF (9%), splinter hemorrhages (5%), Roth’s spots (5%), and Osler’s nodes (4%). [12] Describe 2 potential prophylaxis regimens Single dose 30-60 minutes before procedure Children PO Amoxicillin 50mg/kg Cephalexin 50mg/kg (Pen-allergic) Clindamycin 20mg/kg (Pen-allergic Azithromycin 15mg/kg (Pen-allergic) Unable to take PO Cefazolin or Ceftriaxone 50mg/kg IM/IV Clindomycin 20mg/kg IM/IV See Table 170.7

2018 CandiEM

156. Acute Rhinosinusitis in Adults

strains. The preferred option is levofloxacin. Ancillary therapies (see Table 5) for acute rhinosinusitis have little supporting data. Some studies examining treatments for viral upper respiratory infections have shown: ? Efficacy in symptom control: decongestants (especially topical decongestants), topical anticholinergics and nasal steroids (high dose), [II A*] ? Possible efficacy: zinc gluconate lozenges, vitamin C, Echinacea extract, saline irrigation [conflicting or insufficient data (...) ) + $3 for generics on 30-day supply or less, Michigan Department of Community Health M.A.C. Manager, 12/18 Table 5. Adjuvant Therapy for Acute Rhinosinusitis Drug Dose Cost * Likely to be effective in treating symptoms Decongestants 1 Topical 2 Oxymetazoline 0.05% (Afrin®) Systemic Pseudoephedrine (Sudafed®) 2 sprays each nostril every 12 hours for max 3 d 60 mg every 6 hours or sustained release 120 mg every 12 hours gen $3 gen $10-23 Anticholinergics Topical Ipratropium 0.03% (Atrovent®) 2 sprays

2018 University of Michigan Health System

158. Solithromycin Triskel - community-acquired pneumonia, anthrax and tularaemia

are considered acceptable alternatives where macrolide resistance rates are low. A combination of a ß-lactam and a macrolide is recommended for moderate or severe CAP or in cases of failure to respond to the first line treatment. The guidelines do not recommend empiric treatment for atypical pathogens (L. pneumophila and M. pneumoniae) for all patients with CAP, although this position remains a topic of intense debate. The prevalence of penicillin-resistant S. pneumoniae (PRSP), macrolide-resistant S (...) , clindamycin, vancomycin or rifampicin are suggested as supplementary antibiotics for inhalational anthrax Currently in the EU, ciprofloxacin, levofloxacin and penicillin VK are approved in some countries for treatment of anthrax. Assessment Report EMA/CHMP/226929/2017 Page 7/93 2.2 About the product Solithromycin is a fluoroketolide. In vitro, it shows activity against macrolide-resistant S. pneumoniae and M. pneumoniae and against some macrolide-resistant S. aureus. Replacement of the cladinose sugar

2017 European Medicines Agency - EPARs

159. Antibiotic prescribing - especially broad spectrum antibiotics

Antibiotic prescribing - especially broad spectrum antibiotics Antimicrobial stewardship: prescribing Antimicrobial stewardship: prescribing antibiotics antibiotics Key therapeutic topic Published: 15 January 2015 nice.org.uk/guidance/ktt9 pathways K Ke ey points y points Antimicrobial resistance poses a significant global threat to public health, especially because antimicrobials underpin routine medical practice. Addressing antimicrobial resistance through improving stewardship is a national (...) with the problem from 2008 recommends that trusts should develop restrictive antibiotic guidelines that use narrow-spectrum agents alone or in combination as appropriate. The report suggests that these guidelines should avoid recommending clindamycin and second- and third-generation cephalosporins (especially in older people) and should recommend minimising the use of quinolones, carbapenems (for example, imipenem and meropenem) and prolonged courses of aminopenicillins (for example, ampicillin and amoxicillin

2015 National Institute for Health and Clinical Excellence - Advice

160. Clostridium difficile infection: risk with broad-spectrum antibiotics

) or the MHRA or NICE websites for up-to-date information. Summary Use of broad-spectrum antibiotics is associated with an increased incidence of Clostridium difficile infection. This briefing reviews the evidence assessing the risk of C. difficile infection associated with individual broad-spectrum antibiotics based on the highest quality published evidence. Both antibiotic prescribing practice and the epidemiology of C. difficile infections are changing. C. difficile has been reported with clindamycin (...) should be interpreted with caution and should not be considered to indicate conclusively which antibiotics have the highest risks of C. difficile infection. Three meta-analyses in people with hospital-associated and community-associated C. difficile infection confirmed that the antibiotics most strongly associated with the infection were clindamycin, cephalosporins and quinolones. However, the interpretation of data on the risk of C. difficile with different antibiotics is extremely difficult

2015 National Institute for Health and Clinical Excellence - Advice

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