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Clindamycin Topical

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161. Xpert GBS test for the intrapartum detection of group B streptococcus

). For women in these groups, the RCOG (2012) guidelines recommend that 3 g intravenous benzylpenicillin should be given as soon as possible after the onset of labour and then 1.5 g given 4-hourly until delivery. Women with an allergy to benzylpenicillin should have 900 mg of clindamycin intravenously every 8 hours. NICE is not aware of other CE marked devices that have a similar function to the Xpert GBS test for the rapid detection of GBS in women during labour. Costs and use of the technology The Xpert (...) External Assessment Centre. The interim process & methods integrated process statement sets out the process NICE uses to select topics, and how the briefings are developed, quality assured and approved for publication. Project team Project team Newcastle and York External Assessment Centre Medical T echnologies Evaluation Programme, NICE Xpert GBS test for the intrapartum detection of group B streptococcus (MIB28) © NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk

2015 National Institute for Health and Clinical Excellence - Advice

162. Adalimumab for treating moderate to severe hidradenitis suppurativa

been diagnosed with moderate to severe hidradenitis suppurativa at least 1 year earlier and who were intolerant to, or whose disease had not responded to, oral antibiotics. Moderate to severe disease was defined as people with Hurley stage II or III hidradenitis suppurativa in at least 1 affected anatomic region, and a total abscess and inflammatory nodule (AN) count greater than 3. Neither of the trials recruited people from the UK. Treatment with oral or topical antibiotics during the trial (...) that there is no standard of care and no NICE guidance; there were no medical treatments specifically licensed for hidradenitis suppurativa until adalimumab received its marketing authorisation. The committee noted the results of a survey of the UK Dermatology Trials Network and British Association of Dermatologists, presented in the company submission, which showed that the most commonly used treatments in the UK – after topical antibiotics – are oral antibiotics; first tetracycline, and then a combination

2016 National Institute for Health and Clinical Excellence - Technology Appraisals

163. BTS Clinical Statement on Pulmonary Arteriovenous Malformations

in the absence of antibiotics 94 but prevented or resolved earlier with prior antibiotic administration. 94 Based on earlier endocarditis guidance, oral administration is convention- ally 1–2 hours before a procedure, with a further dose post-pro- cedure. Coamoxiclav is the preferred agent 92 94 with clindamycin or metronidazole suggested for penicillin-allergic patients. Anti- biotics are usually administered orally, but there may be particu- larly high-risk patients who have had prior abscesses for whom (...) , oxygenation and right-to-left shunts by 100% oxygen or 99m technetium perfusion scans were insufficiently sensitive to rule out clinically significant PAVMs. 8 119 120 More recent cerebral abscess data have further emphasised the importance of smaller PAVMs, with cerebral abscesses commonly occurring table 1 Summary of Good Practice Points topic subtopic summary 1. Embolisation All Refer all if technically feasible. 2. Medical management (DIPPSSOH) Dental Antibiotic prophylaxis for all (also for surgery

2017 British Thoracic Society

166. CRACKCast E098 – Sexually Transmitted Infections

% KOH solution to wet mount slide (whiff test). Metronidazole 500 mg PO BID x 7 days. Metronidazole gel 0.75% 5 g intravaginally once daily x 5 days. Clindamycin cream 2% 5 g intravaginally qhs x 7 days. Vulvovaginal candidiasis Common nonspecific findings of pruritus, abnormal discharge, dyspareunia, and external dysuria. Vulvar erythema and edema with satellite lesions, erythema of the vaginal mucosa, and a thick curdy whitish vaginal discharge. Fluconazole 150 mg PO single dose. Topical OTC (...) as outpatient – parenteral if systemic complications. Daily antiviral therapy will decrease the frequency while being taken but does not affect frequency or severity once discontinued. Topical antiviral therapy not recommended. Example regimens: Primary : Acyclovir 400 mg PO TID x 7-10 days OR Valacyclovir 1000 mg PO BID x 7-10 days Secondary : Acyclovir 400 mg PO TID x 5 days OR Valacyclovir 1000 mg PO daily daily x 5 days Question 5) List 3 complications of herpes infection Meningoencephalitis Hepatitis

2017 CandiEM

167. CRACKCast E126 – Diabetes Mellitus and Disorders of Glucose Homeostasis

complications is essential in Emergency Medicine, as we often encounter patients afflicted with diabetes and related disorders of glucose homeostasis on shift. Shownotes – Also check out EMCases Rapid Review video on DKA and Rosen’s In Perspective : This is an important topic – the complications of diabetes lead to immense morbidity and mortality. Our body (specifically the brain) needs a tight control on serum glucose for optimal functioning – this podcast is all about what happens when the balance is off (...) outlining the antimicrobial therapies for serious infections in diabetics. A summarized table is provided below. Infectious Condition Antimicrobial Therapy Diabetic Foot Infection Mild: Consider TMP-SMX, 800/160 BID or Clindamycin 300 mg q6h Moderate to Severe: Clindamycin 600 mg IV q6h +/- Piptazo 3.375 g IV q6h and Vancomycin 15 mg/kg IV q12h Malignant Otitis Externa Oral: Ciprofloxacin 500 mg PO BID for 10-14 days IV: Ceftazidime 2 g IV q8h +/- Gentamicin 2 mg/kg IV q8h Mucormycosis Amphoteracin B 1

2017 CandiEM

168. CRACKCast E137 – Skin Infections

that extends through the epidermis into the dermis. It is manifested as ulcers with a punched-out appearance, with raised reddened margins covered with thick crust. It has a predilection for the lower extremities. Unlike impetigo, ecthyma can result in cutaneous scarring. Treatment: Mild-moderate non-bullous impetigo = topical mupirocin TID for 5 days Severe impetigo, bullous impetigo, ulcerative impetigo = Staph and MRSA coverage: Clindamycin AND Septra Cephalexin AND Septra [2] What is the eagle effect (...) ). Also: Penicillins work on the cell wall, but if bacteria are not in the growth phase, its ineffective. Clindamycin works on the ribosomes, so gets around this issue. [3] What is the difference b/n a furuncle and carbuncle? Folliculitis, furuncles, and carbuncles are purulent infections originating in the hair follicle. They are more likely to occur after damage to the hair follicle, such as from shaving. Folliculitis usually resolves on its own but can be treated with warm compresses or topical

2017 CandiEM

169. CRACKCast E120 – Dermatologic presentations

soft tissue infections, drug eruptions, or immune disorders. Patients with Stevens-Johnson syndrome (<10% TBSA) and toxic epidermal necrolysis require inpatient treatment, preferably in a burn unit. Cutaneous signs of systemic disease may include pruritus, urticaria, erythema multiforme, erythema nodosum, pyoderma gangrenosum, and others. Physicians should be familiar with one or two topical steroid preparations of low, medium, and high potency and their appropriate therapeutic use. Hydrocortisone (...) dermatophytic infection of the skin, hair, and/or nails, usually by the Trichophyton organism. Infections of the body, groin, and extremities usually respond to topical antifungal agents. A number of effective topical antifungal agents are available, including clotrimazole, haloprogin, miconazole, tolnaftate, terbinafine, naftifine, and others. Two or three daily applications of the cream form of any of these preparations result in healing of most superficial lesions in 1 to 3 weeks. Tinea Capitis Tinea

2017 CandiEM

171. Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children Full Text available with Trip Pro

and the C. difficile strains present. Restriction of fluoroquinolones, clindamycin, and cephalosporins (except for surgical antibiotic prophylaxis) should be considered (strong recommendation, moderate quality of evidence) . XXVI. What is the role of proton pump inhibitor restriction in controlling CDI rates? Although there is an epidemiologic association between proton pump inhibitor (PPI) use and CDI, and unnecessary PPIs should always be discontinued, there is insufficient evidence (...) (BOD). The guideline was endorsed by ASHP, SIDP, and PIDS. Guidelines and Conflicts of Interest All members of the expert panel complied with the IDSA policy on conflicts of interest, which requires disclosure of any financial, intellectual, or other interest that might be construed as constituting an actual, potential, or apparent conflict. To provide thorough transparency, IDSA requires full disclosure of all relationships, regardless of relevancy to the guideline topic [14]. Evaluation

2017 Infectious Diseases Society of America

173. Antibacterial-coated sutures versus non-antibacterial-coated sutures for the prevention of abdominal, superficial and deep, surgical site infection (SSI)

undergoing assessment, and thus has a conflict of interest according to the EUnetHTA guidelines for handling conflict of interest. Professor Kriwanek has attended symposia related to and gave lectures on the topic of antibacterial-coated sutures which were sponsored by the company Johnson & Johnson. This sponsoring included the refunding of accommodation, travel costs and congress fees. He has no other conflicts of interest related to the topic of antibacterial-coated sutures to declare. According

2017 EUnetHTA

174. CRACKCast E058 – Ankle and Foot

Malleolar Fracture Bi mall eolar fractures: *unstable Caused by an oblique shearing force May still be non-operative if stable. May need a CT scan to figure the subtle #’s Tri malleolar fractures: Medial, lateral AND posterior malleoli All need ORIF Open fractures: Irrigation, reduction ABx, tetanus Ancef, Gentamycin Add Clindamycin or Penicillin G for soil contamination (for Clostridium) Pilon fractures Distal tibial metaphysis (falls) Look for calcaneus, tibial plateau, femoral neck, acetabulum (...) ://orthoinfo.aaos.org/topic.cfm?topic=A00632 Tillaux fractures are Salter-Harris III fractures through the anterolateral aspect of the distal tibial epiphysis, with variable amounts of displacement Pathophysiology: occurs because the epiphyseal plate closes in a medial→lateral fashion Occurs in an abduction-external rotation mechanism, requires an open epiphysis. Kids usually 12-15 yrs old. May require ORIF depending on degree of displacement Wisecracks 1. Discuss soft tissue injuries of the ankle Soft tissue

2017 CandiEM

175. CRACKCast E071 – Ophthalmology Part B

and oxidizing material needs removal Need eye shielding Need IV ceftazidime Need topical erythromycin 3) List 4 options for treatment of corneal abrasions Mechanical Corneal Abrasions FB sensation, photophobia, decreased VA Pain relief with topical anesthetics diagnose the problem as corneal injury Watch for a positive Seidel’s sign – which suggests a corneal perforation Treatment Full lid eversion and examination! Contact lenses shouldn’t be worn until the abrasion is healed (3-5 days) Eye patches aren’t (...) needed! Cycloplegic prn g. Tropicamide Topical antibiotics – probably only needed for people who wear contact lenses Pseudomonal coverage if contact lens wearer (tobramycin 0.5% 1-2 drops q 4hrs) Topical analgesics: Ketorolac 0.5% QID Diclofenac 0.1% QID Tetanus immunization only needed for any “tetanus-prone” injury with dirt and organic matter NO cases of tetanus have been documented from simple corneal abrasions Symptoms should resolve by 24-72 hrs Corneal Foreign Bodies High risk features

2017 CandiEM

176. CRACKCast E070 – Oral Medicine

paralysis If presence of trismus, may need surgical airway as not always responsive to paralysis (internal pterygoid or masseter muscle spasm) Broad antibiotics to cover hemolytic strep, mixed strep-staph and bacteroides species. Usually recommended High-dose antibiotic therapy, such as 24 million units penicillin daily Q 4hrs IV plus metronidazole 1 g IV load, with 500 mg IV q6h, Clindamycin 900 mg q6h also is effective but as always, if very ill consider going broader (eg Mero + Vanco + Clinda) CT (...) Ulcerative Gingivitis ANUG (also known as trench mouth) is a bacterial invasion of non-necrotic tissue! Think cellulitis of the gingiva, except with a gray pseudomembranous layer forming in the mouth (usually ant incisor or molar region) Mainstays of treatment are: Analgesia In order to start brushing and eating again, need to tx pain. Systemic Tylenol / NSAIDS combined with topical viscous lidocaine Antibiotics Penicillin or tetracycline (avoid in children with primary teeth due to staining) Improved

2017 CandiEM

177. CRACKCast E071 – Ophthalmology Part A

need topical anesthetics Irrigate until pH is NORMAL Remove particulate matter from the fornices After irrigation Cycloplegic 5% erythromycin ointment QID Pain management Check IOP Severity of injury judged by corneal cloudiness Long term: scarring, symblepharon, glaucoma, cataracts Irritants, solvents, detergent, super glue, mace exposures are treated just like chemical burns Superglue: only need referral if eyelids are inverted and lashes scratching the eyeball 2) What is the treatment of UV (...) keratitis? Radiation burns Ultraviolet keratitis (tanning booths, sunlamps, high altitude, welder’s arc) Latent period of 6-10 hrs then: Foreign body sensation, tearing, intense pain photophobia, blepharospasm Signs Decreased VA, conjunctival injection Treatment Cycloplegic Topical broad spectrum abx (weak evidence for this) PO analgesics Symptoms should resolve in 24 hrs 3) What is ophthalmia neonatorum? In which time-frame are each bacteria expected to be causative? What is the treatment? Ophthalmia

2017 CandiEM

178. Light therapies for acne. Full Text available with Trip Pro

Light therapies for acne. Acne vulgaris is a very common skin problem that presents with blackheads, whiteheads, and inflamed spots. It frequently results in physical scarring and may cause psychological distress. The use of oral and topical treatments can be limited in some people due to ineffectiveness, inconvenience, poor tolerability or side-effects. Some studies have suggested promising results for light therapies.To explore the effects of light treatment of different wavelengths (...) greatly in wavelength, dose, active substances used in photodynamic therapy (PDT), and comparator interventions (most commonly no treatment, placebo, another light intervention, or various topical treatments). Numbers of light sessions varied from one to 112 (most commonly two to four). Frequency of application varied from twice daily to once monthly.Selection and performance bias were unclear in the majority of studies. Detection bias was unclear for participant-assessed outcomes and low

2016 Cochrane

179. Management of acne

contraceptives¶ Systemic antibiotics OR BPO OR topical retinoids† OR both OR Fixed-dose combinations: BPO/clinda OR BPO/adapalene OR, after failure of above, clinda/tretinoin‡ Figure 2: Clinical treatment algorithm for acne. A complete list of recommendations is available in the full guideline (Appendix 4, available at www.cmaj.ca/lookup/suppl/doi:10.1503/cmaj.140665/-/DC1). BPO = benzoyl peroxide, clinda = clindamycin, dashed line = optional path. *Blue light and oral zinc may be considered for mild (...) -to-moderate papulopustular acne (low strength of recommendation). †Best evidence is for adapalene and tazarotene. ‡Lower-quality evidence available for clindamycin–tretinoin gel. §Evaluate after 2–3 months. ¶For women only. **Evaluate monthly for isotretinoin. Guidelines CMAJ 5 ple applications. Many acne medications may not be covered by provincial plans; in these cases, it may be particularly important to consider cost. For comedonal acne, we recommend topical reti noids or benzoyl peroxide (medium

2015 CPG Infobase

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