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21. Penicillin V four times daily for five days versus three times daily for 10 days in patients with pharyngotonsillitis caused by group A streptococci: randomised controlled, open label, non-inferiority study. Full Text available with Trip Pro

Penicillin V four times daily for five days versus three times daily for 10 days in patients with pharyngotonsillitis caused by group A streptococci: randomised controlled, open label, non-inferiority study. To determine whether total exposure to penicillin V can be reduced while maintaining adequate clinical efficacy when treating pharyngotonsillitis caused by group A streptococci.Open label, randomised controlled non-inferiority study.17 primary healthcare centres in Sweden between September (...) 2015 and February 2018.Patients aged 6 years and over with pharyngotonsillitis caused by group A streptococci and three or four Centor criteria (fever ≥38.5°C, tender lymph nodes, coatings of the tonsils, and absence of cough).Penicillin V 800 mg four times daily for five days (total 16 g) compared with the current recommended dose of 1000 mg three times daily for 10 days (total 30 g).Primary outcome was clinical cure five to seven days after the end of antibiotic treatment. The non-inferiority

2019 BMJ

22. Evaluation and Management of Penicillin Allergy: A Review. (Abstract)

Evaluation and Management of Penicillin Allergy: A Review. β-Lactam antibiotics are among the safest and most effective antibiotics. Many patients report allergies to these drugs that limit their use, resulting in the use of broad-spectrum antibiotics that increase the risk for antimicrobial resistance and adverse events.Approximately 10% of the US population has reported allergies to the β-lactam agent penicillin, with higher rates reported by older and hospitalized patients. Although many (...) patients report that they are allergic to penicillin, clinically significant IgE-mediated or T lymphocyte-mediated penicillin hypersensitivity is uncommon (<5%). Currently, the rate of IgE-mediated penicillin allergies is decreasing, potentially due to a decreased use of parenteral penicillins, and because severe anaphylactic reactions to oral amoxicillin are rare. IgE-mediated penicillin allergy wanes over time, with 80% of patients becoming tolerant after a decade. Cross-reactivity between penicillin

2019 JAMA

23. Comparative effectiveness of injectable penicillin versus a combination of penicillin and gentamicin in children with pneumonia characterised by indrawing in Kenya: protocol for an observational study. Full Text available with Trip Pro

Comparative effectiveness of injectable penicillin versus a combination of penicillin and gentamicin in children with pneumonia characterised by indrawing in Kenya: protocol for an observational study. WHO treatment guidelines are widely recommended for guiding treatment for millions of children with pneumonia every year across multiple low-income and middle-income countries. Guidelines are based on synthesis of available evidence that provides moderate certainty in evidence of effects (...) would require pragmatic clinical trials. However, these remain relatively expensive and time consuming. This protocol describes an approach to using secondary analysis of a new, large observational dataset as a potentially cheaper and quicker way to examine the comparative effectiveness of penicillin versus penicillin plus gentamicin in treatment of indrawing pneumonia. Addressing this question is important, as although it is now recommended that this form of pneumonia is treated with oral

2017 BMJ open

24. Comparative effectiveness of injectable penicillin versus a combination of penicillin and gentamicin in children with pneumonia characterised by indrawing in Kenya: a retrospective observational study. Full Text available with Trip Pro

Comparative effectiveness of injectable penicillin versus a combination of penicillin and gentamicin in children with pneumonia characterised by indrawing in Kenya: a retrospective observational study. Kenyan guidelines for antibiotic treatment of pneumonia recommended treatment of pneumonia characterised by indrawing with injectable penicillin alone in inpatient settings until early 2016. At this point, they were revised becoming consistent with WHO guidance after results of a Kenyan trial (...) provided further evidence of equivalence of oral amoxicillin and injectable penicillin. This change also made possible use of oral amoxicillin for outpatient treatment in this patient group. However, given non-trivial mortality in Kenyan children with indrawing pneumonia, it remained possible they would benefit from a broader spectrum antibiotic regimen. Therefore, we compared the effectiveness of injectable penicillin monotherapy with a regimen combining penicillin with gentamicin.We used a large

2017 BMJ open

25. Is a positive intracutaneous test induced by penicillin mediated by histamine? A cutaneous microdialysis study in penicillin-allergic patients Full Text available with Trip Pro

Is a positive intracutaneous test induced by penicillin mediated by histamine? A cutaneous microdialysis study in penicillin-allergic patients Diagnostic workup of penicillin allergy comprises skin testing with penicillins, and patients are deemed allergic if skin test is positive. However, the literature suggests that skin test-positive patients may be challenge-negative, indicating that the skin test may be falsely positive.To investigate real-time histamine release from a positive (...) intracutaneous test induced by penicillin in patients with positive and negative challenges to penicillin.Skin microdialysis was performed in 21 penicillin-allergic patients with positive skin test, 13 non-allergic volunteers serving as negative controls, and 7 grass pollen-allergic patients serving as positive controls. Histamine was measured by microdialysis after skin test with penicillin/grass/NaCl. Penicillin challenge was subsequently performed in 12 of the patients.Only 10/21 patients (47.6%) were

2017 Clinical and translational allergy

26. New aspects of the interplay between penicillin binding proteins, <i>murM</i> and the two component system CiaRH of penicillin-resistant <i>Streptococcus pneumoniae</i> serotype 19A isolates from Hungary. Full Text available with Trip Pro

New aspects of the interplay between penicillin binding proteins, murM and the two component system CiaRH of penicillin-resistant Streptococcus pneumoniae serotype 19A isolates from Hungary. The Streptococcus pneumoniae clone Hungary19A-6 expresses unusually high levels of β-lactam resistance, which is in part due to mutations in the MurM gene, encoding a transferase involved in the synthesis of branched peptidoglycan. Moreover, it contains the allele ciaH232, encoding (...) the histidine kinase CiaH (M. Müller, P. Marx, R. Hakenbeck, and R. Brückner, Microbiology 157:3104-3112, 2011, https://doi.org/10.1099/mic.0.053157-0). High-level penicillin resistance primarily requires the presence of low-affinity (mosaic) penicillin binding protein (PBP) genes, as, for example, in strain Hu17, a closely related member of the Hungary19A-6 lineage. Interestingly, strain Hu15 is β-lactam sensitive due to the absence of mosaic PBPs. This unique situation prompted us to investigate

2017 Antimicrobial Agents and Chemotherapy

27. Penicillin skin testing in methicillin-sensitive staphylococcus aureus bacteremia: A cost-effectiveness analysis. Full Text available with Trip Pro

Penicillin skin testing in methicillin-sensitive staphylococcus aureus bacteremia: A cost-effectiveness analysis. Beta-lactams are the mainstay for treating methicillin-susceptible Staphylococcus aureus (MSSA) infections complicated by bacteremia due to superior outcomes compared with vancomycin. With approximately 11% of inpatients reporting a penicillin (PCN) allergy, many patients receive suboptimal treatment for MSSA bacteremia.Evaluate the cost-effectiveness of penicillin skin testing (PST

2019 PLoS ONE

28. Risk of meticillin resistant <i>Staphylococcus aureus</i> and <i>Clostridium difficile</i> in patients with a documented penicillin allergy: population based matched cohort study. Full Text available with Trip Pro

Risk of meticillin resistant Staphylococcus aureus and Clostridium difficile in patients with a documented penicillin allergy: population based matched cohort study. To evaluate the relation between penicillin allergy and development of meticillin resistant Staphylococcus aureus (MRSA) and C difficile.Population based matched cohort study.United Kingdom general practice (1995-2015).301 399 adults without previous MRSA or C difficile enrolled in the Health Improvement Network (...) database: 64 141 had a penicillin allergy and 237 258 comparators matched on age, sex, and study entry time.The primary outcome was risk of incident MRSA and C difficile. Secondary outcomes were use of β lactam antibiotics and β lactam alternative antibiotics.Among 64 141 adults with penicillin allergy and 237 258 matched comparators, 1365 developed MRSA (442 participants with penicillin allergy and 923 comparators) and 1688 developed C difficile (442 participants with penicillin allergy and 1246

2018 BMJ

29. Proactive management of penicillin and other antibiotic allergies. (Abstract)

Proactive management of penicillin and other antibiotic allergies. Background: Antibiotic allergies, especially penicillin, are the most frequent drug allergy listed in the medical record. Proactive evaluations of antibiotic allergies, particularly penicillin allergies, have been recommended by various specialty societies. Objective: To review the history of the discovery of penicillin, implications of the penicillin allergy label, various delabeling strategies as well as a brief overview (...) of the approach to cephalosporin, fluoroquinolone, and macrolide allergy. Methods: Recent studies on penicillin allergy delabeling and on cephalosporin and fluoroquinolone allergies were reviewed. Results: Although Alexander Fleming is often solely credited with the discovery of penicillin, other scientists were critical to the development of penicillin as a life-saving antibiotic. The vast majority of patients with a penicillin allergy label are not allergic; however, this label results in increased

2020 Allergy and Asthma Proceedings

30. The complexity of T cell-mediated penicillin hypersensitivity reactions. Full Text available with Trip Pro

The complexity of T cell-mediated penicillin hypersensitivity reactions. Penicillin refers to a group of beta-lactam antibiotics that are the first-line treatment for a range of infections. However, they also possess the ability to form novel antigens, or neoantigens, through haptenation of proteins and can stimulate a range of immune-mediated adverse reactions - collectively known as drug hypersensitivity reactions (DHRs). IgE-mediated reactions towards these neoantigens are well studied (...) , discussing the nature of the lesional T cells, the characterisation of drug-responsive T cells isolated from patient blood, and the potential mechanisms by which penicillins enter the antigen processing and presentation pathway to stimulate these deleterious responses. Thus, we highlight the need for a more comprehensive understanding of the underlying genetic and molecular basis of penicillin-induced DHRs.This article is protected by copyright. All rights reserved.

2020 Allergy

31. Accuracy of Penicillin Allergy Diagnostic Tests: A Systematic Review and Meta-analysis. Full Text available with Trip Pro

Accuracy of Penicillin Allergy Diagnostic Tests: A Systematic Review and Meta-analysis. Having a penicillin allergy label associates with higher risk for antibiotic resistance and increased healthcare use.To assess the accuracy of skin tests and specific IgE quantification in the diagnostic evaluation of patients reporting a penicillin/β-lactam allergy.We performed a systematic review and diagnostic accuracy meta-analysis, searching on MEDLINE, Scopus and Web of Science. We included studies (...) conducted in patients reporting a penicillin allergy and in whom skin tests and/or specific IgE quantification were performed and compared with drug challenge results. We quantitatively assessed the accuracy of diagnostic tests with bivariate random-effects meta-analyses. Meta-regression and subgroup analyses were performed to explore causes of heterogeneity. Studies' quality was evaluated using QUADAS-2 criteria.We included 105 primary studies, assessing 31,761 participants. Twenty-seven studies were

2020 Journal of Allergy and Clinical Immunology

32. High-cost, high-need patients: the impact of reported penicillin allergy. (Abstract)

High-cost, high-need patients: the impact of reported penicillin allergy. More than 90% of patients who report a penicillin allergy have the allergy disproved when tested. Unnecessary use of alternative (non-beta-lactam) antibiotics can result in more treatment failures and adverse reactions. We described the prevalence and impact of a reported penicillin allergy in high-cost, high-need (HCHN) patients.Retrospective cohort.We identified HCHN patients in a care management program of an urban (...) academic medical center (January 1, 2014, to December 31, 2016). We used multivariable logistic regression models to determine the association between a reported penicillin allergy and antibiotic use. We used multivariable Poisson regression models to determine the association between a reported penicillin allergy, with or without multiple drug intolerance syndrome (MDIS; ≥3 reported drug allergies), and healthcare resource utilization (HRU).Of 1870 HCHN patients, 383 (20%) reported penicillin allergy

2020 American Journal Of Managed Care

33. Update on penicillin allergy delabeling. (Abstract)

Update on penicillin allergy delabeling. To review phenotyping and risk classification of penicillin allergy and provide an update on penicillin allergy delabeling strategies for primary care.Beta-lactams are considered the treatment of choice for a wide range of bacterial pathogens; however, many patients receive second-line agents due to being labeled as having an allergy to penicillin. This approach can lead to antibiotic resistance and inferior health outcomes. While 10% of the population (...) is labeled as penicillin allergic, penicillin anaphylaxis occurs in less than 1% of patients. For patients with delayed benign skin rashes (e.g., urticaria or maculopapular exanthem >1 h after administration) attributable to beta-lactam administration occurring more than 12 months ago, direct oral challenge (rechallenge with antibiotic in the clinical setting) can be a safe and effective strategy, with immediate reactions occurring in less than 5% of such low-risk patients and delayed reactions appearing

2020 Current opinion in pediatrics

34. Empirical prescribing of penicillin G/V reduces risk of readmission of hospitalized patients with community-acquired pneumonia in Norway: a retrospective observational study. Full Text available with Trip Pro

Empirical prescribing of penicillin G/V reduces risk of readmission of hospitalized patients with community-acquired pneumonia in Norway: a retrospective observational study. Norwegian guideline recommendations on first-line empirical antibiotic prescribing in hospitalised patients with community-acquired pneumonia (CAP) are penicillin G/V in monotherapy, or penicillin G in combination with gentamicin (or cefotaxime) in severely ill patients. The aim of this study was to explore how different (...) duration and clinical outcomes from electronic patient records and the hospital administrative system. We used directed acyclic graphs for statistical model selection, and analysed data with mulitvariable logistic and linear regression.We included 651 patients. Median age was 77 years [IQR; 64-84] and 46.5% were female. Median LOS was 4 days [IQR; 3-6], 30-day readmission rate was 14.4% and 30-day mortality rate was 6.9%. Penicillin G/V were empirically prescribed in monotherapy in 51.5% of patients

2020 BMC pulmonary medicine

35. The association of penicillin allergy with outcomes after open ventral hernia repair. (Abstract)

The association of penicillin allergy with outcomes after open ventral hernia repair. Up to 11% of patients report a penicillin allergy (PA), with 1-2% demonstrating a true IgE mediated allergy upon testing. PA patients often receive non-beta-lactam antibiotic surgical prophylaxis (non-BLP). This study evaluates the relationship of PA to outcomes after open ventral hernia repair (OVHR).A prospective institutional database was queried for patients undergoing OVHR. Demographics, operative

2020 Surgical endoscopy

36. Impacts of Penicillin Binding Protein 2 Inactivation on β-Lactamase Expression and Muropeptide Profile in Stenotrophomonas maltophilia Full Text available with Trip Pro

Impacts of Penicillin Binding Protein 2 Inactivation on β-Lactamase Expression and Muropeptide Profile in Stenotrophomonas maltophilia Penicillin binding proteins (PBPs) are involved in peptidoglycan synthesis, and their inactivation is linked to β-lactamase expression in ampR-β-lactamase module-harboring Gram-negative bacteria. There are seven annotated PBP genes, namely, mrcA, mrcB, pbpC, mrdA, ftsI, dacB, and dacC, in the Stenotrophomonas maltophilia genome, and these genes encode PBP1a

2017 mSystems

37. ASCIA Penicillin Allergy Guide for health professionals

ASCIA Penicillin Allergy Guide for health professionals • In severe penicillin allergy (e.g. anaphylaxis, bronchospasm, urticaria, angioedema), avoid ALL penicillins, cephalosporins and other beta-lactam antibiotics • In non-severe penicillin allergy (e.g. mild rash) use cephalosporins and carbapenems with caution • Some reactions (e.g. nausea) are not considered allergies and do not warrant prohibiting penicillin use Contraindicated At all times where reasonable evidence of penicillin allergy (...) exists Caution Avoid if severe penicillin allergy (e.g. anaphylaxis) Use with caution if non-severe allergy (e.g. minor rash) Seek specialist advice Considered Safe In the absence of other contraindications Cefaclor Cefepime Cefotaxime Cefoxitin Ceftazidime Ceftriaxone Cefuroxime Cephalexin Cephazolin Doripenem, ertapenem, imipenem, meropenem Aztreonam Azithromycin, erythromycin, roxithromycin, clarithromycin Ciprofloxacin, norfloxacin, moxifloxacin Clindamycin, lincomycin Doxycycline, minocycline

2016 Australasian Society of Clinical Immunology and Allergy

38. The incidence of penicillin allergy among ED patients with acute cellulitis treated with penicillin antibiotics

The incidence of penicillin allergy among ED patients with acute cellulitis treated with penicillin antibiotics Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites. Email salutation (e.g. "Dr Smith" or "Joanne") for correspondence

2018 PROSPERO

39. Short-term oral antibiotics may be as effective as the standard course of penicillin for children with acute streptococcal pharyngitis

Short-term oral antibiotics may be as effective as the standard course of penicillin for children with acute streptococcal pharyngitis Short-term oral antibiotics may be as effective as the standard course of penicillin for children with acute streptococcal pharyngitis ADA Websites Access news, member benefits and ADA policy Attend ADA's premier event Access cutting-edge continuing education courses Find evidence to support your clinical decisions Access member-only practice content Investing (...) boards Evidence Education * Associated Topics Short-term oral antibiotics may be as effective as the standard course of penicillin for children with acute streptococcal pharyngitis Shukan Kanuga, DDS, MSD . Overview Systematic Review Conclusion Three to 6 days of short-term late-generation antibiotics have comparable treatment efficacy as a 10-day course of oral penicillin in children with acute group A β-hemolytic streptococcus (GABHS) pharyngitis. Critical Summary Assessment On the basis of good

2015 ADA Center for Evidence-Based Dentistry

40. Systematic review: Penicillin is the drug of choice to treat all stages of syphilis despite a paucity of clinical trials data for the treatment of some stages, pregnant women and HIV-infected people

Systematic review: Penicillin is the drug of choice to treat all stages of syphilis despite a paucity of clinical trials data for the treatment of some stages, pregnant women and HIV-infected people Penicillin is the drug of choice to treat all stages of syphilis despite a paucity of clinical trials data for the treatment of some stages, pregnant women and HIV-infected people | BMJ Evidence-Based Medicine We use cookies to improve our service and to tailor our content and advertising to you (...) Penicillin is the drug of choice to treat all stages of syphilis despite a paucity of clinical trials data for the treatment of some stages, pregnant women and HIV-infected people Article Text Therapeutics/Prevention Systematic review Penicillin is the drug of choice to treat all stages of syphilis despite a paucity of clinical trials data for the treatment of some stages, pregnant women and HIV-infected people Susan Tuddenham , Khalil G Ghanem Statistics from Altmetric.com Commentary on : Clement ME

2015 Evidence-Based Medicine

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