UWHC Guidelines for the Use of Beta-Lactam Antibiotics in Patients with Reported Allergies to Penicillin
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Cusumano-Et-Al-2017.Pdf
International Journal of Infectious Diseases 63 (2017) 1–6 Contents lists available at ScienceDirect International Journal of Infectious Diseases journal homepage: www.elsevier.com/locate/ijid Rapidly growing Mycobacterium infections after cosmetic surgery in medical tourists: the Bronx experience and a review of the literature a a b c b Lucas R. Cusumano , Vivy Tran , Aileen Tlamsa , Philip Chung , Robert Grossberg , b b, Gregory Weston , Uzma N. Sarwar * a Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA b Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA c Department of Pharmacy, Nebraska Medicine, Omaha, Nebraska, USA A R T I C L E I N F O A B S T R A C T Article history: Background: Medical tourism is increasingly popular for elective cosmetic surgical procedures. However, Received 10 May 2017 medical tourism has been accompanied by reports of post-surgical infections due to rapidly growing Received in revised form 22 July 2017 mycobacteria (RGM). The authors’ experience working with patients with RGM infections who have Accepted 26 July 2017 returned to the USA after traveling abroad for cosmetic surgical procedures is described here. Corresponding Editor: Eskild Petersen, Methods: Patients who developed RGM infections after undergoing cosmetic surgeries abroad and who ?Aarhus, Denmark presented at the Montefiore Medical Center (Bronx, New York, USA) between August 2015 and June 2016 were identified. A review of patient medical records was performed. Keywords: Results: Four patients who presented with culture-proven RGM infections at the sites of recent cosmetic Mycobacterium abscessus complex procedures were identified. -
Cefalexin in the WHO Essential Medicines List for Children Reject
Reviewer No. 1: checklist for application of: Cefalexin In the WHO Essential Medicines List for Children (1) Have all important studies that you are aware of been included? Yes No 9 (2) Is there adequate evidence of efficacy for the proposed use? Yes 9 No (3) Is there evidence of efficacy in diverse settings and/or populations? Yes 9 No (4) Are there adverse effects of concern? Yes 9 No (5) Are there special requirements or training needed for safe/effective use? Yes No 9 (6) Is this product needed to meet the majority health needs of the population? Yes No 9 (7) Is the proposed dosage form registered by a stringent regulatory authority? Yes 9 No (8) What action do you propose for the Committee to take? Reject the application for inclusion of the following presentations of cefalexin: • Tablets/ capsules 250mg • Oral suspensions 125mg/5ml and 125mg/ml (9) Additional comment, if any. In order to identify any additional literature, the following broad and sensitive search was conducted using the PubMed Clinical Query application: (cephalexin OR cefalexin AND - 1 - pediatr*) AND ((clinical[Title/Abstract] AND trial[Title/Abstract]) OR clinical trials[MeSH Terms] OR clinical trial[Publication Type] OR random*[Title/Abstract] OR random allocation[MeSH Terms] OR therapeutic use[MeSH Subheading]) Only one small additional study was identified, which looked at the provision of prophylactic antibiotics in patients presenting to an urban children's hospital with trauma to the distal fingertip, requiring repair.1 In a prospective randomised control trial, 146 patients were enrolled, of which 69 were randomised to the no-antibiotic group, and 66 were randomised to the antibiotic (cefalexin) group. -
The Antibacterial Activity of Cefpodoxime and the Novel Β
Session-198 b SATURDAY-279 The Antibacterial Activity of Cefpodoxime and the Novel -lactamase Inhibitor ETX1317 Against Recent Clinical Isolates of b-lactamase-producing Enterobacteriaceae Entasis Therapeutics S. McLeod1, M. Hackel2, R. Badal2, A. Shapiro1, J. Mueller1, R. Tommasi1, and A. Miller1 1-781-810-0120 1Entasis Therapeutics, Waltham, MA and 2IHMA, International Health Management Associates, Schaumburg, IL USA www.entasistx.com Abstract In vitro activity of ETX1317 vs. comparator BLIs Cumulative activity vs. 911 ESBL-enriched Enterobacteriaceae from 2013-2015 Activity vs. 35 sequenced KPC+ and/or MBL+ Enterobacteriaceae MIC (mg/L) Background β-lactamase inhibition (IC50, µM) Strain ID Species encoded bla genes IPM CAZ-AVI CPD-ETX1317 ETX1317 ETX1317 is a novel, diazabicyclooctenone inhibitor of serine β-lactamases that Number (cumulative %) of isolates inhibited at MIC (mg/L) Class A Class C Class D Drug %S* ARC3528*¥ E. cloacae AmpC [∆308-313(SKVALA)] 0.25 32 0.125 4 restores β-lactam activity against multidrug-resistant Enterobacteriaceae. ETX0282, < 0.03 0.06 0.12 0.25 0.5 1 2 4 8 16 32 > 32 ARC4165*¥ C. freundii CMY-2; AmpC [N366Y]; TEM-1; SHV-5 2 32 ≤0.03 4 the oral prodrug of ETX1317, is currently under investigation in combination with BLI CTX-M-15 SHV-5 KPC-2 TEM-1 AmpC* P99 OXA-24/40 OXA-48 0 5 6 14 19 34 20 27 17 18 18 733 3 CPD 10.8 ARC6479* K. oxytoca NDM-1 16 >32 32 32 cefpodoxime proxetil (CPDP), which is hydrolyzed in vivo to release cefpodoxime 0% 0.5% 1% 3% 5% 9% 11% 14% 16% 18% 20% 100% (CPD). -
Antimicrobial Surgical Prophylaxis
Antimicrobial Surgical Prophylaxis The antimicrobial surgical prophylaxis protocol establishes evidence-based standards for surgical prophylaxis at The Nebraska Medical Center. The protocol was adapted from the recently published consensus guidelines from the American Society of Health-System Pharmacists (ASHP), Society for Healthcare Epidemiology of America (SHEA), Infectious Disease Society of America (IDSA), and the Surgical Infection Society (SIS) and customized to Nebraska Medicine with the input of the Antimicrobial Stewardship Program in concert with the various surgical groups at the institution. The protocol established here-in will be implemented via standard order sets utilized within One Chart. Routine surgical prophylaxis and current and future surgical order sets are expected to conform to this guidance. Antimicrobial Surgical Prophylaxis Initiation Optimal timing: Within 60 minutes before surgical incision o Exceptions: Fluoroquinolones and vancomycin (within 120 minutes before surgical incision) Successful prophylaxis necessitates that the antimicrobial agent achieve serum and tissue concentrations above the MIC for probable organisms associated with the specific procedure type at the time of incision as well as for the duration of the procedure. Renal Dose Adjustment Guidance The following table can be utilized to determine if adjustments are needed to antimicrobial surgical prophylaxis for both pre-op and post-op dosing. Table 1 Renal Dosage Adjustment Dosing Regimen with Dosing Regimen with CrCl Dosing Regimen with -
Antimicrobial Stewardship Guidance
Antimicrobial Stewardship Guidance Federal Bureau of Prisons Clinical Practice Guidelines March 2013 Clinical guidelines are made available to the public for informational purposes only. The Federal Bureau of Prisons (BOP) does not warrant these guidelines for any other purpose, and assumes no responsibility for any injury or damage resulting from the reliance thereof. Proper medical practice necessitates that all cases are evaluated on an individual basis and that treatment decisions are patient-specific. Consult the BOP Clinical Practice Guidelines Web page to determine the date of the most recent update to this document: http://www.bop.gov/news/medresources.jsp Federal Bureau of Prisons Antimicrobial Stewardship Guidance Clinical Practice Guidelines March 2013 Table of Contents 1. Purpose ............................................................................................................................................. 3 2. Introduction ...................................................................................................................................... 3 3. Antimicrobial Stewardship in the BOP............................................................................................ 4 4. General Guidance for Diagnosis and Identifying Infection ............................................................. 5 Diagnosis of Specific Infections ........................................................................................................ 6 Upper Respiratory Infections (not otherwise specified) .............................................................................. -
Susceptibility of Pseudomonas Cepacia Isolated from Children with Cystic Fibrosis1
003 1-3998/86/2011-1174$02.00/0 PEDIATRIC RESEARCH Vol. 20, No. 1 1, 1986 Copyright O 1986 International Pediatric Research Foundation, Inc. Printed in (I.S.A. Decreased Baseline P-Lactamase Production and Inducibility associated with Increased Piperacillin Susceptibility of Pseudomonas cepacia Isolated from Children with Cystic Fibrosis1 CLAUDIO CHIESA,~PAULINE H. LABROZZI, AND STEPHEN C. ARONOFF Department of Pediatrics [C.C., P.H.L., S.C.A.], Case- Western Reserve University School ofMedicine and the Division of Pediatric Infectious Diseases [S.C.A.], Rainbow Babies and Children's Hospital, Cleveland, Ohio ABSTRACT. The incidence of pulmonary infections in creased since 1978 and is now recovered from 20% of patients children with cystic fibrosis caused by Pseudomonas ce- in some centers (3, 4). pacia, an organism which may possess an inducible 8- Sputum isolates of P. cepacia from children with cystic fibrosis lactamase, has increased since 1978. Seven of 13 sputum are resistant to most P-lactam agents in vitro. In an in vitro study isolates of P. cepacia from children with cystic fibrosis comparing the susceptibilities of 62 consecutive sputum isolates, were classified as inducible by quantitative enzyme produc- concentrations of 64 pg/ml of aztreonam and piperacillin were tion following preincubation with 100, 200, or 400 pg/ml required to inhibit 79 and 87.1 % of the bacterial population, of cefoxitin. The recovery of inducible strains tended to be respectively; 90% of the isolates were inhibited by 8 pg/ml of associated with recent ceftazidime therapy. Susceptibility ceftazidime (5). In vitro, ceftazidime has proven more active to aztreonam, ceftazidime, and piperacillin alone or com- against P. -
Below Are the CLSI Breakpoints for Selected Bacteria. Please Use Your Clinical Judgement When Assessing Breakpoints
Below are the CLSI breakpoints for selected bacteria. Please use your clinical judgement when assessing breakpoints. The lowest number does NOT equal most potent antimicrobial. Contact Antimicrobial Stewardship for drug selection and dosing questions. Table 1: 2014 MIC Interpretive Standards for Enterobacteriaceae (includes E.coli, Klebsiella, Enterobacter, Citrobacter, Serratia and Proteus spp) Antimicrobial Agent MIC Interpretive Criteria (g/mL) Enterobacteriaceae S I R Ampicillin ≤ 8 16 ≥ 32 Ampicillin-sulbactam ≤ 8/4 16/8 ≥ 32/16 Aztreonam ≤ 4 8 ≥ 16 Cefazolin (blood) ≤ 2 4 ≥ 8 Cefazolin** (uncomplicated UTI only) ≤ 16 ≥ 32 Cefepime* ≤ 2 4-8* ≥ 16 Cefotetan ≤ 16 32 ≥ 64 Ceftaroline ≤ 0.5 1 ≥ 2 Ceftazidime ≤ 4 8 ≥ 16 Ceftriaxone ≤ 1 2 ≥ 4 Cefpodoxime ≤ 2 4 ≥ 8 Ciprofloxacin ≤ 1 2 ≥ 4 Ertapenem ≤ 0.5 1 ≥ 2 Fosfomycin ≤ 64 128 ≥256 Gentamicin ≤ 4 8 ≥ 16 Imipenem ≤ 1 2 ≥ 4 Levofloxacin ≤ 2 4 ≥ 8 Meropenem ≤ 1 2 ≥ 4 Piperacillin-tazobactam ≤ 16/4 32/4 – 64/4 ≥ 128/4 Trimethoprim-sulfamethoxazole ≤ 2/38 --- ≥ 4/76 *Susceptibile dose-dependent – see chart below **Cefazolin can predict results for cefaclor, cefdinir, cefpodoxime, cefprozil, cefuroxime axetil, cephalexin and loracarbef for uncomplicated UTIs due to E.coli, K.pneumoniae, and P.mirabilis. Cefpodoxime, cefinidir, and cefuroxime axetil may be tested individually because some isolated may be susceptible to these agents while testing resistant to cefazolin. Cefepime dosing for Enterobacteriaceae ( E.coli, Klebsiella, Enterobacter, Citrobacter, Serratia & Proteus spp) Susceptible Susceptible –dose-dependent (SDD) Resistant MIC </= 2 4 8 >/= 16 Based on dose of: 1g q12h 1g every 8h or 2g every 8 h Do not give 2g q12 Total dose 2g 3-4g 6g NA Table 2: 2014 MIC Interpretive Standards for Pseudomonas aeruginosa and Acinetobacter spp. -
Australian Public Assessment Refport for Ceftaroline Fosamil (Zinforo)
Australian Public Assessment Report for ceftaroline fosamil Proprietary Product Name: Zinforo Sponsor: AstraZeneca Pty Ltd May 2013 Therapeutic Goods Administration About the Therapeutic Goods Administration (TGA) • The Therapeutic Goods Administration (TGA) is part of the Australian Government Department of Health and Ageing, and is responsible for regulating medicines and medical devices. • The TGA administers the Therapeutic Goods Act 1989 (the Act), applying a risk management approach designed to ensure therapeutic goods supplied in Australia meet acceptable standards of quality, safety and efficacy (performance), when necessary. • The work of the TGA is based on applying scientific and clinical expertise to decision- making, to ensure that the benefits to consumers outweigh any risks associated with the use of medicines and medical devices. • The TGA relies on the public, healthcare professionals and industry to report problems with medicines or medical devices. TGA investigates reports received by it to determine any necessary regulatory action. • To report a problem with a medicine or medical device, please see the information on the TGA website <http://www.tga.gov.au>. About AusPARs • An Australian Public Assessment Record (AusPAR) provides information about the evaluation of a prescription medicine and the considerations that led the TGA to approve or not approve a prescription medicine submission. • AusPARs are prepared and published by the TGA. • An AusPAR is prepared for submissions that relate to new chemical entities, generic medicines, major variations, and extensions of indications. • An AusPAR is a static document, in that it will provide information that relates to a submission at a particular point in time. • A new AusPAR will be developed to reflect changes to indications and/or major variations to a prescription medicine subject to evaluation by the TGA. -
Comparative Ceftaroline Activity Tested Against Staphylococcus Aureus Associated with Acute Bacterial Skin and Skin Structure Infection from a Tertiary Care Center
RESEARCH PAPER Medical Science Volume : 5 | Issue : 4 | April 2015 | ISSN - 2249-555X Comparative Ceftaroline Activity Tested Against Staphylococcus Aureus Associated with Acute Bacterial Skin and Skin Structure Infection from A Tertiary Care Center KEYWORDS MRSA, Ceftaroline, vancomycin Dr. Umamageswari S. S. M. Dr. S. Habeeb Mohammed Dr. Shameem Banu Associate Professor- Microbiology Associate Professor-Surgery Professor and HOD- Microbiology Chettinad Hospital & Research Chettinad Hospital & Research Chettinad Hospital & Research Insitute Insitute Insitute Dr. Jayanthi S. Associate Professor- Microbiology Chettinad Hospital & Research Insitute ABSTRACT Methicillin resistant Staphylococcus aureus (MRSA), commonest cause of acute bacterial skin and skin structure infection (ABSSSI) has only limited treatment options like vancomycin, Linezolid and teicoplanin. Staphylococcus aureus with reduced susceptibilities to vancomycin is developing nowadays among nosocomial infec- tion. A newest cephalosporin – Ceftaroline has received FDA approval for the treatment of ABSSSI recently has unique activity against MRSA. The aim of the study is to know the prevalence of Staphylococcus aureus in ABSSSI patients and to evaluate the in vitro activity of Ceftaroline, in comparison with other drugs. Minimum Inhibitory Concentration for vancomycin and Ceftaroline were determined by E-test strips. Out of 235 Staphylococcus aureus isolated from ABSSSI patient 32% were MRSA. No vancomycin resistant strain isolated in our study. In vitro, Ceftaroline control the growth of MRSA very effectively at 2mg/ml itself. Ceftaroline is a most welcomed drug in the treatment of MRSA. INTRODUCTION: MATERIALS AND METHODS: Complicated skin and skin structure infection (CSSSIs), now This study was carried out in Chettinad health city and known by the new US FDA as Acute bacterial skin and skin Research Institute, a tertiary care center hospital (Chen- structure infections (ABSSSI) are the most common infec- nai) between April 2013 and May 2014. -
Penicillin Allergy Guidance Document
Penicillin Allergy Guidance Document Key Points Background Careful evaluation of antibiotic allergy and prior tolerance history is essential to providing optimal treatment The true incidence of penicillin hypersensitivity amongst patients in the United States is less than 1% Alterations in antibiotic prescribing due to reported penicillin allergy has been shown to result in higher costs, increased risk of antibiotic resistance, and worse patient outcomes Cross-reactivity between truly penicillin allergic patients and later generation cephalosporins and/or carbapenems is rare Evaluation of Penicillin Allergy Obtain a detailed history of allergic reaction Classify the type and severity of the reaction paying particular attention to any IgE-mediated reactions (e.g., anaphylaxis, hives, angioedema, etc.) (Table 1) Evaluate prior tolerance of beta-lactam antibiotics utilizing patient interview or the electronic medical record Recommendations for Challenging Penicillin Allergic Patients See Figure 1 Follow-Up Document tolerance or intolerance in the patient’s allergy history Consider referring to allergy clinic for skin testing Created July 2017 by Macey Wolfe, PharmD; John Schoen, PharmD, BCPS; Scott Bergman, PharmD, BCPS; Sara May, MD; and Trevor Van Schooneveld, MD, FACP Disclaimer: This resource is intended for non-commercial educational and quality improvement purposes. Outside entities may utilize for these purposes, but must acknowledge the source. The guidance is intended to assist practitioners in managing a clinical situation but is not mandatory. The interprofessional group of authors have made considerable efforts to ensure the information upon which they are based is accurate and up to date. Any treatments have some inherent risk. Recommendations are meant to improve quality of patient care yet should not replace clinical judgment. -
Antibiotic Review
8/28/19 Disclosure 2 E. Monee’ Carter-Griffin DNP, MA, RN, ACNP-BC Antibiotic has no financial relationships with commercial Review interests to disclose. Any unlaBeled and/or E. Monee’ Carter-Griffin, DNP, MA, RN, ACNP-BC unapproved uses of drugs or products will Be Associate Chair for Advanced Practice Nursing disclosed. University of Texas at Arlington, College of Nursing & Health Innovation Dallas Pulmonary & Critical Care, PA • Identify the general characteristics of • SusceptiBility à determine which antibiotics. antibiotics a bacteria is sensitive to • Discuss the mechanism of action, • à pharmacokinetics, and spectrum of activity MIC lowest concentration of drug that inhiBits growth of the Bacteria for the most common antiBiotic drug classes. Antibiotic Objectives • Identify commonly prescriBed antiBiotics • Trough à lowest concentration of within the drug classes including dosage Lingo drug in bloodstream range and indication for prescribing. – Collect prior to administration of • Identify special considerations for specific drug antibiotics and/or drug classes. • Peak à highest concentration of • Practice appropriate prescriBing for common drug in bloodstream bacterial infections. • Review Basic antiBiotic stewardship 3 4 principles. • Penicillins • Bactericidal or bacteriostatic • Cephalosporins • Narrow or Broad spectrum • Carbapenems General • Can elicit allergic responses Antibiotic • MonoBactam Characteristics • Affect normal Body flora Drug Classes • Macrolides • Fluoroquinolones • Sulfonamides • Tetracyclines 5 6 1 8/28/19 • Penicillins – Natural penicillins 8 – Aminopenicillins Penicillins Penicillins – Anti-staphylococcal penicillins • Mechanism of action àbactericidal à – Anti-pseudomonal penicillins interrupts cell wall synthesis 7 • Pharmacokinetics • Spectrum of Activity – Gram positive organisms Natural – Penicillin G à mostly given IM, But Natural • Streptococcus species (e.g. S. Penicillins one variation can Be given IV Penicillins pyogenes) • Poorly aBsorBed via PO • Some enterococcus species (e.g. -
TML\MSH Microbiology Department Policy & Procedure Manual Policy
TML\MSH Microbiology Department Policy # MI\ANTI\04\03\v03 Page 1 of 5 Policy & Procedure Manual Section: Antimicrobial Susceptibility Testing Subject Title: Appendix III - Double Disk Manual Test for ESBL Issued by: LABORATORY MANAGER Original Date: January 10, 2000 Approved by: Laboratory Director Revision Date: November 21, 2005 APPENDIX III - DOUBLE DISK TEST FOR ESBL I. Introduction Class A or Bush Group 1 extended spectrum beta-lactamases (ESBLs) are inhibited by clavulanic acid. This may be detected by testing the suspected organism to a 3rd generation cephalosporin alone and in combination with clavulanic acid. If the combination results in an expanded zone of inhibition compared to that of the 3rd generation cephalosporin alone, it is indicative of the presence of an ESBL. II. Materials Mueller-Hinton (MH) agar (150) mm 20/10 mg amoxicillin-clavulanate disc 30 mg ceftazidime disc 30 mg ceftriaxone or cefotaxime disc 30 mg aztreonam disc 10 mg cefpodoxime disc (optional) 30 mg cefoxitin disc Quality control strain: E. coli ATCC 51446 III. Procedure 1. Prepare a bacterial suspension of the organism to be tested that has a turbidity equivalent to that of a 0.5 McFarland standard. 2. Inoculate a Mueller-Hinton agar plate with this suspension in accordance with NCCLS M100-S10 (M2) guidelines for disc diffusion testing. 3. Place the amoxicillin-clavulanic acid disc towards the centre of the plate. 4. Carefully measure 15 mm out from the edge of that disc at 90o angles marking the plate. 5. Place a ceftazidime disk on the plate so that its inner edge is 15 mm (the mark) from the amoxicillin-clavulanic acid disc (See Figure 1 KB-ESBL Template).