scholarly journals Antimicrobial susceptibility of Neisseria gonorrhoeae isolates and syndromic treatment of men with urethral discharge in Kingston, Jamaica, 2018–19

2021 ◽  
Author(s):  
Suzette M Cameron-McDermott ◽  
Geoffrey J Barrow ◽  
Alicia M Webster ◽  
Carrington O De La Haye ◽  
Denise H E Wood ◽  
...  
Keyword(s):  
Neisseria Gonorrhoeae ◽  
Antimicrobial Susceptibility ◽  
Treatment Guidelines ◽  
Health Centre ◽  
Clinical Information ◽  
Sexual Partners ◽  
Evidence Based ◽  
Evidence Based Treatment ◽  
Urethral Discharge ◽  
Comprehensive Health

Abstract Objectives To quantitatively determine the antimicrobial susceptibility of clinical Neisseria gonorrhoeae isolates from men with urethral discharge in Jamaica and to describe the syndromic treatment therapies administered. Methods Urethral eSwabs (Copan) were collected from 175 men presenting with urethral discharge to the Comprehensive Health Centre STI Clinic, Kingston, Jamaica. Clinical information was collected and MICs of eight antimicrobials were determined for N. gonorrhoeae isolates (n = 96) using Etest and interpreted using CLSI criteria. Results The median age of the subjects was 28 years (range: 18–73 years) with a median of 2 sexual partners (range: 1–25) per male in the previous 3 months. All examined N. gonorrhoeae isolates were susceptible to ceftriaxone (96/96), azithromycin (91/91), cefixime (91/91) and spectinomycin (91/91). For ciprofloxacin and gentamicin, respectively, 98.9% (91/92) and 91.3% (84/92) of the isolates were susceptible and 1.1% (1/92) and 8.7% (8/92) showed intermediate susceptibility/resistance. For tetracycline and benzylpenicillin, respectively, 38.0% (35/92) and 22.0% (20/91) of the isolates were susceptible, 52.2% (48/92) and 74.7% (68/91) showed intermediate susceptibility/resistance and 9.8% (9/92) and 3.3% (3/91) were resistant. Syndromic treatment was administered as follows: 93.1% received 250 mg of ceftriaxone intramuscularly plus 100 mg of doxycycline orally q12h for 1–2 weeks and 6.9% received 500 mg of ciprofloxacin orally plus 100 mg of doxycycline orally q12h for 1 week. Conclusions Ceftriaxone (250 mg) remains appropriate for gonorrhoea treatment in the examined population of men in Kingston, Jamaica. Surveillance of N. gonorrhoeae AMR should be expanded in Jamaica and other Caribbean countries to guide evidence-based treatment guidelines.

Treatment of interictal psychiatric disorder in epilepsy. I. Affective and anxiety disorders

2002 ◽  
Vol 14 (1) ◽  
pp. 39-43 ◽  
Author(s):  
Cm van der Feltz-Cornelis
Keyword(s):  
Anxiety Disorders ◽  
Psychiatric Disorder ◽  
Affective Disorders ◽  
Treatment Guidelines ◽  
Systematic Research ◽  
Evidence Based ◽  
Evidence Based Treatment ◽  
General Psychiatry ◽  
Dsm Iv ◽  
Patients With Epilepsy

Background:Interictal affective disorders are common in patients with epilepsy and there is a need for evidence-based treatment guidelines.Objective:This paper gives an overview of research concerning treatment of interictal affective disorders and interictal anxiety disorders in epilepsy.Methods:Literature review supplemented by clinical experience.Results:Interictal psychiatric disorder can be characterized as intermittent pleomorphic psychopathology. The most common manifestations are interictal dysphoric disorder (IDD) and depression. There is a lack of randomized control trials (RCTs) concerning effectiveness and side-effects of antidepressants in epilepsy patients.Conclusion:Treatment implications of the concept of IDD and other interictal disorders are an optimized dosage of anti-epileptics in combination with antidepressants. This coincides with recent guidelines concerning combinations of psychotropic medication, such as for depression and bipolar disorder, in general psychiatry. Systematic research involving the DSM-IV categories of generalized anxiety disorder, panic disorder and agoraphobia and depression is not yet available. Prevalence and treatment of interictal anxiety disorders and depressive disorder in epilepsy should be the subject of further research, in order to enable development of evidence-based treatment guidelines for these disorders in epilepsy patients.

PTSD Treatment of African American Adults in Primary Care: The Gap Between Current Practice and Evidence-Based Treatment Guidelines

2011 ◽  
Vol 103 (7) ◽  
pp. 585-593 ◽  
Author(s):  
Ruth Elaine Graves ◽  
John R. Freedy ◽  
Notalelomwan U. Aigbogun ◽  
William B. Lawson ◽  
Thomas A. Mellman ◽  
...  
Keyword(s):  
Primary Care ◽  
African American ◽  
Current Practice ◽  
Treatment Guidelines ◽  
Evidence Based ◽  
Evidence Based Treatment ◽  
Ptsd Treatment ◽  
African American Adults

Psychosocial Factors and Diabetes Mellitus: Evidence-Based Treatment Guidelines

2005 ◽  
Vol 1 (3) ◽  
pp. 255-270 ◽  
Author(s):  
Frank Petrak ◽  
Stephan Herpertz ◽  
Christian Albus ◽  
Axel Hirsch ◽  
Bernhard Kulzer ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Psychosocial Factors ◽  
Treatment Guidelines ◽  
Evidence Based ◽  
Evidence Based Treatment

scholarly journals Antimicrobial Susceptibility Patterns in Neisseria gonorrhoeae Isolated from South African Pregnant Women

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Glynis Oree ◽  
Meleshni Naicker ◽  
Hopolang Clifford Maise ◽  
Partson Tinarwo ◽  
Nathlee Samantha Abbai
Keyword(s):  
Neisseria Gonorrhoeae ◽  
Pregnant Women ◽  
Antimicrobial Susceptibility ◽  
Susceptibility Testing ◽  
Treatment Guidelines ◽  
Antimicrobial Susceptibility Testing ◽  
Penicillin G ◽  
Transmitted Infection ◽  
Adverse Pregnancy ◽  
Susceptibility Patterns

Background. Neisseria gonorrhoeae, a sexually transmitted infection, is associated with adverse pregnancy and neonatal outcomes. Emerging resistance towards various antibiotics has been observed globally. However, there is a lack of data on antimicrobial susceptibility patterns in N. gonorrhoeae isolated from pregnant women in our setting. This study fills in this gap in the literature. Methods. The study population included pregnant women, recruited from the antenatal clinic of the King Edward VIII hospital (KEH) in Durban. Endocervical swabs were obtained from 307 women. The swab was placed in Amies Charcoal media for culture assessments. Pure isolates of N. gonorrhoeae were subjected to antimicrobial susceptibility testing using the Etest™ method. The MIC values were assessed in accordance with the European Committee on Antimicrobial Susceptibility Testing (EUCAST, 2019) breakpoints. Results. The prevalence of N. gonorrhoeae by culture was 1.9%. High MIC values to penicillin G (12-64 mg/L) indicating a resistant phenotype were observed for all isolates tested, with 50% of the isolates displaying complete resistance. Isolates with intermediate (1 mg/L) and resistance (1.9-32 mg/L) profiles to tetracycline were observed. Resistance to ciprofloxacin (1.16-3 mg/L) was also observed. Isolates displayed either dual or triple resistance to penicillin G, tetracycline, or ciprofloxacin. All isolates showed susceptibility to spectinomycin (>64 mg/L), azithromycin (1 mg/L), ceftriaxone (>0.125 mg/L), and cefixime (>0.125 mg/L). Conclusion. Despite lack of resistance to ceftriaxone and azithromycin, continuous surveillance for emerging patterns of resistance to these antibiotics is needed since they form part of the treatment guidelines.

A practice transformation model to improve lung cancer care.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 92-92
Author(s):  
Daisy E. Escobar ◽  
Mohd Khushman ◽  
Jennifer Young Pierce ◽  
Cathy Tinnea ◽  
Austin Cadden ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Treatment Guidelines ◽  
Quality Care ◽  
Treatment Decision ◽  
Baseline Period ◽  
Transformation Model ◽  
Molecular Testing ◽  
Evidence Based ◽  
Exact Test ◽  
Evidence Based Treatment

92 Background: Lung cancer has the highest cause of cancer death, treatment of which is both complicated and expensive. Emerging actionable biomarkers and treatments provide both opportunity and treatment challenges. Adherence to evidence-based treatment and advanced care discussions add value to care. Oncology practices need to document the above to participate in value-based care reimbursement models. A Practice Transformation (PT) model was implemented to address quality and cost issues. Methods: After IRB approval, baseline data on lung cancer patients diagnosed during a 6-month period (Jul-Dec 2017) were collected through chart abstraction and treatment planning surveys. Rates of molecular testing ordered, results available at time of treatment decision-making, guideline concordant treatment decisions, and documentation of advanced care discussions were presented to the PT team. After education on recent clinical trial results and NCCN treatment guidelines, the PT team determined strategies for change. The PT team met after two 3-month periods of PT for education updates and progress reports. Data was compared on newly diagnosed patients during a 6-month period (Jul-Dec 2018), one year after the baseline period. Results: A total of forty-two patients were diagnosed in two 6-month periods, baseline and study period. Average age was 65 years, 57% male, 71% Caucasian, 95% ever smokers, 71% adenocarcinoma histology. Rate of ordering any molecular testing was (16/19) 84% in the baseline period vs (20/23) 86% in the study period. However, extended molecular testing increased from 16% (3/19) to 60% (12/20), p = .05 Fishers exact test. At treatment initiation, evidence-based treatment selections went from 47% to 52%. Documentation of advanced care discussions, 42% (8/19) to 56% (13/23), did not change significantly. Conclusions: A PT model that included education, and two cycles of implementation and feedback, resulted in increased molecular testing to inform evidence-based treatment selections. Increased awareness of the lack of documentation of advanced care discussions provides opportunity for continued improvement to effect quality care.

scholarly journals Lack of Adherence to Evidence-based Treatment Guidelines for Nontuberculous Mycobacterial Lung Disease

2014 ◽  
Vol 11 (1) ◽  
pp. 9-16 ◽  
Author(s):  
Jennifer Adjemian ◽  
D. Rebecca Prevots ◽  
Jack Gallagher ◽  
Kylee Heap ◽  
Renu Gupta ◽  
...  
Keyword(s):  
Lung Disease ◽  
Treatment Guidelines ◽  
Evidence Based ◽  
Evidence Based Treatment ◽  
Nontuberculous Mycobacterial Lung Disease

Antimicrobial susceptibility in Neisseria gonorrhoeae isolates from five sentinel surveillance sites in Zimbabwe, 2015–2016

2017 ◽  
Vol 94 (1) ◽  
pp. 62-66 ◽  
Author(s):  
Ahmed S Latif ◽  
Lovemore Gwanzura ◽  
Anna Machiha ◽  
Francis Ndowa ◽  
Andrew Tarupiwa ◽  
...  
Keyword(s):  
Public Health ◽  
Neisseria Gonorrhoeae ◽  
Inhibitory Concentration ◽  
Treatment Guidelines ◽  
Multidrug Resistant ◽  
Health Concern ◽  
National Treatment ◽  
African Region ◽  
Urethral Discharge ◽  
Ciprofloxacin Resistance

ObjectivesGonorrhoea and antimicrobial resistance (AMR) in Neisseria gonorrhoeae are major public health concerns worldwide. Enhanced AMR surveillance for gonococci is essential globally. In Zimbabwe, very limited gonococcal AMR data were reported. Our aims were to (i) implement quality-assured gonococcal AMR surveillance in Zimbabwe and (ii) investigate gonococcal AMR at five health centres in 2015–2016.MethodsGonococcal isolates from 104 men with urethral discharge were tested for susceptibility to kanamycin, ceftriaxone, cefixime, ciprofloxacin and azithromycin using Etest.ResultsAll isolates (102 possible to test) were susceptible to ceftriaxone and cefixime. The level of resistance (intermediate resistance) to kanamycin and ciprofloxacin was 2.0% (2.0%) and 18.6% (27.5%), respectively. The two kanamycin-resistant isolates (R≥128 mg/L) had a kanamycin minimum inhibitory concentration (MIC) of >256 mg/L. The ciprofloxacin resistance ranged from 9.5% to 30.8% in the five sentinel sites. Only 10 (9.6%) of the isolates were tested for susceptibility to azithromycin and 1 (10.0%) was resistant (MIC=4 mg/L).ConclusionsThe emergence of multidrug-resistant gonorrhoea internationally is a major public health concern and gonococcal AMR surveillance is crucial globally. In Zimbabwe, gonococcal AMR surveillance has now been implemented and quality assured according to WHO standards. The results of this first surveillance will be used to directly inform revisions of the national treatment guidelines. It is imperative to further strengthen the surveillance of gonococcal AMR, and ideally also treatment failures, in Zimbabwe and most countries in the WHO African region, which requires continuous national and international support, including technical support, and political and financial commitment.

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