Practical Experience with Clinical Algorithms for Reducing Unnecessary Antibiotic Use in the Management of Streptococcal Pharyngitis

2003 ◽  
pp. 36-48
Author(s):  
W.J. McIsaac
Keyword(s):  
Antibiotic Use ◽  
Practical Experience ◽  
Streptococcal Pharyngitis ◽  
Clinical Algorithms

scholarly journals Evidence of the Efficacy of Flurbiprofen 8.75 mg Lozenges for Patients Receiving Antibiotics for Laboratory-Confirmed Streptococcal Pharyngitis

2021 ◽  
pp. 014556132110257
Author(s):  
Bernard Schachtel ◽  
Adrian Shephard ◽  
Emily Schachtel ◽  
Tim Shea ◽  
Adam Smith ◽  
...  
Keyword(s):  
Antibiotic Treatment ◽  
Streptococcal Infection ◽  
Analgesic Efficacy ◽  
Antibiotic Use ◽  
Streptococcal Pharyngitis ◽  
Antibiotic Administration ◽  
Serious Adverse Events ◽  
Double Blind ◽  
Acute Pharyngitis ◽  
Throat Pain

Objectives: To determine the efficacy of flurbiprofen 8.75 mg lozenges for patients with laboratory-confirmed streptococcal pharyngitis both before and concomitant with antibiotics. Methods: This post hoc analysis comprised adult participants from 2 earlier randomized, double-blind, placebo-controlled studies evaluating the analgesic efficacy of flurbiprofen 8.75 mg lozenges in acute pharyngitis. Throat swabs were obtained to diagnose streptococcal infection. Prior to and 2 hours after each dose of study medication (flurbiprofen or placebo lozenges), patients rated 3 symptoms of acute pharyngitis (sore throat pain, difficulty swallowing, and swollen throat) using visual analogue scales. Appropriate antibiotic treatment was initiated when culture results were reported. Mean changes in each pharyngeal symptom were compared over the immediate 24 hours before and during the initial 24 hours of antibiotic treatment. Results: Twenty-four patients provided both preantibiotic and concomitant antibiotic efficacy outcomes. Relief of throat pain was 93% greater in the flurbiprofen group than in the placebo group before antibiotic coadministration and 84% greater than placebo during antibiotic administration (both P < .05). Relief of difficulty swallowing was 71% greater in the flurbiprofen group than in the placebo before antibiotic administration (P = .16) and 107% greater during concomitant antibiotic administration (P = .04). Relief of the sensation of throat swelling was 295% greater with flurbiprofen than placebo before antibiotic administration (P = .008) and 70% greater during concomitant antibiotic administration (P = .06). For placebo-treated patients, relief from throat pain and difficulty swallowing were similar before and during antibiotic treatment (P > .05), indicating no benefit with antibiotic administration for these symptoms. No treatment-related discontinuations or serious adverse events were reported. Conclusions: Irrespective of antibiotic use, flurbiprofen 8.75 mg lozenges provide well-tolerated, effective relief of pharyngeal symptoms in patients with streptococcal infection. In the 24 hours after administration, antibiotics provide no relief of throat pain or difficulty swallowing beyond the topical demulcent effects of placebo lozenges.

scholarly journals Single-centre, open-label, randomised, trial to compare rapid molecular point-of-care streptococcal testing to standard laboratory-based testing for the management of streptococcal pharyngitis in children: study protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e047271
Author(s):  
Jeffrey M Pernica ◽  
Fiona Smaill ◽  
April J Kam ◽  
Amy Bartholomew ◽  
Quynh Doan ◽  
...  
Keyword(s):  
Point Of Care ◽  
Randomised Trial ◽  
Antibiotic Use ◽  
Streptococcal Pharyngitis ◽  
Primary Study ◽  
Standard Laboratory ◽  
Open Label ◽  
Caregiver Satisfaction ◽  
Clinician Satisfaction ◽  
Antigen Tests

IntroductionStreptococcal pharyngitis, which commonly occurs in children, should be treated with antibiotics. Clinical prediction rules to differentiate streptococcal pharyngitis from viral infection are not recommended in children. Rapid point-of-care (POC) antigen tests have limited sensitivity and so are not often used in Canadian paediatric emergency departments (EDs). Standard paediatric practice is to rely on laboratory-based testing, which often results in a delay before the results can be communicated to the patient; this may impede appropriate prescribing, decrease caregiver satisfaction and delay recovery. The objective of this study is to determine whether a novel rapid molecular POC assay for streptococcal pharyngitis leads to more appropriate antibiotic use in children seeking care in a paediatric ED than standard laboratory-based testing.Methods and analysisA randomised, superiority, open-label, trial with two parallel groups. Children presenting to a tertiary paediatric ED at least 3 years of age who have a throat swab ordered for diagnosis of streptococcal pharyngitis will be eligible; those who have taken antibiotics within 72 hours prior to presentation and those with additional active infections will be excluded. The primary study outcome will be appropriate antibiotic treatment at 3–5 days postenrolment. Secondary outcomes include time to symptom resolution, caregiver satisfaction, caregiver/child absenteeism, number of subsequent healthcare visits, clinician satisfaction and incremental cost-effectiveness of POC testing. A total of 352 participants will be needed.Ethics and disseminationAll study documentation has been approved by the Hamilton Integrated Research Ethics board and informed consent will be obtained from all participants. Data from this trial will be presented at major conferences and published in peer-reviewed publications to facilitate collaborations with networks of clinicians experienced in the dissemination of clinical guidelines.Trial registration numberNCT04247243.

The Fundamentals of the Clinical Fellowship Experience

2016 ◽  
Vol 1 (11) ◽  
pp. 81-85
Author(s):  
Melanie Hudson
Keyword(s):  
Growth And Development ◽  
Transition Period ◽  
Clinical Skills ◽  
Practical Experience ◽  
Professional Experience ◽  
New Graduate ◽  
Independent Practitioner

The Clinical Fellowship Experience is described by the American Speech-Hearing-Language Association (ASHA) as the transition period from constant supervision to independent practitioner. It is typically the first paid professional experience for the new graduate, and may be in a setting with which the new clinician has little or even no significant practical experience. The mentor of a clinical fellow (CF) plays an important role in supporting the growth and development of this new professional in areas that extend beyond application of clinical skills and knowledge. This article discusses how the mentor may provide this support within a framework that facilitates the path to clinical independence.

AHA: Streptococcal Pharyngitis

2009 ◽  
Vol 39 (8) ◽  
pp. 17
Author(s):  
NEIL SKOLNIK ◽  
MATHEW CLARK
Keyword(s):  
Streptococcal Pharyngitis

Towards the digital land reclamation

2020 ◽  
pp. 5-9
Author(s):  
Sergey Vasil'ev ◽  
Vyacheslav Schedrin ◽  
Aleksandra Slabunova ◽  
Vladimir Slabunov
Keyword(s):  
Retrospective Analysis ◽  
Land Reclamation ◽  
Practical Experience ◽  
Maximum Effect ◽  
Optimal Management ◽  
Scientific Potential ◽  
History Of ◽  
Definition Of ◽  
Further Development ◽  
Full Cooperation

The aim of the research is a retrospective analysis of the history and stages of development of digital land reclamation in Russia, the definition of «Digital land reclamation» and trends in its further development. In the framework of the retrospective analysis the main stages of melioration formation are determined. To achieve the maximum effect of the «digital reclamation» requires full cooperation of practical experience and scientific potential accumulated throughout the history of the reclamation complex, and the latest achievements of science and technology, which is currently possible only through the full digitalization of reclamation activities. The introduction of «digital reclamation» will achieve greater potential and effect in the modernization of the reclamation industry in the «hightech industry», through the use of innovative developments and optimal management decisions.

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