Assessment of the rationale for the use of preventive antibiotic (clindamycin) therapy in patients operated on for anal fistula based on authors’ own experience

Nowa Medycyna ◽  
2021 ◽  
Vol 28 (1) ◽  
Author(s):  
Marzena Kesler ◽  
Aleksandra Koch ◽  
Magdalena Rychlik ◽  
Jacek Bierca ◽  
Małgorzata Kołodziejczak
Keyword(s):  
Antibiotic Therapy ◽  
Anal Fistula ◽  
General Surgery ◽  
Anaerobic Bacteria ◽  
Bacterial Pathogen ◽  
Primary Treatment ◽  
Antimicrobial Treatment ◽  
County Hospital ◽  
Common Causes ◽  
Variable Sensitivity

Introduction. Bacterial infection of the anal glands has been considered the main cause of anal fistulae for many years. Other most common causes include Crohn’s disease, ulcerative colitis, any type of immunosuppression (e.g. HIV infection, immunosuppressants), foreign bodies, and injuries. Studies assessing the type of bacterial pathogen involved in the formation of an anal fistula are sparse. Furthermore, it seems that although surgery remains the primary treatment of the disease, the importance of treating cryptic infection and the use of antibiotic therapy based on culture findings seems underestimated. Aim. The aim of this study was to assess the rationale for the use of preventive antibiotic therapy in patients after proctological surgeries. Material and methods. In the period from January 1 to December 31, 2019, 46 patients (40 men, 6 women) aged 28 to 71 years (mean age 49 years) were operated on at the Department of General Surgery of the County Hospital in Ostrów Mazowiecka for anal fistulae. All patients were operated on by the same surgeon experienced in proctological surgery. Bacterial cultures were collected intraoperatively and preventive antibiotic therapy in the form of IV clindamycin 2 × 600 mg was used in all patients. Results. A large number of Bacteroides spp. showed high resistance (88%) to clindamycin. Anaerobic bacteria showed 60% resistance to clindamycin. Conclusions. 1. Clindamycin should not be used in preventive antimicrobial treatment in patients undergoing surgical treatment for anal fistula in the Department of General Surgery of the County Hospital in Ostrów Mazowiecka. 2. The variable sensitivity of bacteria to antimicrobials should be considered and antibiotic prophylaxis should be changed depending on the resistance developed to the subsequent antibiotics used.

scholarly journals Management of acute streptococcal pharyngitis: still the subject of controversy

Open Medicine ◽  
2013 ◽  
Vol 8 (6) ◽  
pp. 713-719 ◽  
Author(s):  
Elżbieta Mazur
Keyword(s):  
Antibiotic Therapy ◽  
Group A Streptococcus ◽  
Scientific Evidence ◽  
Bacterial Pathogen ◽  
Streptococcal Pharyngitis ◽  
Antimicrobial Treatment ◽  
Acute Pharyngitis ◽  
Drug Of Choice ◽  
European Guidelines ◽  
Microbiological Testing

AbstractAlthough most cases of acute pharyngitis are viral in origin, antibiotics are overused in its treatment. Streptococcus pyogenes (group A streptococcus, GAS), the principal bacterial pathogen of acute sore throat, is responsible for merely 5–30% of cases. Moreover, GAS pharyngitis is currently the only commonly occurring form of acute pharyngitis for which antibiotic therapy is definitely indicated. Therefore the differentiation between GAS pharyngitis and that of viral etiology is crucial. Accordingly, scientific societies as well as respected advisory bodies in Europe and North America, issued guidelines for the management of acute pharyngitis with the aim of minimizing unnecessary antibiotic prescriptions in its treatment. The aim of this review work is to confront the state of the art in acute GAS pharyngitis diagnosis and treatment with different approaches to its management represented by current European and North American guidelines. Although based on scientific evidence, international guidelines differ substantially in opinions whether GAS pharyngitis diagnosis should be based on microbiological testing, clinical algorithm or a combination of both. On the other hand, some European guidelines consider GAS pharyngitis to be a mild, self-limiting disease that does not require a specific diagnosis or antimicrobial treatment except in high-risk patients. There is an agreement among guidelines that if antibiotic therapy is indicated, phenoxymethyl penicillin should be the drug of choice to treat GAS pharyngitis.

Microbiology and Antimicrobial Treatment of Otitis Media

1981 ◽  
Vol 90 (3_suppl2) ◽  
pp. 30-36 ◽  
Author(s):  
Jerome O. Klein
Keyword(s):  
Otitis Media ◽  
Antimicrobial Agents ◽  
Anaerobic Bacteria ◽  
Initial Therapy ◽  
Antimicrobial Treatment ◽  
Young Infants ◽  
Asymptomatic Children ◽  
Group A ◽  
And Staphylococcus Aureus ◽  
Current Incidence

Appropriate choice of antimicrobial agents for therapy of otitis media (OM) is based on an understanding of the microbiology of the acute and chronic diseases. The results of studies of bacteriology of OM are very similar: Streptococcus pneumoniae and Hemophilus in fluenzae are the most important pathogens; Gram-negative enteric bacilli are isolated from middle ear fluids (MEF) of approximately 20% of infants to 6 weeks of age; group A β-hemolytic Streptococcus and Staphylococcus aureus are infrequent causes of otitis. Preliminary results suggest that anaerobic bacteria are responsible for some episodes of OM. Viruses and mycoplasma are infrequently isolated from MEF but Chlamydia trachomatis appears to be a significant cause of OM in young infants. Recent studies of asymptomatic children with persistent MEF indicate that bacterial pathogens are present in some of these fluids. The significance of these results is uncertain, but they suggest that the persistent effusion may be a result of prolonged infection or may be an immune response to bacterial antigens. Based on the bacteriology, amoxicillin or ampicillin are the currently preferred drugs for initial treatment of otitis media. For the child who is allergic to penicillins, cefaclor or erythromycin combined with a sulfonamide or trimethoprim-sulfamethoxazole are satisfactory alternatives. The current incidence of ampicillin-resistant H influenzae responsible for OM is low but if the patient does not respond to initial therapy with ampicillin or amoxicillin, infection with a resistant strain of H influenzae should be considered and a change in therapy to include a sulfonamide, trimethoprim-sulfamethoxazole or cefaclor is appropriate.

scholarly journals Evaluation of tularemia cases focusing on the oculoglandular form

2014 ◽  
Vol 8 (10) ◽  
pp. 1277-1284 ◽  
Author(s):  
Sebnem Eren Gok ◽  
Aysel Kocagul Celikbas ◽  
Nurcan Baykam ◽  
Ayse Atay Buyukdemirci ◽  
Mustafa Necati Eroglu ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Clinical Findings ◽  
Antimicrobial Treatment ◽  
Ocular Involvement ◽  
Systemic Antibiotic Therapy ◽  
Appropriate Treatment ◽  
Microagglutination Test ◽  
The Subject ◽  
The Mean ◽  
Topical Antimicrobial

Introduction: Tularemia is a zoonotic disease caused by Francisella tularensis. The oculoglandular form is one of the rarest forms. In this study, evaluated tularemia patients, focusing on the ocular form and the efficacy of early antibiotic therapy. Methodology: During a tularemia outbreak, the epidemiological and clinical findings, laboratory assays, and drugs used for the treatment of 48 patients were recorded prospectively. The diagnosis of tularemia was confirmed with microagglutination test (MAT) as well as clinical findings. Results: The mean age of the subject was 48.6 years; 23 (47.9%) of them were female. Thirty-six (81.25%) patients had clinical presentation compatible with oropharyngeal tularemia, seven (14.58%) with oculoglandular tularemia, and two (4.1%) with ulceroglandular tularemia. The most common symptoms were fever (91.6%) and sore throat (81.2%), and the most common findings were lymphadenopathy (91.6%) and tonsillopharyngitis (81.2%). In the oculoglandular form, fever, lymphadenopathy, periorbital edema, conjunctival injection, and chemosis were found. The most distinctive ophthalmic feature was follicular conjunctivitis and conjunctival epithelial defects. Forty-five cases had positive serological results with MAT. All the patients were treated with antibiotics considered effective against F. tularensis, and topical antimicrobial treatment was given to the patients with oculoglandular tularemia. Twenty-six (54.16%) patients, who were admitted within three weeks of the onset of symptoms, recovered without sequel. Conclusions: During tularemia outbreaks, ocular involvement should be considered carefully. The early administration of appropriate treatment will be more effective in resolving the infection and preventing complications. Along with systemic antibiotic therapy, topical treatment will help recovery.

scholarly journals EP.TU.740Implementing a departmental handbook to improve induction for FY1s during COVID-19 pandemic

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Jessica Annett ◽  
Tabitha Neminathan ◽  
Simon Fisher ◽  
Barney Stephenson PhD
Keyword(s):  
General Surgery ◽  
Multiple Choice ◽  
County Hospital ◽  
Free Text ◽  
Crucial Information ◽  
Net Promoter ◽  
The Impact ◽  
Question Survey ◽  
Discharge Summaries

Abstract Aims The 2020 cohort of FY1s qualified during the COVID-19 pandemic; most prequalification placements were cancelled. Induction provides crucial information for new FY1s. We assessed the impact of redesigning the General Surgery induction handbook at Hereford County Hospital. Methods A 40-question survey, designed against standards in ’Recommendations for safe trainee changeover’ published by the Academy of Medical Royal Colleges, was sent to all FY1s commencing General Surgery in August 2020 two weeks following induction. The survey contained 5 sections: introduction; testing your knowledge parts A and B; team atmosphere; and demographics. Answer modalities included: binary answer; multiple choice; Net Promoter Scores (NPS); and free text. Submissions were made electronically via Microsoft Forms. Feedback guided redesign of the induction handbook which was sent to FY1s rotating December 2020. Information included: how to contact seniors; requesting investigations; referring to specialties and expected duties. A repeat survey was sent to FY1s 4 weeks following induction. Results 10/11 FY1s responded during the first rotation; 9/11 during the second. FY1s felt more confident requesting bloods (NPS +50 to + 90), requesting imaging (NPS –20 to + 70), completing discharge summaries (NPS +30 to + 80) and referring to specialties (NPS –40 to + 60). There was a better understanding of different shift types (NPS –40 to + 30). More FY1s correctly recalled on call bleeps for the medical registrar (from 56% to 75%) and the anaesthetic registrar (from 50% to 78%). Most (78%, NPS +78) felt they had enough support from other FY1s which remained the same (NPS +78) through the second rotation. As a result of the COVID-19 pandemic, prequalification experience varied greatly between individual FY1s. Conclusion Overall, FY1s were more confident requesting investigations, referring to other specialties and completing discharge summaries after redesign of the induction handbook. Considering disruptions in pre-qualification training as a result of the COVID-19 pandemic, a thorough departmental induction handbook can be an invaluable resource tool to aid rotation into a new specialty.

scholarly journals Evaluation of Secondary Chronic Suppurative Osteomyelitis of Jaw in 15 Cases: A Retrospective Analysis

2021 ◽  
Author(s):  
Varsha Manekar ◽  
Vandana Gadve ◽  
Vijaya Dhote ◽  
Sulabha Radke
Keyword(s):  
Antibiotic Therapy ◽  
Chronic Osteomyelitis ◽  
Imaging Techniques ◽  
Demographic Data ◽  
Correct Diagnosis ◽  
Maxillofacial Surgery ◽  
Signs And Symptoms ◽  
Oral And Maxillofacial Surgery ◽  
Odontogenic Infections ◽  
Common Causes

Introduction: Chronic osteomyelitis may become a refractory condition and is more difficult to treat. Therefore, for correct diagnosis and evaluation of chronic osteomylitis, primary health care practitioners must have knowledge of signs and symptoms associated with osteomyelitis for effective management. Aim: To evaluate secondary chronic suppurative osteomyelitis of jaw in 15 cases. Materials and Methods: This was a retrospective study of all patients treated for maxillo-mandibular secondary chronic osteomyelitis over a period of six years (January 2013 to December 2018) in Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Nagpur, Maharashtra, India. This study was carried out in between November 2019 to November 2020. A total of fifteen cases were identified which were diagnosed as Secondary Chronic Suppurative Osteomyelitis (SCO) and treated for same. The cases were evaluated for demographic data, risk factors, aetiology, clinical presentation, radiological findings and the management. Data was collected through retrospective search of records and was arranged in descriptive tabular format without statistical analysis. Results: Out of 15 cases 9 (60%) were female. The patients ranged in age from 21 to 56 years with a mean age of 36.6±9.0 years. The mean age at first symptoms was 35.5 years (20-55), with a standard deviation of 9.12 years. The distribution of osteomyelitis in the jaws was dominated by the cases that occurred in the mandible i.e., 73.33% (11 cases) and the maxilla 26.66% (four cases) with most common involved site was body and angle region of mandible (eight cases) followed by premolar region two cases and anterior region one case. In this study, five cases (33.33%) had carious lesion and seven cases (46.67%) had infected extraction socket. Other causes of infection were osteoradionecrosis in one case and superimposed infection like mucormycosis in two cases. The most common causes of chronic osteomyelitis of the jaws were directly related to odontogenic infections like infected unhealed socket. Decortication and curettage was done in four cases. Decortication and sequestrectomy were performed in five cases and debridement of necrosed bone in three cases. Sinus opening, debridement of necrosed wall and packing were done in three cases of SCO involving maxilla. Duration of antibiotic therapy in all patients averaged five weeks. Conclusion: The accurate diagnosis with the help of recent imaging techniques, adequate antibiotic therapy as well as surgical treatment was keys for the success of SCO management.

Treatment of mucosa-associated lymphoid tissue lymphoma of the stomach with radiation alone.

1998 ◽  
Vol 16 (5) ◽  
pp. 1916-1921 ◽  
Author(s):  
N R Schechter ◽  
C S Portlock ◽  
J Yahalom
Keyword(s):  
Side Effects ◽  
Antibiotic Therapy ◽  
Lymphoid Tissue ◽  
Low Dose ◽  
Complete Response ◽  
Primary Treatment ◽  
Low Grade ◽  
Low Dose Radiotherapy ◽  
H Pylori

PURPOSE Mucosa-associated lymphoid tissue (MALT) lymphoma of the stomach (MLS) has recently been defined as a distinct clinicopathologic entity, often associated with Helicobacter pylori infection. Many regard antibiotic therapy as the primary treatment of MLS, but in the absence of H pylori infection, or when salvage of antibiotic failures is required, gastrectomy and/or chemotherapy have frequently been used. This study evaluates the efficacy of low-dose radiotherapy alone as an alternative to surgery. PATIENTS AND METHODS Seventeen patients with stage I to II(2) low-grade MLS without evidence of H pylori infection or with persistent lymphoma after antibiotic therapy of associated H pylori infection were included in this series. Median age was 69 years (range, 39 to 84). Median total radiation dose was 30 Gy (range, 28.5 to 43.5 Gy) delivered in 1.5-Gy fractions within 4 weeks to the stomach and adjacent lymph nodes. Following treatment, all patients underwent endoscopic evaluation and biopsy at a median of 4 months, at 6-month intervals to 2 years, and annually thereafter. RESULTS All obtained a biopsy-confirmed complete response. At a median follow-up time of 27 months (range, 11 to 68) from completion of radiotherapy, event-free survival was 100%. Treatment was well tolerated, with no significant acute side effects. All remained asymptomatic at last follow-up. CONCLUSION These results suggest that effective treatment of MLS with low-dose radiation therapy alone is feasible and safe, and allows stomach preservation. Longer follow-up evaluation is required to determine the long-term efficacy of this treatment approach and its side effects. Further studies should clarify the indications for radiotherapy in H pylori-negative or antibiotic-resistant cases of MLS.

Empirical antibiotic therapy of complicated skin and soft tissue infections in dermatological practice

2011 ◽  
Vol 152 (7) ◽  
pp. 252-258
Author(s):  
Andrea Magyar ◽  
Edina Garaczi ◽  
Edit Hajdú ◽  
Lajos Kemény
Keyword(s):  
Soft Tissue ◽  
Antibiotic Therapy ◽  
Streptococcus Pyogenes ◽  
Anaerobic Bacteria ◽  
Empirical Therapy ◽  
Soft Tissue Infections ◽  
Empirical Antibiotic Therapy ◽  
Gram Negative ◽  
First Choice ◽  
Complicated Skin

Erysipelas is an acute bacterial infection of the skin predominantly caused by Streptococcus pyogenes. According to the international classification complicated erysipelas belongs to the complicated skin and soft tissue infections. Complicated infections are defined as severe skin involvement or when the infection occurs in compromised hosts. These infections frequently involve Gram-negative bacilli and anaerobic bacteria. Aims: The aim of this study was to compare the efficacy of the empirical antibiotic therapy for the patients who were admitted to the Department of Dermatology and Allergology, University of Szeged. Methods: The empirical therapy was started according to a previously determined protocol. The data of 158 patients with complicated skin and soft tissue infections were analyzed and the microbiology culture specimens and the isolates were also examined. Results and conclusions: The results show that penicillin is the first choice for the treatment of erysipelas. However, the complicated skin and soft tissue infections require broad-spectrum antibiotics. Orv. Hetil., 2011, 152, 252–258.

Etiology and Antimicrobial Treatment of Acute Sinusitis

1981 ◽  
Vol 90 (3_suppl2) ◽  
pp. 68-71 ◽  
Author(s):  
Jack M. Gwaltney ◽  
Austin Sydnor ◽  
Merle A. Sande
Keyword(s):  
Maxillary Sinusitis ◽  
Anaerobic Bacteria ◽  
Antimicrobial Treatment ◽  
Acute Sinusitis ◽  
X Ray ◽  
Parainfluenza Viruses ◽  
Inappropriate Treatment ◽  
Dental Origin ◽  
The Face

Acute maxillary sinusitis is a disease of varied etiology. Over half of the cases are caused by Streptococcus pneumoniae and Hemophilus influenzae. Anaerobic bacteria account for another 10% of cases and these are usually of dental origin. The rest of the cases are caused by several other bacteria, each of which cause a small proportion. Rhinoviruses, influenza, and parainfluenza viruses also in-vade the sinuses and probably lead to secondary bacterial infection. Diagnosis of acute sinusitis on clinical grounds is difficult. Sinus transillumination and x-ray are the most valuable routine tests available. Ampicillin, amoxicillin, trimethoprim-sulfamethoxazole, and cefaclor have been shown to be effective treatment for most cases of acute sinusitis. Infection persists when there is inadequate or inappropriate treatment. The patient may become relatively asymptomatic in the face of persistent active infection. Follow-up clinical and x-ray examinations are indicated, when possible, to detect treatment failures. Although not a routine diagnostic procedure, sinus puncture and aspiration may be of value in the seriously ill patient or one who has not responded to treatment.

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