Antibiotics

Study protocol for a Multi-centre, Investigator-initiated, Randomized Controlled Trial to Compare the Effects of Prehospital Antibiotic Treatment for Sepsis Patients with Usual Care after Training Emergency Medical Services (EMS) Personnel in Early Recognition (– The Prehospital ANTibiotics Against Sepsis (PHANTASi) trial

Research Audit and Clinical Practice, Volume 15, Issue 4, Pages 165 – 220 (2016)

Abstract

Introduction: Sepsis is one of the most frequent reasons for referral to emergency departments (EDs) worldwide. Sepsis becomes more serious when left untreated with a high mortality rate, exceeding even those of myocardial infarction and stroke. Therefore, much effort has been put in to start with appropriate therapy as early as possible. Emergency medical services (EMS) personnel have already made a significant difference in improving care for patients with acute coronary syndrome, multiple trauma and stroke. Patients with severe sepsis or septic shock could also benefit from timely prehospital care. Earlier recognition and initiation of treatment by EMS personnel may improve survival of these critically ill patients.

Methods and analysis: The Prehospital Antibiotics against Sepsis (PHANTASi) trial is an investigator- initiated, multicentre, randomized controlled open-label clinical trial nested within a step wedge design. This study compares the effects of usual care to that of training EMS personnel in recognizing and initiating treatment in the prehospital setting together with early administration of antibiotics for patients suspected of (severe) sepsis and septic shock. Primary outcome is 28 day mortality. Secondary outcomes include, length of hospital stay and admission to intensive care units.

Ethics and dissemination: This study has been approved by the research ethics committee of VU University Medical Centre, Amsterdam, The Netherlands (Protocol 2013.458/ NL 42001.029.13). The results of the study will be disseminated at several research conferences and international peer reviewed journals. The study will be implemented and reported in line with the CONSORT statement.

Please subscribe to see more.
Subscribe
Already a member? Log in here

Study protocol for a Multi-centre, Investigator-initiated, Randomized Controlled Trial to Compare the Effects of Prehospital Antibiotic Treatment for Sepsis Patients with Usual Care after Training Emergency Medical Services (EMS) Personnel in Early Recognition (– The Prehospital ANTibiotics Against Sepsis (PHANTASi) trial Read More

Effectiveness of early antibiotic administration in septic patients with cancer

Research Audit and Clinical Practice, Volume 12, Issue 4, Pages 185 - 252 (2013)

Abstract

Introduction: First dose intravenous antimicrobial therapy should be administered within 1 hour of admission but this is achieved in a minority of patients..

Methods: We performed a retrospective analysis at the largest Oncology hospital in Europe. Nurse-led administration of initial antibiotic therapy was introduced to the admissions unit.

Results: The nurse led protocol increased compliance with the 1 hour target from 40% to 88.6%. There was a statistically significant decrease in the mean length of stay (p=0.045) which was more pronounced in the neutropenic population (p=0.006). There was a trend to improved 30 day mortality.

Conclusions: A nurse led protocol can be effective in improving compliance with the 1 hour target. Early administration of intravenous antibiotics in cancer patients with sepsis is associated with a shorter length of inpatient stay and a trend to decreased mortality.

Please subscribe to see more.
Subscribe
Already a member? Log in here

Effectiveness of early antibiotic administration in septic patients with cancer Read More

Management of Exacerbation of COPD

Clinical Reviews, Volume 7, Issue 1, Pages 1 - 60 (2008)

COPD is a progressive debilitating lung condition the clinical course of which is punctuated by acute severe increases in symptoms (exacerbations). These can be life threatening and are a considerable cause of morbidity and mortality as well as frequently requiring hospital admission. The aims of treatment are to prevent attacks through vaccination, smoking cessation, appropriate medication, the provision of pulmonary rehabilitation and also patient education. During an attack treatment should be provided in the most suitable place for the individual (home or hospital) and consists of an accurate diagnosis, clinical assessment and the provision of bronchodilators, corticosteroids and antibiotics where appropriate. More severe attacks necessitating hospital assessment and admission may require ventilatory support and even intensive care. Where possible patients should be involved in decision making, particularly with regard to treatment and a possible ceiling of care.

Please subscribe to see more.
Subscribe
Already a member? Log in here

Management of Exacerbation of COPD Read More

The Management of Community Acquired Pneumonia

Clinical Reviews, Volume 7, Issue 1, Pages 1 - 60 (2008)

Community acquired pneumonia (CAP) is a common cause of hospital admission. The first 24–48 hours are crucial in the correct diagnosis and management of CAP. In this article we highlight the pitfalls in diagnosis and the important management steps. The correct assessment of severity with CURB65 scoring, proper supportive measures and appropriate antibiotics are key to effective treatment of CAP.

Please subscribe to see more.
Subscribe
Already a member? Log in here

The Management of Community Acquired Pneumonia Read More

Principles and Practice of Antibiotic Therapy for Cellulitis

Original Articles, Volume 1, Issue 2, Pages 33 - 76 (2002)

Abstract

Cellulitis is a common medical emergency. Investigations often fail to establish the specific microbial aetiology and there are few data to support common choices of antibiotic therapy used to treat cellulitis. Potentially unusual pathogens can be predicted from the epidemiological circumstances at presentation, while empirical treatment choices must be based on an understanding of the underlying pharmacokinetic and pharmacodynamic principles that govern antibiotic-microbe interactions. Animal models have established conditions that predict treatment success, taking into account confounding factors such as bacterial inoculum size. Synergistic combinations of antibiotics can improve outcome in difficult cases.

Please subscribe to see more.
Subscribe
Already a member? Log in here

Principles and Practice of Antibiotic Therapy for Cellulitis Read More

Shopping Basket
Scroll to Top

Start typing and press enter to search

Start typing and press enter to search