Category Hospital practice
Lablogatory – medical pathology unpacked – a great clinical resource
If you have a curiosity about what actually goes on in a medical pathology lab. and matters pathological, then this is the site for you. There are fabulous clinical case presentations with detailed pathological correlation (many great photos) – just the thing for medical post graduate students but also great for others involved with diagnosis and treatment […]
Wasted spectrum 101 – amoxicillin+clavulanate overuse
Amoxicillin+clavulanate (Augmentin) is an important broad spectrum agent that includes Gram negative anaerobic coverage (see below). We rely on it for a variety of complex infections, often as a second line. Compared with amoxycillin alone, the incidence of gastrointestinal, hepatic and haematological side effects is significantly higher for amoxicillin+clavulanic acid. It may be associated with a […]
Sparing meropenem 101: what alternatives exist for the treatment of ESBL-producers?
Guest post: Patrick Harris, Staff Specialist in Microbiology, Central Laboratory, Pathology Queensland, Brisbane In a previous post we looked at bacteria that produce AmpC-type beta-lactamases, such as Enterobacter spp. Perhaps a more familiar, and increasingly common, problem is presented by species such as E. coli or K. pneumoniae, which have acquired extended-spectrum beta-lactamase enzymes (or ‘ESBLs’). […]
More Choosing Wisely recommendations released today
Choosing Wisely Australia is an organisation that aims to improve the quality of healthcare provided to Australians by urging healthcare providers to reconsider tests, procedures or treatments where the evidence suggests no benefit or may lead to harm in some cases. Today the organisation released 50 new recommendations from 12 new Australian professional bodies to […]
Antimicrobial prophylaxis, quinolone resistance and prostate biopsy safety
Guest post: Patrick Harris, Staff Specialist in Microbiology, Central Laboratory, Pathology Queensland, Brisbane Overseas travel and prostate biopsies: a key risk-factor for infectious complications with multi-drug resistant bacteria Given an ageing population and the current reliance upon PSA testing to screen for prostate cancer, patients are increasingly being referred for trans-rectal ultrasound (TRUS)-guided prostate biopsies. Millions […]
Antibiotics and the QT Interval
Guest post : Ian Whyte, Professor of Clinical Pharmacology at Calvary Mater Newcastle and University of Newcastle Case report (Knorr et al 2008 Ciprofloxacin-induced Q-T interval prolongation) 16-year-old boy was admitted for the treatment of an acute flare of Crohn’s disease and a perirectal abscess. The patient was started on ciprofloxacin 400 mg IV twice daily […]
Appendicitis and antibiotics unpacked
Guest posting: Dr Celia Cooper, Paediatric Infectious Diseases & Microbiology, South Australia Pathology, Adelaide Dr Cooper’s recent presentation to the Australian New Zealand Paediatric Infectious Diseases Interest Group in November is provided with her permission. Her presentation highlights important messages: Post-operative antibiotics for patients with non-perforated appendicitis who have acute surgery are unnecessary (refer to IDSA Guidelines […]
Tell me about your ‘Penicillin Allergy’ ….
Guest posting: Dr Kathryn Patchett, Staff Specialist (Immunology), Pathology North. A dilemma Penicillin allergy* is the most commonly reported drug allergy with up to 10% of patients reporting some kind of allergy [1-4]. Penicillin allergy is also among the leading cause of drug induced anaphylaxis, including fatalities (although fortunately the later are comparatively rare). Such […]
Alternative recommended antibiotics to ceftriaxone by syndrome and bug
Ceftriaxone (a third generation cephalosporin-TGC) remains an overused agent in some of our (HNELHD) facilities. We aim to keep usage below 20 defined daily doses per 1000 patient-days (as is done at John Hunter Hospital for instance) to prevent adverse ecological impacts on resistance – increases in MRSA, VRE, multi-resistant Gram negatives and C. difficile are all associated […]
Magical thinking- do antibiotics improve chronic wound healing?
We’ve previously addressed this topic here. It’s certainly the case that chronic skin ulcers (leg or elsewhere) drive an enormous amount of antibiotic prescribing, perhaps because these ulcers are so hard to heal and a degree of therapeutic impatience occurs. The annual survey of chronic wounds last year in our health district indicated that 28% of inpatients […]