Treatment of infective endocarditis
Discussion of whole list of options of antimicrobials for different varieties of endocarditis is quite a large topic. This discussion is only a broad outline of the antimicrobial treatment of infective endocarditis, meant mainly for exam purpose rather than actual clinical treatment. References to more detailed guidelines have been provided for those who wish to learn more.
Inoculum Effect
High microbial density as in vegetations cause less antimicrobial activity of some antimicrobial agents. This is known as inoculum effect and has been documented with β-lactams and glycopeptides but not linezolid, in the treatment of St...
Source: Cardiophile MD - July 16, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
Clinician-Led Stewardship To Curb Medical Excess
In a recent New England Journal of Medicine (NEJM) perspective, Durand and colleagues propose “medical-imaging stewardship.” They believe that imaging can be more appropriately used through “provider-led imaging stewardship,” based on the model of antimicrobial stewardship.
Antimicrobial stewardship is a hospital program composed of an expert pharmacist and infectious disease physician. Its goal is to improve appropriateness of antimicrobial use through restriction of antibiotics, post-prescription review, and education. Clinician-led stewardship could limit overuse and improve care beyond antimicrobial use or imag...
Source: Health Affairs Blog - November 30, 2015 Category: Health Management Authors: Dan Morgan Tags: Costs and Spending Health Professionals Hospitals Innovations in Care Delivery Medicare Quality antimicrobials Choosing Wisely Patient Safety patient uses of evidence Physicians Source Type: blogs
A New Look at Phenotypic Screening
There have been several analyses that have suggested that phenotypic drug discovery was unusually effective in delivering "first in class" drugs. Now comes a reworking of that question, and these authors (Jörg Eder, Richard Sedrani, and Christian Wiesmann of Novartis) find plenty of room to question that conclusion.
What they've done is to deliberately focus on the first-in-class drug approvals from 1999 to 2013, and take a detailed look at their origins. There have been 113 such drugs, and they find that 78 of them (45 small molecules and 33 biologics) come from target-based approaches, and 35 from "systems-based" appro...
Source: In the Pipeline - August 26, 2014 Category: Chemists Tags: Drug Assays Source Type: blogs
MKSAP: 52-year-old man with fatigue and fever
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 52-year-old man is admitted to the hospital with fatigue and fever of 3 days’ duration. He is a health care worker and has a bicuspid aortic valve. He takes no medications.
Blood cultures are obtained at the time of admission, and he is started on empiric vancomycin for possible endocarditis.
On hospital day 2, his initial blood cultures become positive for gram-positive cocci in clusters, and on hospital day 3, his blood cultures grow methicillin-resistant Staphylococcus aureus. Susceptibility to vancomy...
Source: Kevin, M.D. - Medical Weblog - June 29, 2013 Category: Family Physicians Tags: Conditions Infectious disease Source Type: blogs
