Podcasts about Clindamycin

Clindamycin is an antibiotic for infection. It inhibits protein synthesis by binding to the 50s ribosomal subunit and is well known to contribute to C. Diff. risk. Acetaminophen is a common over-the-counter medication that relieves pain and fever. It does not have much benefit in reducing inflammation, however. Ferrous sulfate is a supplement that can be useful in treating anemia. Dark stools and constipation are two common adverse effects. Eletriptan is a medication used to abort migraine headaches. It has serotonin action. I discuss the potential for interactions with other serotonergic medications. Methocarbamol is an older skeletal muscle relaxant that makes an appearance on the Beers list as it can cause sedation, confusion, and increase the risk of falls.

Show notes at pharmacyjoe.com/episode968. In this episode, I'll discuss linezolid vs clindamycin for toxin inhibition in patients with invasive group A streptococcus infections. The post 968: Linezolid Instead of Clindamycin for Toxin Inhibition appeared first on Pharmacy Joe.

Case Study 1: Missed Co-InfectionI had a patient who didn't get better after a month of doxycycline for Lyme disease. Six months later, she was still sick. It turned out that the deer tick bite also transmitted Babesia, a co-infection. After treating her with azithromycin and atovaquone, she recovered successfully.Case Study 2: Unrecognized TransmissionAnother patient unknowingly had Babesia and donated blood. The recipient of the blood transfusion developed Babesia as a result.Rising Awareness of BabesiaAs we enter another summer, it's important to recognize that Babesia is an increasing concern as a tick-borne pathogen. The first case of babesiosis caused by the B. microti parasite was identified in 1969 in a person who had vacationed in Massachusetts. Research by Krause and colleagues in 1998 found that 24 out of 46 untreated Babesia-infected subjects had Babesia DNA in their blood for an average of 82 days.Serious Health RisksBabesia can lead to serious health issues, including atrial fibrillation, noncardiogenic pulmonary edema, and anemia. In New York, between 1982 and 1991, seven people with Babesia died. On Nantucket Island, another patient developed pancarditis and died.Chronic IllnessI've seen patients remain chronically ill until they were treated for Babesia. This highlights the importance of considering Babesia in patients who don't respond to standard Lyme disease treatments. Transmission RisksBabesia can be transmitted through blood transfusions and, though rare, from a pregnant mother to her unborn child. Pregnant women should take extra precautions to avoid tick bites and exposure to infected animals. If infection occurs, immediate medical attention is crucial to protect both the mother and baby.Treatment OptionsTreating Babesia typically involves a combination of antimicrobial medications. The standard treatment includes atovaquone and azithromycin. Clindamycin and quinine are also used but have more side effects. Recently, a new drug called tafenoquine has been introduced for patients who relapse after standard treatment. According to a study by researchers at the Yale School of Public Health, adding tafenoquine can be a lifesaver for vulnerable patients.Treatment ManagementThese treatments can effectively reduce the parasite load in the blood and alleviate symptoms. It's important for patients to complete the full course of treatment to prevent relapse and ensure the parasite is fully eradicated. For patients with weakened immune systems or the elderly, longer or repeated courses of treatment may be necessary.ConclusionBeing vigilant about Babesia, especially in patients who don't respond to Lyme disease treatments, can make a significant difference. Proper diagnosis and treatment are crucial for effective management and recovery.

Episode 162: Early-Onset Sepsis      Dr. Kooner explains how to diagnose early-onset sepsis by using clinical evaluation and clinical tools. Dr. Schlaerths describes the signs and symptoms of sepsis in neonates, and Dr. Arreaza adds comments about GBS bacteriuria.  Written by Lovedip Kooner, MD, editing Hector Arreaza, MD, and comments by Katherine Schlaerth, MD. Rio Bravo Family Medicine Residency Program.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Introduction:Neonatal sepsis is defined as pathogenic bacterial growth from blood or cerebral spinal fluid culture within the first 28 days of life. Neonatal sepsis can be divided into two categories: early-onset sepsis (EOS) and late-onset.  EOS is neonatal sepsis within 72 hours or 7 days after birth, depending on the specialist. How common is early-onset sepsis (EOS)?According to the CDC, the infant mortality rate rose for the first time in 20 years in the USA. In the U.S., the incidence of EOS is 0.5 in 1,000 live births and carries a mortality rate of about 3%. What causes EOS?Most infections are due to ascending lower vaginal tract flora. Other causes include intra-amniotic infections and maternal hematogenous spread of systemic infections. Group B streptococcus (S. agalactiae) accounts for about 1/3 of the infectious organisms, followed by E. coli which accounts for about 1/4, and Viridans streptococci account for about 1/5 of infections. Cases of E. coli are seen more often with prolonged rupture of membranes and intrapartum antibiotic exposure. Other notable infections are Listeria monocytogenes, coagulase-negative staphylococci (CoNS), herpes simplex virus, and enteroviruses. The role of GBS.Approximately 30% of women have vaginal and rectal GBS colonization and 50% will transmit it to the newborn. Without maternal antibiotic treatment, 1-2% of those infants will develop EOS. The American College of Obstetricians and Gynecologists (ACOG) recommends universal culture-based screening for GBS at 36-37 weeks and 6 days regardless of mode of delivery. GBS bacteriuria: Treat it (symptomatic and asymptomatic) if >105 CFU/mL. Do not treat it in asymptomatic patients if GBS 18 hours, intrapartum fever, or GBS positive in previous pregnancy.Nucleic acid amplification test: NAAT in pregnancy is not recommended to determine colonization status. However, if NAAT is obtained in the intrapartum period, give IAP if positive. But, you must also give IAP if negative + mentioned risk factors (18h, Maternal fever >100.4F)What is considered adequate intrapartum antibiotic prophylaxis? Penicillin and ampicillin are the recommended antibiotics for prophylaxis. Cefazolin can be given if there is a penicillin-allergy with a low risk for anaphylaxis. Clindamycin and vancomycin are reserved for cases of maternal penicillin allergy. Specifically, clindamycin can be used only if GBS is known to be sensitive to clindamycin. Vancomycin must be used if GBS is resistant to clindamycin. Do not use erythromycin. You will Administered at least 4 hours before delivery.IAP is believed to reduce neonatal GBS disease by: (1) temporarily reducing maternal vaginal GBS colonization; (2) preventing colonization of the fetus or newborn's surfaces and mucous membranes; and (3) achieving antibiotic levels in the newborn's bloodstream sufficient to surpass the minimum inhibitory concentration (MIC) for eliminating group B streptococci.Diagnosis of EOS:Clinical presentation: Tachycardia, tachypnea, temperature instability, supplemental oxygen requirement, and lethargy. Hypoglycemia should not be considered a sign of EOS.Diagnosing early-onset sepsis is achieved through blood or cerebrospinal fluid (CSF) cultures. Not effective methods for diagnosing EOS include laboratory tests, such as a complete blood cell count or C-reactive protein (CRP), as well as surface cultures, gastric aspirate analysis, or urine culture.Most infants will generally show signs of EOS GBS infection within the initial 24 hours of birth, with approximately 85% exhibiting symptoms during this timeframe.Waiting for cultures and/or signs can delay lifesaving treatment.Management:According to the American Academy of Pediatrics (AAP), the management of term and late-term infants is undertaken via the clinical condition assessment, the categorical risk factor assessment, and the multivariate risk assessment. As a part of the 2015 AAP guidelines, the Categorical Risk Factor Assessment is more of an algorithmic approach based on the presence or absence of specific risk factor threshold values such as:Ill-appearing infant. Mother diagnosed with chorioamnionitis.Mother GBS positive with inadequate intrapartum prophylaxis.ROM >18 hours.Birth before 37 weeks of gestation.Antibiotics are not always needed, and they can even cause damage. Information taken from the American Academy of Pediatrics, “Management of Neonates Born at ≥35 0/7 Weeks' Gestation With Suspected or Proven Early-Onset Bacterial Sepsis,” published on December 1, 2018:(1) Any newborn infant who is ill-appearing or (2) when the mother has a clinical diagnosis of chorioamnionitis -> laboratory testing must be ordered, and empirical antibiotic therapy should be started.(3) A mother who is colonized with GBS and who received inadequate intrapartum antibiotic prophylaxis, with a duration of ROM being >18 hours or birth before 37 weeks' gestation -> laboratory testing should be ordered.(4) A mother who is colonized with GBS who received inadequate IAP but with no additional risk factors -> observation in the hospital for ≥48 hours.______________________________Conclusion: Now we conclude episode number 162, “Early-onset Sepsis Introduction.” Dr Kooner explained the role of GBS in the pathophysiology of EOS, Dr. Schlaerth discussed the importance of clinical evaluation and Dr. Arreaza explained that GBS screening in the third trimester is not needed when there is a GBS positive urine culture early in pregnancy. Don't miss part 2 of this discussion. By the way, we do not recommend using feces to prevent or treat sepsis, we just shared anecdotal information to end with a funny note.This week we thank Hector Arreaza, Lovedip Kooner, and Katherine Schlaerth. Audio editing by Adrianne Silva.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Neonatal Early-Onset Sepsis Calculator by Kaiser Permanente, available at: https://neonatalsepsiscalculator.kaiserpermanente.org/.Espinosa K, Brown SR. Neonatal Early-Onset Sepsis Calculator. Am Fam Physician. 2021;104(6):636-637.https://www.aafp.org/pubs/afp/issues/2021/1200/p636.html.Puopolo KM, Benitz WE, Zaoutis TE; COMMITTEE ON FETUS AND NEWBORN; COMMITTEE ON INFECTIOUS DISEASES. Management of Neonates Born at ≥35 0/7 Weeks' Gestation With Suspected or Proven Early-Onset Bacterial Sepsis. Pediatrics. 2018 Dec;142(6):e20182894. doi: 10.1542/peds.2018-2894. PMID: 30455342. https://pubmed.ncbi.nlm.nih.gov/30455342/.Briggs-Steinberg C, Roth P. Early-Onset Sepsis in Newborns. Pediatr Rev. 2023 Jan 1;44(1):14-22. doi: 10.1542/pir.2020-001164. PMID: 36587021. https://pubmed.ncbi.nlm.nih.gov/36587021/.Flannery DD, Puopolo KM. Neonatal Early-Onset Sepsis. Neoreviews. 2022 Nov 1;23(11):756-770. doi: 10.1542/neo.23-10-e756. PMID: 36316253. https://pubmed.ncbi.nlm.nih.gov/36316253/.Polin RA; Committee on Fetus and Newborn. Management of neonates with suspected or proven early-onset bacterial sepsis. Pediatrics. 2012 May;129(5):1006-15. doi: 10.1542/peds.2012-0541. Epub 2012 Apr 30. PMID: 22547779. https://pubmed.ncbi.nlm.nih.gov/22547779/.Royalty-free music used for this episode: Good Vibes_Adventure Time by Simon Pettersson, downloaded on July 20, 2023, from https://www.videvo.net/  

On episode #43 of the Infectious Disease Puscast, Sara reviews the infectious disease literature for the weeks of 11/22 – 12/06/23. Host: Sara Dong Subscribe (free): Apple Podcasts, RSS, email Become a patron of Puscast! Links for this episode Treatment for first cytomegalovirus infection post-hematopoietic cell transplant (CID) Mortality among children aged

In this episode, we dive deep into the world of oral and maxillofacial surgery with Dr. Naushad Edibam. Join us as we explore a critical topic in the field: the potential risks associated with self-reported allergies to clindamycin during implant procedures. Dr. Edibam, a renowned expert in oral surgery, shares his expertise and research findings, shedding light on whether a patient's reported clindamycin allergy can influence the success or failure of dental implants. With a focus on evidence-based insights, we delve into the implications for practitioners and their patients. Hear about his latest research findings on the subject and the latest developments in implantology. Discover the potential risk factors, steps to follow for high-risk patients, common pitfalls, how to properly identify an allergy, and much more. Tune in to stay at the forefront of oral and maxillofacial surgery knowledge with Dr. Naushad Edibam!Key Points From This Episode:We start by hearing about Dr. Edibam's training and practice setup.Dr. Naushad Edibam shares what got him interested in the topic.An overview of the findings from his systematic review article.Reasons for the association of dental failure with administering clindamycin.Protocol for identifying genuine medical penicillin allergies.Obvious signs of high-risk patients and the steps to follow.The underlying reasons why clindamycin may be a cause for concern.Alternatives to administering clindamycin to patients.Essential recommendations and advice for administering antibiotics.We discuss whether antibiotics are needed for implant patients.His approach to administering antibiotics to patients.Gaps, data limitations, and where more research is needed. Possible ways to reduce the potential of implant failure.Our usual rapid-fire questions!Links Mentioned in Today's Episode:Dr. Naushad Edibam — https://www.stamfordoms.com/p/oral-surgeon-Stamford-CT-Naushad-Edibam-DMD-p20861.aspDr. Naushad Edibam Email — nedibam@stamfordoms.comNCBI - WWW Error Blocked Diagnostic — https://pubmed.ncbi.nlm.nih.gov/37102260/AME'S Dental College and Hospital — https://www.amesdentalcollege.com/Buddha's Brain — https://www.amazon.com/Buddhas-Brain-audiobook/dp/B004CDDLBG/Ahsoka — https://www.imdb.com/title/tt13622776/KLS Martin — https://www.klsmartin.com/en/Everyday Oral Surgery Website — https://www.everydayoralsurgery.com/ Everyday Oral Surgery on Instagram — https://www.instagram.com/everydayoralsurgery/ Everyday Oral Surgery on Facebook — https://www.facebook.com/EverydayOralSurgery/Dr. Grant Stucki Email — grantstucki@gmail.comDr. Grant Stucki Phone — 720-441-6059

Contributor: Meghan Hurley MD Educational Pearls: What is Cellulitis? A common and potentially serious bacterial skin infection. Caused by various types of bacteria, with Streptococcus and Staphylococcus species being the most common. What is Preseptal Cellulitis and why is it more serious than facial cellulitis? Preseptal Cellulitis, also known as Periorbital Cellulitis, is a bacterial infection of the soft tissues in the eyelid and the surrounding area. This requires prompt and aggressive treatment to avoid progression into Orbital Cellulitis. How is Preseptal Cellulitis treated? Oral antibiotics for five to seven days. In the setting of trauma (scratching bug bites) Clindamycin or TMP-SMX (for MRSA coverage) and Amoxicillin-clavulanic acid or Cefpodoxime or Cefdinir. If there is no trauma, monotherapy with amoxicillin-clavulanic acid is appropriate. Check immunization status against H.influenzae and adjust appropriately. What is Orbital Cellulitis, how is it diagnosed, and why is it more serious than Preseptal Cellulitis? Orbital cellulitis involves the tissues behind the eyeball and within the eye socket itself. Key features include: Eye pain. Proptosis (Bulging of the eye out of its normal position). Impaired eye movement. Blurred or double vision. This can lead to three very serious complications: Orbital Compartment Syndrome. This can push eye forward, stretch optic nerve, and threaten vision. Meningitis given that the meninges of the brain are continuous with optic nerve. Endophthalmitis, which is inflammation of the inner coats of the eye. This can also threaten vision. If suspected, get a CT of the orbits and/or an MRI to look for an abscess behind the eyes. How is Orbital Cellulitis treated? IV antibiotics. Cover for meningitis with Ceftriaxone and Vancomycin. Add Metronidazole until intracranial involvement has been ruled out. Drain the abscess surgically. Usually this is performed by an ophthalmologist or an otolaryngologist. Admit to the hospital. References Bae C, Bourget D. Periorbital Cellulitis. 2023 Jul 17. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 29261970. Chaudhry IA, Shamsi FA, Elzaridi E, Al-Rashed W, Al-Amri A, Al-Anezi F, Arat YO, Holck DE. Outcome of treated orbital cellulitis in a tertiary eye care center in the middle East. Ophthalmology. 2007 Feb;114(2):345-54. doi: 10.1016/j.ophtha.2006.07.059. PMID: 17270683. Seltz LB, Smith J, Durairaj VD, Enzenauer R, Todd J. Microbiology and antibiotic management of orbital cellulitis. Pediatrics. 2011 Mar;127(3):e566-72. doi: 10.1542/peds.2010-2117. Epub 2011 Feb 14. PMID: 21321025. Wong SJ, Levi J. Management of pediatric orbital cellulitis: A systematic review. Int J Pediatr Otorhinolaryngol. 2018 Jul;110:123-129. doi: 10.1016/j.ijporl.2018.05.006. Epub 2018 May 8. PMID: 29859573. Summarized by Jeffrey Olson MS2 | Edited by Meg Joyce & Jorge Chalit, OMSII  

In this episode, we announce the second iteration of the HelixTalk Drug Superlative Awards -- awards given to medications on the market that are outstanding or notorious. In announcing these completely fictitious awards, we review key clinical pearls and pitfalls that every clinician should be aware of with these notable medications. Key Concepts The award for the most unique phase III patient population for a widely used medication goes to … Pneumovax-23 (PPSV-23) for its predecessor versions that were studied in South African novice gold miners. The award for the most misunderstood boxed warning goes to … all of the DOACs (but specifically apixaban and rivaroxaban). In particular, due to BOTH an increased risk of thrombosis and bleeding when switching from a DOAC to warfarin therapy in patients with atrial fibrillation. The award for the biggest difference between pharmacokinetic properties and pharmacodynamic effects goes to … aspirin due to its short-half life and short duration of analgesic effect and yet very prolonged antiplatelet effect. The award for the drug that should be dispensed with extra toilet paper … TIE between irinotecan and clindamycin. The most common dose-limiting adverse effect of irinotecan is diarrhea – loperamide is extensively used in these patients. Clindamycin earns the award because it is the antibiotic most associated with Clostridium difficile-associated diarrhea (CDAD). References Smit P, Oberholzer D, Hayden-Smith S, Koornhof HJ, Hilleman MR. Protective efficacy of pneumococcal polysaccharide vaccines. JAMA. 1977;238(24):2613-2616. Farrar JL, Childs L, Ouattara M, et al. Systematic Review and Meta-Analysis of the Efficacy and Effectiveness of Pneumococcal Vaccines in Adults. Pathogens. 2023;12(5):732. Published 2023 May 19. doi:10.3390/pathogens12050732 Pavia M, Bianco A, Nobile CG, Marinelli P, Angelillo IF. Efficacy of pneumococcal vaccination in children younger than 24 months: a meta-analysis. Pediatrics. 2009;123(6):e1103-e1110. doi:10.1542/peds.2008-3422 Deshpande A, Pasupuleti V, Thota P, Pant C, Rolston DD, Sferra TJ, Hernandez AV, Donskey CJ. Community-associated Clostridium difficile infection and antibiotics: a meta-analysis. J Antimicrob Chemother. 2013 Sep;68(9):1951-61. doi: 10.1093/jac/dkt129.

In this episode, we review the high-yield topic of ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Clindamycin⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠from the Microbiology section. Follow ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Medbullets⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets --- Send in a voice message: https://podcasters.spotify.com/pod/show/medbulletsstep1/message

On this podcast episode, I discuss clindamycin pharmacology, adverse effects, drug interactions, and much more! Clindamycin (oral administration) can cause esophageal irritation and it is recommended to take this medication with a full glass of water. C. Diff risk and frequent dosing are two of the biggest downsides to using clindamycin to manage infections. Clindamycin has good activity against many gram-positive organisms like Staph and Strep as well as anaerobic activity.

Episode Notes In this episode, Dr. Angelina Davis talks to us about the use of clindamycin + vancomycin vs. linezolid for the treatment of necrotizing soft tissue infections. The article reviewed in this episode can be found here: https://pubmed.ncbi.nlm.nih.gov/37351452/ For more information about DASON, please visit: https://dason.medicine.duke.edu

Visit: https://nursing.com/140meds to request your free copy of "140 Must Know Meds" Generic Name Clindamycin Trade Name Cleocin Indication Skin infections, respiratory tract infections, septicemia, intra-abdominal infections, osteomyelitis Action Bacteriostatic: inhibits protein synthesis Therapeutic Class Anti-infectives Pharmacologic Class Lincosamide Nursing Considerations • Arrhythmias, pseudomembranous colitis, diarrhea, phlebitis • Monitor bowel function • Assess for infection, obtain cultures prior to therapy • Monitor liver function tests • Monitor CBC

Don't miss this week's episode as Tom demystifies Clindamycin and its use in dentistry.  Plus we talk street drugs and what current trends are that we need to know as parents, dentists, and community members.  Join Jeff and JB as talk pharmacology with one of our faves, Tom Viola! With over 30 years' experience as a pharmacist, educator, speaker and author, Tom Viola, R.Ph., C.C.P. has earned his reputation as the go-to specialist for delivering quality continuing education content through his informative engaging presentations. Tom's sellout programs provide an overview of the most prevalent oral and systemic diseases and the most frequently prescribed drugs used in their treatment.  Special emphasis is given to dental considerations and strategies for effective patient care planning.  As a clinical educator, Tom is a member of the faculty of twelve dental professional degree programs and has received several awards for outstanding teacher of the year. Tom instructs dental hygiene students and practice dental hygienists in pharmacology and local anesthesia in preparation for national board exams.  As a published writer, Tom is well known internationally for his contributions to several professional journals in the areas of pharmacology, pain management and local anesthesia. In addition, Tom has served as a contributor, chapter author and peer reviewer for several pharmacology textbooks.As a professional speaker, Tom has presented continuing education courses to dental professionals internationally since 2001. Meeting planners agree that Tom is their choice to educate audiences within this specialty.

On episode #11 of the Infectious Disease Puscast, Daniel and Sara review the infectious disease literature for the previous two weeks, 9/1/22 - 9/14/22. Subscribe (free): Apple Podcasts, Google Podcasts, RSS Become a patron of Puscast! Links for this episode Post-Ebola symptoms infection (CID) Legionella identified as cause of cluster of pneumonia cases (PAHO) Frequency of exposure to antibiotics for enteropathogenic bacteria among young children (PNAS) Should Linezolid replace Clindamycin as the adjunctive antimicrobial of choice in Toxic Shock Syndrome (CID) Treatment with a three-drug regimen for Pulmonary Tuberculosis (OFID) The skip phenomenon in Staphylococcus Aureus Bacteremia (Science Direct) The relationship between antibiotic agent and mortality in patients with Febrile Neutropenia (OFID) Antibiotic indications and appropriateness in the pediatric intensive care unit (CID) Clinical features and treatment outcomes of Pulmonary Mycobacterium avium-intracellulare complex (OFID) Outcomes of partial oral antibiotic treatment for complicated S. Aureus Bacteremia in drug users (CID) Short-versus long-course antibiotic treatment for uncomplicated vancomycin-resistant enterococcal bacteraemia (CMI) Infectious Disease Consults of Pseudomonas aeruginosa bloodstream infection and impact on health outcomes (OFID) Paracoccidioidomycosis: current status and future trends (Clinical Microbiology) Comparative outcomes of Candida Auris Bloodstream Infections (CID) Efficacy and immunogenicity of R21/Matrix-M vaccine against clinical Malaria (The Lancet) Leishmaniasis: Diagnosis and Treatment in the United States (JPIDS) Malaria Surveillance — United States, 2018 (CDC) Anti-bacteriophage immunity in phage therapy (JID) Improving understanding and utilization of the antibiogram among medical residents (Cambridge)  Music is by Ronald Jenkees

Join our Emergency General Surgery team as they discuss Necrotizing Soft-Tissue Infections. Hosted by Drs. Jordan Nantais, Ashlie Nadler, Stephanie Mason and Graham Skelhorne-Gross. Necrotizing Soft-Tissue Infections: - Also known as “flesh eating disease”, gas gangrene, necrotizing fasciitis/myositis, Fournier's gangrene.  - Early findings are non-specific - Rapidly fatal - diagnostic delay can lead to tremendous additional morbidity and mortality Classification: - Type 1 - polymicrobial category (most common) found in immunosuppressed or elderly - Type 2 - monomicrobial infection [Group A Streptococcus > Methicillin-resistant Staphylococcus aureus (MRSA)] - Type 3 - monomicrobial infection (Vibrio or Clostridium) - Type 4 - fungal (rare) in immunocompromised or after penetration or trauma from candida or Zygomycetes. Initial Workup - History: (comorbidities, immunosuppression, recent infections or trauma) - Exam: swelling, open lesions, drainage, erythema, crepitus, and pain out of proportion      - Most common: swelling, pain, erythema      - Bullae, skin necrosis, crepitus are less common - Labs: Hb, wbc, Na, Creat, glucose, and CRP - Imaging: CT, MRI *sensitive and specific but may not change management - Cut-down: bedside vs in OR - Gm stain  Management - Initially: two large bore IVs, foley catheter, aggressive fluid resuscitation, broad spectrum antibiotics, vasopressors PRN - Abx choices: carbopenem or piperacllin-tazobactam or cefotaxime plus metronidazole. Clindamycin (antitoxin effect) and vancomycin (MRSA) should be considered. - OR: must debride all dead/infected tissue, involve other surgical specialties as needed      - Mark edge of cellulitis and use as initial debridement      - Healthy dermis – pearly and white      - Healthy fat – pale, yellow, glistening      - Healthy fascia – should bleed, doesn't easily separate from muscle      - Healthy muscle – contract with cautery      - Dressing: betadine-soaked gauze on the wound      - Most patients will need at least 3 ORs (second OR generally 8-12 hours after the first)      - No VAC or stoma at first OR References:  1.    Pelletier J, Gottlieb M, Long B, Perkins JC Jr. Necrotizing Soft Tissue Infections (NSTI): Pearls and Pitfalls for the Emergency Clinician. J Emerg Med. 2022 Apr;62(4):480-491. doi: 10.1016/j.jemermed.2021.12.012. Epub 2022 Jan 31.  2.    Sarani B, Strong M, Pascual J, Schwab CW. Necrotizing fasciitis: current concepts and review of the literature. J Am Coll Surg. 2009 Feb;208(2):279-88.  3.    Edlich RF, Cross CL, Dahlstrom JJ, Long WB 3rd. Modern concepts of the diagnosis and treatment of necrotizing fasciitis. J Emerg Med. 2010 Aug;39(2):261-5 4.    Hoesl V, Kempa S, Prantl L, Ochsenbauer K, Hoesl J, Kehrer A, Bosselmann T. The LRINEC Score-An Indicator for the Course and Prognosis of Necrotizing Fasciitis? J Clin Med. 2022 Jun 22;11(13):3583 5.    Bulger EM, May A, Bernard A, Cohn S, Evans DC, Henry S, Quick J, Kobayashi L, Foster K, Duane TM, Sawyer RG, Kellum JA, Maung A, Maislin G, Smith DD, Segalovich I, Dankner W, Shirvan A. Impact and Progression of Organ Dysfunction in Patients with Necrotizing Soft Tissue Infections: A Multicenter Study. Surg Infect (Larchmt). 2015 Dec;16(6):694-701. 6.    LRINEC Score from: https://www.mdcalc.com/calc/1734/lrinec-score-necrotizing-soft-tissue-infection#:~:text=Patients%20were%20classified%20into%20three,%25%20and%20NPV%20of%2096%25. Retrieved July 2022. If you liked this episode, check out our recent episode titled, "Journal Review in Colorectal Surgery: Timing of Biologics and Surgery in the Setting of Crohn's Disease" which can be found here. Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Download the cheat: https://bit.ly/50-meds  View the lesson: https://bit.ly/ClindamycinCleocinNursingConsiderations    Generic Name Clindamycin Trade Name Cleocin Indication Skin infections, respiratory tract infections, septicemia, intra-abdominal infections, osteomyelitis Action Bacteriostatic: inhibits protein synthesis Therapeutic Class Anti-infectives Pharmacologic Class Lincosamide Nursing Considerations • Arrhythmias, pseudomembranous colitis, diarrhea, phlebitis • Monitor bowel function • Assess for infection, obtain cultures prior to therapy • Monitor liver function tests • Monitor CBC

Toxic Shock Syndrome can be hard to recognize and differentiate from clinical entities such as Kawasaki, MIS-C, and DRESS. This brief podcast episode will raise awareness of situations in which TSS can occur and drive home important management pearls – like why you need to add Clindamycin. PEMBlog.com Follow @PEMTweets on Twitter Check out the […]

Dr. Ebell and Dr. Wilkes discuss the POEM titled ' For mild/moderate acne, adapalene + BPO, clindamycin + BPO, and adapalene alone are most effective, in that order '

In this episode, Dr. Christopher Tookey and Dr. Rose Wolbrink discuss management of acne with a focus on over the counter creams, gels and ointments available at most stores and pharmacies.  A disclaimer, we're providing general guidance but everyone is different and you should always discuss with your health care professional management of any disease and therapy before trying anything you discover from a source on the internet (including this podcast). This podcast does not reflect the opinon of our employer. 

For over 50 years, the standard has been that Staph aureus bacteremia and endovascular infections must be treated with a bactericidal antibiotic, like beta lactams or vancomycin. A new study suggests that bacteriostatic antibiotic, like clindamycin, could be used to treat MRSA bacteremia.Redeem your CPE or CME credit here! References and resources: Guthridge I, Smith S, Law M, et al. Efficacy and Safety of Intravenous Lincosamide Therapy in Methicillin-Resistant Staphylococcus aureus Bacteremia. Antimicrob Agents Chemother. 2021 Aug 17;65(9):e0034321. doi: 10.1128/AAC.00343-21. Epub 2021 Aug 17. PMID: 34125589.Continuing Education Information:Learning Objectives: 1. Identify if an uncomplicated patient with MRSA bacteremia may be eligible for bacteriostatic medications2. Describe some of the advantages of using drugs like clindamycin in these patients0.05 CEU | 0.5 HrsACPE UAN: 0107-0000-21-339-H01-PInitial release date: 10/12/21Expiration date: 10/12/2022Complete CPE & CME details can be found here !What's new?GameChangers Pharmacotherapy Podcast will release new episodes on Mondays starting 10/18/2021We are making it easier to claim CE Credit for listening each week! This October - we'll launch a simple, one membership option so you can get one-click CE redemption for GameChangers episodes.  Name changes! You'll notice the podcast show will change to CEimpact - you'll still get new GameChangers episodes released each week on Mondays. Keep listening here and your feed will automatically switch over to CEimpact on 10/18.

KSQD 7-07-2021: The problem of the evolution of Coronavirus to make more aggressive variants that frustrate exiting the Pandemic -- get vaccinated! More about the BCG vaccine for tuberculosis and efficacy to help against other respiratory infections; The biochemistry and health benefits of Kombucha and tea products; Allergic reactions to penicillin and how to test for them; Gut restoration foods to repair Clindamycin damage to the gut microbiome; Functional Medicine picks up where Conventional Medicine leaves off; The difficult problem of microplastics, which are everywhere now; Balancing calcium, magnesium zinc and vitamin supplements for osteoporosis and sleep problems

KSQD 7-07-2021: The problem of the evolution of Coronavirus to make more aggressive variants that frustrate exiting the Pandemic -- get vaccinated! More about the BCG vaccine for tuberculosis and efficacy to help against other respiratory infections; The biochemistry and health benefits of Kombucha and tea products; Allergic reactions to penicillin and how to test for them; Gut restoration foods to repair Clindamycin damage to the gut microbiome; Functional Medicine picks up where Conventional Medicine leaves off; The difficult problem of microplastics, which are everywhere now; Balancing calcium, magnesium zinc and vitamin supplements for osteoporosis and sleep problems

In this episode, Scott R. Plotkin, MD, PhD, and Brian D. Weiss, MD, answer questions from a healthcare professional audience on topics related to NF1 and plexiform neurofibromas including:  Whole exome sequencing for diagnosisWhen to treat asymptomatic tumorsGenetic testing of family membersChoosing a MEK inhibitorSupportive care for acneiform rashOther RAS pathway inhibitorsPresenters:Scott R. Plotkin, MD, PhDExecutive DirectorPappas Center for Neuro-OncologyProfessor of NeurologyHarvard Medical SchoolBoston, MassachusettsBrian D. Weiss, MDClinical Professor of PediatricsCancer and Blood Diseases Institute Division of Oncology  Medical DirectorSolid Tumor ProgramCincinnati Children's Hospital Medical CenterCincinnati, OhioLink to full program, including downloadable slidesets, expert commentaries, and on-demand webcast:https://bit.ly/3AXckHQ

Let's get on to Macrolides, Lincosamides. A little bit of stuff on protein biosynthesis won't hurt to help us understand the pharmacology of these class of drugs, macrolides and Lincosamides. Bacterial protein synthesis involves proteins required for reproduction, and is made possible by ribosomal RNA, mRNA and tRNA. To begin, the double stranded DNA first unwinds in an untwisting motion in the region which codes for the specific protein to be made and only that one strand of the DNA serves as a template for what is known as transcription. RNA polymerase makes a copy of this segment, which now stands as what is called mRNA. Once the strand of mRNA is complete, it detaches from that segment, and in turn become attached to ribosomes. Now it gets interesting. Bacterial ribosomes are made of two subunits, the small 30s and a bigger 50s ribosomal subunits, together makes up 70s ribosomal unit. The numbers don't add up right? Yes 30+50 is not 70. If you want to know why, download the Podroom app and join the discussion, there you can ask me and I'll explain. For now, we move. The ribosomal subunits attach to the mRNA strand like a zipper and begin the synthesis of the polypeptide chain, along that strand. Now the amino acids needed for this synthesis, is bound to tRNA, so tRNA + amino acids bind to the ribosome which is on the mRNA strand and begins to work its way from one end of the strand to the other, making the polypeptide chain in the process, until it hits a stop codon which makes it stop and release the full polypeptide chain it has been making. The 70s ribosome couples itself back and awaits further instruction. It's very easy, see, these are the steps 1.    Bacterial DNA unwinds to reveal a segment to be copied 2.    RNA polymerase makes a copy of this segment, a complete mirror image of the segment, detaches this new copy, which now stands alone as mRNA 3.    This mRNA attaches to 70s ribosome, which clasps the strands above and below with its two subunits 50s and 30s 4.    tRNA which contains amino acids is then bound to the ribosome and this moves along the mRNA strand to synthesize the polypeptide chain. 5.    Macrolides and Lincosamides inhibit this ribosome and do not allow it to move. If it cannot move, polypeptide and hence protein synthesis stops, and bacteria cannot grow, everything becomes static, that is why they say these drugs are bacteriostatic. So now, drugs that affect ribosomes in protein synthesis either affect the 50s or 30s subunits of the 70s ribosome. Don't worry, there is a mnemonic for that. Buy AT 30 and CELL @50 Aminoglycosides and tetracyclines inhibit protein synthesis by inhibiting the 30s ribosomal subunit. Chloramphenicol, Erythromycin (macrolides), Lincosamides and Linezolid all inhibit 50s ribosomal subunit. So macrolides – are a class of antibiotics that contain the following drugs 1.    Erythromycin – the oldest, strep, staph, pertusis, diphtheria, M. pnemonia 2.    Clarithromycin- strongly g +ve, used in eradication of H. pylori, renal toxicity 3.    Azithromycin – strong G -ve, RTI mainly As you go from erythromycin to azithromycin, you go from old to new, and also their half lives increases in that fashion, and hence their frequency of dosing reduces. *MOA* - just like I said, inhibits 50s, along with other counterparts in the mnemonic CELL @50 *Spectrum of activity* – G -ve and +ve, anaerobes (upper airway), atypical bacteria (legionella, chlamydia, mycoplasma etc), others like mycobacterium avium complex, campylobacter, treponema pallidum etc *Absorption* - food decreases it, why enteric coated ones are made. Clarithromycin is well absorbed irrespective of food. *Distribution-* all body fluids and placenta except CSF *and Elimination* - Hepatic: ALL, only clarithromycin is partially excreted by renals, why it needs renal adjustment at times. Cannot dialyze. Erythro t1/2- 1.5hrs, clarithromycin about 6hrs, Azithro – 68hrs *Resistance* - 80% is through the active efflux mechanism in which the mef gene encodes for an efflux pump that actively pumps macrolide out of the cell, away from the ribosome it is supposed to inhibit. Another mechanism is one in which a gene alters the binding site of the macrolide on the ribosome. Lastly, there is cross resistance which occurs between all macrolides. *Adverse Reactions* - M- Motility A: Arrythmias (prolonged qt interval) C: Cholestatic Hepatitis R: Rash 0: eosinophilia *Drug interaction* : it inhibits CYP3A4 enzyme leading to increased effects of carbamazepine, theophylline, warfarin, valproate. Enough of Macrolides. Let's talk about a close relative in mechanism of action. The Lincosamides Briefly! In this class is Clindamycin and Lincomycin They are active against staph, gram +ve and -ve anaerobes. Also against Bacteroides. Mechanism of action – You know this already, yes say it, of course if you Cell@ 50 you will know it binds to 50s ribosome and hence inhibits protein synthesis. It is absorbed well, penetrates well into most tissues including bone, but not CSF Excreted via the liver, bile and Urine. Resistance: mechanisms via drug inactivation, alteration of 50s ribosomal subunit by adenine methylation and mutation of the 50s ribosomal protein. *USES:* 1.    Anaerobic infections 2.    Osteomyelitis, arthritis 3.    AIDS related toxoplasmosis (combined with pyrimethamine) 4.    AIDS related pneumocystis carinii pneumonia. ADVERSE REACTIONS: 1.    Severe diarrhea- pseudomembranous enterocolitis caused by clostridium deficille 2.    High IV dose – neuromuscular blockade 3.    Neutropenia 4.    Impaired liver function 5.    Hypersensitivity And that's all fellas. Next, we talk about Sulphonamides in the next episode. This content is made for medical students, all pharmacology enthusiasts and medical practitioners who want to refresh their memory within the shortest possible time. This is meant to be used in conjunction with detailed pharmacology notes or texts, not sufficient as a standalone.

This episode covers clindamycin!

 Este es Medical commons un podcast de la academia de atención Primaria para el mejoramiento de la calidad de la atención en salud de las Américas, a continuación intentaremos dar una revisión sistemática por los temas mayormente  preguntados en los exámenes de residencias médicas en Colombia y que frecuentemente son motivo de consulta en atención primaria.  Todas las decisiones médicas y recomendaciones aquí expresadas deben de ser comparadas con la información académica oficial y jamás deben de ser tomados como un absoluto, los actos médicos derivados de estos audios son responsabilidad de aquellos que ejercen. La mayoría de los hospitales tienen un comité de medicamentos compuesto por médicos y farmacéuticos que se aseguran de que el uso de vancomicina se realice en circunstancias controladas. De hecho, en muchos hospitales, es necesario solicitar el permiso del experto en enfermedades infecciosas o del farmacéutico antes de utilizar vancomicina. La vancomicina es uno de los pocos medicamentos que todavía son activos contra MRSA. El otro problema con la vancomicina es que las concentraciones del fármaco requieren vigilancia, ya que es tanto ototóxico como nefrotóxico; el farmacéutico debe asegurarse de que el proveedor de atención médica ordene las concentraciones séricas del medicamento. El personal médico debe comprobar estas concentraciones y ajustar la dosis en función de la función renal. La enfermera es probablemente la primera persona en ver el pedido de vancomicina y siempre debe hablar con el farmacéutico para determinar si el pedido es apropiado. El farmacéutico debe verificar el registro de administración de medicamentos del paciente antes de dar luz verde. Finalmente, la enfermera debe educar al paciente sobre los efectos secundarios de la vancomicina como el síndrome de Redman y la posibilidad de disfunción renal y del oído. Sin un enfoque de equipo, el uso empírico de vancomicina hará que el fármaco sea inútil para la mayoría de las infecciones.   Referencia Murphy PB, Bistas KG, Le JK. Clindamycin. [Updated 2020 Jun 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519574/    Este podcast se distribuye bajo los términos de Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/ ), que permite su uso, duplicación, adaptación, distribución y reproducción en cualquier medio o formato, siempre que otorgue el crédito apropiado al autor o autores originales y la fuente, se proporciona un enlace a la licencia Creative Commons, y se indican los cambios realizados.

#23: Today's episode is all about how I cleared up my acne! My skin was my biggest insecurity for over a decade and I'm so excited to share with you all the products that have cleared my acne, evened out my skin tone, and overall helped boost my confidence. Must have products: Cleanser (First Aid Beauty, Cetaphil, or Cerave); The Ordinary Niacinamide + Zinc serum; Moisturizer (Clinique Dramatically Different Moisturizing Gel & First Aid Beauty Ultra Repair Cream) Other products mentioned- not necessary, but good add ons: Exfoliant (First Aid Beauty); Clindamycin lotion & Tretinoin cream (prescribed by my dermatologist but I use these sparingly) Follow the host, Morgan: @morganflitthealth Podcast Instagram: @alittlebitofeverythingpodcast New episodes every Tuesday!

Contributor: Don Stader, MD Educational Pearls: Toxic shock syndrome (TSS) is a rare cause of shock typically caused by Staph aureus or Strep pyogenes, that produces a toxin that leads to rapid onset hypotension with a diffuse erythematous rash. Signs of TSS may include rapid onset of altered mental status, dizziness, nausea, abdominal discomfort, hypotension, and rash TSS is associated with foreign bodies, such as tampons or nasal packing - make sure to remove any offending object Clindamycin is the drug of choice because it stops protein synthesis which helps treat toxic shock because toxic shock is caused by a protein (TSST-1) made by the bacteria.   TSS is associated iwth high morbidity and mortality despite treatments Despite the association with TSS, there is little supporting evidence for prophylactic antibiotics when placing nasal packing References Gottlieb M, Long B, Koyfman A. The Evaluation and Management of Toxic Shock Syndrome in the Emergency Department: A Review of the Literature. J Emerg Med. 2018;54(6):807-814. doi:10.1016/j.jemermed.2017.12.048 Lange JL, Peeden EH, Stringer SP. Are prophylactic systemic antibiotics necessary with nasal packing? A systematic review. Am J Rhinol Allergy. 2017;31(4):240-247. doi:10.2500/ajra.2017.31.4454 Summarized by Jackson Roos, MS4 | Edited by Erik Verzemnieks, MD

A 16 year old male is being seen in the ER for cellulitis and a skin abscess. He has already undergone I & D of the abscess and he's waiting to be discharged. You order a shot of Clindamycin, 600mg to be given IM prior to his discharge. Five minutes later, you're called back into the room and you see the patient is in respiratory distress and having very labored breathing. His face is puffy and his voice sounds muffled. As you consider what to do next, you are struck with a very important question. What type of hypersensitivity reaction is this again? Is it the one with IgE, type 1, type 2, I can't quite remember. Okay, not really that's really not the most important thing at the moment, you know its anaphylaxis, you know that you need to give him Epi; so you draw up 0.5mg and you give it IM, probably saving this guy's life. So I'll admit maybe the type of hypersensitivity reaction isn't the most clinically relevant information in a crisis situation, but I will say hypersensitivity reactions are high-yield in terms of board review, and they also shed light on the pathophysiology behind many common diseases. Today on the Medgeeks podcast we discuss hypersensitivity reactions. - Do you have a question you'd like for us to answer? Submit your question here (it's free) and we'll answer on our next podcast episode: https://www.askmedgeeks.com - Stay up to date with our monthly audio program; In the Know. Get a free trial: https://www.medgeek.co/in-the-know-order-form-free - Follow us on Instagram here: https://www.Instagram.com/medgeeksinc - Check out our free resources here: https://medgeeks.co/start-here - This podcast should not be used in any legal capacity whatsoever, including but not limited to establishing standard of care in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the podcast, video, or blog.

EM ID is back again with Patrick Bafuma interviewing Dr. Nico Cortes-Penfeld from the University of Nebraska Medical Center.  He specializes in orthopedic infectious diseases.  Patrick interview Nico for two discussions, with the first being clindamycin.  Join back for the next discussion on septic arthritis.

Session 26 A 20-year-old menstruating adult is tachycardic, somnolent, and hypotensive with GI symptoms and macular rash. What sort of organism do you suspect? As always, we're joined by Dr. Karen Shackelford from BoardVitals. Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points. [01:35] Question of the Week A 20-year-old female patient presents 5th day of her menstrual period complaining about abdominal pain, vomiting, watery diarrhea, and myalgia for 12 hours. On exam, her temperature is 103.13 F. Her blood pressure is 80/60 mm/Hg. And her heart rate is 135 beats per minute. She is ill-appearing, somewhat somnolent, has hyperemic 02:04 and a generalized erythematous macular rash that involves her palms and soles. Which of the following best describes the cause of her illness? (A) Gram-negative diplococci (B) Gram-negative obligate intracellular bacteria (C) Gram-positive facultative anaerobic cocci (D) Single positive stranded RNA virus [Related episode: Biology Grab Bag of Questions for the MCAT] [02:50] Thought Process Behind the Correct Answer The correct answer here is C. The patient has toxic shock syndrome. It didn't mention in the question but she had an indwelling tampon. Highly absorbent tampons are the biggest risk factor. But interestingly, half of the women who develop toxic shock syndrome during the menstrual period are not using tampons actually. Related to the menstrual period, however, a toxic shock is usually the result of infection by Staphylococcus aureus. It releases endotoxins. But also, 05:33 axis is superantigen. And that's what triggers the syndrome. It triggers the activation of T-lymphocyte and they release massive amounts of cytokine. The post-immune response is limited in patients with toxic shock. Studies show that people who end with toxic shock, they failed to develop an antibody against the bacteria that usually developed in up to 95% of the population in childhood. The criteria for diagnosis include fever, chills, hypotension, and dermatologic findings. Evident multi-system organ involvement is at least 3 body systems and that counts the skin. In this patient's case, she had her circulatory system. She had hyperemia of her mucus membranes. The maculopapular rash would eventually desquamate after 1-2 weeks. She had nausea, vomiting, diarrhea in the GI system. Her mental status was somnolent. Some people have seizures from somnolence or encephalopathy that the other organ involvement may include intrinsic renal failure or prerenal failure. Myalgias are also sometimes resolved in elevated serum creatinine phosphokinase. hepatic dysfunction is also not uncommon. [07:50] The Treatment If there's foreign body removal, the treatment of any surgical wounds is the rapid administration of appropriate antibiotics. This includes Vancomycin and Clindamycin with the Penicillin that has B-lactamase inhibitor. [08:10] Understanding the Wrong Answer Choices You would probably suspect meningococcal meningitis but then you would have thought they would have given you a clue about the stiff neck. Rocky Mountain spotted fever for answer choice B would also be a good thought. The USMLE Step 1 is going to give you clues to the most typical case. For instance, with Rocky Mountain spotted fever, they would probably mention that the patient was in an endemic area. But they wouldn't necessarily say he was bitten by a mosquito. Finally, Dengue fever is the diagnosis for answer choice D. Remember that they're not going to hand-feed you every single detail. It's not always going to be that easy. [11:00] BoardVitals Check out BoardVitals' USMLE Step 1 QBank or their COMLEX Level 1 QBank. They have 1-month, 3-month, and 6-month packages. Every time you purchase, a vaccine is donated. If you get the 3-month or 6-month package, they offer the Ask a Clinician feature where you can respond to a question. Then one of the physicians from BoardVitals will respond to you as well. Use the promo code BOARDROUNDS to save 15% off. Links: BoardVitals (promo code: BOARDROUNDS to save 15% off)

In this podcast, Dr. Wade Swenson, an otolaryngologist with Ridgeview Specialty Clinics, provides an overview of the work-up and management of common pediatric neck masses. Objectives:    Upon completion of this podcast, participants should be able to: Identify the most appropriate algorithm to work-up and manage pediatric neck masses. Choose a focused differential diagnosis of a pediatric neck mass. Recognize when a referral to an otolaryngologist for a pediatric neck mass is recommended. CME credit is only offered to Ridgeview Providers for this podcast activity. Complete and submit the online evaluation form, after viewing the activity.  Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within 2 weeks.  You may contact the accredited provider with questions regarding this program at  rmccredentialing@ridgeviewmedical.org. Click on the following link for your CME credit: CME Evaluation: "Pediatric Neck Masses" (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.)  The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition.”   FACULTY DISCLOSURE ANNOUNCEMENT  It is our intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias, either the exposition or the conclusions presented. Planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event. SHOW NOTES: CHAPTER 1: Pediatric neck masses fall into 3-categories:  Inflammatory, Congenital, and Neoplastic.  Seventy-five percent (75%) of neck masses are inflammatory, 20% congenital, and 5% or fewer are consistent with malignancy. The American Academy of Family Practice has a great algorithm on Pediatric Head and Neck masses. The majority of children with enlarged lymph nodes are largely reactive in nature. Most neck masses that are rubbery, mobile and B/L, are indicative of inflammatory in nature. Five (5) or more CTs of head and neck region can increase pediatric malignancy 3-fold. Palpate the parotids, submental, anterior SCM, posterior triangle, supraclavicular lymph nodes. Specific characteristics of a neck mass its midline or lateral.  The size, fixed or mobile, painful or non-tender, firm or soft, solitary or multiple nodes, skin changes. Do an oral and dental exam. Staph and strep are the bacterial causes of most inflammatory neck masses. Antibiotics typically used include: Keflex, Augmentin, and Clindamycin for 10-days; recheck in 3-days to document improvement or continued concern. Atypical mycobacterium infection is generally the cause of chronic inflammatory granulomatous processes.  Often found in the submandibular and periparietal lymph nodes. Generally unilateral and non-tender lymph nodes. Workup includes: PPD skin tests, Bartonella Henslae (or Cat Scratch Fever) and Toxoplasmosis. CHAPTER 2: Physical location and history will guide you to the diagnosis of thyroglossal and brachiocleft cyst. Up to 50% of cysts present infected. Thyroglossal cyst present in the midline from hyoid bone to thyroid isthmus. They tend to be smooth and will often be raised when a child sticks out their tongue. The average of diagnosis is around 6-yrs. of age. About 40% present before the age of 10. Typical treat similar to infected lymph node. With a course of abx and observation to "cool down" the neck mass for 5-6 weeks and then usually surgery. I&D are not recommended as it can cause a fistula track. Imaging choice for a thyroglossal cyst is ultrasound. Furthermore, confirming normal thyroid function in imperative, as you do not want to be fooled by an ectopic thyroid. It is acceptable for the primary care to initiate abx therapy with referral to ENT 1-2 weeks after abx management for recheck and further evaluation. ENT typically recommends surgery for congenital neck masses b/c they do not resolve on their own. Brachiocleft cyst represents 1/3 of congenital neck masses. Most common is a 2nd brachiocleft cyst. Present high in the neck anterior and deep to the SCM border below the angle of the mandible. Ultrasound you guessed it is the imaging modality of choice. One limitation of US is not great at differentiating a lymph node vs. cancer. That's where history and physical exam findings come into play. As an example - Is it a supraclavicular mass, firm, fixed, hard with dimensions greater than 3cm, which is going to be more concern for cancer. Most common cause of pediatric head and neck CA is Hodgkin's lymphoma. Look for fever, chills, malaise, night sweat, weight loss, pallor, fatigue, and failure to thrive. Vascular anomalies are relatively uncommon and are typically referred to as lymphatic malformation. Typically referred to pediatric ENT at Children's or the U. Another name for these lymphatic malformation are also called Cystic Hygromas. Hygromas are typically soft, doughy, trans-illuminate - found commonly in posterior triangle. US are initial imaging choice, however CT or MR can help with delineating the extent of the hygroma. There is about a 5% or fewer risk of malignancy in children with persistent head or neck masses. FNA's are NOT recommended in children. Forty to 50% of cancers in children with head and neck masses are lymphomas. Incisional or excisional biopsy for larger neck masses is generally the next step in evaluation and treatment. SUMMARY OF EVALUATING PEDIATRIC NECK MASSES: Evaluation of pediatric neck masses include: observation, antibiotics, imaging with US to differentiate if lymph node remains - consider obtaining PPD, bartonella and toxoplasmosis titer - looking for granulomatous disease. Next step is surgical removal of the lymph node. As far as labs go - often times the ENT will have the specific titers they want for ruling out certain disease processes. Leave the detailed lab ordering to ENT. When the lymph node is finally excised, generally sent for pathology and culture. RECAP: Neck masses are common. Majority are benign in etiology. They fall into 3-categories: inflammatory, congenital, or neoplastic. Characterize the neck mass with a detailed physical exam. Location, size, mobility, consistency, single or multiple, unilateral or bilateral. Is there fever or chills, accompanied with sxs? Managed with observation and a course of abx. No improvement, consider an US to further differentiate the mass. No improvement 4-6 weeks, send off to ENT for further evaluation.

My guest this week is Kiran Krishnan, a Research Microbiologist who has been involved in the dietary supplement and nutrition field for the past 18 years. He comes from a strict research background and established a clinical research organization where he designed and conducted dozens of human clinical trials in human nutrition. Kiran is a Co-founder and Chief Scientific Officer at Microbiome Labs. He is on the Scientific Advisory Board and a Science Advisor for 7 other companies in the industry. In his career, he has developed over 50 private label nutritional products. He is a frequent lecturer on the human microbiome at several health summits, medical and nutrition conferences, radio shows and has appeared in several international documentaries. In this episode, Kiran and I talk about the important role bacteria plays in our gut microbiome, its connection to the brain and how it can directly affect children's behavior. Children suffering from anxiety and stress, or who are on the Autism spectrum can benefit in different ways by looking into and addressing their gut health. Experiencing a disruption or imbalance in the gut microbiome does not always manifest in gastrointestinal symptoms, it is also common for children to experience behavioral alterations without any GI symptoms present. Learn more about Kiran and ways to treat and manage gut health here.   Episode Highlights   What is the gut microbiome? Think of the microbiome as an ecosystem made up of trillions of bacteria, viruses and fungi that live in your gut   The Role of Bacteria in Our Bodies We have over 100 trillion bacteria cells in our system that are vital to our everyday function About 90% of our day-to-day metabolic biochemical functions that differentiate us as humans come from those bacteria   Connecting The Microbiome and Behavior The bacteria in our gut microbiome have a direct connection to our brain through the vagus nerve The vagus nerve allows bacteria to send signals to the brain that affect how we behave There are organisms in the microbiome that can heighten anxiety and increase stress levels, as well as, organisms that can give you a sense of calm   How Our Microbiome Gets Disrupted For humans to optimally function, the healthy balance of the bacteria in the gut microbiome is essential A single course of antibiotics can throw this balance off entirely and result in: Heightened anxiety due to the growth of particular bacterial strains that cause an anxious response, and decrease the growth of strains that cause calming responses Examples of recovery time for your gut microbiome due to specific antibiotics A 10-day course of Clindamycin can take your body up to 2 years to recover Use of a Z-Pak can take almost a year to recover A single 600mg dose of Augmentin knocks your gut bacteria down by 99%   Rebalancing the Gut Microbiome Every single person has a unique microbiome, therefore, what works for one person might not work for another Diversity in the microbiome is very important Adding diverse probiotic strains to your routine like Just Thrive probiotics can aid in strengthening immune health within the digestive system   Where to learn more about Kiran Krishnan... Register at microbiomelabs.com for access to order! Instagram: @microbiomelabs   Connect with Dr. Nicole Beurkens on... Instagram Facebook Drbeurkens.com

In this podcast Dr. Stephen Dunlop, an emergency medicine physician with a certificate in tropical medicine and hygiene, addresses fever and other ailments in individuals returning from traveling. Objectives:    Upon completion of this podcast, participants will be able to: Identify what risk factors predispose towards certain tropical diseases/conditions. Apply appropriate differential diagnoses related to a patient with a fever who returned from traveling. Understand the basic work-ups needed in a patient experiencing fever who returned from traveling. CME credit is only offered to Ridgeview Providers for this podcast activity. Complete and submit the online evaluation form, after viewing the activity.  Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within 2 weeks.  You may contact the accredited provider with questions regarding this program at  rmccredentialing@ridgeviewmedical.org. Click on the following link for your CME credit: CME Evaluation: Fever in the Returned Traveler (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.)  The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition.”   FACULTY DISCLOSURE ANNOUNCEMENT  It is our intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias, either the exposition or the conclusions presented. Planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event. Show Notes: Dr. Steve Dunlop is an emergency physician practicing at Hennepin County Medical Center. He trained at the University of Minnesota in med school, then did his emergency medicine residency at HCMC. Steve has his master's in public health and completed his certificate from the American Society of Tropical Medicine and Hygiene. He's widely published and is an assistant professor of emergency medicine at the University of Minnesota. He's quite the traveling man and is no stranger to sub Saharan Africa and many other parts of the world. Indeed he is an international physician of mystery and we're honored to have him join us to discuss fever in the return traveler. Today's talk will focus primarily on the process of assessing the return traveler and the big, bad uglies that we don't miss in these patients. So, buckle up and enjoy this tropical disease safari with Dr. Dunlop.   CHAPTER 1:     Malaria is a parasitic disease that is transmitted by the anopheles mosquito. Plasmodium falciparum malaria is the most common, and tends to be the most serious. Malaria has an interesting, somewhat complex life cycle and patients present with cyclical fevers, headache, body aches, nausea and other non-specific symptoms. There are over 200 million cases a year and up to 500,000 deaths per year. Up to 2000 cases per year in the United States are reported. After inoculation by an infected mosquito, there is an incubation period of 7-to 30-days.      We'll summarize this first segment with an overview of the general topic of fever in the return traveler as outlined by Dr. Dunlop. As we discussed, there are diagnoses that we in medicine are trained to think about, and while we consider them in our differential diagnosis, they are still considered "zebras" in medicine. These diagnoses happen, but for some reason, causes of febrile illness that would be considered "zebras" seem to be less apt to make it on that differential list, or are basically the, "come on, you're kidding, right?" diagnosis.      In the case of a disease like malaria, especially when it presents in the developed world, patients often are seen 3-times or more before the diagnosis is made.  Different diseases have varying incubation periods and latency periods. These unknowns make the diagnosis, let alone the awareness of these various so-called 'tropical diseases" all the more difficult. We first must ask the relevant questions, which should start with "have you traveled anywhere recently?", "When?", "For how long?", "Where?", and "What did you do there?".      Delusions of parasitosis are not always delusions. As Fred's example of the fish tape worm reveals, one should always perform a careful and detailed exam. With regards to some of the parasite illnesses, the latency periods can be months to years, and a continuous or oscillating fever is not always necessary.      With regard to malaria, for instance, a fever may not be present when the patient shows up with their other non-specific symptoms. Again, the latency period is variable with malaria, not to mention the various causes of malaria.      The topic of tropical diseases is important to Dr. Dunlop because of the realization that the world has become a smaller place. One can easily travel to the other side of the world in a day. Minnesota, for instance, has one of the highest immigrant refugee per capita rates in the country, and consequently one of the largest global health programs in the country. Minnesota alone has over 1-million border crossings per year. Therefore, it is all the more important for general practitioners and other front line providers to have a greater awareness of where these patients recently came from and/or have traveled back to lately.      Seeing and evaluating a refugee immigrant versus other immigrants also carries nuance. Refugees in general undergo a very robust pre-departure screening, treatment and vaccinations. Other migrants however, may not have had the same king of screenings and treatments as refugees.      People travel extensively now, and sometimes forget to tell us about some of the quick stop-over trips that are made in the course of a larger holiday. It's, therefore, important to also consider these extra "side-trips" in the course of the bigger trip and access our resources. Dr. Dunlop refers to the CDC Yellow Book. Specifically, the "clinician view" tab should be accessed. This site allows us to see the most updated travel medicine guidelines regarding vaccines and chemoprophylaxis. As Dr. Dunlop states, fresh water exposure history will clue us in to various parasitic illnesses, such as schistosomiasis. Food intake is also taken into consideration, but this can become murky, and of course can lead to a variety of GI illnesses. Vaccine preventable illnesses, such as Hepatitis A, Typhoid and Yellow Fever, depending on where you are traveling, may be advised. Regarding malaria prophylaxis in particular, chemoprophylaxis regimens need to be given before, during and after an abroad trip. This CDC Yellow Book resource advises specific advice for specific regions and cities in all countries. All the vaccines, chemoprophylaxis, precautions and other considerations are provided here.      Public health programs track various diseases, however, the data gathering is largely backed by wealthier governments. The CDC in particular has surveillance posts throughout the world which monitors health and disease phenomena. WHO [the World Health Organization] takes on the responsibility of disseminating this information, but the efforts do tend to be collaborative.        CHAPTER 2:      VFR travelers, or "visiting friends and relatives" comprise of the majority of malaria cases in our country. Many of these people. for reasons unclear, don't always adhere to chemoprophylaxis during their often extended visits to their home countries. As a side note, malaria was common in the United States until the mid-1800's, and was largely eradicated in the ensuing decades due to DDT. Good for the malaria, bad for the eagles, and a lot of other critters. A pesticide that unfortunately killed a lot of other organisms as well.      Dr. Dunlop presents a case, that Fred and I butcher our way through. Bear in mind, folks, this discussion is meant to be broad, and not super-granular in terms of each tropical illness, although our friendly Dr. Robotvoice that you've already met, will chime in periodically to give us some factoids about some of these diseases we should be considering. So, we have a 35-year old male, VFR traveler who goes back to Ghana. He returns with a fever. While home in Ghana, he stayed in his village; and basically while there, he lived like the locals - so to not stick out like a sore "Americanized" thumb amongst his friends and family. However, as Steve points out, and while we should be ever vigilant for malaria and still test for it, and still consider the other tropical diseases in this patient, it's still prudent to do the tests for the common illnesses. Influenza, pneumonia, strep, UTIs, etc.      How do we test for malaria now? Thick and thin blood smears are still the standard in diagnosis of malaria. But, those smears can also show other diseases, such as African Sleeping Sickness. However, the rapid malaria tests are even more commonly performed now, and will give you a quicker turnaround in the diagnosis. The sensitivity and specificity of the rapid malaria tests are good, and if the patient looks non-septic, perhaps improves with conservative care or some IV fluids, the test is sufficient. It's common to repeat the test several times if the patient continues with symptoms. The thick and thin smears are still warranted, though, in these cases as well. CDC can be helpful, however is not diagnostic of malaria.       In this same patient, if the malaria testing is negative, and other screening of common febrile causes is negative, then throw in some bone pain, joint pain, severe headache and a blanching rash - Dengue Fever is to be considered. Getting Dengue again further down the road can be much worse, such as Dengue Hemorrhagic Fever. Chikungunya is making itself known quite well in recent years too. While there is less likelihood of these and other viral diseases to cause severe illness, they are helpful to track from a public health standpoint. Sex tourism is quite common as well, and STIs must also be considered, such as HIV. In fact, some health systems are doing rapid HIV tests on all-comers. There is about a 0.1% positive rate at Hennepin Ed, for instance, and the significance here is that we're identifying the superinfected hosts who are at the highest likelihood of passing it to others. So, again, besides doing our basic work-ups like a chest x-ray, urinalysis, etc., the work-up for malaria is indicated as directed. A CDC and LFTs can also be helpful. Leukopenia, thrombocytopenia and transaminitis, a lot of vector borne illnesses will exhibit these findings. Rickettsial diseases are included in this.      There is a high incidence of gram negative sepsis with severe malaria, therefore, a comprehensive sepsis work-up and treatment plan with brad spectrum abx is appropriate; even in the setting of a positive malaria test or smear. IV quinidine is approved for use in the United States, although production of this is now an issue. There is hope that other drugs will go through the FDA process, although this is expensive. Artesunate is the IV med for malaria used elsewhere in the world, and the CDC has an investigative provision to use this drug when and if quinidine is not available. Malarone can be given PO or crushed and placed in an NG tube if IV preparations are temporarily unavailable. Doxycycline and Clindamycin do have some utility in malaria treatment as well. So, in the unlikely event that you are treating the sick malaria patient, these can be used as well in a pinch.        CHAPTER 3:      For respiratory patients who have traveled and you don't know the etiology, think respiratory isolation until you have a better sense of what's going on. Most likely, it is not something serious. However, there are serious respiratory illnesses endemic to certain countries and regions, such as MERS and SARS. Again, the Yellow Book can be helpful here. Personal protection including masks for patient and providers/care givers is recommended.      Diarrheal illnesses are also to be considered such as cholera. In general, abx are not always needed. The extreme cases of fever, abdominal pain and severe diarrhea is a different story, though, and abx can be given here. While some of the diarrheal etiologies for travelers are viral, many are bacterial. There is some resistance to certain antibiotics in campylobacter. Traveler's Diarrhea, for instance, does not require antibiotic therapy. Patients at higher risk are often on antacid meds at baseline. Situational needs may warrant antibiotics, such as the need to avoid a bathroom break next to a pride of lions, or a curious hippopotamus. Imodium is helpful, as is bismuth subsalicylate. Warn your patients about the black stools, though, too. Bismuth may be able to be used as prophylaxis as well. Imodium can be helpful for traveler's diarrhea, but it can lead to obstipation and it should be avoided in severe cases. Contacting the CDC for general questions about a tropical illness is an option. Steve also mentions that in the Hennepin service area, the option of contacting the Emergency Physician on duty is also an option. Again, look into the option of having a rapid malaria test available at your shop.      Dr. Dunlop discusses EMR systems, in this case, EPIC showing an improved ability to screen patients based on their demographics, country of origin, travel history, etc. of potential infectious considerations. For instance, what kind of malaria or other travel illnesses to consider based on what the patient's registration information provides.      Follow-up for most patients who have been diagnosed with a travel illness, especially something complex like malaria, it would be best to refer them to someone steeped in this field. As Dr. Dunlop mentions, it's prudent to look up ASTMH certified providers in your area. This information could be obtained from a travel medicine clinic, and would be a good place to start. Health care providers as patients tend to be some of the worst offenders in terms of compliance with travel medicine, chemoprophylaxis, etc. Utilizing a travel medicine clinic will be most prudent, and besides medications, many other topics can be addressed, including issues one wouldn't think of, like vaccinations - that may be problematic for older patients, insurance coverage for medications, etc.  

We have a special Holiday Episode with very special guest Steph (@stephhlitee). This week we discuss your cousin that thinks salt is spicy, how to keep the vagine Ph balance aligned, and Drake's impact on the light skin community. Listen to find out more ;) P.S. @lostinthetrill, you won a sweatshirt! :)

The post Clindamycin (Cleocin) Nursing Pharmacology Considerations appeared first on NURSING.com.

This episode discussed the difference between probiotics, synbiotic and prebiotics as well as information on probiotics.  I also discuss antibiotic induced Clostridium difficile infections also known as C Diff infections.  Remember that the toxin produced by this bacteria is what causes the symptoms and issues with this infection.  It can be severe and extreme and require antibiotic therapy to eliminate the infection and if not successful colectomy!  This is a great episode and quite informative!

Lauren Petersen, PhD, is a postdoctoral associate investigating the microbiome and she’s back on the podcast to update us on her research. Be sure to listen to our first interview first! I sent Lauren some of the probiotics we use in our practice, and she said, “they look great!” Lauren did some calculations for the number of CFUs, and she got pretty much exactly what the bottle claims for live organisms, with growth on both Lactobacillus-selective and Bifidobacterium-selective medias. The same was not true for Renew probiotics where her qPCR analysis showed that Bifidobacterium was pretty much all dead. Here are some photos of the Lactobacillus-selective and Bifidobacterium-selective plates that Lauren used to grow the probiotics. She shot for 250 CFUs per plate (based on if all the organisms per gramme probiotic were alive) and that's pretty much what she got! Sign up for our Highlights email and every week we’ll send you a short (but sweet) email containing the following: One piece of simple, actionable advice to improve your health and performance, including the reference(s) to back it up. One item we read or saw in the health and fitness world recently that we would like to give a different perspective on, and why. One awesome thing that we think you’ll enjoy! Here’s the outline of this interview with Lauren Petersen, PhD: [00:00:32] Previous episode: The Athlete Microbiome Project: The Search for the Golden Microbiome. [00:03:10] Prevotella. [00:04:42] uBiome and The American Gut Project. [00:05:25] Scher, Jose U., et al. "Expansion of intestinal Prevotella copri correlates with enhanced susceptibility to arthritis." Elife 2 (2013): e01202. [00:06:33] Probiotics: S. boulardii. [00:08:48] Bifidobacteria. [00:09:54] Testing probiotics: Renew Life. [00:12:06] D-Lactate Free Bifido Probiotic. [00:12:28] Sign up for our highlights email. [00:14:44] qPCR analysis definitely picked up lactobacillus. [00:15:33] 16S vs qPCR. [00:16:03] RNA-Seq. [00:17:20] Whole-genome shotgun. [00:18:26] 60-day Bionic Fiber Program. [00:19:11] Brummel & Brown 35% Vegetable Oil Spread with Yogurt + bananas. I’m not linking to this rubbish because it’s not fit for human consumption. [00:21:25] Akkamansia. [00:21:49] Remely, Marlene, et al. "Increased gut microbiota diversity and abundance of Faecalibacterium prausnitzii and Akkermansia after fasting: a pilot study." Wiener klinische Wochenschrift 127.9-10 (2015): 394-398. [00:24:41] Tolerating inulin. [00:25:22] Celeriac root. [00:26:19] Where do the microbes come from? [00:28:33] Antibiotics. [00:29:09] Cephalexin antibiotic. [00:29:56] Clindamycin antibiotic. [00:32:08] Amoxicillin antibiotic. [00:33:54] Metabolic endotoxaemia. [00:39:28] Mother Dirt. [00:41:42] FMT and the Taymount Clinic. [00:42:17] 4-Cresol Vancomycin.

Your Guide to Ending Acne

Your Guide to Ending Acne

  Summary: Dr. Robert Centor’s Knowledge Food, Part 2!  On this episode of The Curbsiders, we continue our discussion with the legendary Dr. Centor, focusing on pharyngitis and the highly entertaining origin of the Centor Criteria.  Not only do we learn how to dominate pharyngitis, but we also uncover one of Dr. Watto’s knowledge deficits - Lemierre’s Syndrome.  (He owes us a two minute talk on Lemierre’s Syndrome in case you’re wondering. I know I am.) Clinical Pearls: Admit your own limitations!  Many overestimate their skills as a clinical educator. Preadolescents get streptococcal pharyngitis (...or it’s nothing). Adolescents are much more complicated with streptococcus, EBV, CMV, acute HIV, fusobacterium, and multiple other causes. Important: Separate the causes of pharyngitis in preadolescents and adolescents. General rule: Sore throats should not cause rigors; if present then admit patient, obtain blood cultures, and start antibiotics. Do NOT miss a peritonsillar abscess or Lemierre’s Syndrome in acute pharyngitis. Pharyngitis improves within three to five days.  Failure to improve should prompt a more thorough investigation. Lemierre’s Syndrome (1 in 70,000 untreated pharyngitis patients) is septic thrombophlebitis of the internal jugular vein.  The treatment is IV antibiotics and NOT anticoagulation.   Dr. Centor and the IDSA recommends Amoxicillin once daily and, if penicillin allergic, Clindamycin.  The most recent IDSA update recommends a 10-day course of Amoxicillin (50mg/kg up to 1000mg once daily). Dr. Centor’s “Take-Home” Points: Adolescents tend to have more complicated pharyngitis Pharyngitis and rigors?  Admit, obtain cultures, and start antibiotics. Sore throats don’t get worse and, if they do, you need to rethink the case Disclosures: Dr. Centor reports no relevant financial disclosures for this topic. Learning objectives: By the end of this podcast listeners will be able to: Identify the limitations of the Centor Criteria in regards to (a) preadolescents and (b) adolescents, taking special precautions in the adolescent population Understand which acute pharyngitis patients require a more thorough investigation Be able to identify Amoxicillin as the treatment of choice for acute bacterial pharyngitis with Clindamycin as the second-line antibiotics choice. Links from the show: Check our Dr. Centor’s wonderful blog, at http://www.medrants.com or on twitter https://twitter.com/medrants Centor’s Criteria (MDCalc) -- http://www.mdcalc.com/modified-centor-score-for-strep-pharyngitis/ IDSA Guidelines on Diagnosis and Management of Group A Streptococcus Pharyngitis - http://cid.oxfordjournals.org/content/early/2012/09/06/cid.cis629.full.pdf+html Original article using the Centor score for pharyngitis https://www.ncbi.nlm.nih.gov/pubmed/6763125?dopt=abstract Dr. Centor’s article on fusobacterium Centor RM, et al. The clinical presentation of Fusobacterium-positive and streptococcal-positive pharyngitis in a university health clinic: a cross-sectional study. Ann Intern Med. 2015 Feb 17;162(4):241-7. doi: 10.7326/M14-1305.

Se noter og links på sivp.dk/16 Hvornår antibiotika kan være en god ide til en hudpatient Lene bruger systemisk antibiotika til patienter, hvor der er et stort omfang af læsioner, eller når læsionerne sidder steder, hvor det kan være svært at vaske effektivt. For eksempel kan en anbefaling af shampoovask af en langhårsrace give dårlig complience og dermed manglende effekt af behandlingen. Ved dybe pyodermier bruger Lene ofte kun topikal antibiotika eventuelt som et blandingsprodukt med steroid, for helt at undgå den systemiske behandling. Ifølge vores antibiotikavejledning bør vi vælge Clindamycin som førstevalg ved hudbetændelser. Lene gør dog opmærksom på, at hvis en patient har fået antibiotika før, vil op til 30 % have bakterier, der er resistente overfor Clindamycin. Dernæst kan vi for eksempel vælge 1. generations cefalosporiner som Cefalexin (Cefaseptin Vet, Therios og Tsefalen) og Cefadroxil (Cefa-Cure) (information fra medicintildyr.dk) Alternativt ville Sulfa-TMP også være udmærket at bruge, men det er pt ikke i handlen som veterinært produkt. Lene fortæller at efter podning med resistensbestemmelse, kan det vise sig, at selv smalspektret antibiotika som almindelige penicillin kan være effektivt. Og da dette ikke betyder at vi afviger fra kaskedereglen på en ufordelagtig måde, kan det endda forsvares juridisk. Tilstrækkelig erstatning for antibiotika Ud fra en resistensmæssig betragtning er det bedst at holde sig helt fra systemisk antibiotika – også selvom man starter smalspektret. Lene anbefaler en shampoo med klorhexidin til brug enten dagligt eller 3 gange den første uge afhængigt af omfanget af problemerne. Derfra 2 gange om ugen indtil læsionerne er væk. Som eksempel nævner Lene Hot Spot-patienter: Det er en helt overfladisk hudbetændelse og man diskuterer endda hvor mange bakterier, der er i læsionerne. Der ville klorhexidinshampoo sammen med smertestillende og eventuelt en skærm være en ideel behandling. Ønsker du at dræbe Malassezia skal klorhexidinen koncentration op på 3 – 4 %, men ønsker du kun at ramme Stafylokokker er almindelige koncentration (0,02-0,05%) tilstrækkeligt. I podcasten snakker jeg desuden med Lene om at steroidbehandling er kontroversielt til pyodermier. Bekymringen går på om vi undertrykker immunforsvaret nok til at infektionen kan få bedre fat. En tilstrækkelig antiinflammatorisk effekt kan opnås med andre stoffer. Udtagelse af prøve til dyrkning Lene argumenterer for at det vil være en god ide med podning før al systemisk antibiose, men ved også godt, at ejerne nogle gange sætter begrænsninger. Her spiller økonomien ofte en stor rolle. Som modsvar kan det måske hjælpe med argumenter om ikke at selektere for resistente kulturer og korrekt førstevalg vil give en bedre økonomi på lang sigt. Hvis hudlæsion er våd, kan prøven tages direkte fra overfladen. Ellers prikker Lene hul på en pustel og får noget materie ud. Lene bruger laboratoriet KU Sund Vet Diagnostik, der både er meget dygtige og har en god service. Samtidig bidrager prøverne til den nationale resistensovervågning. Den primær årsag bag recidiverende pyodermier Der er oftest en primær årsag til pyodermier, hvor udredningen starter med en undersøgelse for lopper og andre parasitter. Det kan eventuelt være relevant at starte med en forsøgsbehandling alene på mistanken om parasitter. Herfra snakker Lene med ejeren om foder og sætter eventuel en Foder Trail op, hvor hunden skal køre på en eliminationsdiet i 2 - 6 måneder. Hvis den indledende udredning er gjort grundigt nok og hunden ikke reagerer tilfredsstillende på eliminationsdiet vil den med stor sandsynlighed have Atopi. Herfra kan mængden af hudproblemer holdes nede, men ikke nødvendigvis holdes helt væk. Det vil dog oftest være muligt at kunne tage eventuelle problemer i opløbet inden de udvikler sig til krævende hudinfektioner.

When it comes to treating skin disease, we know that Staphylococcus pseudintermedius is a common cause of canine pyoderma. Previous dermatology studies have found that dogs with superficial or deep bacterial pyoderma respond well to clindamycin administration, with success rates of approximately 71-100%. As a result, dermatologists often recommend using clindamycin hydrochloride as an antibiotic for systemic therapy to treat canine pyoderma, with a dosage ranging is 5.5-11 mg/kg once a day to twice a day. In this VetGirl podcast, we discuss whether or not you can use clindamycin at 11mg/kg once-aday versus 5.5 mg/kg twice-a-day when it comes to dosing in dogs.

When it comes to treating skin disease, we know that Staphylococcus pseudintermedius is a common cause of canine pyoderma. Previous dermatology studies have found that dogs with superficial or deep bacterial pyoderma respond well to clindamycin administration, with success rates of approximately 71-100%. As a result, dermatologists often recommend using clindamycin hydrochloride as an antibiotic for systemic therapy to treat canine pyoderma, with a dosage ranging is 5.5-11 mg/kg once a day to twice a day. In this VetGirl podcast, we discuss whether or not you can use clindamycin at 11mg/kg once-aday versus 5.5 mg/kg twice-a-day when it comes to dosing in dogs.

Aims: To investigate if vaginal application of dequalinium chloride (DQC, Fluomizin (R)) is as effective as vaginal clindamycin (CLM) in the treatment of bacterial vaginosis (BV). Methods:This was a multinational, multicenter, single-blind, randomized trial in 15 centers, including 321 women. They were randomized to either vaginal DQC tablets or vaginal CLM cream. Follow-up visits were 1 week and 1 month after treatment. Clinical cure based on Amsel's criteria was the primary outcome. Secondary outcomes were rate of treatment failures and recurrences, incidence of post-treatment vulvovaginal candidosis (VVC), lactobacillary grade (LBG), total symptom score (TSC), and safety. Results: Cure rates with DQC (Cl: 81.5%, C2: 79.5%) were as high as with CLM (Cl: 78.4%, C2: 77.6%). Thus, the treatment with DQC had equal efficacy as CLM cream. A trend to less common post-treatment VVC in the DQC-treated women was observed (DQC: 2.5%, CLM: 7.7%; p = 0.06). Both treatments were well tolerated with no serious adverse events occurring. Conclusion: Vaginal DQC has been shown to be equally effective as CLM cream, to be well tolerated with no systemic safety concerns, and is therefore a valid alternative therapy for women with BV {[}ClinicalTrials.gov, Med380104, NCT01125410]. Copyright (C) 2011 S. Karger AG, Basel

Die Bakterielle Vaginose stellt in der gynäkologischen Infektiologie nach wie vor eine der häufigsten Erkrankungen der Vagina dar. Die auftretenden Symptome wie gräulich homogener Fluor vaginalis oft verbunden mit fischartigem Geruch sind für die Patientinnen sehr belastend und werden nicht selten aufgrund fehlender Diagnosestellung nicht gezielt behandelt. Bis jetzt konnten die der Bakteriellen Vaginose zugrunde liegenden Ursachen noch nicht hinreichend geklärt werden. Um die immunmodulatorischen Effekte zu untersuchen, die mit den Veränderungen der vaginalen Mikroflora im Sinne der Bakteriellen Vaginose assoziiert sind, und in Hinblick auf mögliche neue sowohl therapeutische als auch diagnostische Ansätze, bestimmten wir bei insgesamt 81 nicht schwangeren Frauen die pro-inflammatorischen Zytokine Interleukin-6 und IL- 12 und das anti-inflammatorische Zytokin IL-10 im Vaginalsekret mittels Elisa. Wir untersuchten 45 Patientinnen im Durchschnittsalter von 30,0 Jahren mit der klinischen Diagnose Bakterielle Vaginose und 36 asymptomatische Frauen im Durchschnittsalter von 33,7 Jahren. Interleukin-6 und IL-12 werden über die Immunantwort vom TH1-Typ vermittelt und zählen zu den pro-inflammatorischen Zytokinen, während Interleukin-10 hingegen ein TH2-vermittelter anti-inflammatorischer Immunmediator ist. Ziel war die Beurteilung der Rolle der zellvermittelten Immunität beim Krankheitsbild der BV. Die Auswertungen unserer Messergebnisse zeigten weder für die proinflammatorischen Zytokine IL-6 (p = 0,782807) und IL-12 (p = 0,671506) noch für das anti-inflammatorische Zytokin IL-10 (p = 0,389744) einen signifikanten Unterschied im Vergleich zur Kontrollgruppe. Die für die BV-typischen diagnostischen Marker, wie beispielsweise der pH-Wert, waren statistisch signifikant (p < 0,0001) verändert. Für die Aminprobe ließen sich in der Patientengruppe 42 / 45 positive Ergebnisse finden, während in der Kontrollgruppe 0 / 36 positiv waren. Anhand unserer Ergebnisse scheint die lokale Immunität zumindest in Bezug auf die von uns bestimmten Zytokine bei der Bakteriellen Vaginose eine untergeordnete Rolle zu spielen. Demzufolge lassen sich kaum Anhaltspunkte erkennen, aufgrund derer neue therapeutische Ansätze im Sinne einer Immuntherapie als effektiv zu sehen wären. So gilt eine Behandlung mit Metronidazol oder Clindamycin weiterhin als Mittel der Wahl, eine begleitende Therapie mit Laktobazillen zur Stabilisierung der Mikroflora wäre zu überlegen. Bei Frauen, die an BV erkrankt sind, kommt es vermehrt zu Komplikationen sowohl während der Schwangerschaft, wie ein Spontanabort oder eine Frühgeburt, als auch bei nicht schwangeren Frauen, wie eine Adnexitis oder Endometritis. Aufgrund dessen, dass das Krankheitsbild der Bakteriellen Vaginose möglicherweise in direktem Zusammenhang mit solchen Komplikationen steht, ist die Forschung auf dem Gebiet der BV notwendig und sinnvoll. Es wäre wichtig, Richtlinien für eine schnelle und sichere Diagnosestellung zu erarbeiten, um eine höhere therapeutischen Effektivität zu erreichen.