Antibiotic therapy in acute pancreatitis : from global overuse to evidence based recommendations
| Autor: | Nikolay Veligotsky, Dániel Pécsi, Andriy Kozachenko, Bálint Erőss, Julia Mayerle, Zsolt Szakács, Ajay Sud, Minas Baltatzis, Illia Olehovych Tiuliukin, Yaroslav Susak, János Sümegi, Anna V Shirinskaya, Serge Chooklin, Erika Darvasi, Sabite Kacar, J. Enrique Domínguez-Muñoz, Stephanie-Susanne Stecher, Balázs Koncz, Juan Armando Rodriguez-Oballe, Ping Xue, Samuel Raimundo Fernandes, Wei-Wei Chen, József Hamvas, Isabel Miguel Salas, Roland Hágendorn, Wei Huang, Péter Hegyi, Mila Kovacheva-Slavova, Imola Török, Gabriele Capurso, Vizhynis Yeshy, Natalia Fabisiak, Floreta Kurti, Balázs Németh, Jae Hyuck Chang, Zoltán Szepes, António Pedro Gomes, Judit Bajor, Eun Kwang Choi, Gabriel Sandblom, Áron Vincze, Patrícia Sarlós, László Gajdán, Amir Gougol, Anita Gasiorowska, Dóra Illés, Anikó Nóra Szabó, Hanaz Jumaa, Csaba Góg, Péter Varjú, Vladimir L Poluektov, Adrienn Halász, Qing Xia, Ferenc Izbéki, Barnabás Bod, Natalia V Shirinskaya, Aliaksandr Varabei, Alexandra Mikó, Dóra Mosztbacher, Andrea Párniczky, Szilárd Gódi, Ming-Chu Chang, Marian Bátovský, Weiqin Li, Beata Kuśnierz-Cabala, Piotr Ceranowicz, David João Aparício, Joana Rita Carvalho, Hubert Zatorski, Mária Papp, Maria Jesus Oliveira, Xavier Molero, József Czimmer, Márta Varga, László Czakó, Ewa Małecka-Panas, Elizabeth Pando, Javier Lopez-Diaz, Eszter Margit Tóth, Katalin Márta, Marco Marino, Tamás Takács, Andrea Szentesi, Jimin Han, Danielle Moore, Péter Jenő Hegyi, Gabriella Pár, Kshaunish Das, Attila Szepes, Robert Sutton, Tamás Lantos, Ákos Szücs, Marcel Tantau, Yu-Ting Chang, Georgios I. Papachristou, María Lourdes Ruiz-Rebollo, Sara Bertilsson, Beatriz Burgueño-Gómez, János Novák, Goran Poropat, Imre Szabó |
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| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Consensus Evidence-based practice Microbiological culture medicine.drug_class Endocrinology Diabetes and Metabolism Clinical Decision-Making Antibiotics Guideline Klinikai orvostudományok Procalcitonin Antimicrobial Stewardship 03 medical and health sciences 0302 clinical medicine Bacterial infections Surveys and Questionnaires Humans Medicine Practice Patterns Physicians' Intensive care medicine BIOMEDICINE AND HEALTHCARE. Clinical Medical Sciences. Internal Medicine Randomized Controlled Trials as Topic Acute disease BIOMEDICINA I ZDRAVSTVO. Kliničke medicinske znanosti. Interna medicina Evidence-Based Medicine Hepatology business.industry Antibiotic Gastroenterology Bacterial Infections Orvostudományok Recommendation medicine.disease Anti-Bacterial Agents Acute pancreatitis Infection Pancreatitis 030220 oncology & carcinogenesis Acute Disease Biomarker (medicine) 030211 gastroenterology & hepatology Guideline Adherence business Biomarkers |
| Zdroj: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) Agência para a Sociedade do Conhecimento (UMIC)-FCT-Sociedade da Informação instacron:RCAAP Pancreatology Volume 19 Issue 4 |
| ISSN: | 1424-3903 |
| Popis: | Although evidence indicates that use of procalcitonin to guide antibiotic decisions for the treatment of acute respiratory infections (ARI) decreases antibiotic consumption and improves clinical outcomes, algorithms used within studies had differences in PCT cut-off points and frequency of testing. We therefore analyzed studies evaluating procalcitonin-guided antibiotic therapy and propose consensus algorithms for different respiratory infection types. Areas covered: We systematically searched randomized-controlled trials (search strategy updated on February 2018) on procalcitonin-guided antibiotic therapy of ARI in adults using a pre-specified Cochrane protocol and analyzed algorithms from 32 trials that included 10,285 patients treated in primary care settings, emergency departments (ED), and intensive care units (ICU). We derived consensus algorithms for use of procalcitonin by the type of ARI including community-acquired pneumonia, bronchitis, chronic obstructive pulmonary disease or asthma exacerbation, sepsis, and post-operative sepsis due to respiratory infection. Consensus algorithm recommendations differ with regard to timing of treatment (i.e. timing of initiation in low-risk patients or discontinuation in high-risk patients) and procalcitonin cut-off points for the recommendation/strong recommendation to discontinue antibiotics (≤ 0.25/≤ 0.1 µg/L in ED and inpatients, ≤ 0.5/≤ 0.25 µg/L in ICU patients, and reduction by ≥ 80% from peak levels in sepsis patients). Expert commentary: Our proposed algorithms may facilitate safe and efficient implementation of procalcitonin-guided antibiotic protocols in diverse healthcare settings. Still, the decision about initiation and cessation of antibiotic treatment remains a clinical decision based on the patient assessment and the severity of illness and use of procalcitonin should not delay empirical treatment in high risk situations. info:eu-repo/semantics/publishedVersion |
| Databáze: | OpenAIRE |
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