Antibiotics

Infectious Diseases, “Answers”

EMKF

Although there are no prospective randomized controlled trials looking specifically at ED patients with UTI symptoms, it is safe to say that a urine culture in healthy adult non-pregnant females with new onset urinary symptoms without concern for pyelonephritis or bacteraemia is unlikely to change management or outcome… SO STOP ORDERING THEM

Surviving Sepsis Guidelines 2021: Recommendations and Best Practice Statements

EMKF
  • The recommendation for an initial fluid bolus of 30 mL/kg was downgraded from a strong recommendation to a weak recommendation, based on the low quality of evidence. However, resuscitation should start immediately.
  • Balanced crystalloid solution (e.g., lactated Ringer’s solution) should be used (rather than normal saline) for resuscitation.
  • Administration of vasopressors should be initiated via peripheral access, as opposed to waiting for placement of central venous access.
  • Patients with ongoing vasopressor requirements should receive intravenous corticosteroids (this recommendation was strengthened); however, administration of intravenous vitamin C is explicitly not recommended.

Cut, Drain & Give some Antibiotics

EMKF

Antibiotics after I&D lead to significantly better outcomes with significantly fewer antibiotic-treated participants having clinical failure requiring a new antibiotic or another drainage procedure. New abscesses may develop in 10.1 percent of the antibiotic group compared to 19.1 percent of the placebo group.

 

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