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Broom M, Best E, Heffernan H, Svensson S, Hansen Hygstedt M, Webb R, Gow N, Holland D, Thomas M, Briggs S. Outcomes of adults with invasive meningococcal disease with reduced penicillin susceptibility in Auckland 2004-2017. Infection 2022; 51:425-432. [PMID: 35982367 DOI: 10.1007/s15010-022-01897-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/25/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE The purpose of this study was to assess the clinical outcomes of adults with invasive meningococcal disease (IMD) and to compare the outcomes of patients with IMD caused by a penicillin susceptible isolate (minimum inhibitory concentration (MIC) ≤ 0.06 mg/L) with patients with IMD caused by an isolate with reduced penicillin susceptibility (MIC > 0.06 mg/L). We also assessed the outcomes of patients with IMD caused by an isolate with reduced penicillin susceptibility who were treated exclusively with intravenous (IV) benzylpenicillin. METHODS Retrospective study of all culture positive IMD in adult patients (age ≥ 15 years) in the Auckland region from 2004 to 2017. RESULTS One hundred and thirty-nine patients were included; 94 had penicillin susceptible isolates (88 cured, 6 died), and 45 had an isolate with reduced penicillin susceptibility (41 cured, 1 possible relapse, 3 died). The median benzylpenicillin/ceftriaxone treatment duration was 3 days for both groups. There was no difference in the patient outcomes of both groups. Eighteen patients with IMD caused by an isolate with reduced penicillin susceptibility received benzylpenicillin alone and were cured. CONCLUSIONS This study provides further support to existing data that has shown that short duration IV beta-lactam treatment is effective for IMD in adults. Only a small number of patients with meningitis caused by an isolate with reduced penicillin susceptibility received benzylpenicillin alone, limiting its evaluation. For Neisseria meningitidis meningitis, we recommend ceftriaxone as empiric treatment and as definitive treatment when this is caused by an isolate with reduced penicillin susceptibility.
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Affiliation(s)
- Matthew Broom
- Auckland City Hospital Infectious Diseases Department, Auckland District Health Board, 2 Park Road, Grafton, Auckland, 1023, New Zealand. .,North Shore Hospital Infectious Diseases Department, Waitemata District Health Board, 124 Shakespeare Road, Takapuna, Auckland, 0620, New Zealand.
| | - Emma Best
- Starship Hospital Infectious Diseases Department, Auckland District Health Board, 2 Park Road, Grafton, Auckland, 1023, New Zealand.,Department of Paediatrics, University of Auckland, Level 12, Support Building Auckland City Hospital, 2 Park Road, Grafton, Auckland, 1023, New Zealand
| | - Helen Heffernan
- The Institute of Environmental Science and Research, 34 Kenepuru Drive, Kenepuru, Porirua, New Zealand
| | - Sara Svensson
- Auckland City Hospital Infectious Diseases Department, Auckland District Health Board, 2 Park Road, Grafton, Auckland, 1023, New Zealand.,University of Gothenburg, 405 30, Gothenburg, Sweden.,Norra Ӓlvsborgs Lӓnssjukhus, Lӓrketorpsvӓgen, 461 73, Trollhӓttan, Sweden
| | - Maria Hansen Hygstedt
- Auckland City Hospital Infectious Diseases Department, Auckland District Health Board, 2 Park Road, Grafton, Auckland, 1023, New Zealand.,University of Gothenburg, 405 30, Gothenburg, Sweden.,, Ӧgonkliniken, Lansmansgatan 20, 431 30, Molndal, Sweden
| | - Rachel Webb
- Middlemore Hospital Kidz First Infectious Diseases Department, Counties Manukau District Health Board, 100 Hospital Road, Middlemore, Auckland, 2025, New Zealand
| | - Nick Gow
- North Shore Hospital Infectious Diseases Department, Waitemata District Health Board, 124 Shakespeare Road, Takapuna, Auckland, 0620, New Zealand
| | - David Holland
- Middlemore Hospital Infectious Diseases Department, Counties Manukau District Health Board, 100 Hospital Road, Middlemore, Auckland, 2025, New Zealand
| | - Mark Thomas
- Auckland City Hospital Infectious Diseases Department, Auckland District Health Board, 2 Park Road, Grafton, Auckland, 1023, New Zealand.,Department of Molecular Medicine, University of Auckland, Grafton Campus, Grafton, Auckland, 1023, New Zealand
| | - Simon Briggs
- Auckland City Hospital Infectious Diseases Department, Auckland District Health Board, 2 Park Road, Grafton, Auckland, 1023, New Zealand
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2
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Sharma N, Zahoor I, Sachdeva M, Subramaniyan V, Fuloria S, Fuloria NK, Naved T, Bhatia S, Al-Harrasi A, Aleya L, Bungau S, Behl T, Singh S. Deciphering the role of nanoparticles for management of bacterial meningitis: an update on recent studies. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:60459-60476. [PMID: 34545518 PMCID: PMC8452126 DOI: 10.1007/s11356-021-16570-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 09/12/2021] [Indexed: 04/15/2023]
Abstract
Meningitis is an inflammation of the protective membranes called meninges and fluid adjacent the brain and spinal cord. The inflammatory progression expands all through subarachnoid space of the brain and spinal cord and occupies the ventricles. The pathogens like bacteria, fungi, viruses, or parasites are main sources of infection causing meningitis. Bacterial meningitis is a life-threatening health problem that which needs instantaneous apprehension and treatment. Nesseria meningitidis, Streptococcus pneumoniae, and Haemophilus flu are major widespread factors causing bacterial meningitis. The conventional drug delivery approaches encounter difficulty in crossing this blood-brain barrier (BBB) and therefore are insufficient to elicit the desired pharmacological effect as required for treatment of meningitis. Therefore, application of nanoparticle-based drug delivery systems has become imperative for successful dealing with this deadly disease. The nanoparticles have ability to across BBB via four important transport mechanisms, i.e., paracellular transport, transcellular (transcytosis), endocytosis (adsorptive transcytosis), and receptor-mediated transcytosis. In this review, we reminisce distinctive symptoms of meningitis, and provide an overview of various types of bacterial meningitis, with a focus on its epidemiology, pathogenesis, and pathophysiology. This review describes conventional therapeutic approaches for treatment of meningitis and the problems encountered by them while transmitting across tight junctions of BBB. The nanotechnology approaches like functionalized polymeric nanoparticles, solid lipid nanoparticles, nanostructured lipid carrier, nanoemulsion, liposomes, transferosomes, and carbon nanotubes which have been recently evaluated for treatment or detection of bacterial meningitis have been focused. This review has also briefly summarized the recent patents and clinical status of therapeutic modalities for meningitis.
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Affiliation(s)
- Neelam Sharma
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Ishrat Zahoor
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Monika Sachdeva
- Fatima College of Health Sciences, Al Ain, United Arab Emirates
| | | | | | | | - Tanveer Naved
- Amity Institute of Pharmacy, Amity University, Noida, India
| | - Saurabh Bhatia
- Natural & Medical Sciences Research Centre, University of Nizwa, Nizwa, Oman
- Amity Institute of Pharmacy, Amity University, Haryana, India
| | - Ahmed Al-Harrasi
- Natural & Medical Sciences Research Centre, University of Nizwa, Nizwa, Oman
| | - Lotfi Aleya
- Chrono-Environment Laboratory, UMR CNRS 6249, Bourgogne Franche-Comté University, Besancon, France
| | - Simona Bungau
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania
| | - Tapan Behl
- Chitkara College of Pharmacy, Chitkara University, Punjab, India.
| | - Sukhbir Singh
- Chitkara College of Pharmacy, Chitkara University, Punjab, India.
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3
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Antibiotic treatment of common infections: more evidence to support shorter durations. Curr Opin Infect Dis 2021; 33:433-440. [PMID: 33148985 DOI: 10.1097/qco.0000000000000680] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Although there is increasing recognition of the link between antibiotic overuse and antimicrobial resistance, clinician prescribing is often unnecessarily long and motivated by fear of clinical relapse. High-quality evidence supporting shorter treatment durations is needed to give clinicians confidence to change prescribing habits. Here we summarize recent randomized controlled trials investigating antibiotic short courses for common infections in adult patients. RECENT FINDINGS Randomized trials in the last five years have demonstrated noninferiority of short-course therapy for a range of conditions including community acquired pneumonia, intraabdominal sepsis, gram-negative bacteraemia and vertebral osteomyelitis. SUMMARY Treatment durations for many common infections have been based on expert opinion rather than randomized trials. There is now evidence to support shorter courses of antibiotic therapy for many conditions.
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4
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Ellis J, Luintel A, Chandna A, Heyderman RS. Community-acquired acute bacterial meningitis in adults: a clinical update. Br Med Bull 2019; 131:57-70. [PMID: 31556944 DOI: 10.1093/bmb/ldz023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 06/20/2019] [Accepted: 06/27/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Acute bacterial meningitis (ABM) in adults is associated with a mortality that may exceed 30%. Immunization programs have reduced the global burden; in the UK, declining incidence but persistently high mortality and morbidity mean that clinicians must remain vigilant. SOURCES OF DATA A systematic electronic literature search of PubMed was performed to identify all ABM literature published within the past 5 years. AREAS OF AGREEMENT AND CONTROVERSY Clinical features cannot reliably distinguish between ABM and other important infectious and non-infectious aetiologies. Prompt investigation and empirical treatment are imperative. Lumbar puncture (LP) and cerebrospinal fluid microscopy, biochemistry and culture remain the mainstay of diagnosis, but molecular techniques are increasingly useful. The 2016 UK joint specialist societies' guideline provides expert recommendations for the management of ABM, yet published data suggest clinical care delivered in the UK is frequently not adherent. Anxiety regarding risk of cerebral herniation following LP, unnecessary neuroimaging, underutilization of molecular diagnostics and suboptimal uptake of adjunctive corticosteroids compromise management. GROWING POINTS There is increasing recognition that current antibiotic regimens and adjunctive therapies alone are insufficient to reduce the mortality and morbidity associated with ABM. AREAS TIMELY FOR DEVELOPING RESEARCH Research should be focused on optimization of vaccines (e.g. pneumococcal conjugate vaccines with extended serotype coverage), targeting groups at risk for disease and reservoirs for transmission; improving adherence to management guidelines; development of new faster, more accurate diagnostic platforms (e.g. novel point-of-care molecular diagnostics); and development of new adjunctive therapies (aimed at the host-inflammatory response and bacterial virulence factors).
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Affiliation(s)
- Jayne Ellis
- Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, 235 Euston Rd, Bloomsbury, London, UK
| | - Akish Luintel
- Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, 235 Euston Rd, Bloomsbury, London, UK
| | - Arjun Chandna
- Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, 235 Euston Rd, Bloomsbury, London, UK
| | - Robert S Heyderman
- Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, 235 Euston Rd, Bloomsbury, London, UK
- Division of Infection and Immunity, University College London, Rayne Building, 5 University Street, London, UK
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Macheda G, Luc A, Béraud G, Castan B, Gauzit R, Lesprit P, Tattevin P, Thilly N, Pulcini C. Impact of the French Infectious Diseases Society's (SPILF) proposals for shorter antibiotic therapies. Med Mal Infect 2019; 49:456-462. [PMID: 31351803 DOI: 10.1016/j.medmal.2019.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/31/2018] [Accepted: 07/03/2019] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To compare the practices of French infection specialists related to antibiotic therapy duration between 2016 and 2018. METHODS We conducted two identical surveys (in 2016 and 2018) targeting hospital-based infection specialists (medical physicians, pharmacists) who gave at least weekly advice on antibiotic prescriptions. The questionnaire included 15 clinical vignettes. Part A asked about the durations of antibiotic therapies they would usually advise to prescribers, and part B asked about the shortest duration they would be willing to advise for the same clinical situations. RESULTS We included 325 specialists (165 in 2016 and 160 in 2018), mostly infectious disease specialists (82.4%, 268/325), members of antibiotic stewardship teams in 72% (234/325) of cases. Shorter antibiotic treatments (as compared with the literature) were advised to prescribers in more than half of the vignettes by 71% (105/147) of respondents in 2018, versus 46% (69/150) in 2016 (P<0.001). Guidelines used by participants displayed fixed durations for 77% (123/160) of cases in 2018 versus 21% (35/165) in 2016. Almost all respondents (89%, 131/160) declared they were aware of the 2017 SPILF's proposal. CONCLUSION The release of guidelines promoting shorter durations of antibiotic therapy seems to have had a favourable impact on practices of specialists giving advice on antibiotic prescriptions.
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Affiliation(s)
- G Macheda
- Infectious diseases department, université de Lorraine, CHRU de Nancy, 54000 Nancy, France
| | - A Luc
- Plateforme d'aide à la recherche clinique, CHRU de Nancy, 54000 Nancy, France
| | - G Béraud
- Médecine interne et maladies infectieuses, CHU de Poitiers, 86021 Poitiers, France; Centre de recherche du CHU de Québec, université Laval, hôpital Saint-Sacrement, chemin Sainte-Foy, Québec, Canada; Hasselt university, interuniversity institute for biostatistics and statistical bioinformatics, Censtat, Hasselt, Belgium
| | - B Castan
- Unité fonctionnelle d'infectiologie régionale, centre hospitalier d'Ajaccio, 20303 Ajaccio, France
| | - R Gauzit
- Équipe mobile d'infectiologie, université Paris Descartes, hôpitaux universitaires Paris centre-site Cochin, AP-HP, 75014 Paris, France
| | - P Lesprit
- Hôpital Foch, 92151 Suresnes, France
| | - P Tattevin
- Maladies infectieuses et réanimation médicale, hôpital Pontchaillou, CHU de Rennes, 35033 Rennes, France
| | - N Thilly
- Plateforme d'aide à la recherche clinique, CHRU de Nancy, 54000 Nancy, France; Université de Lorraine, APEMAC, 54000 Nancy, France
| | - C Pulcini
- Infectious diseases department, université de Lorraine, CHRU de Nancy, 54000 Nancy, France; Université de Lorraine, APEMAC, 54000 Nancy, France.
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6
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Macheda G, Dyar OJ, Luc A, Beovic B, Béraud G, Castan B, Gauzit R, Lesprit P, Tattevin P, Thilly N, Pulcini C. Are infection specialists recommending short antibiotic treatment durations? An ESCMID international cross-sectional survey. J Antimicrob Chemother 2019; 73:1084-1090. [PMID: 29346568 DOI: 10.1093/jac/dkx528] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 12/18/2017] [Indexed: 12/21/2022] Open
Abstract
Objectives To evaluate the current practice and the willingness to shorten the duration of antibiotic therapy among infection specialists. Methods Infection specialists giving at least weekly advice on antibiotic prescriptions were invited to participate in an online cross-sectional survey between September and December 2016. The questionnaire included 15 clinical vignettes corresponding to common clinical cases with favourable outcomes; part A asked about the antibiotic treatment duration they would usually advise to prescribers and part B asked about the shortest duration they were willing to recommend. Results We included 866 participants, mostly clinical microbiologists (22.8%, 197/863) or infectious diseases specialists (58.7%, 507/863), members of an antibiotic stewardship team in 73% (624/854) of the cases, coming from 58 countries on all continents. Thirty-six percent of participants (271/749) already advised short durations of antibiotic therapy (compared with the literature) to prescribers for more than half of the vignettes and 47% (312/662) chose shorter durations in part B compared with part A for more than half of the vignettes. Twenty-two percent (192/861) of the participants declared that their regional/national guidelines expressed durations of antibiotic therapy for a specific clinical situation as a fixed duration as opposed to a range and in the multivariable analysis this was associated with respondents advising short durations for more than half of the vignettes (adjusted OR 1.5, P = 0.02). Conclusions The majority of infection specialists currently do not advise the shortest possible duration of antibiotic therapy to prescribers. Promoting short durations among these experts is urgently needed.
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Affiliation(s)
- Gabriel Macheda
- CHRU de Nancy, Service de Maladies Infectieuses et Tropicales, Nancy, France
| | - Oliver J Dyar
- Karolinska Institutet, Department of Public Health Sciences, Global Health - Health Systems and Policy, Stockholm, Sweden
| | - Amandine Luc
- CHRU de Nancy, Plateforme d'Aide à la Recherche Clinique, Nancy, France
| | - Bojana Beovic
- University Medical Centre Ljubljana, Ljubljana, Slovenia.,University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia
| | - Guillaume Béraud
- CHU de Poitiers, Médecine Interne et Maladies Infectieuses, Poitiers, France.,Centre de recherche du CHU de Québec-Université Laval, Hôpital Saint-Sacrement, Chemin Sainte-Foy (Québec), Canada.,Hasselt University, Interuniversity Institute for Biostatistics and statistical Bioinformatics, Censtat, Hasselt, Belgium
| | - Bernard Castan
- CH Ajaccio, Unité fonctionnelle d'infectiologie régionale, Ajaccio, France
| | - Rémy Gauzit
- AP-HP, hôpitaux universitaires Paris centre-site Cochin, université Paris Descartes, Équipe mobile d'infectiologie, Paris, France
| | | | - Pierre Tattevin
- CHU de Rennes, hôpital Pontchaillou, Maladies infectieuses et réanimation médicale, Rennes, France
| | - Nathalie Thilly
- CHRU de Nancy, Plateforme d'Aide à la Recherche Clinique, Nancy, France.,Université de Lorraine, EA 4360 APEMAC, Nancy, France
| | - Céline Pulcini
- CHRU de Nancy, Service de Maladies Infectieuses et Tropicales, Nancy, France.,Université de Lorraine, EA 4360 APEMAC, Nancy, France
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7
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Cabellos C, Pelegrín I, Benavent E, Gudiol F, Tubau F, Garcia-Somoza D, Verdaguer R, Ariza J, Fernandez-Viladrich P. Invasive meningococcal disease: Impact of short course therapy. A DOOR/RADAR study. J Infect 2017; 75:420-425. [PMID: 28847701 DOI: 10.1016/j.jinf.2017.08.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 08/08/2017] [Accepted: 08/18/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Invasive meningococcal disease is a severe infection. The appropriate duration of antibiotic therapy is not well established. METHODS Two hundred and sixty-three consecutive patients with invasive meningococcal disease treated with 4 days' antibiotic therapy were compared with 264 consecutive patients treated previously at the same center with 7 days' antibiotic therapy. A Desirability of Outcome Ranking (DOOR) and Response Adjusted for Duration of Antibiotic Risk (RADAR) study was also performed. RESULTS No relapses were recorded in any patient. Patients on the 4-day course were 63% female, with a median age of 23 years old (IQR 16-54) and patients on the 7-day course were 61% female, with a median age of 17 years old (IQR 12-43). Case fatality rate was 7% in the 4-d patients and 6% in the 7-d patients (p = 0.582). Neurological sequelae were recorded in 6% of the 4-d group and in 7% of the 7-d group ((p = 0.509) and cutaneous sequelae in 3% in both groups. There were no statistical significant differences between the groups in terms of clinical characteristics, laboratory findings or complications. The probability that a patient had a randomly chosen DOOR better with the 4-day regimen than with the 7-day regimen was 80.4% [95% CI 80.1-80.7%]. CONCLUSION Invasive meningococcal disease may be successfully treated with a four-day course of antibiotic therapy without relapses.
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Affiliation(s)
- Carmen Cabellos
- Infectious Diseases Department, IDIBELL-Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain.
| | - Ivan Pelegrín
- Infectious Diseases Department, IDIBELL-Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain.
| | - Eva Benavent
- Infectious Diseases Department, IDIBELL-Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain
| | - Francesc Gudiol
- Infectious Diseases Department, IDIBELL-Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain
| | - Fe Tubau
- Microbiology Department, IDIBELL-Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain
| | - Dolores Garcia-Somoza
- Microbiology Department, IDIBELL-Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain
| | - Ricard Verdaguer
- Microbiology Department, IDIBELL-Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain
| | - Javier Ariza
- Infectious Diseases Department, IDIBELL-Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain
| | - Pedro Fernandez-Viladrich
- Infectious Diseases Department, IDIBELL-Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain
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8
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Garnacho-Montero J, Arenzana-Seisdedos A, De Waele J, Kollef MH. To which extent can we decrease antibiotic duration in critically ill patients? Expert Rev Clin Pharmacol 2017; 10:1215-1223. [PMID: 28837364 DOI: 10.1080/17512433.2017.1369879] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Inadequate empirical antibiotic therapy is associated with higher mortality in critically ill patients with severe infections. Nevertheless, prolonged duration of antibiotic treatment is also potentially harmful. Development of new infections with more resistant pathogens is one of the arguments against the administration of prolonged courses of antibiotics. Areas covered: We aim to describe the optimal duration of antimicrobial therapy in the most common infections affecting critically ill patients. A literature search was performed to identify all clinical trials, observational studies, meta-analysis, and reviews about this topic from PubMed. Expert commentary: Diverse observational studies have reported a poor outcome in critically ill patients without a documented infection who receive prolonged antibiotic therapy. We summarize the available information about the optimal duration of antimicrobial therapy in critically ill patients with severe infections including community-acquired pneumonia, intra-abdominal infections, bacteremia, meningitis and urinary-tract infections as well as the clinical consequences of short antimicrobial courses in certain severe infections. The utility of procalcitonin to reduce the duration of antibiotics is also discussed. Finally, we give clear recommendations about the length of treatment for the most common infections in critically ill patients.
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Affiliation(s)
- José Garnacho-Montero
- a Unidad Clínica de Cuidados Intensivos , Hospital Universitario Virgen Macarena , Sevilla , Spain
| | - Angel Arenzana-Seisdedos
- a Unidad Clínica de Cuidados Intensivos , Hospital Universitario Virgen Macarena , Sevilla , Spain
| | - Jan De Waele
- b Department of Critical Care Medicine , Ghent University Hospital , Ghent , Belgium
| | - Marin H Kollef
- c Pulmonary and Critical Care Division , Washington University School of Medicine , St. Louis MO , USA
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9
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Affiliation(s)
- Louise Elaine Vaz
- Division of Pediatric Infectious Diseases, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, OR
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10
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Abstract
Over the past several decades, the incidence of bacterial meningitis in children has decreased but there remains a significant burden of disease in adults, with a mortality of up to 30%. Although the pathogenesis of bacterial meningitis is not completely understood, knowledge of bacterial invasion and entry into the CNS is improving. Clinical features alone cannot determine whether meningitis is present and analysis of cerebrospinal fluid is essential for diagnosis. Newer technologies, such as multiplex PCR, and novel diagnostic platforms that incorporate proteomics and genetic sequencing, might help provide a quicker and more accurate diagnosis. Even with appropriate antimicrobial therapy, mortality is high and so attention has focused on adjunctive therapies; adjunctive corticosteroids are beneficial in certain circumstances. Any further improvements in outcome are likely to come from either modulation of the host response or novel approaches to therapy, rather than new antibiotics. Ultimately, the best hope to reduce the disease burden is with broadly protective vaccines.
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Affiliation(s)
- Fiona McGill
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK; NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, UK; Leeds University Hospitals NHS Trust, Leeds, UK; Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Robert S Heyderman
- Malawi-Liverpool-Wellcome Trust, Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi; Division of Infection and Immunity, University College London, London, UK
| | - Stavros Panagiotou
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Allan R Tunkel
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Tom Solomon
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK; The Walton Centre NHS Foundation Trust, Liverpool, UK; NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, UK; Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK.
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11
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Takada S, Fujiwara S, Inoue T, Kataoka Y, Hadano Y, Matsumoto K, Morino K, Shimizu T. Meningococcemia in Adults: A Review of the Literature. Intern Med 2016; 55:567-72. [PMID: 26984070 DOI: 10.2169/internalmedicine.55.3272] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We mainly refer to the acute setting of meningococcemia. Meningococcemia is an infection caused by Neisseria meningitidis, which has 13 clinically significant serogroups that are distinguishable by the structure of their capsular polysaccharides. N. meningitidis, also called meningococcus, is a Gram-negative, aerobic, diplococcus bacterium. The various consequences of severe meningococcal sepsis include hypotension, disseminated intravascular coagulation (DIC), multiple organ failure, and osteonecrosis due to DIC. The gold standard for the identification of meningococcal infection is the bacteriologic isolation of N. meningitidis from body fluids such as blood, cerebrospinal fluid (CSF), synovial fluid, and pleural fluid. Blood, CSF, and skin biopsy cultures are used for diagnosis. Meningococcal infection is a medical emergency that requires antibiotic therapy and intensive supportive care. Management of the systemic circulation, respiration, and intracranial pressure is vital for improving the prognosis, which has dramatically improved since the wide availability of antibiotics. This review of the literature provides an overview of current concepts on meningococcemia due to N. meningitidis infection.
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Affiliation(s)
- Shimon Takada
- Department of General Internal Medicine, Nara City Hospital, Japan
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12
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13
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Abstract
Despite current advances in antibiotic therapy and vaccines, meningococcal disease serogroup C (MDC) remains a serious threat to global health, particularly in countries in North and Latin America, Europe, and Asia. MDC is a leading cause of morbidity, mortality, and neurological sequelae and it is a heavy economic burden. At the individual level, despite advances in antibiotics and supportive therapies, case fatality rate remains nearly 10% and severe neurological sequelae are frequent. At the population level, prevention and control of infection is more challenging. The main approaches include health education, providing information to the public, specific treatment, chemoprophylaxis, and the use of vaccines. Plain and conjugate meningococcal C polysaccharide vaccines are considered safe, are well tolerated, and have been used successfully for over 30 years. Most high-income countries use vaccination as a part of public health strategies, and different meningococcal C vaccination schedules have proven to be effective in reducing incidence. This is particularly so with conjugate vaccines, which have been found to induce immunogenicity in infants (the age group with the highest incidence rates of disease), stimulate immunologic memory, have longer effects, not lead to hyporesponsiveness with repeated dosing, and decrease acquisition of nasopharyngeal carriage, inducing herd immunity. Antibiotics are considered a cornerstone of MDC treatment and must be administered empirically as soon as possible. The choice of which antibiotic to use should be made based on local antibiotic resistance, availability, and circulating strains. Excellent options for a 7-day course are penicillin, ampicillin, chloramphenicol, and third-generation cephalosporins (ceftriaxone and cefotaxime) intravenously, although the latter are considerably more expensive than the others. The use of steroids as adjunctive therapy for MDC is still controversial and remains a topic of debate. A combination of all of the aforementioned approaches is useful in the prevention and control of MDC, and each country should tailor its public health policy to its own particular needs and knowledge of disease burden.
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14
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Clinical Practice Guidelines for the Management of Bacterial Meningitis in Adults in Korea. Infect Chemother 2012. [DOI: 10.3947/ic.2012.44.3.140] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Hayashi Y, Paterson DL. Strategies for reduction in duration of antibiotic use in hospitalized patients. Clin Infect Dis 2011; 52:1232-40. [PMID: 21507920 DOI: 10.1093/cid/cir063] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
There is a global crisis of antibiotic resistance in part because of the collateral damage of antibiotic use. Reduction in antibiotic consumption is clearly important to minimize this problem. Limiting treatment duration may be the most clinically palatable means of reducing antibiotic consumption. Antimicrobial stewardship programs play an important role in this process. Their effectiveness may be increased by drawing on evidence from randomized controlled trials regarding optimal antibiotic duration. However, in most clinical scenarios, the recommended duration of therapy in published guidelines is based on expert opinion. Biological markers, such as procalcitonin, have been shown to reduce antimicrobial consumption with no adverse outcome in 11 randomized controlled trials. Although procalcitonin may not be the perfect biomarker, the concept of procalcitonin-guided antibiotic discontinuation after clinical stabilization, in conjunction with antimicrobial stewardship programs, appears to be ready for introduction into clinical practice.
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Affiliation(s)
- Yoshiro Hayashi
- The University of Queensland, Centre for Clinical Research, Brisbane, Australia
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Abstract
OPINION STATEMENT Meningococcal meningitis (MM) is the most common presentation of meningococcal disease and an important cause of morbidity and mortality worldwide. When MM is associated with shock, early recognition and treatment of shock is essential. No investigation should delay starting antibiotics once the diagnosis is suspected. Corticosteroids can be started at the same time as the antibiotics or just before, but this is not a specific recommendation for MM. Low-dose steroids should be used in meningococcal disease with refractory shock. Altered blood flow, cerebral edema, and raised intracranial pressure are problems that should be considered in all patients with MM and decreased consciousness level. When mechanical ventilation is required, the target carbon dioxide level is 4.0 to 4.5 kPa, with avoidance of hypocapnia. Seizures, although not frequent, can occur in MM and require prompt treatment. Other treatments, such as mannitol and activated protein C, should be avoided. Potential new treatments requiring further investigation include neuroprotection with hypothermia or glycerol.
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Knudtson EJ, Lytle ML, Vavricka BA, Skaggs VS, Peck JD, Elimian AE. A comparison of meningococcal carriage by pregnancy status. J Negat Results Biomed 2010; 9:6. [PMID: 20701795 PMCID: PMC2928178 DOI: 10.1186/1477-5751-9-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Accepted: 08/11/2010] [Indexed: 11/22/2022] Open
Abstract
Neisseria meningitidis is the second leading cause of invasive meningitis. A prerequisite for infection is colonization of the nasopharynx, and asymptomatic carrier rates are widely reported in the range of 10-15%. Recent reports have indicated an increased likelihood that a pediatric admission for Neisseria meningitidis will have a mother who is pregnant in the home. We hypothesized that this association may relate to immunologic changes in pregnancy leading to higher carrier rates. We compared the carrier status by performing nasopharyngeal swabs for Neisseria meningitidis in 100 pregnant and 99 non-pregnant women. Average age of the participants was 28.9 +/- 6.7 years. The average gestational age at specimen collection was 27.5 +/- 9.4 weeks. Non pregnant women were significantly more likely to use tobacco (38% vs 24%, p < 0.0001). In the entire 199 patients, only one pregnant patient tested positive for Neisseria meningitidis (0.5%; 95% CI: 0.01%-2.8%). The meningococcal carrier rate in our population is well below what is widely reported in the literature. Assuming a 1% carrier rate in the pregnant group and a 0.5% carrier rate in the non pregnant group, 4,763 patients would be required to detect a difference of this magnitude, given 80% power and an alpha of 0.05.
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Affiliation(s)
- Eric J Knudtson
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, The University of Oklahoma Health Sciences Center, PO Box 26901, WP 2470, Oklahoma City, OK 73160, USA.
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Brigham KS, Sandora TJ. Neisseria meningitidis: epidemiology, treatment and prevention in adolescents. Curr Opin Pediatr 2009; 21:437-43. [PMID: 19421058 DOI: 10.1097/mop.0b013e32832c9668] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Neisseria meningitidis has been recognized as a cause of serious disease for centuries, but changing epidemiology and advances in treatment and prevention strategies mandate that providers be aware of ongoing developments with regard to this infection. Given the high burden of disease in adolescents, it is important for clinicians to be familiar with current recommendations regarding N. meningitidis. RECENT FINDINGS Adolescents and young adults continue to have the second highest incidence of disease from N. meningitidis. New diagnostic techniques, including polymerase chain reaction, have shown promise for enhancing detection of meningococcal infection in selected scenarios. Whereas most isolates of meningococcus remain penicillin-susceptible, fluoroquinolone resistance has now been documented in the US for the first time. Routine immunization using the meningococcal conjugate vaccine continues to be recommended, despite ongoing concern about a possible association between vaccination and Guillain-Barré syndrome. Active research is ongoing to develop a serogroup B vaccine and meningococcal vaccines that are immunogenic in infants and toddlers. SUMMARY Given the increased incidence of meningococcal infection among adolescents and the substantial morbidity and mortality associated with invasive disease, adolescent health providers must be familiar with current antibiotic treatment and prophylaxis guidelines and ongoing developments regarding meningococcal vaccination.
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Affiliation(s)
- Kathryn S Brigham
- Division of Adolescent/Young Adult Medicine, Department of Medicine, Children's Hospital Boston, Harvard MedicalSchool, Boston, Massachusetts 02115, USA.
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Ansart S. [Antibiotic management of presumptive bacterial meningitis in adults (rational, methods, course, and follow-up)]. Med Mal Infect 2009; 39:629-46. [PMID: 19398287 DOI: 10.1016/j.medmal.2009.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Accepted: 02/20/2009] [Indexed: 01/09/2023]
Abstract
The annual incidence of community acquired meningitis ranges between 0.6 and four per 100,000 adults in industrialized countries. The most common causative bacteria are Streptococcus pneumoniae, Neisseria meningitidis, Listeria monocytogenes. The emergence of resistance to antibiotics, especially for S. pneumoniae, could explain the clinical failure of third generation cephalosporins used to treat adults with S. pneumoniae meningitis. The present therapeutic suggestions are more based on the extrapolation of an experimental model than on relevant clinical trials.
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Affiliation(s)
- S Ansart
- Service des maladies infectieuses, CHU Cavale-Blanche, boulevard Tanguy-Prigent, 29609 Brest cedex, France.
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[Treatment of community acquired bacterial meningitis, after microbiological identification]. Med Mal Infect 2009; 39:513-20. [PMID: 19394177 DOI: 10.1016/j.medmal.2009.02.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Accepted: 02/20/2009] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Are the 1996 SPILF consensus conference recommendations on bacterial meningitis (BM) still adequate? OBJECTIVE The literature published after 1996 was analyzed and the reviewers summarized the available data on antibiotic treatment once BM microbiological diagnosis made or strongly suspected. METHOD A review was made using PubMed, 10,015 references were examined. Only articles published after 1997 were analyzed. RESULTS No study allowed to recommend other regimens than those previously recommended in 1996, in case of meningococcal or pneumococcal infection: 3rd generation cephalosporin or amoxicillin, combined with vancomycin in case of penicillin-intermediate or resistant pneumococcus. In some cases, alternatives are possible, in case of pneumococcal infection: meropenem or antipneumococcal fluoroquinolone were recommended by US guidelines. New antibiotics available on the market were tested using experimental pneumococcal meningitis models: daptomycin and ertapenem seemed to be useful but linezolid was not. Among the antibiotic combinations tested, ceftriaxone+rifampicine demonstrated a better efficacy than ceftriaxone+vancomycin. There was not contributive published data on the length of treatment for bacterial meningitis. CONCLUSION No assessed arguments could be found to modify previous guidelines. In case of problem with penicillin-resistant pneumococci, penem or a combination using ceftriaxone and rifampicin may be used.
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Rubinstein E. Short antibiotic treatment courses or how short is short? Int J Antimicrob Agents 2007; 30 Suppl 1:S76-9. [PMID: 17826038 DOI: 10.1016/j.ijantimicag.2007.06.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2007] [Accepted: 06/07/2007] [Indexed: 11/28/2022]
Abstract
Antibiotic therapy in recent years has become more intense and more frequent. Resistance acquisition by community and hospital strains is however also increasing. One of the methods to halt the increase in resistance may be shorter courses of antibiotics, if their clinical efficacy is not impaired. Shorter courses of antibiotic therapy have been very successful in typhoid fever: 3 days; in meningococcal meningitis: a single dose to 3 days' course; ventilator-associated pneumonia: 8 days; and possibly ICU-associated infections: 3-5 days. On the contrary, IV catheter-associated infections require full treatment courses (14 days). More studies are needed in various infectious entities with various agents to be able to better define the optimal duration of therapy.
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Abstract
Meningococcus, an obligate human bacterial pathogen, remains a worldwide and devastating cause of epidemic meningitis and sepsis. However, advances have been made in our understanding of meningococcal biology and pathogenesis, global epidemiology, transmission and carriage, host susceptibility, pathophysiology, and clinical presentations. Approaches to diagnosis, treatment, and chemoprophylaxis are now in use on the basis of these advances. Importantly, the next generation of meningococcal conjugate vaccines for serogroups A, C, Y, W-135, and broadly effective serogroup B vaccines are on the horizon, which could eliminate the organism as a major threat to human health in industrialised countries in the next decade. The crucial challenge will be effective introduction of new meningococcal vaccines into developing countries, especially in sub-Saharan Africa, where they are urgently needed.
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Affiliation(s)
- David S Stephens
- Emory University School of Medicine, Atlanta, GA, USA; Research Service (151I), Atlanta VA Medical Center, Decatur, GA, USA.
| | | | - Petter Brandtzaeg
- Departments of Paediatrics and Clinical Chemistry, Ullevål University Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway
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Briggs S, Ellis-Pegler R, Roberts S, Thomas M, Woodhouse A. Short course intravenous benzylpenicillin treatment of adults with meningococcal disease. Intern Med J 2004; 34:383-7. [PMID: 15271171 DOI: 10.1111/j.1445-5994.2004.00601.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Short-course treatment of meningococcal disease (including meningitis) with 4-5 days of an i.v. beta-lactam is of proven efficacy. Since April 1998, all adult patients with meningococcal disease admitted to Auckland Hospital were prospectively treated with 3 days of i.v. benzylpenicillin. AIMS To assess the clinical features, laboratory findings, disease complications and outcome of patients with meningococcal disease prospectively treated with 3 days of i.v. benzylpenicillin. METHODS A retrospective chart review of all adult patients with meningococcal disease admitted to Auckland Hospital from April 1998 to December 2002 was conducted. RESULTS Ninety patients with definite (n = 72) or -probable (n = 16) meningococcal disease were admitted during the study period. Two were excluded on the basis of treatment duration. The remaining 88 patients received a mean +/- standard deviation duration of treatment of 3.1 +/- 0.5 days (excluding those who died while receiving treatment). Six patients (7%) died, four of whom while on treatment. There were no relapses. CONCLUSION Three days of i.v. benzylpenicillin for the treatment of adults with meningococcal disease is effective.
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Affiliation(s)
- S Briggs
- Infectious Diseases Unit, Auckland Hospital, Auckland, New Zealand
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File TM. Shorter course therapy of serious respiratory infections: new data for new approaches to management. Curr Opin Infect Dis 2004; 17:105-7. [PMID: 15021048 DOI: 10.1097/00001432-200404000-00006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Quagliarello V. Short-course penicillin therapy for meningococcal disease: accumulating evidence and persistent uncertainty. Clin Infect Dis 2003; 37:663-4. [PMID: 12942397 DOI: 10.1086/377209] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2003] [Accepted: 05/20/2003] [Indexed: 11/03/2022] Open
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