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ASYMPTOMATIC BACTERIURIA (ASB)

Population

  • – Nonpregnant women.

Recommendations

IDSA 2019

  • – Do not treat asymptomatic bacteriuria with antibiotics.

  • – Do not screen pediatric patients for asymptomatic bacteriuria.

  • – Only screen pregnant women and patients undergoing urologic procedures.

  • – Treat ASB in pregnant patients for 4–7 d.

Source

COMMON COLD

Population

  • – Healthy adults (those without chronic lung disease or immunocompromising conditions).

Recommendation

Annals of Internal Medicine 2016

  • – Do not prescribe antibiotics for the common cold.

Source

Comment

  1. Harm from antibiotics outweighs benefits, as all causes of common cold are viral.

COCCIDIOIDOMYCOSIS (VALLEY FEVER)

Population

  • – Adults

Recommendation

IDSA 2016

  • – Test for coccidioidomycosis in patients presenting with pneumonia in endemic regions (southwest United States).

  • – Do not start treatment for mild infection.

  • – Do not treat asymptomatic chronic cavitary coccidioidal pneumonia.

  • – Use fluconazole as first-line therapy 400–1200 mg PO daily, including during pregnancy. Check renal function prior to initiating therapy.

  • – Refer to infection disease specialist for extrapulmonary, disseminated coccidioidomycosis.

Source

DIABETIC FOOT INFECTIONS, OUTPATIENT MANAGEMENT

Population

  • – Adults older than 18 y with diabetic foot problems.

Recommendations

IDF 2017, IWGDF 2019

  • – Assess arterial perfusion and need for revascularization.

  • – Debride callus and necrotic tissue to fully visualize wound, measure depth and extent.

  • – Check C-reactive protein, erythrocyte sedimentation rate.

  • – Obtain cultures: tissue or bone specimen preferred; deep swab only after debriding wound.

  • – Obtain x-ray of all new diabetic foot infections. Obtain MRI if osteomyelitis suspected and plain film is not diagnostic.

  • – Request surgical consult for deep abscesses, compartment syndrome, and necrotizing soft tissue infection.

  • – Choose antibiotic based on suspected pathogen and severity.

  • – Treat clinically infected wounds with antibiotics:

    • 1–2 wk for mild-to-moderate infections.

    • 3 wk for more serious skin and soft tissue infections.

    • 6 wk for osteomyelitis.

    • Severe infection: hospital evaluation for parenteral antibiotics and surgical debridement.

Sources

Comment

  1. A deep space infection may have deceptively few superficial signs.

NICE 2019

  • – Every patient with a diabetic foot problem should undergo ...

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