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Antibiotics for treating human brucellosis

Brucellosis is a common infection caused by Brucella bacteria species and can infect both people and animals. It is spread by eating infected food products and through direct contact with infected animals. The bacterial infection can affect different tissues and organs and is treated using antibiotics. Current recommended treatment regimens involve the use of two or more antibiotics in order to avoid relapses occurring and to prevent prolonged use of these drugs, which may lead to problems of drug resistance arising. Drug resistance is a particularly important issue as most people infected with brucellosis live in low socioeconomic areas of developing countries, where tuberculosis is also an endemic health problem. Thus there are concerns over the potential increase in resistance to tuberculosis drugs due to their prolonged use in treating brucellosis.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Not enough evidence on the routine use of surgery in addition to drug treatment for people with tuberculosis of the spine

Spinal tuberculosis (spinal TB) occurs in about 1% to 2% of people with TB (the most common infectious disease in the world). The disease can have a major impact on people's lives. Nerves can be squeezed causing pain, loss of feeling, and breathing problems. It can cause bone loss and curvature of the spine, which can lead to loss of nerve function and paralysis after some years, even if the TB has been cured. Correcting with surgery at this point can be difficult because of the complexity of the surgery required. It has been suggested that surgery might be undertaken at the time the TB of the spine is diagnosed and drug treatment (chemotherapy) is being used. However, all surgery has potential adverse effects. This review of trials found there were insufficient numbers of participants in the two trials located (331 participants) to be able to say if routine surgery early on was of overall benefit. Further trials are needed and such trials should assess the pain that people suffer and their views of the disease and treatment.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Nitrate reductase assay for rapid detection of isoniazid, rifampicin, ethambutol and streptomycin resistance in Mycobacterium tuberculosis: a systematic review and meta-analysis

Colorimetric phenotypic tests recently gained interest because traditional primary drug susceptibility testing of Mycobacterium tuberculosis isolates takes a long time. We used meta-analysis techniques to review the reliability and accuracy of the nitrate reductase assay (NRA), which is one of the most popular colorimetric methods to detect resistance to first-line drugs. Medline, PubMed, ISI Web, Web of Science, and Google Scholar were used to search for studies enrolled in the meta-analysis. The analysis included 35 studies for isoniazid (INH), 38 for rifampin (RIF), and 22 for ethambutol (EMB) and streptomycin (STR). Summary receiver operating characteristic (SROC) curves were applied to summarize diagnostic accuracy. The meta-analyses were performed by the use of Meta-DiSc software (version 1.4) and were focused on sensitivity and specificity values for measurements of accuracy. The pooled sensitivities were 96% for INH, 97% for RIF, 90% for EMB, and 82% for STR. The pooled specificities for INH, RIF, EMB, and STR were 99%, 100%, 98%, and 96%, respectively. The times required to obtain results were between 5 and 28 days by the direct NRA and between 5 and 14 days by the indirect test. In conclusion, the present meta-analysis showed that the NRA is a reliable low-cost rapid colorimetric susceptibility test that can be used for the detection of multidrug-resistant (MDR) tuberculosis, including detection of EMB resistance. However, the test appears to have a relatively low sensitivity for STR and needs further improvement.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Molecular analysis of the rpsL gene for rapid detection of streptomycin-resistant Mycobacterium tuberculosis: a meta-analysis

BACKGROUND: Drug-resistant Mycobacterium tuberculosis (MTB) is a major threat to tuberculosis (TB) control programs and public health. Most conventional methods of drug susceptibility testing (DST) are precise but time-consuming. Molecular analysis of the rpsL gene has been used widely in diagnosing streptomycin-resistant MTB since it is rapid and specific. The aim of the present study was to perform a meta-analysis to assess the accuracy of molecular assay of the rpsL gene for the rapid detection of streptomycin-resistant MTB.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Systematic review and meta-analysis of randomized clinical trials in the treatment of human brucellosis

BACKGROUND: Brucellosis is a persistent health problem in many developing countries throughout the world, and the search for simple and effective treatment continues to be of great importance.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Standardized treatment of active tuberculosis in patients with previous treatment and/or with mono-resistance to isoniazid: a systematic review and meta-analysis

This review assessed outcomes related to treatment failure in tuberculosis patients who had been previously treated or who had documented isoniazid mono-resistance. The authors concluded that there was little published evidence to support the continued use of the currently recommended regimen for the treatment of these patient groups. This conclusion is probably reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

Treatment of human brucellosis: systematic review and meta-analysis of randomised controlled trials

This review examined the efficacy of different antibiotic treatment regimens for brucellosis. The authors recommend long-term treatment using dual or triple regimens with an aminoglycoside. Given several limitations of the included studies, such as methodological differences and the poor quality of the included studies, and the pooling of clinically variable data, the authors' conclusions should be treated with caution.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2008

Effect of duration and intermittency of rifampin on tuberculosis treatment outcomes: a systematic review and meta-analysis

This review concluded that treatment outcomes of tuberculosis treatment were significantly worse with shorter durations of rifampin. Treatment outcomes were similar across the different intermittent schedules evaluated but there was insufficient evidence for administration twice weekly throughout treatment. These conclusions reflected the results of the included trials, which included large numbers of patients, and appear likely to be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

Tuberculosis: Clinical Diagnosis and Management of Tuberculosis, and Measures for Its Prevention and Control

This is the full version of NICE clinical guideline 117. It contains details of the methods and evidence used to develop the guideline. It updates and replaces the full version of ‘Tuberculosis: clinical diagnosis and management of tuberculosis, and measures for its prevention and control’ that was developed by the National Collaborating Centre for Chronic Conditions and published by the Royal College of Physicians in March 2006. The updated recommendations have been developed by the Centre for Clinical Practice at NICE following the NICE short clinical guideline process. New recommendations on the use of interferon-gamma tests for the diagnosis of latent tuberculosis have been added.

NICE Clinical Guidelines - National Institute for Health and Clinical Excellence (UK).

Version: March 2011
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Effectiveness of standard short-course chemotherapy for treating tuberculosis and the impact of drug resistance on its outcome

This well-conducted review assessed standard short-course chemotherapy for patients with tuberculosis. The author concluded that the target cure rate of 85% is not achievable using an intermittent regimen, and that the World Health Organization directly observed treatment short-course-plus multi-drug resistant programme should be adopted. These conclusions are not supported by the results of the review, as they were not directly assessed.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2006

Twice‐ or thrice‐weekly doses versus daily doses of drugs to treat tuberculosis in children

About half a million children are diagnosed with tuberculosis (TB) every year, usually infecting the lungs, but also other organs of the body, and can cause meningitis. Infection in children is relatively common, and so establishing effective drug regimens that are easy to take and monitor is important.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Diarrhoea and Vomiting Caused by Gastroenteritis: Diagnosis, Assessment and Management in Children Younger than 5 Years

When young children suddenly experience the onset of diarrhoea, with or without vomiting, infective gastroenteritis is by far the most common explanation. A range of enteric viruses, bacteria and protozoal pathogens may be responsible. Viral infections account for most cases in the developed world. Gastroenteritis is very common, with many infants and young children experiencing more than one episode in a year.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: April 2009
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Pharmacokinetic/Pharmacodynamic Measures for Guiding Antibiotic Treatment for Hospital-Acquired Pneumonia [Internet]

To conduct a systematic review of the use of pharmacokinetic/pharmacodynamic (PK/PD) measures or strategies to dose and monitor intravenous (IV) antibiotics in the treatment of adults with hospital-acquired pneumonia (HAP).

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: November 2014
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Infection: Prevention and Control of Healthcare-Associated Infections in Primary and Community Care: Partial Update of NICE Clinical Guideline 2

Since the publication of the NICE clinical guideline on the prevention of healthcare-associated infections (HCAI) in primary and community care in 2003, many changes have occurred within the NHS that place the patient firmly at the centre of all activities. First, the NHS Constitution for England defines the rights and pledges that every patient can expect regarding their care. To support this, the Care Quality Commission (CQC), the independent regulator of all health and adult social care in England, ensures that health and social care is safe, and monitors how providers comply with established standards. In addition, the legal framework that underpins the guidance has changed since 2003.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: March 2012
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Prophylaxis Against Infective Endocarditis: Antimicrobial Prophylaxis Against Infective Endocarditis in Adults and Children Undergoing Interventional Procedures [Internet]

Infective endocarditis (IE) is a rare condition with significant morbidity and mortality. It may arise following bacteraemia in a patient with a predisposing cardiac lesion. In an attempt to prevent this disease, over the past 50 years, at-risk patients have been given antibiotic prophylaxis before dental and certain non-dental interventional procedures.

NICE Clinical Guidelines - National Institute for Health and Clinical Excellence (UK).

Version: March 2008
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Closing the Quality Gap: Revisiting the State of the Science (Vol. 4: Medication Adherence Interventions: Comparative Effectiveness)

To assess the effectiveness of patient, provider, and systems interventions (Key Question [KQ] 1) or policy interventions (KQ 2) in improving medication adherence for an array of chronic health conditions. For interventions that are effective in improving adherence, we then assessed their effectiveness in improving health, health care utilization, and adverse events.

Evidence Reports/Technology Assessments - Agency for Healthcare Research and Quality (US).

Version: September 2012
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Bacterial Meningitis and Meningococcal Septicaemia: Management of Bacterial Meningitis and Meningococcal Septicaemia in Children and Young People Younger than 16 Years in Primary and Secondary Care

This guideline covers bacterial meningitis and meningococcal septicaemia, focusing on management of these conditions in children and young people aged younger than 16 years in primary and secondary care, and using evidence of direct relevance to these age groups where available.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: 2010
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Chronic Obstructive Pulmonary Disease: Management of Chronic Obstructive Pulmonary Disease in Adults in Primary and Secondary Care [Internet]

This guideline offers best practice advice on the identification and care of patients with chronic obstructive pulmonary disease (COPD). It aims to define the symptoms, signs and investigations required to establish a diagnosis of COPD. It also aims to define the factors that are necessary to assess its severity, provide prognostic information and guide best management. It gives guidance on the pharmacological and non-pharmacological treatment of patients with stable COPD, and on the management of exacerbations. The interface with surgery and intensive therapy units (ITU) are also discussed.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: June 2010
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Neonatal Jaundice

Jaundice is one of the most common conditions requiring medical attention in newborn babies. Approximately 60% of term and 80% of preterm babies develop jaundice in the first week of life, and about 10% of breastfed babies are still jaundiced at 1 month of age. In most babies with jaundice thevre is no underlying disease, and this early jaundice (termed ‘physiological jaundice’) is generally harmless. However, there are pathological causes of jaundice in the newborn, which, although rare, need to be detected. Such pathological jaundice may co-exist with physiological jaundice.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: May 2010
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Surgical Site Infection: Prevention and Treatment of Surgical Site Infection

Infections that occur in the wound created by an invasive surgical procedure are generally referred to as surgical site infections (SSIs). SSIs are one of the most important causes of healthcare-associated infections (HCAIs). A prevalence survey undertaken in 2006 suggested that approximately 8% of patients in hospital in the UK have an HCAI. SSIs accounted for 14% of these infections and nearly 5% of patients who had undergone a surgical procedure were found to have developed an SSI. However, prevalence studies tend to underestimate SSI because many of these infections occur after the patient has been discharged from hospital.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: October 2008
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