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Otic route: Colistin, neomycin, and hydrocortisone combination contains two antibiotics and a cortisone-like medicine.

Into the ear: Treats swelling, discomfort, and itching caused by ear infections.

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Results: 1 to 20 of 35

What is the efficacy and safety of colistin for the treatment of ventilator-associated pneumonia? A systematic review and meta-regression

BACKGROUND: Experience with intravenous and aerosolized forms of colistin for the treatment of ventilator-associated pneumonia (VAP) in patients without cystic fibrosis is limited. We aimed to assess the safety and efficacy of colistin for the treatment of VAP.

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

Version: 2012

Colistin for the treatment of ventilator-associated pneumonia caused by multidrug-resistant Gram-negative bacteria: a systematic review and meta-analysis

Ventilator-associated pneumonia (VAP) caused by multidrug-resistant (MDR) Gram-negative bacteria (GNB) has emerged as an important and intractable clinical problem. This review assessed the efficacy and safety of colistin for treatment of MDR GNB VAP. PubMed and Embase were searched for controlled studies of colistin for treatment of MDR GNB VAP. The Mantel-Haenszel random-effects model was used to pool odds ratios (ORs) with 95% confidence intervals (CIs). The primary outcome was clinical cure; secondary outcomes were microbiological eradication, ICU mortality, hospital mortality, length of ICU stay and nephrotoxicity. Fourteen controlled studies involving 1167 patients were identified, including six reporting colistin versus β-lactam antibiotics, three reporting aerosolised (AS) plus intravenous (IV) colistin versus IV colistin alone and five reporting colistin combined therapy versus colistin monotherapy. The clinical cure rate of colistin was comparable with that of β-lactam antibiotics (OR=1.00, 95% CI 0.68-1.47). Compared with IV colistin alone, AS plus IV colistin exhibited a better clinical cure (OR=2.12, 95% CI 1.40-3.20). Compared with colistin monotherapy, colistin combined therapy did not appear to provide a better clinical cure (OR=1.38, 95% CI 0.81-2.33). There was no significant difference in nephrotoxicity and other secondary outcomes between the treatment groups. Colistin appears as effective and safe as β-lactam antibiotics for the treatment of MDR GNB VAP. AS colistin may be a beneficial adjunct to IV colistin in the management of MDR GNB VAP. Colistin combined therapy does not appear to provide better outcomes compared with colistin monotherapy.

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

Version: 2014

Systemic colistin use in children without cystic fibrosis: a systematic review of the literature

The review concluded that available evidence, mainly from old case series, suggested that systemic colistin was effective, and had an acceptable safety profile, for treatment of children without cystic fibrosis who have had multi-drug resistant Gram-negative bacterial infections. The limitations of the review, with respect to study quality and evidence, make the reliability of the authors’ conclusions unclear.

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

Version: 2009

Inhaled antibiotics for the treatment of chronic bronchopulmonary Pseudomonas aeruginosa infection in cystic fibrosis: systematic review of randomised controlled trials

INTRODUCTION: Inhaled antibiotics are probably the safest and most effective therapy for Pseudomonas aeruginosa chronic lung infection in cystic fibrosis (CF) patients.

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

Version: 2013

Systematic review of the dry powder inhalers colistimethate sodium and tobramycin in cystic fibrosis

This systematic review evaluated evidence for two dry powder formulations, colistimethate sodium and tobramycin, for the treatment of chronic Pseudomonas aeruginosa in cystic fibrosis, as part of the UK national recommendation process for new technologies. Electronic bibliographic databases were searched in May 2012 (MEDLINE, MEDLINE in-Process, EMBASE, Cochrane Library databases, CINAHL, Web of Science, Conference Proceedings Citation Index and BIOSIS Previews). Relevant outcomes included rate and extent of microbial response (e.g. sputum density of P. aeruginosa), lung function (e.g. forced expiratory volume in 1 s (FEV1)), frequency, severity of acute exacerbations and adverse events. Three trials were included, and both dry powder formulations were reported to be non-inferior in the short term to nebulised tobramycin for FEV1. However, long-term follow-up data were missing and the effect on exacerbation rates was not always reported. Whilst short-term results showed that both dry powder drugs were non-inferior to nebulised tobramycin, there was no long-term follow-up and no phase 3 trials compared nebulised and dry powder colistimethate sodium. The use of FEV1 as the primary end-point may not accurately represent changes in lung health. This review illustrates the difficulty in assessing new technologies where the evidence base is poor.

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

Version: 2013

Colistimethate sodium powder and tobramycin powder for inhalation for the treatment of chronic pseudomonas aeruginosa lung infection in cystic fibrosis: systematic review and economic model

BACKGROUND: Cystic fibrosis (CF) is an inherited condition characterised by the abnormal transport of chloride ions across transporting epithelia. This leads to the production of thick sticky mucus in the lungs, pancreas, liver, intestine and reproductive tract, and an increase in the salt content in sweat. Among other problems, people with CF experience recurrent respiratory infections and have difficulties digesting food. CF affects over 9000 individuals in the UK. CF shortens life expectancy and adversely affects quality of life. In 2010, CF was recorded as the cause of 103 deaths in England and Wales.

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

Version: 2013

Antibiotic Impregnated Cement for Primary Hip or Knee Arthroplasty: A Review of the Clinical and Cost-Effectiveness [Internet]

Given the uncertainty surrounding efficacy and safety of antibiotic impregnated cement (AIC) in primary prophylaxis, and the consequent lack of clarity with regards to resource implications, this report will review the clinical and cost-effectiveness of AIC in primary hip and knee arthroplasty patients.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: September 25, 2015
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Different ways of giving antibiotics to eradicate Pseudomonas aeruginosa infection in people with cystic fibrosis

Cystic fibrosis is an inherited condition where the airways often become blocked with mucus. It is associated with chest infections, which can lead to progressive breathing failure and death. A germ called Pseudomonas aeruginosa is often the cause of infection and is difficult to treat successfully, once infection has become established.

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

Version: 2017

Interventions for children with ear discharge occurring at least two weeks following grommet placement

This review compares the effects and safety of interventions in children with grommets who develop ear discharge beyond the immediate postoperative period.

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

Version: 2016

Nebulisers for giving medication in cystic fibrosis

Nebulisers change a liquid medication into a mist so it can be breathed in. There are different types of nebuliser systems and no review has yet considered whether any nebuliser is better than another.

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

Version: 2013

Inhaling antibiotics to treat lung infection in people with cystic fibrosis

Cystic fibrosis is an inherited disease which results in abnormal mucus in several parts of the body. The main organ affected is the lungs which are susceptible to infection by certain bacteria, the most frequently isolated being Staphylococcus aureus and Pseudomonas aeruginosa. Infection causes inflammation that results in progressive damage to the lungs. We aimed to find out if inhaling antibiotics would reduce the effects of infection. We wanted to learn whether this treatment would improve lung function, quality of life and survival. We also looked for any adverse events. This review includes 19 trials with 1724 people. We found that inhaling an antibiotic to fight these bacteria improved lung function during the study and reduced frequency of exacerbations. However, there was more resistance to antibiotics, tinnitus and change in voice in the treatment groups. Further research is needed to show whether the benefits can be maintained in the long‐term and to work out the best antibiotic to use and at what dose.

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

Version: 2011

Colistimethate sodium powder and tobramycin powder for inhalation for the treatment of chronic Pseudomonas aeruginosa lung infection in cystic fibrosis: systematic review and economic model

Study found that both colistimethate sodium dry powder for inhalation (DPI) and tobramycin DPI were non-inferior to nebulised tobramycin for the treatment of Pseudomonas aeruginosa lung infection in cystic fibrosis, and their cost-effectiveness was uncertain.

Health Technology Assessment - NIHR Journals Library.

Version: December 2013
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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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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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Carbapenems for Multi-Drug Resistant Infections: A Review of Guidelines [Internet]

Carbapenems are beta-lactam antibiotics with a very broad spectrum of activity and act by disrupting the synthesis of bacterial cell walls. Others in the family of beta-lactam antibiotics are cephalosporins, which include cefepime and ceftazidime. In contrast, beta-lactamase inhibitors have little antibacterial activity alone. They include tazobactam and clavulanate. When used with beta-lactams however, the combination therapy provides enhanced and extended spectrum of activity against bacteria containing plasmid-mediated and chromosomal beta-lactamases. In the literature, the terminology “combination therapy” varies. For instance, the combination product piperacillin-tazobactam is often referred to as monotherapy unless combined with other agents such as amikacin or tobramycin.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: August 9, 2016
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Sepsis: Recognition, Assessment and Early Management

Sepsis is a clinical syndrome caused by the body's immune and coagulation systems being switched on by an infection. Sepsis with shock is a life-threatening condition that is characterised by low blood pressure despite adequate fluid replacement, and organ dysfunction or failure. Sepsis is an important cause of death in people of all ages. Both a UK Parliamentary and Health Service Ombudsman enquiry (2013) and UK National Confidential Enquiry into Patient Outcome and Death (NCEPOD, 2015) have recently highlighted sepsis as being a leading cause of avoidable death that kills more people than breast, bowel and prostate cancer combined.

NICE Guideline - National Guideline Centre (UK).

Version: July 2016
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Cirrhosis in Over 16s: Assessment and Management

The guideline covers the identification and assessment of suspected cirrhosis, monitoring to detect complications and management of complications such as ascites and hepatorenal syndrome and referral for tertiary care.

NICE Guideline - National Guideline Centre (UK).

Version: July 2016
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Ivacaftor (Kalydeco) 150 mg Tablet: For Treatment of Cystic Fibrosis with G551D, G1244E, G1349D, G178R, G551S, S1251N, S1255P, S549N, S549R, or G970R Mutation [Internet]

Cystic fibrosis (CF), an autosomal recessive condition, is the most common fatal genetic disease affecting children and young adults in Canada. It is caused by mutations in the CF transmembrane conductance regulator (CFTR) gene, located on chromosome seven. This gene encodes for a chloride channel that regulates transport of salt and water across cell membranes. When CFTR is dysfunctional, secretions become tenacious and sticky, resulting in pathology in multiple organ systems, most notably the lungs and gastrointestinal tract.

Common Drug Review - Canadian Agency for Drugs and Technologies in Health.

Version: July 2015
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Ivacaftor for the treatment of patients with cystic fibrosis and the G551D mutation: a systematic review and cost-effectiveness analysis

Study found that ivacaftor is a clinically effective treatment for patients with cystic fibrosis and the G551D mutation; however, the high cost of ivacaftor may be a barrier to its uptake. Ivacaftor resulted in significant improvements compared with placebo for all but one of the subgroups investigated; further research should prioritise investigating its long-term effectiveness.

Health Technology Assessment - NIHR Journals Library.

Version: March 2014
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The Prevention and Management of Pressure Ulcers in Primary and Secondary Care

Prevention of pressure ulcers usually involves an assessment to identify people most at risk of pressure ulcers, such as elderly, immobile people or those with spinal cord injury. Assessments are most commonly carried out using specific pressure area risk scores (for example, the Braden or Waterlow scales for predicting pressure sore risk or the, Glamorgan scale for paediatric pressure ulcers).

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

Version: April 2014
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