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Cystic fibrosis is a serious genetic disorder that results in abnormal mucus in several parts of the body. In the lungs the abnormal mucus is linked to the likelihood of repeated infection. A pulmonary exacerbation is when symptoms become more severe, mostly due to more worsening infection. Antibiotics are an essential part of treatment and may be given in different ways, one of these is by inhaling the drug. We wanted to learn if this type of treatment improved general health and which method of giving antibiotics was best. We found there have been only six trials with a total of 208 people which compared inhaled antibiotics to intravenous antibiotics for treating pulmonary exacerbations in cystic fibrosis. The results of these trials did not allow us to answer our question. We are not able to show from these trials if inhaled antibiotics are useful for treating pulmonary exacerbations.

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

Version: December 12, 2012

BACKGROUND: There are urgent needs for rapid and accurate drug susceptibility testing of M. tuberculosis. GenoType MTBDRsl is a new molecular kit designed for rapid identification of the resistance to the second-line antituberculosis drugs with a single strip. In recent years, it has been evaluated in many settings, but with varied results. The aim of this meta-analysis was to synthesize the latest data on the diagnostic accuracy of GenoType MTBDRsl in detecting drug resistance to fluoroquinolones, amikacin, capreomycin, kanamycin and ethambutol, in comparison with the phenotypic drug susceptibility test.

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

Version: 2013

ln about 1 out of every 10 pregnancies, babies are exposed to meconium during delivery. Meconium is the baby's first stool. If the baby passes stool before birth, stool containing amniotic fluid can enter the baby's lungs and may cause breathing difficulty while putting the baby at risk for infection and inflammation in the lungs and body.

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

Version: June 28, 2017

Chronic obstructive pulmonary disease (COPD) which includes chronic bronchitis and emphysema, is a leading cause of morbidity and mortality in Canada, with a national estimate of COPD prevalence of approximately 4% in 2011. Patients with COPD can experience exacerbations, or periods of worsening of COPD symptoms such as increased breathlessness, tiredness, fever and change in sputum colour. Bronchiectasis, or dilatation of the airways due to infective causes or cystic fibrosis (CF), had an incidence of 272 per 100 000 in those over 75 years of age in the US as of 2005. The reduced ability to clear secretions from dilated airways eventually leads to airway blockage and loss of lung function.

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

Version: June 27, 2017

The WHO treatment guidelines for drug-resistant tuberculosis (2016 update) contains policy recommendations on priority areas in the treatment of drug-resistant tuberculosis. The revision is in accordance with the WHO requirements for the formulation of evidence-informed policy.

World Health Organization.

Version: 2016

The study found that rapid molecular tests for rifampicin and isoniazid resistance resistance in tuberculosis were sensitive and specific, and may be cost-effective when added to culture drug susceptibility testing in the UK.

Health Technology Assessment - NIHR Journals Library.

Version: May 2015

In the past 30–50 years, the natural history of urinary tract infection (UTI) in children has changed as a result of the introduction of antibiotics and improvements in health care. This change has contributed to uncertainty about the most appropriate and effective way to diagnose and treat UTI in children and whether or not investigations and follow-up are justified.

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

Version: August 2007

Guidelines are recommendations for the care of individuals in specific clinical conditions or circumstances - and these can include prevention and self-care through to primary and secondary care and on to more specialised services. NICE clinical guidelines are based on the best available evidence of clinical and cost effectiveness, and are produced to help healthcare professionals and patients make informed choices about appropriate healthcare. While guidelines assist the practice of healthcare professionals, they do not replace their knowledge and skills.

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

Version: September 2012

Early-onset neonatal bacterial infection (infection with onset within 72 hours of birth) is a significant cause of mortality and morbidity in newborn babies. Parent organisations and the scientific literature report that there can be unnecessary delays in recognising and treating sick babies. In addition, concern about the possibility of early-onset neonatal infection is common. This concern is an important influence on the care given to pregnant women and newborn babies. There is wide variation in how the risk of early-onset neonatal infection is managed in healthy babies. The approach taken by the NHS needs to: prioritise the treatment of sick babies, minimise the impact of management pathways on healthy women and babies, use antibiotics wisely to avoid the development of resistance to antibiotics. These drivers have not always been addressed consistently in the NHS, and this guideline was commissioned to ensure they would be addressed in future.

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

Version: August 2012

People with cancer who undergo anti‐cancer treatment (chemotherapy) often have a tube inserted into a large vein (central venous catheter or CVC) through which their chemotherapy is given. As chemotherapy is usually administered at regular intervals over several months to years, long‐term, semi‐permanent, tunnelled CVCs (TCVCs) or totally implanted devices (TIDs) are frequently used. Despite sterile insertion and post‐insertion care, these long‐term CVCs may become infected. These infections are usually caused by Gram positive bacteria.

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

Version: November 25, 2013

It is a requirement of the Children’s National Service Framework that all ill children should have access to high-quality, cost-effective, evidence-based care. Because it is difficult to evaluate the severity of the illness, there is a need for evidence-based guidance to inform healthcare professionals about how to judge whether a child who presents with a fever is likely to develop a serious illness. Healthcare professionals also need advice to support their decision on whether to observe the child, perform diagnostic tests, start treatment such as antibiotics or refer onwards for specialist care. The guidance should also include advice on the best ways to detect fever, the management of fever itself, and what to tell parents and carers who have made contact with healthcare services. The guidance should be applicable to primary and secondary care and should take account of the number of agencies that are involved in giving health care and giving advice to parents and carers. It is also important that parental preferences, as well as the child’s best interests in terms of health outcomes, should be taken into account when considering the various options for investigation and treatment.

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

Version: May 2013

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

This guideline reviews the evidence for the care of women who present with signs and symptoms of preterm labour and those who are scheduled to have a preterm birth. It also reviews how preterm birth can be optimally diagnosed in symptomatic women, given that many women thought to be in preterm labour when clinically assessed will not deliver preterm. Optimal diagnosis can facilitate transfer to a place where appropriate neonatal intensive care can be provided, a strategy known to improve rates of survival for the baby. Additional areas that will be covered by the guidance (such as information needs for women who presents with signs and symptoms of preterm labour) are outlined in the guideline scope.

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

Version: November 2015

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

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

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

Surgical site infections are caused by bacteria that get in through incisions made during surgery. They threaten the lives of millions of patients each year and contribute to the spread of antibiotic resistance. In low- and middle-income countries, 11% of patients who undergo surgery are infected in the process. In Africa, up to 20% of women who have a caesarean section contract a wound infection, compromising their own health and their ability to care for their babies. But surgical site infections are not just a problem for poor countries. In the United States, they contribute to patients spending more than 400 000 extra days in hospital at a cost of an additional US$ 10 billion per year.

World Health Organization.

Version: 2016

The management of myeloma is complex and challenging. It increasingly involves the use of expensive drugs. The guideline will aim to raise standards nationally while allowing clinical flexibility and defining a common pathway for patients at various stages of their illness, and of different ages and levels of fitness. Although a consistent approach to management is desirable, it needs to reflect the very different groups of patients with myeloma from the fit and suitable for transplant, fairly fit but not suitable for transplant to patients who are extremely frail and/or unwell.

NICE Guideline - National Collaborating Centre for Cancer (UK).

Version: February 2016

Expert-reviewed information summary about oral complications, such as mucositis and salivary gland dysfunction, that occur in cancer patients treated with chemotherapy or radiation therapy to the head and neck.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: December 16, 2016

Two of the five guidelines in the NICE Trauma Suite relate to fractures. These are titled non-complex and complex fractures. In broad terms the non-complex fractures are those likely to be treated at the receiving hospital, whereas the complex fractures require transfer or the consideration of transfer of the injured person to a specialist centre.

NICE Guideline - National Clinical Guideline Centre (UK).

Version: February 2016

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