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Substituting or adding fluoroquinolones to established first‐line antituberculous drug regimens gives no additional benefit or risks

Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis bacteria. Over two billion people worldwide are believed to be latently infected with TB and approximately 10% of these people will develop active TB later in life. The World Health Organization currently only recommend treatment with fluoroquinolones for patients who cannot take standard first‐line drugs. In this review, we examined the effect of including fluoroquinolones in first‐line treatment regimens on people with presumed drug‐sensitive tuberculosis.

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

Version: 2013

Antibiotic therapy for treatment of infective endocarditis

We aimed to assess the existing evidence about the clinical benefits and harms of different antibiotics regimens used to treat people with infective endocarditis.

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

Version: 2016

There is no evidence of difference in clinical and microbiological efficacy of quinolones for uncomplicated acute cystitis in women, but there is some evidence of differences in occurrence and range of adverse reactions.

Urinary tract infection (UTI) refers to the presence of a certain threshold number of bacteria in the urine. Bacterial cystitis (bacteria in the bladder, also called acute cystitis) can occur in men and women and the signs and symptoms include dysuria (pain on passing urine), frequency, cloudy urine, occasionally haematuria (blood in the urine), and is often associated with pyuria (high urine white blood cell count). There is an additional important distinction between complicated and uncomplicated UTI. Complicated UTIs are those associated with fever and/or back pain (indicating kidney infection), UTIs in men, UTIs associated with indwelling or intermittent urinary catheters, obstructive uropathy (any changes in the urinary tract due to obstruction), vesicoureteric reflux (urine travels from the bladder back up toward the kidneys) and other urological abnormalities. These types of infections require more intensive treatment. Uncomplicated acute cystitis is the most prevalent form of uncomplicated UTI in women. Quinolones are recommended as the drugs of choice for acute cystitis in regions where the level of resistance to other antimicrobials namely co‐trimoxazole is high. The aim of this systematic review was to investigate which quinolone is most effective in treating uncomplicated acute cystitis and to also investigate safety and how well they are tolerated. Eleven studies (7535 women) were identified. No two studies compared the same quinolones. We found no significant differences in clinical or microbiological efficacy between quinolones. Several adverse events were reported in the individual studies. These included photosensitivity, insomnia, skin adverse events, central nervous system adverse events and adverse events leading to withdrawal to treatment. We were unable to determine which quinolone would be the safest or the most tolerated due to the lack of head‐to‐head data.

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

Version: 2010

Pneumonia: Diagnosis and Management of Community- and Hospital-Acquired Pneumonia in Adults

The microbial causes of pneumonia vary according to its origin and the immune constitution of the patient. Pneumonia is classified into community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP) and pneumonia in the immunocompromised. The guideline development process is guided by its scope - published after stakeholder consultation. This guideline does not cover all aspects of pneumonia, but focuses on areas of uncertainty or variable practice and those considered of greatest clinical importance. Best practice guidance on the diagnosis and management of CAP and HAP is offered, based on systematic analysis of clinical and economic evidence with the aim of reducing mortality and morbidity from pneumonia and maximising resources.

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

Version: December 2014
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Bismuth Salts for Gastrointestinal Issues: A Review of the Clinical Effectiveness and Guidelines [Internet]

The purpose of this report is to retrieve and review existing evidence of clinical efficacy, safety, and guidelines for bismuth treatment of diarrhea, nausea, indigestion, heartburn, and upset stomach. This report also aims to retrieve and review the existing evidence for the clinical efficacy and safety of bismuth as part of bismuth-containing quadruple therapy (BCQT) in the treatment of H. pylori infection. Finally this report will retrieve and review the existing guidelines on the use of BCQT for H. pylori eradication treatment.

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

Version: November 24, 2015
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Dyspepsia and Gastro-Oesophageal Reflux Disease: Investigation and Management of Dyspepsia, Symptoms Suggestive of Gastro-Oesophageal Reflux Disease, or Both

The guideline applies to adults (aged 18 and over) with symptoms suggestive of dyspepsia, symptoms suggestive of gastro-oesophageal reflux disease (GORD), or both.

NICE Clinical Guidelines - Internal Clinical Guidelines Team (UK).

Version: September 2014
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Tuberculosis: Prevention, Diagnosis, Management and Service Organisation

This guideline makes recommendations on the prevention, diagnosis and management of latent and active tuberculosis (TB), including both drug susceptible and drug resistant forms of the disease. It covers the organisation of relevant TB services. It relates to activities undertaken in any setting in which NHS or public health services for TB are received, provided or commissioned in the public, private and voluntary sectors.

NICE Guideline - Internal Clinical Guidelines Team (UK).

Version: January 2016
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Myeloma: Diagnosis and Management

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
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Bronchiolitis: Diagnosis and Management of Bronchiolitis in Children

Clinical guidelines have been defined as ‘systematically developed statements which assist clinicians and patients in making decisions about appropriate treatment for specific conditions’. This guideline has been developed with the aim of providing guidance on the care of children with bronchiolitis.

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

Version: June 2015
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Diabetic Foot Problems: Prevention and Management

Despite the publication of strategies on commissioning specialist services for preventing and managing diabetic foot problems, there is variation in practice across different NHS settings, and amputation rates still vary up to fourfold in the UK.

NICE Guideline - Internal Clinical Guidelines team.

Version: August 2015
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Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies (Vol. 4: Antibiotic Prescribing Behavior)

Unnecessary prescribing of antibiotics is a major problem in the US and worldwide, contributing to the problem of antimicrobial resistance (AMR). This review examines the effects of quality improvement strategies on reducing inappropriate prescribing of antibiotics, targeting both prescribing of antibiotics for non-bacterial illnesses (“the antibiotic treatment decision”) and prescribing of broad-spectrum antibiotics when narrow-spectrum agents are indicated (“the antibiotic selection decision”).

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

Version: January 2006
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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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Fractures (Complex): Assessment and Management

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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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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Antimicrobial Stewardship Programs in Inpatient Settings: A Systematic Review [Internet]

It is estimated that in 2009, more than 3 million kilograms of antimicrobials were administered to human patients in the United States. While the life-saving benefits of antimicrobials are indisputable, the consequences of use and misuse must also be considered. Major concerns related to the use of antimicrobials are increasing resistance, higher incidence of Clostridium difficile (C. difficile) infection (CDI) and increased healthcare costs (including costs related to adverse events associated with antimicrobial use).

Evidence-based Synthesis Program - Department of Veterans Affairs (US).

Version: September 2013
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Antimicrobial Stewardship Programs in Outpatient Settings: A Systematic Review [Internet]

The majority of antimicrobials prescribed to humans originate in outpatient settings. In making prescribing decisions, primary care providers are faced with patient expectations, and with patient and provider lack of awareness of antimicrobial resistance and lack of understanding of the seriousness of the antimicrobial resistance problem.

Evidence-based Synthesis Program - Department of Veterans Affairs (US).

Version: February 2014
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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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Urinary Incontinence in Neurological Disease: Management of Lower Urinary Tract Dysfunction in Neurological Disease

The guideline covers adults and children (from birth) with lower urinary tract dysfunction resulting from neurological disease or injury.

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

Version: August 2012
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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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Addendum to Haematological Cancers: Improving Outcomes (Update)

Different levels of service are needed to manage haematological cancers, depending on the particular cancer in question. Because of the increased complexity of care and changes in the levels of care from those specified in the 2003 NICE cancer service guidance on improving outcomes in haematological cancers, an update was needed.

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

Version: May 2016
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