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Aims To prospectively evaluate the clinical efficacy of oral antibiotics as an adjunct to intravenous antibiotics and mechanical bowel preparation (MBP) in patients undergoing left sided colorectal surgery. Methods All participants aged 18 years or older and of any gender undergoing an elective open or laparoscopic left sided colorectal resection for benign or malignant colorectal pathologies were considered. The intervention of interest was oral neomycin 1g every 4 hours combined with oral metronidazole 400mg every 8 hours from 24 hours before the proposed surgery. Surgical site infections (SSIs), anastomotic leak, paralytic ileus, need for intervention, and mortality were the evaluated outcome parameters. Results Forty-two consecutive patients received oral antibiotics as an adjunct to intravenous antibiotics and MBP before left sided colorectal surgery. The mean age was 58.8 ± 11.5. There were 23 males (54.8%) and 19 females (45.2%). Use of oral antibiotics was associated with SSI infection rate of 2.4% (1 patient). The rates of clinically significant and non-significant anastomotic leak were 0% and 2.9%, respectively. Moreover, postoperative ileus happened in 11.9% of patients. Furthermore, there was no mortality or need for re-intervention. Conclusions Use of oral antibiotics as an adjunct to intravenous antibiotics and MBP in patients undergoing left-sided colorectal surgery was associated with a surprisingly low rate of SSIs and no significant anastomotic leak. It is time to trust the best available evidence and incorporate the use of oral antibiotics as an adjunct to intravenous antibiotics and MBP in colorectal surgery protocols in the UK hospitals.

Background Limited retrospective data suggest prophylactic oral vancomycin may prevent Clostridioides difficile infection (CDI). We sought to evaluate the effectiveness of oral vancomycin for the prevention of healthcare facility–onset CDI (HCFO-CDI) in targeted patients. Methods We conducted a randomized, prospective, open-label study at Novant Health Forsyth Medical Center in Winston-Salem, North Carolina, between October 2018 and April 2019. Included patients were randomized 1:1 to either oral vancomycin (dosed at 125 mg once daily while receiving systemic antibiotics and continued for 5 days postcompletion of systemic antibiotics [OVP]) or no prophylaxis. The primary endpoint was incidence of HCFO-CDI. Secondary endpoints included incidence of community-onset healthcare facility–associated CDI (CO-HCFA-CDI), incidence of vancomycin-resistant Enterococci (VRE) colonization after receiving OVP, adverse effects, and cost of OVP. Results A total of 100 patients were evaluated, 50 patients in each arm. Baseline and hospitalization characteristics were similar, except antibiotic exposure. No events of HCFO-CDI were noted in the OVP group compared with 6 (12%) in the no-prophylaxis group (P = .03). CO-HCFA-CDI was identified in 2 patients who were previously diagnosed with HCFO-CDI. No patients developed new VRE colonization, with only 1 patient reporting mild gastrointestinal side effects to OVP. A total of 600 doses of OVP were given during the study, with each patient receiving an average of 12 doses. Total acquisition cost of OVP was $1302, $26.04 per patient. Conclusion OVP appears to protect against HCFO-CDI during in-patient stay in targeted patients during systemic antibiotic exposure. Further prospective investigation is warranted.

Background Infections caused by antibiotic-resistant bacteria, including carbapenem-resistant Enterobacteriaceae, have increased in frequency, resulting in significant patient morbidity and mortality. The Infectious Diseases Society of America continues to propose legislative, regulatory, and funding solutions to address this escalating crisis. This report updates the status of development and approval of systemic antibiotics in the United States as of late 2018. Methods We performed a review of the published literature and on-line clinical trials registry at www.clinicaltrials.gov to identify new systemically acting orally and/or intravenously administered antibiotic drug candidates in the development pipeline, as well as agents approved by the US Food and Drug Administration since 2012. Results Since our 2013 pipeline status report, the number of new antibiotics annually approved for marketing in the United States has reversed its previous decline, likely influenced by new financial incentives and increased regulatory flexibility. Although our survey demonstrates progress in development of new antibacterial drugs that target infections caused by resistant bacterial pathogens, the majority of recently approved agents have been modifications of existing chemical classes of antibiotics, rather than new chemical classes. Furthermore, larger pharmaceutical companies continue to abandon the field, and smaller companies face financial difficulties as a consequence. Conclusions Unfortunately, if 20 × '20 is achieved due to efforts embarked upon in decades past, it could mark the apex of antibiotic drug development for years to come. Without increased regulatory, governmental, industry, and scientific support and collaboration, durable solutions to the clinical, regulatory, and economic problems posed by bacterial multidrug resistance will not be found.

Scalds are the most common type of burn in children, and one way to treat them is with xenografts with no topical antimicrobials in line with the recommendations of a recent review. However, this treatment has not been examined in detail. Our aim was to describe the treatment of such children when biological dressings (xenografts) were used without local antimicrobials. We reviewed the medical records of all children admitted to a Swedish National Burn Centre during the period 2010-2012 with scalds who were treated with xenografts. Percentage TBSA injured, age, length of hospital stay, number of operations, antibiotics given, duration of antibiotic treatment, and pain score during the first 3 days, application of xenografts, and clinical notes of wound infection were recorded. We studied 67 children, (43 of whom were boys), with a median (interquartile range [IQR]) age of 1 (1-2) year and median (IQR) TBSA% 6.2 (4-11). Twenty children (30%) required operation. Twelve (18%) developed a wound infection, 29 (43%) had other infections, and 26 (39%) were free from infection. The median (IQR) duration of systemic antibiotics was 10 (6-13) days. On the day that the xenografts were applied 10 of the children had a Face, Legs, Activity, Cry, and Consolability (FLACC) score between 3 and 7, and during the following 2 days, only four children scored in this range. The remaining 57 children had scores amp;lt;3 on the day that xenografts were applied and on the following 2 days. Median (IQR) length of stay/TBSA% was 0.7 (0.4-1.0). Treatment with xenografts was associated with median length of stay/TBSA% amp;lt; 1 and low pain scores. Despite a high rate of prescription of systemic antibiotics, most were for reasons other than wound infection. Funding Agencies|Department of Hand Surgery, Plastic Surgery and Burns, Linkoping University Hospital, Sweden

Infections caused by antibiotic-resistant bacteria, especially the "ESKAPE" pathogens, continue to increase in frequency and cause significant morbidity and mortality. New antimicrobial agents are greatly needed to treat infections caused by gram-negative bacilli (GNB) resistant to currently available agents. The Infectious Diseases Society of America (IDSA) continues to propose legislative, regulatory, and funding solutions to this continuing crisis. The current report updates the status of development and approval of systemic antibiotics in the United States as of early 2013. Only 2 new antibiotics have been approved since IDSA's 2009 pipeline status report, and the number of new antibiotics annually approved for marketing in the United States continues to decline. We identified 7 drugs in clinical development for treatment of infections caused by resistant GNB. None of these agents was included in our 2009 list of antibacterial compounds in phase 2 or later development, but unfortunately none addresses the entire spectrum of clinically relevant GNB resistance. Our survey demonstrates some progress in development of new antibacterial drugs that target infections caused by resistant GNB, but progress remains alarmingly elusive. IDSA stresses our conviction that the antibiotic pipeline problem can be solved by the collaboration of global leaders to develop creative incentives that will stimulate new antibacterial research and development. Our aim is the creation of a sustainable global antibacterial drug research and development enterprise with the power in the short term to develop 10 new, safe, and efficacious systemically administered antibiotics by 2020 as called for in IDSA's "10 × '20 Initiative."

Objectives Drug shortages have risen steadily in the USA. Systemic antibiotics are most frequently in short supply raising concerns about public health safety and patient care. We sought to assess the prevalence and characteristics of systemic antibiotics in short supply as reported by federal agencies and private healthcare providers in the USA on 1 June 2011. Methods Data derived from the US Food and Drug Administration, American Society of Health-System Pharmacists and the Brigham and Women's Hospital. The units of analysis were active ingredient(s) and route of administration. Key findings Overall, 18 antibiotic active ingredients, with 20 routes of administration, were in short supply on 1 June 2011. The prevalence varied from 5.7% reported by the Food and Drug Administration and Brigham and Women's Hospital to 28.3% reported by the American Society of Health-System Pharmacists. Injectable antibiotics had the highest (28.3%) level of shortage. Shortages occurred because of problems with manufacturing (35.0%) and raw materials (15%.0), and for unknown reasons (45.0%). The average duration of the shortages was 591.7 ± 304.9 days. Conclusions Over one-fifth of the systemic antibiotics (one-quarter of the injectables) marketed in the USA were reported to be in short supply on 1 June 2011. One-half of the shortages were attributed to problems with manufacturing and raw materials although reasons for shortages are often unknown.

Botryomycosis is an uncommon chronic suppurative granulomatous bacterial infection that can affect the skin and viscera. Clinically, lesions typically consist of small tender nodules from which draining sinuses may develop to expel a purulent discharge. Histopathological features include characteristic aggregation of microorganisms (grain) within the inflammatory infiltrate. The commonest causative organisms are Staphylococcus aureus and Pseudomonas aeruginosa, of others. Botryomycosis resulting from Prevotella melaninogenica has not been reported previously. We report the case of a middle-aged patient with botryomycosis presenting as nasal cutaneous fistulas caused by P. melaninogenica, which was successfully treated with surgical intervention combined with systemic antibiotic treatment.

The standard recommendation for treating chronic osteomyelitis is 6 weeks of parenteral antibiotic therapy. However, oral antibiotics are available that achieve adequate levels in bone, and there are now more published studies of oral than parenteral antibiotic therapy for patients with chronic osteomyelitis. Oral and parenteral therapies achieve similar cure rates; however, oral therapy avoids risks associated with intravenous catheters and is generally less expensive, making it a reasonable choice for osteomyelitis caused by susceptible organisms. Addition of adjunctive rifampin to other antibiotics may improve cure rates. The optimal duration of therapy for chronic osteomyelitis remains uncertain. There is no evidence that antibiotic therapy for >4–6 weeks improves outcomes compared with shorter regimens. In view of concerns about encouraging antibiotic resistance to unnecessarily prolonged treatment, defining the optimal route and duration of antibiotic therapy and the role of surgical debridement in treating chronic osteomyelitis are important, unmet needs.

C-Reactive protein serum levels were measured in 57 pediatric patients with 3% to 92% total body surface area burns to determine whether a defined rise in C-reactive protein serum levels could indicate sepsis earlier in burn patients. A rise in C-reactive protein serum levels was defined as an increase of at least 3 mg/dL for 2 days or 10 mg for 1 day. Increases the first 2 days after the burn or the day after surgery were excluded, since these injuries increase C-reactive protein serum levels. Patients were defined as septic when they were on systemic antibiotics and exhibited at least two of 16 specific clinical parameters. C-Reactive protein serum levels correctly predicted sepsis 82% of the time (efficiency = 82%). Nonseptic patients generally did not show increased C-reactive protein serum levels (specificity = 69%). When sepsis did occur, it always was preceded by increased C-reactive protein (sensitivity = 100%), and the increased C-reactive protein occurred 2.3 ± 0.5 days before the patient was deemed septic clinically. Hence, a defined rise in C-reactive protein serum levels can predict sepsis sooner in burned children.

Summary Five patients (four black Nigerian males and one Polynesian) with pyoderma gangrenosum (PG) were seen between May 1974 and March 1984, at the Ahmadu Bello University Teaching Hospital, Kaduna, Nigeria. Their age range was 12–42 years (mean 25.6 years). The female expatriate Polynesian patient had PG localized to the upper back while the other four patients had severe and extensive PG lesions. Local cleansing and dressing of the ulcers combined with appropriate systemic antibiotics produced healing in two of these patients. The empirical addition of dapsone and rifampicin led to complete healing in two others, but only transient remission in one patient who, after 22 years of disease activity, died at home from an aggressive and accelerated form of the disease best described as‘malignant pyoderma’gangrenosum.

Background The mainstay of the management of liver abscesses has been intravenous antibiotics and radiologically guided percutaneous drainage. However, not all abscesses are treated successfully in this way, and some require surgical drainage. Laparoscopic drainage of liver abscesses may be an alternative to open surgical drainage. Methods Twenty consecutive patients with liver abscesses treated by laparoscopic drainage in combination with intravenous antibiotics were studied prospectively. Fifteen had had failed percutaneous drainage previously. Results There were 13 right lobe and seven left lobe abscesses ranging from 6 to 25 cm in diameter. Mean operating time was 38 min. Seventeen patients were drained successfully. Three patients developed recurrent symptoms of which two resolved with conservative measures, but one required a second laparoscopic procedure. There were no intraoperative or other postoperative complications in the 20 patients. Follow-up ranged from 5 to 12 months. Conclusions Laparoscopic drainage of liver abscesses, in combination with systemic antibiotics, is a safe and viable alternative in all patients who require surgical drainage following failed medical or percutaneous treatment, and in those with large abscesses.

Treatment programs for prevention of blindness from trachoma in areas of endemicity are based on mass therapy, i.e., the topical application of antibiotic to the eyes of all persons in affected communities. When oral antibiotics are administered as a supplement to topical therapy, the healing rates among children with severe-intensity trachoma significantly improve. Moreover, the use of oral antibiotics (either tetracycline or doxycycline) in selected cases is a cost-effective strategy, particularly in communities where less than 20% of children have active trachoma. Systemic antibiotic treatment should be given only to children with severe- or moderate-intensity disease--those at significant risk of developing blindness. Children should be monitored carefully during systemic chemotherapy for adverse reactions.

Summary The management of pemphigus and pemphigoid is briefly reviewed. Consideration is given to the use of three intravenous daily ‘bolus’ injections of high-dose methyiprednisolone for the treatment of pemphigus, and to long acting tetraeosactrin (Synacthen Depot) injections with concurrent azathioprine for rapid control of bullous pemphigoid in the elderly. The great value of topical and intralesional steroid therapy used in conjunction with an anti-staphylococcal systemic antibiotic is stressed.

Summary.— The technique of Sellotape stripping was used to investigate the role of the stratum corneum in modifying sebum excretion rate and skin surface lipid composition. All experiments were performed on the forehead. The stratum corneum influences the rate of sebum excretion as Sellotape stripping produced a significant increase in sebum excretion rate, but this effect was abolished by systemic antibiotics. Skin surface lipid composition, when sampled by absorbent papers, was not influenced by Sellotape stripping, but when sampled by an ether-soaked sponge after Sellotape stripping, had a lessened epidermal lipid contribution. Thus the stratum corneum modifies skin surface lipid composition when sampled by an organic solvent. Absorbent papers may be preferable to other sampling techniques on the forehead in the investigation of the role of sebaceous biochemical factors in the pathogenesis of acne vulgaris.

SUMMARY.— Six out of 7 consecutive patients seen in the last 4 years suffering from generalized pustular psoriasis (von Zumbusch) have had the pustular phase terminated by a 6 weeks course of systemic antibiotic treatment directed against the coagulase positive staphylococci found on blood culture. Antibiotics to which the isolates were insensitive proved ineffective. The unsuccessful (fatal) case was seen in retrospect to have had inappropriate antibiotic treatment. Two of the patients relapsed but their pustulation was again terminated by the same means. These results were achieved without using methotrexate or systemic corticosteroids. It is suggested that suitable systemic antibiotics offer the safest means of treating this serious form of psoriasis.

In a comparative investigation, 369 patients operated upon for perforated appendicitis were studied retrospectively. During the period 1973–1979 181 patients with perforated appendicitis, treated at Sundsvall Hospital, were all given postoperative peritoneal lavage, whereas 188 patients with the same diagnosis treated at Skövde Hospital received no such treatment. Appendicectomy was performed in all patients and all were given systemic antibiotic therapy. Complications recorded were postoperative deaths, intra-abdominal abscesses, wound infections, postoperative ileus and lavage catheter complications. Postoperative peritoneal lavage did not diminish the frequency of these postoperative complications.