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OBJECTIVE Evaluation of survival of teeth with class III furcation involvement (FI) ≥5 years after active periodontal treatment (APT) and identification of prognostic factors. METHODS All charts of patients who completed APT at the Department of Periodontology of Goethe-University Frankfurt, Germany, beginning October 2004 were screened for teeth with class III FI. APT had to be accomplished for ≥5 years. Charts were analysed for data of class III FI teeth at baseline (T0), at accomplishment of APT (T1), and at the last supportive periodontal care (T2). Baseline radiographic bone loss (RBL) and treatment were assessed. RESULTS One-hundred and sixty patients (age: 54.4 ± 9.8 years; 82 females; 39 active smokers; 9 diabetics, 85 stage III, 75 stage IV, 59 grade B, 101 grade C) presented 265 teeth with class III FI. Ninety-eight teeth (37%) were lost during 110, 78/137 (median, lower/upper quartile) months. Logistic mixed-model regression and mixed Cox proportional hazard model associated adjunctive systemic antibiotics with fewer tooth loss (26% vs. 42%; p = .019/.004) and RBL (p = .014/.024) and mean probing pocket depth (PPD) at T1 (p

Objectives Chronic wound infections may delay the healing process and are responsible for a significant burden on healthcare systems. Since inappropriate management may commonly occur in the care of these patients, this review aims to provide a practical guide underlining actions to avoid in the management of chronic wound infections. Methods We performed a systematic review of the literature available in PubMed in the last 10 years, identifying studies regarding the management of patients with chronic wound infections. A panel of experts discussed the potential malpractices in this area. A list of ‘Don'ts’, including the main actions to be avoided, was drawn up using the ‘Choosing Wisely’ methodology. Results In this review, we proposed a list of actions to avoid for optimal management of patients with chronic wound infections. Adequate wound bed preparation and wound antisepsis should be combined, as the absence of one of them leads to delayed healing and a higher risk of wound complications. Moreover, avoiding inappropriate use of systemic antibiotics is an important point because of the risk of selection of multidrug-resistant organisms as well as antibiotic-related adverse events. Conclusion A multidisciplinary team of experts in different fields (surgeon, infectious disease expert, microbiologist, pharmacologist, geriatrician) is required for the optimal management of chronic wound infections. Implementation of this approach may be useful to improve the management of patients with chronic wound infections.

A 44-year-old male patient developed proptosis, edema, and erythema progressing to complete ptosis and supraduction deficit 2 days after positive COVID-19 test. He failed to improve on systemic antibiotics. MRI showed thickening and T2 enhancement of the superior rectus/levator complex consistent with orbital myositis. He improved on intravenous corticosteroids and experienced continued gradual improvement on oral steroids.

To compare antibiotic sales in eight high-income countries using the 2019 World Health Organization (WHO) Access, Watch and Reserve (AWaRe) classification and the target of 60% consumption of Access category antibiotics.We analysed data from a commercial database of sales of systemic antibiotics in France, Germany, Italy, Japan, Spain, Switzerland, United Kingdom of Great Britain and Northern Ireland, and United States of America over the years 2013-2018. We classified antibiotics according to the 2019 AWaRe categories: Access, Watch, Reserve and Not Recommended. We measured antibiotic sales per capita in standard units (SU) per capita and calculated Access group sales as a percentage of total antibiotic sales.In 2018, per capita antibiotic sales ranged from 7.4 SU (Switzerland) to 20.0 SU (France); median sales of Access group antibiotics were 10.9 SU per capita (range: 3.5-15.0). Per capita sales declined moderately over 2013-2018. The median percentage of Access group antibiotics was 68% (range: 22-77 %); the Access group proportion increased in most countries between 2013 and 2018. Five countries exceeded the 60% target; two countries narrowly missed it ( 55% in Germany and Italy). Sales of Access antibiotics in Japan were low (22%), driven by relatively high sales of oral cephalosporins and macrolides.We have identified changes to prescribing that could allow countries to achieve the WHO target. The 60% Access group target provides a framework to inform national antibiotic policies and could be complemented by absolute measures and more ambitious values in specific settings.Comparer les ventes d'antibiotiques dans huit pays à hauts revenus à l'aide de la classification AWaRe (Access, Watch et Reserve) mise en place en 2019 par l'Organisation mondiale de la Santé, ainsi que de l'objectif de consommation de 60% fixé pour les antibiotiques de la catégorie Access.Nous avons analysé les informations issues d'une base de données commerciales concernant la vente d'antibiotiques systémiques entre 2013 et 2018 en Allemagne, en Espagne, aux États-Unis d'Amérique, en France, en Italie, au Japon, au Royaume-Uni de Grande-Bretagne et d'Irlande du Nord et en Suisse. Nous avons réparti ces antibiotiques selon les catégories AWaRe 2019: Access (antibiotiques dont l'accessibilité est essentielle), Watch (antibiotiques à utiliser sélectivement) et Reserve (antibiotiques de réserve, non recommandés). Nous avons mesuré les ventes d'antibiotiques en unités standard (SU) par habitant, et calculé celles de la catégorie Access sous forme de pourcentage des ventes totales.En 2018, les ventes d'antibiotiques par habitant étaient comprises entre 7,4 SU (Suisse) et 20,0 SU (France); la valeur médiane des ventes d'antibiotiques Access s'élevait à 10,9 SU par habitant (écart: 3,5-15,0). Les ventes par habitant ont diminué modérément au fil des ans entre 2013 et 2018. Le pourcentage médian des antibiotiques Access était de 68% (écart: 22–77%); dans la plupart des pays, leur pourcentage a augmenté entre 2013 et 2018. Cinq pays dépassaient l'objectif de 60%; deux autres s'en approchaient ( 55% en Allemagne et en Italie). La vente d'antibiotiques Access au Japon était faible (22%) en raison d'une forte consommation de macrolides et de céphalosporines orales.Nous avons constaté une évolution dans les prescriptions, ce qui pourrait permettre aux pays d'atteindre l'objectif de l'OMS. Une limite de consommation d'antibiotiques Access fixée à 60% pourrait servir d'orientation aux politiques nationales en la matière, et être complétée par des mesures absolues et des chiffres plus ambitieux dans des contextes spécifiques.Comparar las ventas de antibióticos en ocho países con ingresos altos utilizando la clasificación de acceso, vigilancia y reserva (AWaRe) de la Organización Mundial de la Salud (OMS) de 2019 y el objetivo de consumo del 60% de los antibióticos de la categoría de acceso.Analizamos los datos de una base de datos comercial de ventas de antibióticos sistémicos en Francia, Italia, Japón, Alemania, España, Suiza, Reino Unido de Gran Bretaña e Irlanda del Norte y Estados Unidos de América durante los años 2013-2018. Clasificamos los antibióticos según las categorías AWaRe de 2019: acceso, vigilancia, reserva y no recomendado. Medimos las ventas de antibióticos per cápita en unidades estándar (SU) per cápita y calculamos las ventas del grupo de acceso como porcentaje de las ventas totales de antibióticos.En 2018, las ventas per cápita de antibióticos oscilaron entre 7,4 SU (Suiza) y 20,0 SU (Francia); la media de las ventas de antibióticos del grupo de acceso fue de 10,9 SU per cápita (rango: 3,5-15,0). Las ventas per cápita disminuyeron moderadamente durante 2013-2018. La media del porcentaje de antibióticos del grupo de acceso fue del 68% (rango: 22-77%); la proporción del grupo de acceso aumentó en la mayoría de los países entre 2013 y 2018. Cinco países superaron el objetivo del 60%; dos países lo incumplieron por un escaso margen (55% en Alemania e Italia). Las ventas de antibióticos de acceso en Japón fueron bajas (22%), impulsadas por una venta relativamente alta de cefalosporinas orales y macrólidos.Hemos identificado cambios en la prescripción que podrían permitir a los países alcanzar el objetivo de la OMS. El objetivo del 60% del grupo de acceso proporciona un marco para informar las políticas nacionales de antibióticos y podría complementarse con medidas absolutas y valores más ambiciosos en entornos específicos.مقارنة مبيعات المضادات الحيوية في ثماني دول مرتفعة الدخل باستخدام تصنيف منظمة الصحة العالمية (WHO) للإتاحة والمراقبة والاحتياطي (AWaRe) لعام 2019، والهدف المتمثل في استهلاك 60% من المضادات الحيوية من فئة الوصول.قمنا بتحليل البيانات من قاعدة البيانات التجارية لمبيعات المضادات الحيوية المنتظمة في فرنسا وإيطاليا واليابان وألمانيا وأسبانيا وسويسرا والمملكة المتحدة لبريطانيا العظمى وأيرلندا الشمالية والولايات المتحدة الأمريكية، خلال الأعوام 2013 إلى 2018. وقمنا بتصنيف المضادات الحيوية وفقًا لفئات 2019 AWaRe: الإتاحة، والمراقبة، والاحتياطي، وغير الموصى بها. قمنا بقياس مبيعات المضادات الحيوية للفرد في الوحدات القياسية (SU) للفرد، وكذلك حساب مبيعات مجموعة الإتاحة كنسبة مئوية من إجمالي مبيعات المضادات الحيوية.في عام 2018، تراوحت مبيعات المضادات الحيوية للفرد من 7.4 وحدة قياسية (سويسرا) إلى 20.0 وحدة قياسية (فرنسا)؛ كان متوسط مبيعات المضادات الحيوية لمجموعة الإتاحة 10.9 وحدة قياسية للفرد (النطاق: 3.5 إلى 15.0). انخفض مبيعات الفرد بشكل معتدل خلال الفترة من 2013 إلى 2018. كانت متوسط النسبة المئوية للمضادات الحيوية لمجموعة الوصول 68% (النطاق: 22 إلى 77%)، وزادت نسبة مجموعة الوصول في معظم الدول بين عامي 2013 و2018. وتجاوزت خمس دول الهدف المتمثل في 60%؛ بينما أخفقت دولتان في تحقيق هذا الهدف بفارق ضئيل (55% في ألمانيا وإيطاليا). كانت مبيعات المضادات الحيوية المتاحة في اليابان منخفضة (22%)، نتيجةً للمبيعات المرتفعة نسبيًا من مركبات السيفالوسبورين والماكروليد الفموية.قمنا بتحديد تغييرات في الوصفات يمكنها أن تسمح للدول بتحقيق هدف منظمة الصحة العالمية إن هدف المجموعة المتاحة البالغ 60%، يوفر إطارًا لتوعية السياسات الوطنية للمضادات الحيوية، ويمكن استكماله بتدابير مطلقة، وقيم أكثر طموحًا في أوضاع محددة.، وقيم أكثر طموحًا في أوضاع محددة.旨在根据 2019 年世界卫生组织 (WHO) 可用、慎用和备用 (AWaRe) 分级原则和 60% 可用级抗生素消费目标，比较 8 个高收入国家的抗生素销售情况。.我们分析了 2013 年至 2018 年期间德国、法国、美国、日本、瑞士、西班牙、意大利和英国全身性抗生素销售相关商业数据库的数据。我们根据 2019 年 AWaRe 分级原则对抗生素进行了分级：可用级、慎用级、备用级和不推荐使用。我们基于人均标准单位 (SU) 统计了人均抗生素销售额，并计算了可用级抗生素销售额占抗生素总销售额的百分比。.2018 年，人均抗生素销售额为 7.4 SU（瑞士）至 20.0 SU（法国）不等；可用级抗生素的平均销售额为人均 10.9 SU（范围：3.5–15.0）。2013-2018 年间人均销售额有所下降。可用级抗生素的中位百分比为 68%（范围：22–77%）；2013 年至 2018 年间，大多数国家的可用级抗生素消费比例有所上升。有 5 个国家超过了 60% 的消费目标；两个国家非常接近该目标值（德国和意大利均大于 55%）。鉴于其口服头孢菌素和大环内酯类药物销售额相对较高，日本的可用级抗生素的销售额较低 (22%)。.我们已确定处方更改方案，以帮助各国实现世卫组织的目标。60% 可用级抗生素消费目标为国家制定抗生素政策提供了框架，同时可针对特定环境设定一些绝对控制措施和宣扬更加着眼于未来的价值观。.Сравнить продажи антибиотиков в восьми странах с высоким уровнем дохода, используя классификацию Всемирной организации здравоохранения (ВОЗ) 2019 года для антибиотиков AWaRe («доступ», «наблюдение» и «резерв»), а также прогресс в достижении цели увеличить долю глобального потребления антибиотиков на 60% в группе «доступ».Авторы проанализировали данные из коммерческой базы данных о продажах системных антибиотиков в Германии, Испании, Италии, Соединенном Королевстве Великобритании и Северной Ирландии, Соединенных Штатах Америки, Франции, Швейцарии и в Японии за 2013–2018 годы. Были классифицированы антибиотики по категориям AWaRe 2019: «доступ», «наблюдение», «резерв» и «нерекомендуемые». Авторы измерили продажи антибиотиков на душу населения в стандартных единицах (СЕ) на душу населения и рассчитали продажи в группе «доступ» как процент от общих продаж антибиотиков.В 2018 году продажи антибиотиков на душу населения составляли от 7,4 СЕ (Швейцария) до 20,0 СЕ (Франция); медиана продаж антибиотиков в группе «доступ» составила 10,9 СЕ на душу населения (диапазон: 3,5–15,0). Продажи на душу населения в 2013–2018 годах умеренно снизились. Медиана процентной доли антибиотиков в группе «доступ» составила 68% (диапазон: 22–77%); процентная доля в группе «доступ» увеличилась в большинстве стран в период с 2013 по 2018 год. Пять стран превысили показатель в 60%; две страны чуть не упустили этот показатель ( 55% в Германии и Италии). Продажи антибиотиков в группе «доступ» в Японии были низкими (22%), что было обусловлено относительно высокими продажами пероральных цефалоспоринов и макролидов.Мы определили изменения в назначениях, что позволит странам достичь целевого показателя ВОЗ. Достижение 60% в группе «доступ» служит основой для информационного обеспечения национальной политики в отношении антибиотиков, которую можно было бы дополнить абсолютными показателями и более амбициозными значениями в определенных условиях.

Aim The aim of this single-blind RCT was to evaluate the adjunctive clinical and microbiological effect of systemic amoxicillin (AMX) plus metronidazole (MTZ) to non-surgical treatment of peri-implantitis.Material and methods Patients (N = 62) with peri-implantitis were randomly assigned to receive full-mouth mechanical debridement and decontamination and use of chlorhexidine (control group) or combined with antibiotic therapy of AMX/MTZ (test group). Primary outcome was change in bleeding score from baseline (T-0) to 3-month follow-up (T-3). Secondary parameters were plaque, suppuration, PPD, CAL, bone level, microbiology, adverse events and need for additional surgery. Data were analysed with linear multiple regression analysis.Results 57 patients with 122 implants completed 3-month follow-up. Both groups showed major clinical improvements at T-3 in both peri-implant and periodontal parameters. However, no significant differences were observed between both groups for any of the primary or secondary parameters.Conclusions Systemic antibiotic therapy of AMX/MTZ does not improve clinical and microbiological outcomes of non-surgical peri-implantitis treatment and should not be routinely recommended. Although complete disease resolution may be difficult to achieve, meticulously performed full-mouth non-surgical treatment, achieving a high level of daily oral hygiene and healthy periodontal tissues, can significantly improve the starting position of the subsequent (surgical) peri-implantitis treatment phase.

BACKGROUND/OBJECTIVES To investigate the evaluation and management of atopic dermatitis (AD) in the pediatric emergency department (PED). METHODS This retrospective chart review was performed at the PED of a single institution and examined data from 2012 to 2017. Of 335 visits from patients 18 years and younger coded for AD, 167 visits with documented findings that supported a diagnosis of AD according to guidelines from the American Academy of Dermatology were included. RESULTS The mean age of presentation was 6.3 years (standard deviation [SD]: 5.9). Of 11 patients with multiple visits, the mean between-visit interval was 31 days (SD: 41). Topical corticosteroids (TCSs) were not prescribed or recommended in 63/167 visits. In an additional 46/167 visits, over-the-counter topical hydrocortisone was recommended. Of prescribed TCS, the mean TCS class was 5.5 (SD: 1.9). 61/104 recommended or prescribed TCSs were weak (Class 7), the most likely used class (P

Aim: To compare three periodontitis clusters (A, B and C) for alveolar bone loss (ABL) patterns, antibiotic prescriptions and surgeries and to relate them to the new classification of periodontitis. Materials and Methods: ABL patterns, prescription of systemic antibiotics and the number of surgeries were retrieved for all patients (n = 353) in the clusters. Comparisons and possible predictors for antibiotics were assessed, and results also evaluated in relation to the new classification. Results: Cluster A is characterized by angular defects often affecting the first molars and localized stage III/IV grade C periodontitis. Cluster B contains mainly localized or generalized stage III/IV, grade C patients. Cluster C contains mainly patients with generalized stage III/IV grade C periodontitis. Patients in cluster A received significantly more antibiotics compared to B and C (78% vs. 23% and 17%); the predictors for antibiotic prescription were young age and localized ABL. No differences in numbers of periodontal surgeries were observed between clusters (A = 1.0 ± 1.4, B = 1.3 ± 1.4 and C = 1.3 ± 1.5). Conclusions: Within stage III/IV grade C periodontitis, we could detect three clusters of patients. The distinct localized ABL pattern and younger age in cluster A presumably prompted clinicians to prescribe antibiotics.

Objectives To assess the potential influence of systemic antibiotic administration on the healing of periodontal intrabony defects treated with deproteinized bovine bone mineral (DBBM) and collagen membrane. Materials and methods Forty-one intrabony defects were treated by means of DBBM and collagen membrane (GTR). Postoperatively, the patients received either systemic antibiotics (i.e., 1 g of amoxicillin, twice daily for 7 days) (test) or no antibiotics (control). Clinical attachment level (CAL), probing depth (PD), and gingival recession (GR) were measured at baseline and at 1 year following regenerative surgery. The depth of the intrabony component (INTRA DD) and its width (INTRA DW) were measured during surgery and after 1 year at reentry. The depth (RxD) and width (RxW) of the intrabony defects were evaluated radiographically at baseline and at 1 year. Results No adverse events were observed in any of the two groups throughout the entire study period. In the test group, mean CAL changed from 8.7 ± 1.4 mm at baseline to 5.0 ± 1.7 mm at 1 year (p p p p Conclusions Within their limits, the present study has failed to show any substantial added clinical benefits following the postoperative administration of amoxicillin in conjunction with regenerative periodontal surgery using DBBM and GTR. Clinical relevance The post-surgically administration of systemic antibiotics does not seem to be necessary following regenerative periodontal surgery.

The aim of this article is to present the basics of traumatology in oculoplastic surgery and to review the literature about this topic. This review sums up the problematic of injuries of the eyelid, lacrimal system and orbit. The most important types of trauma, their treatment options, and the most common complications are described. In majority of oculoplastic traumas, surgical reconstruction is the treatment of choice. The surgery is often performer immediately, but sometimes the reconstruction of eyelid and lacrimal injuries can be postponed up to 48 hours, if the immediate surgery is not possible. Although the recommendations from the literature on this topic are variable, most of the patients require at least local antibiotics, more complex traumas systemic antibiotics. Careful diagnostics and correctly performed surgical treatment, either only by ophthalmologist, or oculoplastic surgeon, or a multi-disciplinary team for more complex injuries, are the key to good functional and aesthetic results of the reconstruction.

Background/objectives Studies assessing the utility of spironolactone for treating acne in adolescent females are lacking. Thus, we sought to examine spironolactone's role in treating this patient population. Methods A retrospective review was performed to determine the efficacy of spironolactone treatment in adolescent females seen at Mayo Clinic in Rochester, Minnesota, from 2007 to 2017. Results In a cohort of 80 pediatric patients with a median age of 19 years (range, 14-20 years), 64 patients (80%) experienced improvement of acne on treatment with spironolactone (median dose, 100 mg daily) with a favorable side effect profile. Approximately a quarter of patients (22.5%) had a complete response; more than half (58.8%) had a complete response or a partial response greater than 50%. Initial and maximal responses were observed at a median of 3 months and 5 months, respectively. Patients received treatment with spironolactone for a median duration of 7 months (range, 3-45 months) with limited side effects. Conclusions Spironolactone demonstrated efficacy in treating acne in adolescent females and is a safe long-term alternative to systemic antibiotics in these patients.

BACKGROUND This systematic review aimed to provide a comprehensive view on microbial community shifts after periodontal therapy with and without systemic antibiotics, conducted in randomized controlled trials (RCTs). METHODS Search functions in PubMed, Scopus, the Web of Knowledge, and the Cochrane Oral Health Library databases were used to locate studies published up to December 2018 that reported at least two bacteria before and after periodontal therapy. Gray literature and manual searching were done. Information about reported bacteria in those studies were extracted, and a descriptive microbial community analysis was conducted to observe trends and influencing factors on microbial dynamics. Methodological aspects were examined, including the bacterial detection method, heterogeneity of procedures, and risk of bias (RoB) of the studies. RESULTS The 30 included studies reported 130 different bacterial genera. Four different detection methods were reported: cultivation, polymerase chain reaction, DNA-DNA-checkerboard hybridization, and 16S rDNA amplicon sequencing. No general compositional change between the antibiotic and placebo groups could be found after therapy on the community level. Fifty-five bacteria were reported in two or more studies. Of those, 24 genera decreased and 13 increased more frequently after antibiotic use. Great heterogeneity between procedures and variability in RoB were found among the studies. CONCLUSIONS Microbial shifts occurred regardless of the use of antibiotics. Antibiotic therapy seems to induce more changes in single bacteria. The heterogeneity in methods and reporting of the included studies preclude clinical recommendations on the use or not of adjunctive antibiotics. The present results may guide further research on the topic.

Introduction Burns are a worldwide problem with majority of them occurring in low and middle-income countries. The hurdles in treatment of burns in the resource restricted setting are unique and challenging. The role of intravenous antibiotics in reducing mortality and morbidity related to infection and sepsis has not been studied extensively in the Indian sub-continent. Materials and methods This was a retrospective study conducted at a tertiary burn care center in India over a period of six months with follow up of one month from the day of burn injury. Results Data from a total of 157 patients were collected and analysed. In Prophylaxis group (n = 77), sepsis was detected in 33 patients and 38 patients expired. In No Prophylaxis group (n = 80), sepsis was detected in 37 patients and 40 patients expired. In Inhalational burns subgroup, patients belonging to Prophylaxis group (n = 30) had 20 patients diagnosed with pneumonia while 22 patients did not survive till 30th post burn day. Patients in No Prophylaxis group who had inhalational burns were 38 in number. Pneumonia was diagnosed in 29 of them while 27 did not survive till 30th post burn day. In Pneumonia subgroup, patients belonging to Prophylaxis group had lower mortality rate as compared to No Prophylaxis group. Conclusion Our study does not support the routine usage of antibiotic prophylaxis in patients with burn injuries, but their administration can be considered in certain specific subgroups like patients with inhalational burns and patients developing pneumonia. Pneumonia is an independent risk factor for mortality when no antibiotic prophylaxis is used in burn patients.

Purpose of review Since initial description of the successful use of intravenous bacteriophage therapy in the United States in 2017, there is widespread interest in using bacteriophage therapy for multidrug-resistant (MDR) infections. Recent findings Recent published cases of bacteriophage therapy in transplant candidates and recipients are reviewed highlighting its safety and potential efficacy when used as an adjunct to systemic antibiotics for a variety of clinical indications. An overview of access to bacteriophage therapy in the United States is also provided. Summary The reviewed cases form the basis for ongoing compassionate use of bacteriophage therapy in transplant candidates and recipients with life-threatening MDR infections until data from clinical trials are available to guide therapy.

Bezlotoxumab is a monoclonal antibody approved for the prevention of recurrent Clostridium difficile infection (rCDI). In a previous exposure–response (E–R) analysis of bezlotoxumab exposure and rCDI, based on data from two phase 3 trials in participants who received placebo or bezlotoxumab 10 mg/kg, rCDI was treated as a binary endpoint and discontinued subjects were imputed as not having rCDI, resulting in an apparent positive E–R trend between rCDI rates and bezlotoxumab exposure. Therefore, a time-to-event (TTE) analysis was applied to investigate the E–R relationship, accounting for the time to rCDI occurrence and participant discontinuation. A TTE model, applying a time-dependent hazard function and right-censoring of data based on rCDI, discontinuation, or study end was developed. Exposure effects and covariates effects were evaluated as predictors affecting the hazard. The TTE model consisted of a Gompertz function with age, endogenous immunoglobulin G to C. difficile toxin B (IgG-B), history of CDI, hospitalization, sex, Charlson Comorbidity Index, and concomitant use of systemic antibiotics affecting the hazard. Exposure effects were characterized with a maximum effect (Emax) E–R relationship on the baseline parameter, and bezlotoxumab exposures achieved at the 10 mg/kg dose were found to be on the plateau of the E–R curve. Endogenous IgG-B significantly impacted the Emax, indicating that low-titer participants derive a greater benefit from bezlotoxumab treatment compared with high-titer participants. The results support the conclusions of the previous E–R analysis, where exposures achieved at the 10 mg/kg dose are on the plateau of the E–R curve.

Background: Chronic stimulation of the thalamus is a surgical option in the management of intractable Holmes tremor. Patients with deep brain stimulation (DBS) can encounter infection as a postoperative complication, necessitating explantation of the hardware. Some studies have reported on the technique and the resulting efficacy of therapeutic lesioning through implanted DBS leads before their explantation. Case Description: We report the case of a patient with Holmes tremor who had stable control of symptoms with DBS of the nucleus ventralis intermedius of the thalamus (VIM) but developed localized infection over the extension at the neck, followed by gradual loss of a therapeutic effect as the neurostimulator reached the end of its service life. Three courses of systemic antibiotic therapy failed to control the infection. After careful consideration, we decided to make a rescue lesion through the implanted lead in the right VIM before explanting the complete DBS hardware. The tremor was well controlled after the rescue lesion procedure, and the effect was sustained during a 2-year follow-up period. Conclusion: This case and the previously discussed ones from the literature demonstrate that making a rescue lesion through the DBS lead can be the last plausible option in cases where the DBS system has to be explanted because of an infection and reimplantation is a remote possibility.

Objectives: To assess the adjunctive effect of systemic amoxicillin (AMX) and metronidazole (MTZ) in patients receiving non-surgical treatment (NST) for peri-implantitis (PI). Materials and methods: Thirty-seven patients were randomized into an experimental group treated with NST plus AMX + MTZ (N = 18) and a control group treated with NST alone (N = 19). Clinical parameters were evaluated at 12 weeks post-treatment. The primary outcome was the change in peri-implant pocket depth (PIPD) from baseline to 12 weeks, while secondary outcomes included bleeding on probing (BoP), suppuration on probing (SoP), and plaque. Data analysis was performed at patient level (one target site per patient). Results: All 37 patients completed the study. Both groups showed a significant PIPD reduction after NST. The antibiotics group showed a higher mean reduction in PIPD at 12 weeks, compared with the control group (2.28 ± 1.49 mm vs. 1.47 ± 1.95 mm), however, this difference did not reach statistical significance. There was no significant effect of various potential confounders on PIPD reduction. Neither treatment resulted in significant improvements in BoP at follow-up; 30 of 37 (81%) target sites still had BoP after treatment. Only two implants, one in each group, exhibited a successful outcome defined as PIPD

Acinetobacter baumannii is a pathogenic bacterium commonly associated with multidrug resistance. In this issue of Antimicrobial Agents and Chemotherapy , a challenging case of ventilator-associated pneumonia is presented in which bacteriophage therapy was used as a last resort treatment in combination with systemic antibiotics. The data are promising, and several key areas are highlighted for future research.

Purpose We aimed to show the outcome of very early endoscopic dacryocystorhinostomy (VE-EDCR) in a routine pool of patients with acute dacryocystitis (AD) and abscess formation compared with the standard late external dacryocystorhinostomy L-ExDCR. Methods This was a prospective nonrandomized comparative study conducted from June 2013 to March 2016. Patients with AD and abscess formation were referred to our oculo-facial clinic in a university-based hospital. All patients received systemic antibiotics and were assigned to either of treatment groups. Patients in group 1 underwent late external transcutaneous DCR (L-ExDCR) and group 2 underwent EDCR within 3 days after first visit, named VE-EDCR. Primary outcome measure was success of surgery. Results Forty-one eyes of 41 patients with acute suppurative AD, were included from June 2013 to March 2016. Twenty-two patients underwent VE-EDCR and 19 underwent L-ExDCR. Mean age of patients was 43.41 (SD = 19.84, range 14–98) years. Mean follow-up was 14 (SD = 2.4) months. Anatomic, functional, and overall success in L-ExDCR and VE-EDCR groups were (89.5 and 86.4%, p = 0.99) (89.5% and 86.4%, p = 0.99) (89.5% and 81.8%, p = 0.66) respectively. Mean duration of cellulitis in VE-EDCR and L-ExDCR were 8.00 (SD = 4.63) and 16.11 (SD = 11.58) days, respectively (p = 0.027). No remarkable adverse event was found. Conclusions Success of very early endonasal endoscopic DCR is comparable with the traditional late external DCR. Duration of cellulitis is shorter in VE-EDCR. This therapeutic approach can be considered in patients with acute suppurative dacryocystitis.

The use of prophylactic antibiotics for oculoplastic procedures varies because of a lack of specific guidelines or literature. Comparable studies in clean orbital surgery have shown no proven benefit and its indiscriminate use has been linked to individual harm and rising levels of resistance. We investigated whether avoidance of systemic prophylactic antibiotics in elective lid surgeries increased surgical site infections (SSI).We conducted a case-note audit of consecutive anterior ptosis repair and lateral tarsal strip (LTS) surgeries performed with post-operative oral antibiotics (co-amoxiclav or clarithromycin) and topical chloramphenicol ointment, compared to only topical antibiotics. Data on American Society of Anesthesiologists (ASA) status, age and incidence of surgical site infection at 2 weeks follow-up were collected.Of a cohort of 232 patients, 99 patients had combined systemic and topical antibiotics (ptosis n = 49, LTS n = 50) and 133 had topical antibiotics (ptosis n = 83, LTS n = 50). The groups were not significantly different for age (p = .6, t-test) or ASA status (p = .7, chi2 test). Three patients from the combined group required further treatment for SSI compared with two patients from the topical antibiotic group (p = .7 Fisher's exact test).Avoidance of systemic antibiotic prophylaxis for LTS and anterior ptosis repair procedures was not associated with increased SSI rates. Given that prescriptions of antibiotics carry the risk of side-effects and growing antimicrobial resistance, we feel that our study shows that its routine use in this setting is of no benefit.

A retrospective chart review of 251 new frontalis slings suggests surgical closure technique significantly impacts rates of post-operative infection and exposure. The role of prophylactic systemic antibiotics in reducing infection and exposure is less clear.

Aim Nationwide lockdowns and social restrictions during the COVID‐19 pandemic have reduced childhood infections. We assessed how many items of systemic antibiotics and asthma medicines were dispensed to children aged 0−12 years in Finland before and during the pandemic and analysed the reimbursement costs. Methods The data came from the national Finnish register of reimbursable prescriptions, which is maintained by the country's Social Insurance Institution. It included all prescriptions for antibiotics and asthma medicines dispensed to children aged 0−12 years in 2019 and 2020. Prescription rates per 1000 children were calculated for each quarter and compared using rate ratios and 95% confidence intervals (95% CI). Results Overall dispensing for antibiotics decreased by 55.3% and was most prominent for macrolides for children aged 0−5 years (59.6%, 95% CI 60.9%−58.2%). Asthma medicines decreased by 19.8%, and the most prominent reduction was in short‐acting beta‐agonists for children aged 0−5 years (35.2%, 95% CI 36.1%−34.2%). These reduced reimbursement costs by 3.4 million Euros from 2019 to 2020. Conclusion This nationwide study showed that the number of antibiotics and asthma medicines decreased by 59.6% and 19.8% respectively from 2019 to 2020, generating a cost saving of 3.4 million Euros.

Acne is a dermatosis that affects almost 90% of the adolescent population worldwide and its treatment is performed with retinoids, antimicrobials, acids, and topical or systemic antibiotics. Side effects such as skin irritation in addition to microbial resistance to antibiotics are the main side effects found. Phototherapy with blue light is being used as an alternative treatment. Our objective was to analyze the use of blue light to treat inflammatory acne. We conducted a systematic literature review, following the recommendation PRISMA (Preferred Reporting Items for Systematic Reviews and MetaAnalyses), including in the sample randomized clinical trial studies that compared blue light with another intervention as control. The research was carried out in the PUBMED and WEB of SCIENCE databases and the methodological quality of the studies evaluated were made by the Cochrane Collaboration Bias Risk Scale. After the exclusion of duplicates, the titles and abstracts of 81 articles were evaluated, and 50 articles were selected for full reading, including in the review at the end 8 articles. Studies have shown significant improvements in the overall picture of acne. It is concluded that despite the great potential in its use in the treatment of acne, there is a need for more detailed trials on the effect of blue light on the treatment of inflammatory acne.

OBJECTIVES Part 1 of this two-part study aims to investigate systemic antibiotics (SA) prescribing practices for various endodontic diagnoses and clinical scenarios by general practitioners, post-graduate students and endodontists in Israel and the former Soviet Union (FSU) states. MATERIALS AND METHODS A total of 7500 dentists from Israel and FSU states were invited to fill in an online questionnaire. The questionnaire consisted the SA prescribing for endodontic diagnoses and clinical scenarios (post operative pain, post apical surgery and post avulsion). The international guidelines of the European Society of Endodontology and the American Association of Endodontists were used as the standard of correct practice. RESULTS A total of 1310 dentists (response rate of 17.46%, 498 Israeli and 812 FSU dentists) completed the survey. The rates of prescription SA among the Israeli and the FSU respondents for non-recommended diagnoses and clinical scenarios were 24.75% and 11.42% (P>0.05), 16.57% and 16.17% (P>0.05) respectively. The rates of prescription SA among the Israeli and the FSU respondents for recommended diagnoses and clinical scenarios were 63.39% and 62.9% (P>0.05), 27.2% and 13.9% (P>0.05) respectively. CONCLUSIONS There are gaps between the recommended protocols for prescribing SA for patients with various endodontic diagnoses and clinical scenarios and the actual practices among Israeli and FSU dentists. Continuing education of dentists must be encouraged in order to improve SA prescription practice according to international guidelines. CLINICAL RELEVANCE When not indicated, prescription of systemic antibiotics might lead to antimicrobial resistance, while non-prescription, when required, might have negative repercussions on the patient's health. Knowledge of the prescription habits of dentists in the endodontic practice will help prevent harmful situations.

A 10-month-old girl presented with eyelid edema and erythema that did not improve with systemic antibiotics. Due to a lack of improvement, MRI was performed to avoid ionizing radiation from CT. An orbital abscess was recognized and drained. However, the abscess recurred 2 times. CT scan was performed and a tract in the sphenoid bone helped to diagnose a congenital dural sinus tract with dermoid. Definitive surgery was performed with neurosurgery to remove the entire tract including cutaneous connection. CT scan proved critical to diagnosis and should be considered in infants in select cases despite the concern for ionizing radiation in this vulnerable age group.

Background and purpose - The evidence-based algorithms for treatment of periprosthetic joint infection (PJI) recommend surgical intervention in combination with the use of systemic antibiotics. However, still it is not unusual to treat total knee arthroplasty (TKA) patients with suspected infection using only antibiotics. We investigated treatment pathways for TKA patients with suspected infection in Lithuania. Patients and methods - Of the 4,069 TKA patients (4,269 knees) registered in the Lithuanian Arthroplasty Register (2013-2015) 2,769 patients (2,825 knees) were interviewed 2 years after the surgery. The patients were asked if they had been subject to antibiotic treatment after the TKA surgery and/or if any additional surgical interventions on the operated knee had been performed. The number of patients treated with antibiotics due to problems in the operated knee was identified and cumulative revision rates (CRR) were calculated. Results - 180 (7%) patients of the total 2,769 reported that they had been prescribed antibiotics after the primary TKA; 132 of these patients (70%) said they had received antibiotics due to problems with the operated knee. The 2-year CRR after TKA in patients not treated with antibiotics was 0.7% (95% CI 0.4-1), as compared with 24% (95% CI 17-32) in those who had used antibiotics due to the problems in the operated knee for more than 1 week. Interpretation - In Lithuania there seems to be a lack of adherence to evidence-based treatment guidelines when infection is suspected after primary TKA.

Objectives: antimicrobial stewardship programs (ASPs) have an important role in the appropriate utilization of antibiotics. Some of the core strategies recommended for ASPs are pre-authorization and prospective audit and feedback. In Turkey, a unique nationwide antibiotic restriction program (NARP) has been in place since 2003. The aim of this study was to measure the effect of a prospective audit and feedback strategy system along with the NARP. Methods: a prospective quasi-experimental study was designed and implemented between March and June 2017. A computerized pre-authorization system was used as an ASP strategy to approve the antibiotics. During the baseline period, patients with intravenous (IV) antibiotic use >= 72 h were monitored without intervention. In the second period, feedback and treatment recommendations were given to attending physicians in the case of IV antibiotic use >= 72 h. The modified criteria of Kunin et al. and Gyssens et al. were followed for appropriateness of prescribing. Days of therapy (DOT) and length of stay (LOS) were calculated and compared between the two study periods. Results: a total of 866 antibiotic episodes among 519 patients were observed. A significant reduction in systemic antibiotic consumption was observed in the intervention period (575 vs. 349 DOT per 1000 patient-days; p < 0.001). On multivariate analysis, prospective audit and feedback (odds ratio 1.5, 95% confidence interval 1.09-2.04; p = 0.011) and pre-authorization of restricted antibiotics (odds ratio 1.7; 95% confidence interval 1.2-2.31; p = 0.002) were the predictors of appropriate antimicrobial use. Mean LOS was decreased by 2.9 days (p = 0.095). Conclusions: this study showed that the antimicrobial restriction program alone was effective, but the system should be supported by a tailored ASP, such as prospective audit and feedback., NA

The aim of this work was to evaluate the outcome and efficacy of treatment in a homogeneous group of skeletally immature patients with chronic osteomyelitis of the long bones managed by a combination of radical debridement and insertion of tobramycin-impregnated calcium sulfate pellets to fill the bone defect in a single-stage procedure. Between 2011 and 2016, 12 skeletally immature patients were treated surgically by the reported technique. Single-stage surgery using tobramycin-impregnated calcium sulfate pellets in association with systemic antibiotic therapy yields satisfactory outcomes in skeletally immature children presenting chronic osteomyelitis by reducing the risk of occurrence of comorbidities, hospital stays, and healthcare costs.

Antibiotic lock therapy (ALT), in conjunction with systemic antibiotics, is recommended by scientific societies as a treatment of uncomplicated catheter-related bloodstream infections (CRBSI) in hemodynamically stable hemodialysis patients for whom catheter salvage is the goal. The rationale for this strategy is the eradication of intraluminal biofilms by the highly concentrated antibiotic used in the lock. However, the available evidence supporting this recommendation is scanty, and only includes small, short-term, observational studies (most of them single-arm), with different definitions of CRBSI cure and variable follow-up periods. Furthermore, the ability of an antibiotic to eradicate a biofilm is not predicted by its inherent spectrum of antibacterial activity, since sessile microorganisms in their biofilm display other mechanisms of resistance to antibiotics than their planktonic counter-parts. Additionally, penetration of some antibiotics frequently used into biofilms produced by common microorganisms appears to be low. In this editorial we provide a critical view on the available evidence regarding the efficacy of ALT on the treatment of CRBSI in hemodialysis patients, as well as the microbiological issues and technical challenges of this strategy.

Acne is one of the most common diseases worldwide and affects approximately 50 million individuals in the United States. Oral antibiotics are the most common systemic agent prescribed for the treatment of acne. However, their use may be associated with a variety of adverse outcomes including bacterial resistance and disruption of the microbiome. As a result, multiple treatment guidelines call for limiting the use of oral antibiotics in the treatment of acne, although actual prescribing often does not follow these guidelines. In this review, the rationale for concerns regarding the use of oral antibiotics for the management of acne is reviewed. In addition, we will discuss our approach to complying with the intent of the guidelines, with a focus on novel topical agents, dietary modification, laser and light-based modalities, and systemic medications such as spironolactone, combined oral contraceptives, and oral isotretinoin.

A 22-month-old boy with bilateral epiphora since birth and positive fluorescein dye disappearance test in both eyes underwent nasolacrimal duct probing, with multiple passes to ensure that the obstruction was resolved. Immediately after the procedure was completed, bilateral orbital emphysema developed. The patient was started on systemic antibiotics and systemic steroids and monitored closely. Fundus examination revealed no abnormalities. The emphysema began to resolve on postoperative day 2 and had resolved completely by postoperative day 10.

Background Infectious bacterial diseases exhibiting increasing resistance to antibiotics are a serious global health issue. Bacteriophage therapy is an anti-microbial alternative to treat patients with serious bacterial infections. However, the impacts to the host microbiome in response to clinical use of phage therapy are not well understood. Results Our paper demonstrates a largely unchanged microbiota profile during 4 weeks of phage therapy when added to systemic antibiotics in a single patient with Staphylococcus aureus device infection. Metabolomic analyses suggest potential indirect cascading ecological impacts to the host (skin) microbiome. We did not detect genomes of the three phages used to treat the patient in metagenomic samples taken from saliva, stool, and skin; however, phages were detected using endpoint-PCR in patient serum. Conclusion Results from our proof-of-principal study supports the use of bacteriophages as a microbiome-sparing approach to treat bacterial infections.

To the Editor,I am very grateful to Drs. Yazici and Unal for their letter regarding our recent investigation into the role of systemic antibiotics in the setting of lacrimal surgery.1,2 Their comme...

Background In retrospective series, mechanical and oral antibiotic bowel preparation (MOABP) has been reported to reduce surgical-site infections (SSIs) after colectomy compared with no bowel preparation (NBP). Method This was a subgroup analysis of a multicentre randomized trial that included patients scheduled for elective colectomy. The MOABP group underwent mechanical bowel preparation, and took 2 g neomycin and 2 g metronidazole orally during the day before surgery. The NBP group did not undergo bowel preparation. Patients were categorized according to the side of resection (right versus left colectomy), and these subgroups compared for postoperative outcomes. Results Among 217 patients undergoing right colectomy (106 in MOABP and 111 in NBP group), SSI was detected in seven (7 per cent) and 10 (9 per cent) patients (odds ratio (OR) 0.71, 95 per cent c.i. 0.26 to 1.95; P = 0.510), anastomotic dehiscence in two (2 per cent) and two (2 per cent) patients (OR 1.05, 0.15 to 7.58; P = 1.000), and the mean(s.d.) Comprehensive Complication Index (CCI) score was 9.4(12.9) and 10.5(18.0) (mean difference –1.09; 95 per cent c.i. –5.29 to 3.11; P = 0.608) in the MOABP and NBP groups respectively. Among 164 patients undergoing left colectomy (84 in MOABP and 80 in NBP group), SSI was detected in five (6 per cent) and eight (10 per cent) patients (OR 0.57, 0.18 to 1.82; P = 0.338), anastomotic dehiscence in four (5 per cent) and five (6 per cent) patients (OR 0.75, 0.19 to 2.90; P = 0.742), and the CCI score was 10.2(13.1) and 6.5(11.0) (mean difference 3.68, –0.06 to 7.42; P = 0.053) in the MOABP and NBP groups respectively. Conclusions MOABP did not decrease the rate of SSI or complications in patients undergoing either right or left colectomy compared with NBP., Mechanical preparation in colorectal surgery

Objective. To investigate the role of implant surface debridement alone and in conjunction with systemic antibiotics on the clinical and microbiological variables of periimplantitis. Materials and Methods. Data of forty-six patients with at least one dental implant having bleeding-on-probing (BoP), probing pocket depth (PPD) of more than 5 mm, and radiographic bone loss of more than 3 mm were retrieved from clinical records. Data was recorded for dental implant with the deepest PPD, BoP, and bone loss from each patient. “Group-A” received implant surface debridement alone, while “group-B” additionally received systemic antibiotics. Clinical and microbiological data of patients were compared before and after the treatment. Results. At the implant level, a significant reduction of PPD, mucosal recession (MR), and BoP was achieved for all patients. Group B achieved significant improvement in MR and BoP compared to group A at implant level. PPD, MR, and plaque scores showed improvement at implant site level. At 3 months recall visit, 44% of group A and 52% of group B implants required surgical treatment. The presence and proportions of studied bacteria of both groups did not differ significantly at the recall visit when compared to the initial visit. However, P. intermedia and P. micros showed a significant reduction in group A at the recall visit. Conclusions. Implant surface debridement improved the clinical parameters of periimplantitis. In addition, adjunctive use of systemic antibiotics increased mucosal recession and improved bleeding on probing in periimplantitis.

Objectives To examine national variation in systemic antibiotic use in long-term care facilities (LTCFs) and identify facility characteristics associated with antibiotic utilization. Methods This retrospective cohort study included 312 375 residents of 2536 Australian LTCFs between 2011 and 2016. LTCFs were categorized as low, medium or high antibiotic use facilities according to tertiles of DDDs of systemic antibiotics dispensed per 1000 resident-days. Multivariable logistic regression estimated the associations between facility characteristics (ownership, size, location, medication quality indicator performance, prevalence of after-hours medical practitioner services) and antibiotic use (low versus high). Results LTCFs in the lowest and highest antibiotic use categories received a median of 54.3 (IQR 46.5–60.5) and 106.1 (IQR 95.9–122.3) DDDs/1000 resident-days, respectively. Compared with not-for-profit LTCFs in major cities, government-owned non-metropolitan LTCFs were less likely to experience high antibiotic use [adjusted OR (aOR) 0.47, 95% CI 0.24–0.91]. LTCFs with 69–99 residents were less likely to experience high antibiotic use (aOR 0.69, 95% CI 0.49–0.97) than those with 25–47 residents annually. Greater prevalence of medical practitioner services accessed after-hours was associated with high antibiotic use [aOR 1.10 (per 10% increase in after-hours services), 95% CI 1.01–1.21]. South Australian LTCFs (aOR 2.17, 95% CI 1.38–3.39) were more likely, while Queensland (0.43, 95% CI 0.30–0.62) and Western Australian (aOR 0.34, 95% CI 0.21–0.57) LTCFs were less likely to experience high antibiotic use than New South Wales LTCFs. Conclusions Considerable facility level variation in systemic antibiotic use was observed across Australian LTCFs. Identification of facility characteristics associated with antibiotic use provides a basis for targeted stewardship initiatives.

The surgery of the impacted mandibular third molar is the most frequent procedure in dentistry. The prescription of systemic antibiotics after the third molar extraction is widespread among dentists, but this is still argumentative. This study is aimed at evaluating the postoperative effects of local antibiotic mixed with platelet-rich fibrin (PRF) and a postoperative systemic antibiotic prescribed for mandibular third molar surgery. The study included 75 patients divided into a control and 4 test groups ( n = 15 ). In the control group, only PRF was placed into the extracted socket, and no antibiotic was prescribed. In the first and third groups, PRF was applied to the socket; penicillin and clindamycin were prescribed as oral medications, respectively. In the second and fourth groups, only PRF combined with penicillin and clindamycin was applied into the socket, respectively. The outcome variables were pain, swelling, analgesic intake, and trismus. These variables were also assessed based on the first, second, third, and seventh days following the operation. Unpaired Student’s t -test and Mann–Whitney U test were used for analysis. There were significant differences in the total VAS pain scores between the control and group 3 ( p < 0.05 ), groups 1 and 2 ( p < 0.01 ), and group 4 ( p < 0.001 ) in ascending order. For analgesic intake, there was no significant difference for group 1 ( p > 0.05 ). However, there were statistical differences between the control group and groups 2 and 3 ( p < 0.01 ) and group 4 ( p < 0.001 ). Trismus and swelling did not differ among the groups ( p > 0.05 ). This study showed that the effects of local and systemic antibiotics with the use of PRF reduced postoperative outcomes. Moreover, local antibiotics with PRF may be a viable method to avoid the possible side effects of systemic antibiotics.

Hidradenitis suppurativa (HS) is a chronic, recurrent, debilitating, and frequently misdiagnosed inflammatory skin disease that often requires surgical intervention. To assess the prevalence of HS patients in surgeons' practice and surgeons' approach to treating HS patients, we created a self-administered, Hurley stage-based questionnaire that was distributed during the Latvian Association of Surgeons meeting. Of the total 60 questionnaires distributed, 56 (93%) were collected and 53 (88%) of them were considered valid. Overall, 73.6% of the surgeons confirmed having seen patients with chronic inflamed suppurative lesions in the skin folds during their practice. Median reported number of HS patients in the surgeons' practice was 3, ranging from 0 to 30. Similarly, 73.6% of surgeons would undertake HS treatment. The proportion of surgeons undertaking treatment was higher if the surgeons had diagnosed HS by themselves but was not affected by personal knowledge of HS. Surgeons chose monotherapy for Hurley stages I, II, and III in 64.2%, 64.2%, and 62.3% of the cases, respectively. The most common therapeutic choice for monotherapy was topical antiseptics (26.4%) or topical antibiotics (20.8%) for Hurley stage I and surgery or systemic antibiotics for Hurley stage II (20.8% or 17.0%, respectively) and Hurley stage III (32.1% or 11.3%, respectively). A wide diversity of treatment approaches in specified clinical scenarios was observed, which indicates the need for local guidelines.

This systematic review aimed to assess (1) whether systemic antibiotics are beneficial or harmful in healthy children who present with an odontogenic abscess in the primary dentition with or without systemic involvement and (2) if antibiotics are beneficial, which type, dosage and duration are the most effective. Electronic databases (Medline, Embase, and the Cochrane Library) were screened from 1948 up to August 2020. No filters with respect to study design were applied. Outcomes of interest included pain, swelling, pain relief, adverse effects, signs of infection, quality-of-life measurements and medication required for pain relief. Altogether, 352 titles and abstracts were screened for eligibility; of these, 19 were selected for full text assessment. All were excluded because none of them fulfilled the inclusion criteria and addressed the (adjunctive) use of antibiotics in children who present with an odontogenic abscess in the primary dentition. At present, there is no single randomised or non-randomised clinical study evaluating the effectiveness and harms of systemic antibiotics administered in children who present with an odontogenic abscess in the primary dentition. There is no clinical evidence to support nor to refute the use of antibiotics in children who present with an odontogenic abscess in the primary dentition without signs of local spread or systemic involvement. Given this lack of scientific evidence, the use of antibiotics cannot be recommended in these children. Well-designed clinical trials are indicated to fully understand the impact and necessity of antibiotics in these situations.

There are several cases of liver abscesses caused by the ingestion of a foreign body, especially in the elderly. Fish bones or chicken bones are sharp foreign bodies that can migrate through the digestive tract to the liver parenchyma. We reported a 71-year-old man who presented to the emergency department with fever and epigastric pain. Computed tomography scan showed a liver abscess related to a long and sharp foreign body which is protruding from the left lobe of the liver. Systemic antibiotic treatment was initiated and later the foreign body was removed by laparoscopic surgery.Existen numerosos casos publicados en la literatura que muestran abscesos hepáticos producidos por la ingestión de un cuerpo extraño, especialmente en ancianos. Los huesos de pollo, y con mayor frecuencia las espinas de pescado, pueden perforar el tubo digestivo y migrar hasta el parénquima hepático y originar un absceso. Reportamos el caso de un paciente de 71 años que acude a urgencias por dolor epigástrico y fiebre. Se realizó tomografía computarizada abdominal, que identificó un absceso hepático junto con un cuerpo extraño puntiforme que penetraba en el hígado. El paciente fue intervenido quirúrgicamente, realizando drenaje del absceso y retirada del cuerpo extraño mediante abordaje laparoscópico.

Hidradenitis suppurativa (HS) is a chronic inflammatory disease that disproportionately affects women of childbearing age. Pregnancy influences HS severity for many women, thus diligent continued management throughout pregnancy and postpartum may be required. Herein, we provide an updated review of pregnancy and lactation safety data for HS medications, including topical antiseptic washes, topical and systemic antibiotics, biologic and nonbiologic immunomodulators, immunosuppressants, adjunct medical therapies, and pain medications, to help guide risk-benefit discussions between providers and HS patients.

Purpose of review Many paediatric orbital subperiosteal abscesses (SPA) are effectively managed conservatively with systemic antibiotics, but surgical drainage is required in some patients. This review aims to summarize the current literature to determine predictors of surgical intervention. Recent findings Nearly all the data regarding this topic come from analysis of retrospective case series. There is consensus that large volume SPAs require surgical drainage; however, the cutoff for volume differs between studies. Proptosis more than 5 mm, superior location of SPA and patient age more than 9 years are also all factors that may predispose towards surgical treatment. Summary A conservative approach may be trialled in younger patients with medial, smaller volume SPAs. Larger volume SPA, presence of proptosis, superior location of SPA and patient age more than 9 years should lower the threshold for considering surgical intervention. Given that many studies have been retrospective, future studies should be prospective and specifically aim to determine a cutoff for SPA volume.

Background This study aimed to assess the effectiveness and safety of percutaneous needle aspiration (PNA) and percutaneous catheter drainage (PCD) in the treatment of liver abscess. Methods A prospective randomized study was conducted in the Department of Surgery, JN Medical College, Aligarh Muslim University, Aligarh, UP, India, between February 2018 and August 2019, after getting approval from the institutional ethics committee. A total of 543 patients with liver abscess were randomized into two groups using computer-generated randomization method. Appropriate details regarding patients' clinico-demographic profile and investigations were also collected. The effectiveness of either treatment was measured in terms of duration of intravenous antibiotic, clinical improvement, reduction in the size of cavity, treatment success rate, duration of hospital stay including long-term outcomes such as sonographic resolution of cavity and recurrence rate at 6 months post-treatment. Results The PCD group had statistically significant rate of duration of antibiotics need, days for clinical improvement and time for 50% reduction in abscess cavity and treatment success rate with comparable long-term outcomes. Conclusion PCD is more efficient than PNA and can be used primarily in the treatment of both amoebic and pyogenic liver abscesses along with systemic antibiotics. However, PNA can serve as a safe alternative when PCD is not available.

To the Editor,The results of a study on Pseudomonas aeruginosa ventilator-associated pneumonia, repdorted in this journal, suggested that initial combination therapy followed by early de-escalation...

The aim of this follow-up study was, to compare the effects of mechanical periodontal therapy with or without adjunctive amoxicillin and metronidazole on the subgingival microbiome of smokers with periodontitis using 16S rDNA amplicon next generation sequencing. Fifty-four periodontitis patients that smoke received either non-surgical periodontal therapy with adjunctive amoxicillin and metronidazole (n = 27) or with placebos (n = 27). Subgingival plaque samples were taken before and two months after therapy. Bacterial genomic DNA was isolated and the V4 hypervariable region of the bacterial 16S rRNA genes was amplified. Up to 96 libraries were normalized and pooled for Illumina MiSeq paired-end sequencing with almost fully overlapping 250 base pairs reads. Exact ribosomal sequence variants (RSVs) were inferred with DADA2. Microbial diversity and changes on the genus and RSV level were analyzed with non-parametric tests and a negative binomial regression model, respectively. Before therapy, the demographic, clinical, and microbial parameters were not significantly different between the placebo and antibiotic groups. Two months after the therapy, clinical parameters improved and there was a significantly increased dissimilarity of microbiomes between the two groups. In the antibiotic group, there was a significant reduction of genera classified as Porphyromonas, Tannerella, and Treponema, and 22 other genera also decreased significantly, while Selenomonas, Capnocytophaga, Actinomycetes, and five other genera significantly increased. In the placebo group, however, there was not a significant decrease in periodontal pathogens after therapy and only five other genera decreased, while Veillonella and nine other genera increased. We conclude that in periodontitis patients who smoke, microbial shifts occurred two months after periodontal therapy with either antibiotics or placebo, but genera including periodontal pathogens decreased significantly only with adjunctive antibiotics.

Surgical site infection (SSI) is a major cause of morbidity worldwide following elective colorectal resection, affecting up to 20% of patients 1, 2, 3. Reduction in SSI rates requires a multi‐faceted approach 4 and can be achieved with the use of SSI reduction bundles 5. Such bundles include prophylactic intravenous antibiotics 6 which represent an undisputed standard of care 4. They do not include the use of mechanical bowel preparation (MBP) alone which is not recommended in elective colonic resection to reduce SSI 7, 8, 9, although may offer an advantage in elective rectal resection 10. A long‐standing area of controversy is the use of mechanical bowel preparation and oral antibiotics (MOAB) prior to elective colorectal resection 11, 12. Marked differences exist between clinicians worldwide 13. Recent guidelines from the American Society of Colon and Rectal Surgeons strongly recommend the use of MOAB in elective colorectal resection to reduce SSI 14, 15. Other international bodies have recognized the increasing body of evidence and altered their recommendations in a more conservative manner but stopped short of endorsing this practice because of the lack of Level 1 evidence 16. This paper summarizes the arguments for and against the use of MOAB in elective colorectal resection, highlighting the areas of controversy and evidence gaps, and provides pragmatic suggestions for colorectal practice (Fig. ​(Fig.11). Open in a separate window Figure 1 Arguments for and against the use of mechanical bowel preparation and oral antibiotics in elective colorectal resection. MOAB, mechanical bowel preparation and oral antibiotics; MIS, minimally invasive surgery; ERAS, enhanced recovery after surgery; BMI, body mass index; SSI, surgical site infection; ABx, antibiotics; CDI, Clostridium difficile infection; QI, quality improvement.