It causes no symptoms in more than One-half of infected patients, but can also cause a wide spectrum of illnesses and
death. The incidence and severity. have increased in recent years. The most important modifiable risk factor for C. difficile infection is antibiotic PI3K inhibitor exposure; this risk is dose-related and higher with longer courses and combination therapy. C. difficile infection is also associated with older age, recent hospitalization, multiple comorbidities, use of gastric acid blockers, inflammatory bowel disease, and immunosuppression. It has become more common in younger, healthier patients in community settings. The most practical testing options are rapid testing with nucleic acid amplification or enzyme immunoassays to detect toxin, or a two-step strategy Treatment includes discontinuing the contributing antibiotic, if possible. Mild C. difficile infection should be treated with oral metronidazole; severe infection should be treated with oral vancomycin. Fidaxomicin may be an effective alternative. Recurrences of the infection should be treated based on severity. Tapering and the pulsed-dose method of oral vancomycin therapy for second recurrences are effective. selleck Prevention includes responsible antibiotic prescribing and vigilant
handwashing. Probiotics prevent antibiotic-associated diarrhea, but are not recommended specifically for preventing C. difficile infection. Copyright (c) 2014 American Academy of Family Physicians.”
“Objectives.
Among patients who arrive at an emergency department (ED) with pain, over half remain in moderate or severe pain at ED discharge. Our objectives were to identify ED physicians’ prescribing patterns when discharging patients with common musculoskeletal conditions and to determine if disparities in opioid prescribing exist.
Design.
Five-year retrospective investigation.
Setting.
An urban, academic ED with approximately 100,000 annual visits, where physicians write discharge prescriptions,
including over-the-counter medications, using a computerized order entry system.
Patients.
Adult patients who were discharged home JQ-EZ-05 from an ED with fractures (clavicle or long bone fractures) or non-fracture musculoskeletal diagnoses (sprains, strains, sciatica, or back pain).
Outcome Measures.
Patient demographics and pain medications prescribed for use at home.
Results.
The study sample included 13,335 patients with a mean age of 39 years. Half were female; 52% were white; 39% were black; and 7% were Hispanic. Among fracture patients, 77% received an opioid prescription, 2% received a non-opioid prescription, and 21% received no analgesic prescription. The percentages for patients with non-fracture diagnoses were 65% (opioids), 18% (non-opioid analgesics), and 17% (no analgesic). Patients aged 80 years and older were significantly less likely to receive opioid prescriptions.