geoffrey modest medical blogs

Antimicrobial prophylaxis for 3 common urologic procedures: more than half had antibiotics overprescribed, according to the American Urological Association (AUA) guidelines of 2008 ( See  antibiotic overprescribing by urologists jama2019  in dropbox, or  doi:10.1001/jamanetworkopen.2018.6248 ) Details: -- the AUA guidelines recommend antimicrobial prophylaxis for most urologic procedures to be no more than 24 hours post procedure -- 375 patients from 5 geographically diverse Veterans Health Administration sites from across the United States, from January 2016 to July 2017. These records were manually reviewed for periprocedural or post procedural antimicrobial prescribing -- 98% male, mean age 64, 77% white -- additionally, 29,530 records were evaluated by administrative data through the VA system overall for antimicrobial prescribing practices -- urologic procedures assessed: transurethral resection of bladder tumor (TURBT), ...

 the CDC just published their findings on antibiotic use in the US, showing significant decreases (see  https://www.cdc.gov/getsmart/pdf/stewardship-report.pdf ​ ) Details: -- outpatient settings (clinics, doctors' offices, ERs):      --47 million unnecessary antibiotic prescriptions/yr​     ​-- overall antibiotic scripts decreased by 5% in period 2011-14 from 75 million scripts to 64 million in children <19 yo, though has increased from 192 to 198 million in adults (especially high prescribing rates in kids <2 and adults >65). however, more often antibiotics prescribed may be "less effective and carry more risk over more targeted first-line drugs recommended by national guidelines" (in 2010-11, only 37% of adults received guideline-recommended antibiotics for sinus infection or pharyngitis, more like 60% in kids for these infections and otitis media.)     --the CDC still feels...

will pass along the infectious disease society "choosing-wisely" recommendations for decreasing antibiotic use. although none of these are new or surprising, data suggest that antibiotics are still being prescribed for these conditions unwisely....  (see  http://www.choosingwisely.org/doctor-patient-lists/infectious-diseases-society-of-america/  ) 1. don't treat asymptomatic bacteruria with antibiotics. (except pregnant patients, those undergoing invasive urological surgery including prostate surgery, or those within 1 year of kidney or kidney pancreas transplant) 2. avoid antibiotics for upper respiratory infections. most are viral. but one should treat group A strep and pertussis 3. don't use antibiotics for stasis dermatitis of lower extremities. use leg elevation and compression. [in my experience, this can be a difficult call: stasis dermatitis can really look like cellulitis with bright red, well-demarcated erythema, though with less indurati...