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Biomedical subjects

D Nathwani

Publications and source records attributed to D Nathwani.

At least 37 records · Page 2Linked to original sources
PubMed2001

The management of skin and soft tissue infections: outpatient parenteral antibiotic therapy in the United Kingdom.

In a study in Scotland, skin and soft tissue infections (SSTIs) accounted for 10% of hospitalizations, with mean stays of approximately 5 days, and were the second most common reason for hospital-based intravenous antibiotic therapy lasting more than 48 h. A total of 125 patients with SSTIs were recently treated using an outpatient parenteral antibiotic therapy (OPAT) service. The patients received intravenous antibiotic therapy for a mean duration of 5.32 days. The two primary agents administered were once-daily ceftriaxone and teicoplanin. Of the 125 patients, 123 (98.4%) were cured or improved; 2 worsened and required surgery. Patient satisfaction was very high. OPAT saved the inpatient facility 665 bed days. Economic benefits were realized despite use of more expensive agents. Data indicate that if the hospital stay of patients with SSTIs were reduced by only 1 day, savings would amount to pound(1/2)-1 million per year. OPAT is a feasible alternative to inpatient management of SSTIs and may safely, effectively and cost-effectively reduce the number of hospital days for these infections.

Anti-Bacterial Agents↗
PubMed2000

Acute meningococcaemia complicated by late onset gastrointestinal vasculitis.

Extra-meningeal and non-cutaneous manifestations of meningococcal infection are well recognized but rare. Herein we report a little recognized complication of meningococcaemia, namely late-onset gastrointestinal vasculitis. In the case presented, the prostacycline analogue iloprost was used in an attempt to minimize incipient digital gangrene ina patient with evidence of protracted immunological phenomena. In addition, diclofenac was used to treat severe arthralgia. Withdrawal of iloprost on day 19 was associated with abdominal pain and peritonism. Laparotomy demonstrated ischaemia and ulceration in the caecum, and histology revealed full thickness mucosal ulceration with a prominent vasculitic process. It is postulated that these findings were immunologically mediated, with possible rebound vasoconstriction following withdrawal of iloprost. It is also possible that NSAID use contributed to the findings via cyto-toxicity to mucosal cells.

Adolescent↗
PubMed2000

Cost and dosing issues.

Twice-daily dosing is recommended for ciprofloxacin for most indications. Trovafloxacin and grepafloxacin can be administered once-daily. Levofloxacin should probably be administered twice daily in serious, life-threatening infections. The acquisition cost of ciprofloxacin is currently higher than the newer agents, but a lower acquisition cost does not necessarily mean a lower overall cost of treatment. A cheaper agent which is less effective or safe just shifts costs to other areas by creating further clinical problems with their attendant costs. The total costs associated with treatment with newer agents are as yet undefined. Restricting the prescription of a particular antibiotic may result in the increased use of an alternative regimen which may cost the same or even more than the original ('cost shifting'). This interesting observation needs to be substantiated with future research. Ciprofloxacin is available in both intravenous and oral formulations and suitable for sequential intravenous-oral therapy with its attendant benefits. It is currently the gold-standard quinolone in the hospital setting for a broad range of infections, particularly Pseudomonas aeruginosa infections. Initially, the newer quinolones are most likely to be used to treat severe, community-acquired pneumonia.

Anti-Infective Agents↗
PubMed2000

Place of parenteral cephalosporins in the ambulatory setting: clinical evidence.

During the last decade, 6 parenteral third generation cephalosporins have been introduced into clinical practice. The three most frequently used agents are cefotaxime, ceftazidime and ceftriaxone. Although primarily used in hospitals, these agents are increasingly employed in the ambulatory setting. In particular, ceftriaxone, because of its favourable pharmacokinetic profile allowing once-daily administration by a bolus injection, has demonstrated both tolerability and efficacy in the ambulatory setting during extensive worldwide use. Sophisticated parenteral infusion systems enable cephalosporins that require more frequent administration to be delivered in this setting. In noncomparative studies involving a range of patient populations and serious infections (mostly bone, joint and soft tissue, and pneumonia and febrile episodes in neutropenia), these cephalosporins achieved equivalent efficacy and tolerability, and considerable cost savings, since patients were able to receive all or part of their treatment in the home or outpatient setting. However, more comparative studies of ambulatory parenteral therapy in the inpatient setting or ambulatory oral therapy are necessary to further clarify the true cost effectiveness of this type of healthcare delivery. This is increasingly relevant in countries where parenteral antimicrobials are not the 'standard of care' in managing many serious infections. Published experience to date confirms that third generation cephalosporins, particularly ceftriaxone, should have an essential place in the therapeutic formulary of any ambulatory parenteral antibiotic programme.

Ambulatory Care↗
PubMed2000

Uptake of influenza vaccination and the reasons for non-vaccination in the high-risk patients of Angus, Scotland.

OBJECTIVE: To ascertain the uptake of influenza vaccination, the main prompts to vaccination and the reasons for non-vaccination in the high-risk patients of Angus, Scotland. DESIGN: Prospective questionnaire survey. SETTING: A small rural district general hospital. SUBJECTS: General medical inpatients and outpatients. RESULTS: The overall uptake of vaccination was 44.8% (n = 250). The main prompts to vaccination were general practitioners (48.2%), the media (11.6%), practice and district nurses (8.9%), friends and relatives (8.9%) and posters at health centres and chemists (7.1%). The main reason for non-vaccination was a lack of awareness of high-risk status (50.7%). CONCLUSION: The uptake of influenza vaccination in the Angus region of Scotland is unsatisfactorily low. This is mostly due to a lack of knowledge regarding high-risk status, although other reasons, including concerns about the side effects of vaccination, are also important.

Female↗
PubMed1999

Feasibility of an outpatient and home parenteral antibiotic therapy (OHPAT) programme in Tayside, Scotland.

Outpatient and home parenteral antibiotic therapy (OHPAT) is under-utilized in the U.K. We performed a feasibility study over a 5-month period in a regional U.K. infection unit. After exclusions, 183 antibiotic treated patients were evaluated. Ninety-five received intravenous (i.v.) therapy, of whom 32 received at least 4 days. Prolonged i.v. therapy was most frequent in soft tissue infections. In these patients, length of stay and duration of i.v. treatment were correlated (r = 0.74, 0.51-0.87). Eighty-three (86%) of patients who received IV therapy judged OHPAT to be an acceptable alternative to hospitalization. Those who did not were older (mean age 64 vs. 46 years, P<0.001) and were less likely to have a carer willing to administer the antibiotic at home (8/28 vs. 117/151, P<0.001). Twenty-five of 32 (79%) patients treated with prolonged parenteral therapy and 27/95 (28%) treated with any length of parenteral therapy met criteria for OHPAT. Thirteen of these were safely and successfully managed as outpatients by ward staff, OHPAT is an acceptable alternative to inpatient therapy in Tayside and may reduce the duration of hospitalization or prevent admission in certain patients.

Adult↗
PubMed1999

How do you measure the impact of an antibiotic policy?

The principle aim of antibiotic policies is to bring about a change in prescribing which will lead to decreased cost, reduction of resistance and improved quality (judicious, safe and appropriate) of antibiotic prescribing. Before embarking upon developing, disseminating and subsequently implementing an antibiotic policy clinicians and key decision makers need to make explicit at the onset of policy development, how they plan to evaluate its impact. Quality indicators of the process of implementing policies and their impact on various outcomes need to be identified. These number and complexity of these indicators is dependent on local resource but they must be specific to the organisation, simple, measurable and meaningful. This information needs to be shared and acted upon.

Anti-Bacterial Agents↗
PubMed1999

Cost considerations in the evaluation of new therapies for gram-positive bacteria.

The rapid emergence of antibiotic resistance in hospitals and the community, particularly amongst Gram-positive cocci, has not been paralleled by adequate understanding of the true clinical and economic impact of infection with resistant pathogens. Furthermore, the development of novel compounds to combat this threat has been slow until recently when a number of new agents, some with a unique structure and mode of action (e.g. linezolid), are now being developed for clinical use. This paper aims to outline (1) the costs associated with infection by a resistant organism (2) the pharmacoeconomic arguments when considering a new drug and (3) the key decisions when evaluating a new drug such as linezolid, for inclusion in a formulary or policy with particular reference to the treatment of serious Gram-positive infections.

Cross Infection↗
PubMed1999

Out-patient parenteral antimicrobial therapy--a viable option for the management of cutaneous leishmaniasis.

Cutaneous infection with Leishmania braziliensis complex requires treatment with parenteral pentavalent antimonials to prevent development of mucocutaneous leishmaniasis. Patients with imported disease are usually managed in hospital because of concerns over drug toxicity. This study describes the clinical features and outcome of infection treated in the UK in an out-patient setting. Thirteen marines (aged 19-35 years) who acquired leishmaniasis in Belize were studied prospectively. Three had at least two lesions (0. 6-3 cm diameter), eight had regional lymphadenopathy and one had localized painless lymphatic thickening. Histology for amastigotes and PCR for Leishmania braziliensis complex was positive in all. Culture was positive in six. Patients received 1.5-2 g (mean 1.7 g) (20 mg/kg) sodium stibogluconate intravenously daily for 20 days. All developed transient musculoskeletal symptoms and asymptomatic hepatitis. Eleven developed biochemical pancreatitis, and one thrombocytopenia. Three developed transient ECG changes and one herpes zoster. There were four device-related infections, two requiring hospitalization (one required surgical drainage of an abscess). All lesions re-epithelialized. A total of 250 bed-days were saved over a 67-day period. These results indicate that in selected patients, out-patient therapy for cutaneous leishmaniasis with parenteral high-dose sodium stibogluconate may be appropriate, provided there is adequate monitoring of therapy.

Adult↗