The document provides guidelines for the treatment of pneumonia in children. It discusses recommendations for both outpatient and inpatient treatment depending on the age and severity of the patient. For outpatients, first-line antibiotics include amoxicillin and macrolides. Hospitalized patients may receive IV antibiotics like cefotaxime or cefuroxime. The guidelines provide dosing recommendations for various antibiotics. Follow up care involves monitoring for improvement in symptoms and signs. Studies discussed found short course oral antibiotics can be as effective as longer IV courses for non-severe cases.
This document discusses infant feeding and intolerances. It provides recommendations from the WHO on exclusive breastfeeding for 6 months and continuing breastfeeding until 2 years of age. It also discusses the benefits of breastfeeding for both babies and mothers. The document then covers types of milk intolerances such as protein and lactose intolerance. It describes the identification and treatment of various milk intolerances in infants.
This document summarizes new randomized controlled trials in critical care nutrition published between 2009-2011 and their impact on existing clinical practice guidelines. It discusses several new RCTs on probiotics, fish oils, arginine, glutamine, and lipid emulsions. For probiotics and fish oils, the new evidence strengthens recommendations for their use. However, for arginine and glutamine, the new RCTs did not clearly support benefits. Overall, the new data impacts some recommendations and highlights areas requiring further research.
Food Protein-induced Allergic Proctocolitis to Multiple FoodsCorina Ardelean
Food Protein-induced Allergic Proctocolitis to Multiple Foods
Case of Study presented to the EAACI Food Allergy Training Course "Prevention and Treatment of Food Allergy" from Manchester, UK (14-16 September 2017)
1. A randomized controlled trial compared early initiation of parenteral nutrition (PN) versus enteral nutrition (EN) in critically ill patients who required nutritional support for at least 2 days.
2. The trial found no significant difference in mortality or other outcomes between the PN and EN groups. Patients in both groups did not receive target calorie levels.
3. The results suggest that early nutritional support through PN is neither more harmful nor beneficial than support through EN. EN should be started early when possible, and PN reserved for when EN is contraindicated. Target calorie levels should be aimed for according to individual patient needs and local ICU policies.
Clinical features, mechanism of development of cow milk protein allergy.
Diagnostic algorithm and review of available data about cow milk protein allergy.
This document summarizes research on addressing undernutrition in elderly patients through improved dietary protein intake. It describes:
1. Current treatment options are often insufficient to meet protein needs, and even patients at low risk of undernutrition have inadequate intake.
2. Research found protein-enriched foods and drinks significantly increased intake for at-risk patients, helping more to meet recommendations. However, intake was still inadequate for many.
3. Interviews revealed elderly are often unaware of undernutrition risks and importance of protein. They are reluctant to change diets. Successful options must fit within current food preferences and habits.
This document discusses cows' milk protein allergy (CMPA). It notes that CMPA is more common than lactose intolerance and can cause infant distress and impaired growth. Diagnosis is difficult as there is no single diagnostic test, and it is often missed leading to delayed treatment. Management involves dietary avoidance of cows' milk protein and using extensively hydrolyzed formula for bottle-fed infants. Delayed diagnosis can negatively impact growth and development. Guidelines are needed to shorten time to diagnosis and treatment to reduce burden on healthcare systems.
Distinguish IgE and non-IgE mediated aspects of cow’s milk allergy (CMA)
Review the clinical effects of extensively hydrolyzed formula in infants with CMA
This document discusses infant feeding and intolerances. It provides recommendations from the WHO on exclusive breastfeeding for 6 months and continuing breastfeeding until 2 years of age. It also discusses the benefits of breastfeeding for both babies and mothers. The document then covers types of milk intolerances such as protein and lactose intolerance. It describes the identification and treatment of various milk intolerances in infants.
This document summarizes new randomized controlled trials in critical care nutrition published between 2009-2011 and their impact on existing clinical practice guidelines. It discusses several new RCTs on probiotics, fish oils, arginine, glutamine, and lipid emulsions. For probiotics and fish oils, the new evidence strengthens recommendations for their use. However, for arginine and glutamine, the new RCTs did not clearly support benefits. Overall, the new data impacts some recommendations and highlights areas requiring further research.
Food Protein-induced Allergic Proctocolitis to Multiple FoodsCorina Ardelean
Food Protein-induced Allergic Proctocolitis to Multiple Foods
Case of Study presented to the EAACI Food Allergy Training Course "Prevention and Treatment of Food Allergy" from Manchester, UK (14-16 September 2017)
1. A randomized controlled trial compared early initiation of parenteral nutrition (PN) versus enteral nutrition (EN) in critically ill patients who required nutritional support for at least 2 days.
2. The trial found no significant difference in mortality or other outcomes between the PN and EN groups. Patients in both groups did not receive target calorie levels.
3. The results suggest that early nutritional support through PN is neither more harmful nor beneficial than support through EN. EN should be started early when possible, and PN reserved for when EN is contraindicated. Target calorie levels should be aimed for according to individual patient needs and local ICU policies.
Clinical features, mechanism of development of cow milk protein allergy.
Diagnostic algorithm and review of available data about cow milk protein allergy.
This document summarizes research on addressing undernutrition in elderly patients through improved dietary protein intake. It describes:
1. Current treatment options are often insufficient to meet protein needs, and even patients at low risk of undernutrition have inadequate intake.
2. Research found protein-enriched foods and drinks significantly increased intake for at-risk patients, helping more to meet recommendations. However, intake was still inadequate for many.
3. Interviews revealed elderly are often unaware of undernutrition risks and importance of protein. They are reluctant to change diets. Successful options must fit within current food preferences and habits.
This document discusses cows' milk protein allergy (CMPA). It notes that CMPA is more common than lactose intolerance and can cause infant distress and impaired growth. Diagnosis is difficult as there is no single diagnostic test, and it is often missed leading to delayed treatment. Management involves dietary avoidance of cows' milk protein and using extensively hydrolyzed formula for bottle-fed infants. Delayed diagnosis can negatively impact growth and development. Guidelines are needed to shorten time to diagnosis and treatment to reduce burden on healthcare systems.
Distinguish IgE and non-IgE mediated aspects of cow’s milk allergy (CMA)
Review the clinical effects of extensively hydrolyzed formula in infants with CMA
A study was conducted to evaluate weight loss using a high antioxidant cocoa meal replacement and lifestyle intervention over 12 weeks. Fifty participants consumed 2 meal replacements per day along with a sensible third meal, totaling 1,200-1,500 calories daily. They participated in weekly phone calls and self-monitoring groups. The average weight loss was 31.3 pounds with a 5.8 inch waist circumference reduction. Weight loss ranged from 6.6-24.6% of starting weight. No dropouts occurred, showing the program's effectiveness through accountability and lifestyle changes.
This document discusses the role of arginine-supplemented diets in critically ill patients. It summarizes the largest randomized controlled trial of an immunonutrition formula enriched with arginine, glutamine, antioxidants, and omega-3 fatty acids, which found no differences in outcomes. Subsequent analyses found no effect on mortality or infectious complications. However, some smaller studies found increased mortality in septic patients receiving arginine. Guidelines now recommend against the use of arginine-supplemented diets for critically ill patients based on the current evidence.
פירוט הרכיבים הטבעיים שנמצאים ב Cane תוסף תזונה טבעי המסייע לחולי סוכרת להגיע לאיזון ברמות הסוכר שלהם. Cane הוא תוסף תזונה מבית קיורהלייף, חברה הדואגת לאיכות חייהם של החולים במחלות כרוניות.
http://www.cane-curalife.com/
What’s New in the Diagnosis and Management of Cow’s Milk Protein Allergy.
Distinguish IgE and non-IgE mediated aspects of cow’s milk allergy (CMA).
Review the clinical effects of formula in infants with CMA
Importance of nutrition in hospitalized patientsAzam Jafri
Malnutrition is common in hospitalized patients and is associated with increased complications, prolonged hospital stays, and higher mortality rates. Proper nutrition is important for recovery, as malnutrition can weaken the body and impair the healing process. Oral nutritional supplements have been shown to improve patient outcomes by helping maintain muscle mass and support recovery from illness, surgery, or injury. Hospitals should screen patients for risk of malnutrition and consider supplemental nutrition to improve health outcomes.
Alishba, a 6-month-old infant, presented with chronic diarrhea, vomiting, and eczema after being exclusively breastfed for the first 5 months and then introduced to cow's milk formula for the past month. There is a maternal history of eczema and asthma.
The most likely diagnosis is cow milk protein allergy. Differential diagnoses include lactose intolerance, pyloric stenosis, and gastroesophageal reflux disease.
Management would include strict elimination of cow milk protein via exclusive breastfeeding or a hypoallergenic formula. Oral steroids may be used if eosinophilic esophagitis is present. Skin prick tests and serum IgE tests can help confirm
Objectives:
- Most probable diagnosis? Based on which information from the case study?
- Which diagnostic tests would you perform?
- What information do you provide these parents about therapy and prognosis?
As a newly emphasized modality to treat infectious complications and also to folloew non-antibiotic regimens against infection, Probiotics has recieved more and more attention now a days.
1) Complementary and alternative medicine (CAM) includes natural products like herbs, vitamins, probiotics, and mind-body practices like yoga and acupuncture. CAM use is common, with 65% of patients using herbal preparations.
2) Milk thistle extract, which contains silybin, is used for liver support. Studies on its effectiveness for hepatitis have shown mixed results, with some studies finding lower liver enzymes but no impact on viral levels. Larger and higher quality studies are still needed.
3) Adulterants in herbal supplements and traditional Chinese medicines have been found to cause liver injury. Herbalife supplements were linked to 12 and 10 cases of liver injury in Israel and Switzerland
The document provides 10 tips for enteral nutrition in intensive care units based on recent American and European guidelines and expert consensus:
1) Low-dose enteral nutrition can be started within 48 hours of admission, even during treatment with small or moderate doses of vasopressor agents.
2) A percutaneous enteral access should be used when enteral nutrition is anticipated for 4 weeks or longer.
3) Energy delivery should not be calculated to match energy expenditure before day 4-7, and use of energy-dense formulas can be restricted to cases where full-volume isocaloric enteral nutrition is not tolerated or fluid restriction is needed.
4) The occurrence of refeeding syndrome should be assessed
- Plant-based diets are commonly promoted by doctors like Dean Ornish and Caldwell Esselstyn who limit or forbid various foods like oils, sugar, and refined grains. However, religious vegetarians in Taiwan who avoid meat but not other restricted foods have higher risk biomarkers.
- Studies on Adventist vegetarians find their health benefits may be due more to avoiding coffee, doughnuts and eggs rather than meat itself. Fish-eating Adventists may have lowest mortality while vegan/vegetarian Adventists have similar outcomes to Mormons who avoid substances but not meat.
- Contrary to claims, animal protein is not clearly linked to bone loss and vegetarians often have lower bone density than omnivores
Cow’s milk protein allergy and intolerance practical issuesApollo Hospitals
This article discusses practical issues in diagnosing cow's milk protein allergy and intolerance in children. It notes that these conditions are often difficult to distinguish based on clinical features alone. Cow's milk protein allergy is an immunoglobulin E-mediated reaction to proteins in cow's milk, while intolerance involves non-immunological mechanisms. The article provides guidance on differentiating the two and indicates when referral to a pediatric gastroenterologist is appropriate. It also reviews prevalence rates and common clinical presentations of cow's milk protein allergy and intolerance in infants and children.
AHS13 Stephan Guyenet Insulin and Obesity: Reconciling Conflicting Evidence Ancestral Health Society
The pancreatic hormone insulin regulates the trafficking and metabolism of carbohydrate and fat. Since insulin influences fatty acid flux in fat tissue, and manipulating insulin can influence body fatness, this has raised the possibility that insulin plays a role in common obesity. Two competing hypotheses propose that 1) elevated insulin is a compensatory response to insulin resistance that develops with fat gain, or 2) elevated insulin outpaces insulin resistance and favors fat gain. Each hypothesis appears to be supported by a large amount of evidence. This presentation will outline a framework capable of reconciling this seemingly conflicting evidence.
This document provides details about a 40-year-old female patient who presented with malnutrition due to chronic alcoholic pancreatitis, liver cirrhosis, and a history of gastric bypass surgery performed 10 years prior. She was admitted to the hospital for placement of a PICC line and initiation of total parenteral nutrition (TPN) due to failure to thrive. Her hospital course and treatment are described, including monitoring of her nutritional status and prescription of TPN to meet her nutrient needs. The case highlights the importance of thorough nutritional assessment and management of patients with complex medical histories and nutritional complications following bariatric surgery.
The document discusses probiotics as a potential new treatment for irritable bowel syndrome (IBS). It summarizes five studies that examined the effects of various probiotic supplements on IBS symptoms like constipation. The studies showed mixed results, with some finding probiotics improved constipation and overall IBS symptoms, while others found no significant improvement. The document concludes that probiotics may help IBS, but further research is needed to determine which species, dosages, and IBS subtypes are most effective.
This document summarizes an educational presentation on approaches to food allergies. It discusses diagnosing food allergies through history, skin prick tests, and IgE blood tests. It also covers managing non-acute food allergies through allergen avoidance, medical treatment, and immunotherapy. Finally, it reviews updates on preventing food allergies through early introduction of foods for high-risk infants and maintaining regular ingestion once introduced. Clinical teaching points emphasize the importance of history, avoiding IgG tests, baked goods aiding egg tolerance, flu vaccine safety, epinephrine dosing, and early solid food introduction.
Amoxicillin 250 mg Capsules-Summary of Product CharacteristicsBrown & Burk UK Ltd
Amoxicillin Capsule is used to treat infections in different parts of the body caused by bacteria. It is also used to stop infections when you have a tooth removed or other surgery. Amoxicillin Capsule may also be used in combination with other medicines to treat stomach ulcers.
A study was conducted to evaluate weight loss using a high antioxidant cocoa meal replacement and lifestyle intervention over 12 weeks. Fifty participants consumed 2 meal replacements per day along with a sensible third meal, totaling 1,200-1,500 calories daily. They participated in weekly phone calls and self-monitoring groups. The average weight loss was 31.3 pounds with a 5.8 inch waist circumference reduction. Weight loss ranged from 6.6-24.6% of starting weight. No dropouts occurred, showing the program's effectiveness through accountability and lifestyle changes.
This document discusses the role of arginine-supplemented diets in critically ill patients. It summarizes the largest randomized controlled trial of an immunonutrition formula enriched with arginine, glutamine, antioxidants, and omega-3 fatty acids, which found no differences in outcomes. Subsequent analyses found no effect on mortality or infectious complications. However, some smaller studies found increased mortality in septic patients receiving arginine. Guidelines now recommend against the use of arginine-supplemented diets for critically ill patients based on the current evidence.
פירוט הרכיבים הטבעיים שנמצאים ב Cane תוסף תזונה טבעי המסייע לחולי סוכרת להגיע לאיזון ברמות הסוכר שלהם. Cane הוא תוסף תזונה מבית קיורהלייף, חברה הדואגת לאיכות חייהם של החולים במחלות כרוניות.
http://www.cane-curalife.com/
What’s New in the Diagnosis and Management of Cow’s Milk Protein Allergy.
Distinguish IgE and non-IgE mediated aspects of cow’s milk allergy (CMA).
Review the clinical effects of formula in infants with CMA
Importance of nutrition in hospitalized patientsAzam Jafri
Malnutrition is common in hospitalized patients and is associated with increased complications, prolonged hospital stays, and higher mortality rates. Proper nutrition is important for recovery, as malnutrition can weaken the body and impair the healing process. Oral nutritional supplements have been shown to improve patient outcomes by helping maintain muscle mass and support recovery from illness, surgery, or injury. Hospitals should screen patients for risk of malnutrition and consider supplemental nutrition to improve health outcomes.
Alishba, a 6-month-old infant, presented with chronic diarrhea, vomiting, and eczema after being exclusively breastfed for the first 5 months and then introduced to cow's milk formula for the past month. There is a maternal history of eczema and asthma.
The most likely diagnosis is cow milk protein allergy. Differential diagnoses include lactose intolerance, pyloric stenosis, and gastroesophageal reflux disease.
Management would include strict elimination of cow milk protein via exclusive breastfeeding or a hypoallergenic formula. Oral steroids may be used if eosinophilic esophagitis is present. Skin prick tests and serum IgE tests can help confirm
Objectives:
- Most probable diagnosis? Based on which information from the case study?
- Which diagnostic tests would you perform?
- What information do you provide these parents about therapy and prognosis?
As a newly emphasized modality to treat infectious complications and also to folloew non-antibiotic regimens against infection, Probiotics has recieved more and more attention now a days.
1) Complementary and alternative medicine (CAM) includes natural products like herbs, vitamins, probiotics, and mind-body practices like yoga and acupuncture. CAM use is common, with 65% of patients using herbal preparations.
2) Milk thistle extract, which contains silybin, is used for liver support. Studies on its effectiveness for hepatitis have shown mixed results, with some studies finding lower liver enzymes but no impact on viral levels. Larger and higher quality studies are still needed.
3) Adulterants in herbal supplements and traditional Chinese medicines have been found to cause liver injury. Herbalife supplements were linked to 12 and 10 cases of liver injury in Israel and Switzerland
The document provides 10 tips for enteral nutrition in intensive care units based on recent American and European guidelines and expert consensus:
1) Low-dose enteral nutrition can be started within 48 hours of admission, even during treatment with small or moderate doses of vasopressor agents.
2) A percutaneous enteral access should be used when enteral nutrition is anticipated for 4 weeks or longer.
3) Energy delivery should not be calculated to match energy expenditure before day 4-7, and use of energy-dense formulas can be restricted to cases where full-volume isocaloric enteral nutrition is not tolerated or fluid restriction is needed.
4) The occurrence of refeeding syndrome should be assessed
- Plant-based diets are commonly promoted by doctors like Dean Ornish and Caldwell Esselstyn who limit or forbid various foods like oils, sugar, and refined grains. However, religious vegetarians in Taiwan who avoid meat but not other restricted foods have higher risk biomarkers.
- Studies on Adventist vegetarians find their health benefits may be due more to avoiding coffee, doughnuts and eggs rather than meat itself. Fish-eating Adventists may have lowest mortality while vegan/vegetarian Adventists have similar outcomes to Mormons who avoid substances but not meat.
- Contrary to claims, animal protein is not clearly linked to bone loss and vegetarians often have lower bone density than omnivores
Cow’s milk protein allergy and intolerance practical issuesApollo Hospitals
This article discusses practical issues in diagnosing cow's milk protein allergy and intolerance in children. It notes that these conditions are often difficult to distinguish based on clinical features alone. Cow's milk protein allergy is an immunoglobulin E-mediated reaction to proteins in cow's milk, while intolerance involves non-immunological mechanisms. The article provides guidance on differentiating the two and indicates when referral to a pediatric gastroenterologist is appropriate. It also reviews prevalence rates and common clinical presentations of cow's milk protein allergy and intolerance in infants and children.
AHS13 Stephan Guyenet Insulin and Obesity: Reconciling Conflicting Evidence Ancestral Health Society
The pancreatic hormone insulin regulates the trafficking and metabolism of carbohydrate and fat. Since insulin influences fatty acid flux in fat tissue, and manipulating insulin can influence body fatness, this has raised the possibility that insulin plays a role in common obesity. Two competing hypotheses propose that 1) elevated insulin is a compensatory response to insulin resistance that develops with fat gain, or 2) elevated insulin outpaces insulin resistance and favors fat gain. Each hypothesis appears to be supported by a large amount of evidence. This presentation will outline a framework capable of reconciling this seemingly conflicting evidence.
This document provides details about a 40-year-old female patient who presented with malnutrition due to chronic alcoholic pancreatitis, liver cirrhosis, and a history of gastric bypass surgery performed 10 years prior. She was admitted to the hospital for placement of a PICC line and initiation of total parenteral nutrition (TPN) due to failure to thrive. Her hospital course and treatment are described, including monitoring of her nutritional status and prescription of TPN to meet her nutrient needs. The case highlights the importance of thorough nutritional assessment and management of patients with complex medical histories and nutritional complications following bariatric surgery.
The document discusses probiotics as a potential new treatment for irritable bowel syndrome (IBS). It summarizes five studies that examined the effects of various probiotic supplements on IBS symptoms like constipation. The studies showed mixed results, with some finding probiotics improved constipation and overall IBS symptoms, while others found no significant improvement. The document concludes that probiotics may help IBS, but further research is needed to determine which species, dosages, and IBS subtypes are most effective.
This document summarizes an educational presentation on approaches to food allergies. It discusses diagnosing food allergies through history, skin prick tests, and IgE blood tests. It also covers managing non-acute food allergies through allergen avoidance, medical treatment, and immunotherapy. Finally, it reviews updates on preventing food allergies through early introduction of foods for high-risk infants and maintaining regular ingestion once introduced. Clinical teaching points emphasize the importance of history, avoiding IgG tests, baked goods aiding egg tolerance, flu vaccine safety, epinephrine dosing, and early solid food introduction.
Amoxicillin 250 mg Capsules-Summary of Product CharacteristicsBrown & Burk UK Ltd
Amoxicillin Capsule is used to treat infections in different parts of the body caused by bacteria. It is also used to stop infections when you have a tooth removed or other surgery. Amoxicillin Capsule may also be used in combination with other medicines to treat stomach ulcers.
Amoxicillin 250 mg capsules - summary of product characteristicsBrown & Burk UK Ltd
Amoxicillin Capsule is used to treat infections in different parts of the body caused by bacteria. It is also used to stop infections when you have a tooth removed or other surgery. Amoxicillin Capsule may also be used in combination with other medicines to treat stomach ulcers.
This document discusses CAPD peritonitis and provides guidelines and recommendations for treatment. It begins by defining CAPD peritonitis and describing the typical incidence rate. It then outlines the ISPD guidelines for empiric antibiotic therapy and treatment strategies based on culture results. The document also describes a clinical audit of peritonitis at Hospital Pulau Pinang that found a peritonitis rate of 1 in 36 patient-months, with gram-negative organisms being the most common causative agents and 60.7% of cases resolving with treatment.
The document provides information on commonly used drugs for children, including paracetamol, ibuprofen, midazolam, salbutamol, gaviscon infant, cefotaxime, caffeine citrate, morphine, and flucloxacillin. It discusses the uses, who can receive each drug, how it is administered, cautions, and side effects. Research is cited showing medication errors can occur in up to 17.8% of hospitalized children and identifying reasons for adverse drug reactions is important for prevention strategies.
Persistent diarrhea is defined as an episode of diarrhea lasting more than 14 days. It accounts for 10% of diarrhea cases but 35% of diarrhea deaths in children under 5. The causes are multifactorial and include pathogens, malnutrition, previous infections, and lack of breastfeeding. Chronic inflammation and impaired gut repair lead to malabsorption. Diagnosis involves assessing nutrition status, diarrhea type, and testing for pathogens if indicated. Treatment focuses on rehydration, nutrition rehabilitation with zinc and micronutrients, and antibiotics for specific pathogens like Shigella. Preventive strategies emphasize breastfeeding, nutrition, water/sanitation, and zinc supplementation.
This document provides information on cystic fibrosis including signs and symptoms, nutrition implications, and treatment. It then presents a case study on a 9.8 month old female patient with CF who was admitted for metabolic insufficiencies. Initial assessment found the patient was underweight. Recommendations included increasing formula intake and supplements. Follow up found weight gain and increased intake meeting goals. Further advancement of formula was recommended.
The patient, a 31-year-old female, presented with vomiting after eating for 5 days and decreased appetite. Diagnostic tests showed erosive gastritis, hiatal hernia, and endometrial cysts indicating endometrial tuberculosis. She was prescribed medications including esomeprazole to treat erosive gastritis and rifampin and isoniazid to treat endometrial tuberculosis. Lifestyle counseling focused on dietary modifications and medication adherence to manage symptoms and cure the infections.
This document provides information on acyclovir, an antiviral medication. It discusses acyclovir's class and structure, pharmacokinetics, mechanism of action in inhibiting viral DNA synthesis, uses for treating herpes viruses and varicella zoster virus, dosage recommendations for adults and pediatrics with considerations for renal impairment and immunocompromised patients, common side effects involving gastrointestinal, renal and nervous systems, and major drug interactions to avoid combining acyclovir with cidofovir, sirolimus, tacrolimus or tizanidine due to risk of kidney damage.
Peptic Ulcer Disease (PUD) refers to circumscribed ulcers in the gastrointestinal tract caused by acid and pepsin exposure, often due to Helicobacter pylori infection. PUD prevalence is higher in developing countries and affects around 4.5 million Americans annually. Duodenal ulcers are more common than gastric ulcers and associated with smoking and blood group O, while gastric ulcers are associated with NSAID use and blood group A. Treatment involves eradicating H. pylori with antibiotic therapy if present and managing symptoms with proton pump inhibitors. Lifestyle changes like smoking cessation and limited alcohol can help prevent recurrence.
- Critically ill patients are at high risk of malnutrition due to poor nutrient intake and increased metabolic demands.
- Early enteral nutrition within 48 hours is recommended to improve outcomes when possible. Parenteral nutrition may be considered after 1 week if enteral nutrition is not feasible.
- Nutrition support aims to meet caloric and protein goals to reduce catabolism and support anabolism while avoiding overfeeding. Standard enteral formulas are preferred over specialty formulas.
- Careful monitoring is needed to optimize delivery of nutrition and minimize risks like aspiration while the patient's condition and ability to tolerate feeds is changing.
This case study presents a 3-year old female patient admitted with fever, coffee ground vomiting and abdominal pain. She had a history of upper respiratory infection and allergy to cephalosporin and amoxicillin. Endoscopy revealed a non-bleeding gastric ulcer. Laboratory tests showed signs of anemia and inflammation. She was diagnosed with NSAIDs-induced peptic ulcer disease. Her treatment plan included cefotaxime, paracetamol, esomeprazole, and pantoprazole. She was discharged after 2 days with counseling on diet, medication use, and follow up.
Uti -for_non-urologists-uncomplicated and complicatedmaiim
This document discusses urinary tract infections (UTIs). It notes that UTIs are the second most common infectious presentation seen in primary care. While UTIs can affect both males and females of all ages, they are more common in women due to anatomical factors. The document reviews the pathogenesis, classification, clinical presentation, diagnosis and treatment of both uncomplicated and complicated UTIs. It provides treatment guidelines and notes the importance of considering local antibiotic resistance patterns when selecting therapy.
Hyperemesis Gravidarum is a severe form of nausea and vomiting during pregnancy that results in dehydration, weight loss and electrolyte imbalance. It affects 0.3-3% of pregnancies. Risk factors include multiple gestation, family history and nulliparity. Nausea is caused by hormonal changes that relax the gastrointestinal tract. Treatment ranges from dietary changes for mild cases to intravenous hydration and antiemetics for severe cases. Corticosteroids may help refractory nausea and vomiting.
Various drugs available in pediatric dentistry and calculation involvedJeyashriTamilarasu
This document discusses various drugs used in paediatric dentistry. It describes drugs for infection control like antibiotics, drugs for pain control including non-steroidal anti-inflammatory drugs and opioids, and local anesthetics. It provides classifications of these drugs and discusses dosages, indications, and side effects of commonly used drugs like amoxicillin, ibuprofen, and paracetamol. Rules for calculating pediatric doses like Clark's rule and Young's rule are also summarized.
A 14-year-old female presented with lethargy, chest pain, vomiting, and a temperature of 95.5°F after ingesting 40-70 acetaminophen tablets (750 mg/kg) following failing a school exam. Her acetaminophen level was critically high at 4-5 hours. She was treated with N-acetylcysteine and recovered without liver toxicity.
This document summarizes guidelines from NICE on prescribing antibiotics for acute sore throat and acute otitis media. It provides criteria for assessing patients based on symptoms to determine if they are likely to benefit from antibiotics. For those unlikely to benefit, it recommends no antibiotics but providing self-care advice; for others it suggests considering a delayed prescription or immediate prescription based on symptoms. It also provides antibiotic options and dosages based on age. The goal is to limit unnecessary antibiotic use while effectively treating those likely to benefit or at high risk of complications.
Esophageal Cancer Treated with Surgery and RadiationYeyan Jin
This case study describes a 58-year-old male diagnosed with stage II adenocarcinoma of the esophagus. His treatment plan involved an esophageal transhiatal esophagectomy with an intrathoracic esophagogastric anastamosis, followed by radiation therapy. Post-operatively, he received TPN to be transitioned to tube feedings. Long term, he was prescribed a tube feeding product to meet his nutritional and caloric needs. Radiation therapy following discharge may cause additional nutritional complications like anorexia, weight loss, and fatigue.
The document discusses various treatments for acute diarrhea in children. It begins by noting that diarrhea remains a significant cause of illness and death in children under 5 years old worldwide. It then reviews several treatment options including oral rehydration therapy (ORT), lactose-free formulas, the clay mineral diosmectite, the antisecretory drug racecadotril, zinc supplementation, and probiotics. For each treatment, it summarizes available evidence on effectiveness and safety from studies and reviews. The document emphasizes that ORT is the recommended first-line treatment for rehydration and that there is insufficient evidence to recommend routine use of other treatments, though some like zinc may provide benefit in specific cases.
This presentation includes basic of PCOS their pathology and treatment and also Ayurveda correlation of PCOS and Ayurvedic line of treatment mentioned in classics.
हिंदी वर्णमाला पीपीटी, hindi alphabet PPT presentation, hindi varnamala PPT, Hindi Varnamala pdf, हिंदी स्वर, हिंदी व्यंजन, sikhiye hindi varnmala, dr. mulla adam ali, hindi language and literature, hindi alphabet with drawing, hindi alphabet pdf, hindi varnamala for childrens, hindi language, hindi varnamala practice for kids, https://www.drmullaadamali.com
Beyond Degrees - Empowering the Workforce in the Context of Skills-First.pptxEduSkills OECD
Iván Bornacelly, Policy Analyst at the OECD Centre for Skills, OECD, presents at the webinar 'Tackling job market gaps with a skills-first approach' on 12 June 2024
This presentation was provided by Steph Pollock of The American Psychological Association’s Journals Program, and Damita Snow, of The American Society of Civil Engineers (ASCE), for the initial session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session One: 'Setting Expectations: a DEIA Primer,' was held June 6, 2024.
This document provides an overview of wound healing, its functions, stages, mechanisms, factors affecting it, and complications.
A wound is a break in the integrity of the skin or tissues, which may be associated with disruption of the structure and function.
Healing is the body’s response to injury in an attempt to restore normal structure and functions.
Healing can occur in two ways: Regeneration and Repair
There are 4 phases of wound healing: hemostasis, inflammation, proliferation, and remodeling. This document also describes the mechanism of wound healing. Factors that affect healing include infection, uncontrolled diabetes, poor nutrition, age, anemia, the presence of foreign bodies, etc.
Complications of wound healing like infection, hyperpigmentation of scar, contractures, and keloid formation.
This slide is special for master students (MIBS & MIFB) in UUM. Also useful for readers who are interested in the topic of contemporary Islamic banking.
LAND USE LAND COVER AND NDVI OF MIRZAPUR DISTRICT, UPRAHUL
This Dissertation explores the particular circumstances of Mirzapur, a region located in the
core of India. Mirzapur, with its varied terrains and abundant biodiversity, offers an optimal
environment for investigating the changes in vegetation cover dynamics. Our study utilizes
advanced technologies such as GIS (Geographic Information Systems) and Remote sensing to
analyze the transformations that have taken place over the course of a decade.
The complex relationship between human activities and the environment has been the focus
of extensive research and worry. As the global community grapples with swift urbanization,
population expansion, and economic progress, the effects on natural ecosystems are becoming
more evident. A crucial element of this impact is the alteration of vegetation cover, which plays a
significant role in maintaining the ecological equilibrium of our planet.Land serves as the foundation for all human activities and provides the necessary materials for
these activities. As the most crucial natural resource, its utilization by humans results in different
'Land uses,' which are determined by both human activities and the physical characteristics of the
land.
The utilization of land is impacted by human needs and environmental factors. In countries
like India, rapid population growth and the emphasis on extensive resource exploitation can lead
to significant land degradation, adversely affecting the region's land cover.
Therefore, human intervention has significantly influenced land use patterns over many
centuries, evolving its structure over time and space. In the present era, these changes have
accelerated due to factors such as agriculture and urbanization. Information regarding land use and
cover is essential for various planning and management tasks related to the Earth's surface,
providing crucial environmental data for scientific, resource management, policy purposes, and
diverse human activities.
Accurate understanding of land use and cover is imperative for the development planning
of any area. Consequently, a wide range of professionals, including earth system scientists, land
and water managers, and urban planners, are interested in obtaining data on land use and cover
changes, conversion trends, and other related patterns. The spatial dimensions of land use and
cover support policymakers and scientists in making well-informed decisions, as alterations in
these patterns indicate shifts in economic and social conditions. Monitoring such changes with the
help of Advanced technologies like Remote Sensing and Geographic Information Systems is
crucial for coordinated efforts across different administrative levels. Advanced technologies like
Remote Sensing and Geographic Information Systems
9
Changes in vegetation cover refer to variations in the distribution, composition, and overall
structure of plant communities across different temporal and spatial scales. These changes can
occur natural.
How to Manage Your Lost Opportunities in Odoo 17 CRMCeline George
Odoo 17 CRM allows us to track why we lose sales opportunities with "Lost Reasons." This helps analyze our sales process and identify areas for improvement. Here's how to configure lost reasons in Odoo 17 CRM
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
বাংলাদেশের অর্থনৈতিক সমীক্ষা ২০২৪ [Bangladesh Economic Review 2024 Bangla.pdf] কম্পিউটার , ট্যাব ও স্মার্ট ফোন ভার্সন সহ সম্পূর্ণ বাংলা ই-বুক বা pdf বই " সুচিপত্র ...বুকমার্ক মেনু 🔖 ও হাইপার লিংক মেনু 📝👆 যুক্ত ..
আমাদের সবার জন্য খুব খুব গুরুত্বপূর্ণ একটি বই ..বিসিএস, ব্যাংক, ইউনিভার্সিটি ভর্তি ও যে কোন প্রতিযোগিতা মূলক পরীক্ষার জন্য এর খুব ইম্পরট্যান্ট একটি বিষয় ...তাছাড়া বাংলাদেশের সাম্প্রতিক যে কোন ডাটা বা তথ্য এই বইতে পাবেন ...
তাই একজন নাগরিক হিসাবে এই তথ্য গুলো আপনার জানা প্রয়োজন ...।
বিসিএস ও ব্যাংক এর লিখিত পরীক্ষা ...+এছাড়া মাধ্যমিক ও উচ্চমাধ্যমিকের স্টুডেন্টদের জন্য অনেক কাজে আসবে ...
it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
6. Introduction
Developing country
± 60% pneumonia cases
caused by bacterial
antibiotic.
In developed country
mostly viral
Alberta Medical Association, 2001; Jadavji T et al,1997
10. Introduction
• Recent research showed
that antibiotic regimen
in WHO guidelines has
reduced 50% mortality
in developed country,
but there’s also excessive
use of antibiotics (75%)
Shann F et al, 1999
Need a guidelines for a
Rational use of antibiotics.
16. Antibiotics for Non
Severe Pneumonia
WHO, 2005; Fonseca W, 2003; Pakistan MASCOT, 2002; Pakistan MASCOT
2003, ISCAP study group, 2004; Awasthi S, et al, 2004, Ayieko P et al, 2007
17. Antibiotics for Non
Severe Pneumonia
WHO, 2005; Fonseca W, 2003; Pakistan MASCOT, 2002; Pakistan MASCOT
2003, ISCAP study group, 2004; Awasthi S, et al, 2004, Ayieko P et al, 2007
18. Antibiotics for Non Severe
Pneumonia
WHO, 2005; Fonseca W, 2003; Pakistan MASCOT, 2002; Pakistan MASCOT 2003, ISCAP
study group, 2004; Awasthi S, et al, 2004, Ayieko P et al, 2007, CATCHUP study group
2002
21. Antibiotics for Non Severe
Pneumonia
Guidelines from The British Thoracic Society
(2002):
• For children < 5 years old: first line drugs is
amoxicillin (well tolerated, not expensive)
The British Thoracic Society, 2002
Alternative antibiotics:
co-amoxiclav, cephachlor,
eritromycin, Chlaritromycin,
and azitromycin
22. Antibiotics for Non Severe
Pneumonia
Guidelines , The British Thoracic Society, 2002:
• In children > 5 years old most common
organism is M. Pneumoniae
• First line drugs is macrolide
The British Thoracic Society, 2002
If S. pneumoniae suspected amoxicillin
If S. aureus suspected macrolide or
combination of flucloxacillin and amoxicillin
23. Antibiotics for Non Severe
Pneumonia
Monotherapy is
recommended.
National Guideline Clearinghouse, 2006
25. Follow Up
• Evaluation performed after
24-72 hours of treatment, if
no improvement change
antibiotics
National Guideline Clearinghouse, 2006
Signs of improvement:
Decrease respiratory rate
Lower fever
Appetite improvement
30. Antibiotic for Admitted
Pneumonia
Guideline for the Management of Community
Acquired Pneumonia in childhood:
The British Thoracic Society, 2002
As therapy begin, the organism
causing pneumonia is unknown.
Treatment based on age and specific
symptoms for specific pathogen.
36. Cephalosporins
• A randomized controlled trial compared
3rd generation of cephalosporins and
Cephachlor no differences
(Paupe J, et all, 1992 )
37. Table 1. Therapeutic management of pneumonia
Patient age Outpatient Inpatient Critically ill
Birth to
20 days
Admit Ampicillin IV or IM:
Age <7 days:
Weight <2 kg (4.4 lb): 50 to
100 mg per kg per day in
divided doses every 12
hours
Weight ≥2 kg: 75 to 150 mg
per kg
per day in divided doses
every 8 hours
Ampicillin IV or
IM, in same
dosages as for
inpatients
plus
Gentamicin IV or
IM, with or
without cefotaxime
IV, in same
dosages as for
inpatients
Ostapachuk, M,.2004
38. Patient age Outpatient Inpatient Critically ill
Birth to
20 days
Admit Ampicillin IV or IM:
Age ≥7 days:
Weight <1.2 kg (2.6 lb): 50 to
100
mg per kg per day divided every
12 hours
Weight 1.2 to 2 kg: 75 to 150 mg
per
kg per day in divided doses every
8 hours
Weight >2 kg: 100 to 200 mg per
kg per day in divided doses every
6 hours
Table 1. Therapeutic management of pneumonia
Ostapachuk, M,.2004
39. Patient
age
Outpatient Inpatient Critically ill
Birth to
20 days
Admit plus
Gentamicin IV or IM:
≥37 weeks of gestation
And Age zero to 7 days: 2.5 mg per kg
every 12 hours
Age >7 days: 2.5 mg per kg every
8 hours
with or without
Cefotaxime (Claforan) IV:
Age ≤7 days: 100 mg per kg per day in
divided doses every 12 hours
Age >7 days:
150 mg per kg per day in divided doses
every 8 hours
Ostapachuk, M,.2004
Table 1. Therapeutic management of pneumonia
40. Patient
age
Outpatient Inpatient Critically ill
3 weeks
to
3 months
If patient is afebrile:
Azithromycin
(Zithromax),
10 mg per kg orally
on day 1, then 5 mg
per kg per day on
days 2 through 5
or
Erythromycin, 30 to
40 mg per kg per day
orally in divided
doses every 6 hours
for 10 days
Admit if patient is
febrile or
hypoxic.
Erythromycin, 40 mg per
kg per day IV in
divided doses every 6
hours*
If patient is febrile, add
one of these agents:
Cefotaxime, 200 mg per
kg per day IV in divided
doses every 8 hours*
or
Cefuroxime (Ceftin), 150
mg per kg per day IV in
divided doses every
8 hours*
Cefotaxime, 200
mg per kg per day
IV in divided doses
every 8 hours
plus cloxacillin
(Tegopen), 150
to 200 mg per kg
per day IV in
divided doses every
6 hours*
or
Cefuroxime alone,
150 mg per kg
per day IV in
divided doses every
8 hours*
Ostapachuk, M,.2004
Table 1. Therapeutic management of pneumonia
41. Patient
age
Outpatient Inpatient Critically ill
4 mo to
5 years
Amoxicillin, 90 mg per
kg per day orally in
divided doses every 8
hours for 7 to 10 days
Consider initial dose of
ceftriaxone
(Rocephin),
50 mg per kg per day
IM, up to 1 g per day.
Follow with oral
therapy for full course.
Alternatives:
amoxicillin clavulanic
acid (Augmentin),
azithromycin, cefaclor
(Ceclor),
clarithromycin
(Biaxin),
erythromycin
Cefotaxime, 150
mg per kg per day
IV in divided doses
every 6 hours*
or
Cefuroxime, 150
mg per kg per day
IV in divided doses
every 8 hours*
If the patient has
pneumococcal
infection:
Ampicillin alone,
200 mg per kg per
day IV in divided
doses every 8
hours*
Cefuroxime, 150 mg per
kg per day IV in divided
doses every 8 hours,
plus erythromycin, 40
mg per kg per day IV or
orally in divided doses
every 6 hours for 10 to
14 days*
or
Cefotaxime, 200 mg per
kg per day IV in divided
doses every 8 hours,
plus cloxacillin, 150 to
200 mg per kg per day IV
in divided doses every 6
hours for 10 to 14 days
Ostapachuk, M,.2004
Table 1. Therapeutic management of pneumonia
42. Table 1. Therapeutic management of pneumonia
Patient
age
Outpatient Inpatient Critically ill
5 years
and older
Azithromycin, 10 mg per
kg (maximum of 500 mg)
orally on day 1, followed
by 5 mg per kg per day on
days 2 through 5
Or Clarithromycin, 15 mg
per kg per day orally in
divided doses every 12 hours
for 7 to 10 days
Or Erythromycin, 40 mg per
kg per day orally in divided
doses every 6 hours for 7 to
10 days
If the patient has
pneumococcal infection:
Amoxicillin alone, 90 mg
per kg per day orally in
divided doses every 8 hours
Cefuroxime, 150
mg per kg per day
IV in divided doses
every 8 hours
plus
Erythromycin, 40
mg per kg per day
IV or orally in
divided doses
every 6 hours for
10 to 14 days
If pneumococcal
infection is
confirmed:
Ampicillin alone,
200 mg per kg per
day IV in divided
doses every 8
hours
Cefuroxime, 150
mg per kg per day
IV in divided doses
every 8 hours
plus
Erythromycin, 40
mg per kg per day
IV or orally in
divided doses every
6 hours for 10 to 14
days
Ostapachuk, M,.2004
43. Follow Up
• Every 6 hours or at
least once a day
• Observations consist
of respiratory rate,
temperature, level of
consciousness and
feeding
National guidelines Clearinghouse, 2006
Amelioration signs :
•Decreasing of
respiratory rate
•No chest indrawing
•Lowering of fever
•Better appetite
44. Follow Up cont’
• Rules of hospital discharge :
– Adequately consumes oral antibiotics
– Antibiotic therapy can be done at home
– Family agree and understand the
management at home
– Support from environment for the therapy
– Family should take their child to the
clinician for next examination
Ostapachuk, M,.2004
45. Pitfalls Management of
Pneumonia in Children
• Chest x-ray should not routinelly done in
children with mild pneumonia. (A)
• Evaluation of chest x-ray only performed if
no improvement or there is worsening. (C)
Enarson M, 2006The British Thoracic Society,2002
46. Pitfalls Management of
Pneumonia in Children
• Antibiotics administration empirically
often inappropriate with the etiology
overused antibiotics . Amoxycillin is the
first line antibiotic for pneumonia.
Alternatives co-amoxyclav, cephachlor,
erytromycin clarytromycin and
azytromycin . (B)
Enarson M, 2006The British Thoracic Society,2002
47. Pitfalls Management of
Pneumonia in Children
• Nasogastric tube should not be applied in
severe pneumonia (D)
• Every pneumonia patient has to be
monitored for oxygen saturation. (A)
• Children with oxygen saturation below
92% must given oxygen therapy with
nasal canule, head box, or facial mask, to
keep the saturation above 92%. (A)
The British Thoracic Society,2002
48. Pitfalls Management of
Pneumonia in Children
• Intravenous fluid administered for 80%
from daily requirement and electrolyte
examination must be done in severe
pneumonia. (C)
• Chest physiotherapy is not always useful
(B)
The British Thoracic Society,2002
49. Study design Evidence
level
Recomendation
Advance systematic study Ia A+
One or more good study Ib A-
One or more prospective study II B+
One or more retrospective
study
III B-
Experts’ assumption formally Iva C
Experts’ assumption informally
or other information
IVb D
Table 2 . Evidence Level and Recommendation
The British Thoracic Society, 2002
50. CONCLUSION
• Antibiotic administration is a challenge for clinician in the
management of pneumonia
• Some pneumonia caused by viral infection
• As we decide to give antibiotic, we must consider which
antibiotic should be used (broad spectrum or narrow
spectrum)
• First give antibiotic empirically based on children age
• Second observe within 24-72 hours
• All of the steps above are useful to prevet pittfalls in the
management of pneumonia
51. Cochrane Database of
Systematic Review 2008
To determine the equivalence in effectiveness and safety
of oral antibiotics compared to parenteral antibiotics
Oral Antibiotics vs Parenteral Antibiotics for
Severe Pneumonia
Rojas-Reyes MX, Rugeles CG, 2006
52. Cochrane Database of
Systematic Review 2008
Published or unpublished randomized controlled trials
(RCTs) comparing any oral and parenteral antibiotic
children 3 months to 5 years
Oral therapy effective and safe alternative to
parenteral antibiotics in hospitalized children
Rojas-Reyes MX, Rugeles CG, 2006
53. Cochrane Database of
Systematic Review 2008
Short –course vs Long-course antibiotic therapy
for non-severe community-acquired
pneumonia
Results:
Analysis of three days of treatment with the same
antibiotic non significant differences in clinical
cure, treatment failure, and relapse rate after
seven days of clinical cure
Haider BA, Saeed MA, Bhutta ZA, 2007
54. Cochrane Database of
Systematic Review 2008
Conclusion
A short course (3 days) of antibiotic
therapy is as effective as a longer
treatment (5 days) for non severe
pneumonia in children under five years
of age.
Haider BA, Saeed MA, Bhutta ZA, 2007
55. Cochrane Database of
Intervention Review
To identify effective antibiotic drug therapy
for community acquired pneumonia in
children by comparing various
antibiotics.
Antibiotics for CAP in Children
Kabra SK, Lodha R, Pandey RM, 2009
56. Cochrane Database of
Intervention Review
• Cotrimoxazole is inferior to amoxycillin and
prokain penicillin
• Penicillin in conjunction with gentamycin
better than chloramphenicol alone.
• Co-amoxyclavulanic acid was better than
amoxycillin alone
• No difference between injectable penicillin and
oral amoxycillin
Kabra SK, Lodha R, Pandey RM, 2009
57. Cochrane Database of
Intervention Review
No differences between
• Injectable penicillin and oral amoxycillin
• Azithromycin and erythromycin
• Cefpodoxime and amoxycillin
• Azithromycin and co-amoxyclavulanic
acid.
Kabra SK, Lodha R, Pandey RM, 2009
58. Conclusion
Ambulatory patients
• Amoxycillin was better than co-trimoxazole
• No difference between azithromycin and
erythromycin
• No difference between cefpodoxime and co-
amoxyclavulanic
Cochrane Database of
Intervention Review
Kabra SK, Lodha R, Pandey RM, 2009
59. Cochrane Database of
Intervention Review
• Hospitalized patients
• Procain penicillin was better than
cotrimoxazole
• Penicillin + gentamycin better than
chloramphenicol alone
• Injectable penicillin and oral amoxycillin
similar failure rates
Kabra SK, Lodha R, Pandey RM, 2009
60. Cochrane Database of
Intervention Review
Over-the-counter (OTC) medications to reduce
cough as an adjunct to antibiotics for acute
pneumonia in children and adults
To evaluate the efficacy of OTC cough
medications as an adjunct to antibiotics in
children and adults with pneumonia
Chang CC, Cheng AC, Chang AB, 2009
61. Cochrane Database of
Intervention Review
• Insufficient evidence to decide whether
OTC medications for cough associated with
acute pneumonia are beneficial.
• Mucolytics may be beneficialinsufficient
evidence
• Codeine and antihistamines should not be
used in young children
Chang CC, Cheng AC, Chang AB, 2009