Posts filed under ‘GUIDELINES’

Infective Endocarditis in Adults – Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association.

Circulation. 2015 Sep 15.

Baddour LM, Wilson WR, Bayer AS, Fowler VG Jr, Tleyjeh IM, Rybak MJ, Barsic B, Lockhart PB, Gewitz MH, Levison ME, Bolger AF, Steckelberg JM, Baltimore RS, Fink AM, O’Gara P, Taubert KA.



Infective endocarditis is a potentially lethal disease that has undergone major changes in both host and pathogen. The epidemiology of infective endocarditis has become more complex with today’s myriad healthcare-associated factors that predispose to infection. Moreover, changes in pathogen prevalence, in particular a more common staphylococcal origin, have affected outcomes, which have not improved despite medical and surgical advances.


This statement updates the 2005 iteration, both of which were developed by the American Heart Association under the auspices of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease of the Young. It includes an evidenced-based system for diagnostic and treatment recommendations used by the American College of Cardiology and the American Heart Association for treatment recommendations.


Infective endocarditis is a complex disease, and patients with this disease generally require management by a team of physicians and allied health providers with a variety of areas of expertise. The recommendations provided in this document are intended to assist in the management of this uncommon but potentially deadly infection. The clinical variability and complexity in infective endocarditis, however, dictate that these recommendations be used to support and not supplant decisions in individual patient management.


October 4, 2015 at 10:20 pm


World Health Organization (WHO)

This early-release guideline will form part of the revised updated WHO consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection due to be published in 2016

Abbreviations and acronyms 6
Definition of key terms 7
Acknowledgements 9
Executive summary 12
Summary of new recommendations 13

1. Introduction 16
1.1 Health sector response to HIV 16
1.2 Objectives 16
1.3 Target audience 17
1.4 Guiding principles 17
1.5 Methods for developing the guidelines 17
1.5.1 Competing interests 17
1.5.2 Guideline contributors 18
1.5.3 Methods for evidence synthesis 19
1.5.4 Peer review 21

2. Recommendations 24
2.1 When to start antiretroviral therapy 24
2.1.1 When to start ART among adults (>19 years old) 24
2.1.2 When to start ART among pregnant and breastfeeding women 30
2.1.3 When to start ART among adolescents (10–19 years of age) 35
2.1.4 When to start ART among children (younger than 10 years of age) 38
2.2 Oral pre-exposure prophylaxis for preventing the acquisition of HIV infection 42
2.3 Programmatic note on the recommendations 50

3. Publication, dissemination and evaluation 54

References 55

Annex 1. Declaration of interests, Clinical Guideline Development Group, June 2015 68

Annex 2. Evidence to decision-making tables and supporting evidence (available in web annex)


October 1, 2015 at 8:02 am

Guidelines for safety in the gastrointestinal endoscopy unit.

Gastrointest Endosc. MAR 2014 V.79 N.3 P.363-72. .

ASGE Ensuring Safety in the Gastrointestinal Endoscopy Unit Task Force, Calderwood AH, Chapman FJ, Cohen J, Cohen LB, Collins J, Day LW, Early DS.


September 5, 2015 at 10:21 am

World Health Organization Guidelines on Postexposure Prophylaxis for HIV: Recommendations for a Public Health Approach

Clin Infect Dis June 1, 2015 V.60 Suppl 3


June 27, 2015 at 11:28 am

GeSIDA/National AIDS Plan: Consensus document on antiretroviral therapy in adults infected by the human immunodeficiency virus (Updated January 2014).

Enferm Infecc Microbiol Clin. 2014 Aug-Sep;32(7):446.e1-42.

Article in Spanish

Panel de expertos de GeSIDA; Plan Nacional sobre el Sida.



This consensus document is an update of combined antiretroviral therapy (cART) guidelines for HIV-1 infected adult patients.


To formulate these recommendations a panel composed of members of the Grupo de Estudio de Sida and the Plan Nacional sobre el Sida reviewed the efficacy and safety advances in clinical trials, cohort and pharmacokinetic studies published in medical journals (PubMed and Embase) or presented in medical scientific meetings. Recommendations strength and the evidence in which they are supported are based on modified criteria of the Infectious Diseases Society of America.


In this update, antiretroviral therapy (ART) is recommended for all patients infected by type 1 human immunodeficiency virus (HIV-1). The strength and grade of the recommendation varies with the clinical circumstances: CDC stage B or C disease (A-I), asymptomatic patients (depending on the CD4+ T-lymphocyte count: <350cells/μL, A-I; 350-500 cells/μL, A-II, and >500 cells/μL, B-III), comorbid conditions (HIV nephropathy, chronic hepatitis caused by HBV or HCV, age >55years, high cardiovascular risk, neurocognitive disorders, and cancer, A-II), and prevention of transmission of HIV (mother-to-child or heterosexual, A-I; men who have sex with men, A-III). The objective of ART is to achieve an undetectable plasma viral load. Initial ART should always comprise a combination of 3 drugs, including 2 nucleoside reverse transcriptase inhibitors and a third drug from a different family (non-nucleoside reverse transcriptase inhibitor, protease inhibitor, or integrase inhibitor). Some of the possible initial regimens have been considered alternatives. This update presents the causes and criteria for switching ART in patients with undetectable plasma viral load and in cases of virological failure where rescue ART should comprise 2 or 3 drugs that are fully active against the virus. An update is also provided for the specific criteria for ART in special situations (acute infection, HIV-2 infection, and pregnancy) and with comorbid conditions (tuberculosis or other opportunistic infections, kidney disease, liver disease, and cancer).


These new guidelines updates previous recommendations related to cART (when to begin and what drugs should be used), how to monitor and what to do in case of viral failure or drug adverse reactions. cART specific criteria in comorbid patients and special situations are equally updated.


June 13, 2015 at 10:40 am

Sexually Transmitted Diseases Treatment Guidelines, 2015

MMWR Recommendations and Reports  June 2015 V.64 N.RR-3

Workowski KA, Bolan GA

These guidelines for the treatment of persons who have or are at risk for sexually transmitted diseases (STDs) were updated by CDC after consultation with a group of professionals knowledgeable in the field of STDs who met in Atlanta on April 30–May 2, 2013. The information in this report updates the Sexually Transmitted Diseases Treatment Guidelines, 2010 (MMWR Recomm Rep 2010;59 [No. RR–12]).

These updated guidelines discuss

1) alternative treatment regimens for Neisseria gonorrhoeae;

2) the use of nucleic acid amplification tests for the diagnosis of trichomoniasis;

3) alternative treatment options for genital warts;

4) the role of Mycoplasma genitalium in urethritis/cervicitis and treatment-related implications;

5) updated HPV vaccine recommendations and counseling messages;

6) the management of persons who are transgender;

7) annual testing for hepatitis C in persons with HIV infection;

8) updated recommendations for diagnostic evaluation of urethritis; and

9) retesting to detect repeat infection.

Physicians and other health-care providers can use these guidelines to assist in the prevention and treatment of STDs.



June 7, 2015 at 11:23 am

Antibiotic consumption and antimicrobial susceptibility evolution in the Centro Hospitalario Pereira Rossell in methicillin resistant Staphylococcus aureus era.

Rev Chilena Infectol. 2009 Oct;26(5):413-9.

Telechea H1, Speranza N, Lucas L, Santurio A, Giachetto G, Algorta G, Nanni L, Pírez MC.

1Depto. de Farmacología y Terapéutica Montevideo, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay.



In the past few years, an increase in methicillin resistant-not multiresistant Staphylococcus aureus was observed in Uruguay among children with community acquired infections. Recommendations for empiric antibiotic treatment required adjustments and new national guidelines were recommended in July 2004. Adherence to these guidelines was indirectly performed by monitoring antibiotic consumption and antimicrobial susceptibility patterns in Uruguay.


To describe and compare antibiotic consumption and antimicrobial susceptibility of Staphylococcus aureus in a Pediatric Hospital of the Centro Hospitalario Pereira Rossell (PH-CHPR) between 2001 and 2006.


Antibiotic consumption in hospitalized children was calculated using the Defined Daily Dose per 100 bed-days (DDD/100). Reference values were obtained from the World Health Organization Collaborating Center for Drug Statistics Methodology of. Consumption. Data were obtained using the WinPharma programme of the Pharmacy Department of CHPR. The fraction of annual occupancy of hospital beds was obtained from the Statistic Division of CHPR. Antibiotic consumption was evaluated between 2001 and 2006 and expressed as DDD/100 and percent change. Antimicrobial susceptibility was evaluated using CHPR’s Microbiology Laboratory data during the same time period.


After 2003 a significant increase in consumption of clindamycin, ceftriaxone, trimethoprim-sulphamethoxazole, cefuroxime, vancomycin and gentamycin was observed, except for cephradine. Consumption of clindamycin, ceftriaxone and trimethoprim-sulphamethoxazole showed the highest increase (6.15%; 1.44% and 1.17% respectively). Detection of Staphylococcus aureus increased significantly mostly from skin and soft tissue infections. Oxacillin susceptibility of S. aureus strains obtained from different sites had a significant and persistent decrease after 2003 (from 81 % during year 2001 to 40% in year 2006 (p < 0.05). Susceptibility to others antibiotics did not decrease. Between 2004 and 2006 the “D effect” decreased from 28% to 21 %. Antimicrobial susceptibility patterns did not differ by site of infection.


Methicillin resistant-not multiresistant Staphylococcus aureus has established itself as a regular community pathogen in Uruguayan children. Changes in antimicrobial consumption patterns reflect the impact of this pathogen in clinical practice and the overall adherence to new recommendations. This change was not associated with an increase in antibiotic resistance. Clindamycin is an alternative treatment although Clindamycin inducible resistance is a worry. Continuous monitoring of antibiotic consumption and local susceptibility patterns are required to promote rational use of antibiotics.


May 27, 2015 at 9:10 am

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