Antibioticos

VOLUME 202 ISSUE 3

Knowing when to stop antibiotic therapy

Gwendolyn L GilbertMed J Aust 2015; 202 (3): 121-122. || doi: 10.5694/mja14.01201
Published online: 16 February 2015

Empirical antibiotic therapy that turns out to be unnecessary, on review, can (and should) be stopped immediately

After 50 years of widespread antibiotic use, we have reached the point where experts are seriously predicting “a postantibiotic era” and the World Health Organization has declared antibiotic resistance “a threat to global security”.1 No one can doubt the enormous benefits of antibiotics in curing or preventing serious sequelae of infections that were once the main causes of death and chronic illness, and enabling modern medical therapies that involve significant immune suppression.

These benefits are dramatic, and toxic side effects are apparently few. This makes it tempting — even now, when we know the risks — to prescribe antibiotics empirically at the first hint of infection, even viral infection,2 lest it progress to serious sepsis (and potential medicolegal or professional embarrassment3). Although unnecessary antibiotic use is sometimes driven by patients’ expectations, they can be modified by public education.4

During the first 30 years of the antibiotic era, the release of each new antibiotic was almost always followed by the emergence of resistance in some previously susceptible bacteria, but there were always new antibiotics in the pipeline, until recently. Now the pipeline has dried up and the incidence and spectrum of resistance among most common pathogens have reached alarming levels.1 How have we come to this point, and what can we do to avoid the “end of the antibiotic era”?

How can we improve our use of antibiotics?

We still argue about how to optimise antibiotic use, but there are some (more or less) undisputed facts:

• the incidence of antibiotic resistance is, broadly, proportional to the total amount of antibiotics used,5 notwithstanding many confounding variables;
• individual antibiotic exposure rapidly alters normal gut microflora, which can take months to recover, risking overgrowth or acquisition of (and, potentially, infection with) multiresistant bacteria, Clostridium difficile or yeasts and spread to hospital, household or nursing home contacts6 — and the broader the spectrum and the longer the course, the greater the risk;
• infections with antibiotic-resistant bacteria are more difficult to treat and are associated with higher mortality — antimicrobial resistance is estimated to cost the United States health system US$21–34 billion per annum;1 and
• all antibiotics have some specific adverse side effects such as allergy (or, rarely, anaphylaxis) or dose-related haematological, gastrointestinal, renal or hepatic toxicity.

Surveys of antibiotic use in hospital and community settings show that a third to a half of all prescriptions are discordant with widely available antibiotic guidelines.7,8 Individual decisions to prescribe are often driven by the prescriber’s experience, confidence and tolerance of risk, rather than by objective clinical indications.2 Antimicrobial stewardship programs are designed to support and share responsibility for logical, evidence-based antibiotic prescribing decisions in the context of inevitable clinical uncertainty, and they can reduce unnecessary — and overall — antibiotic use, without adverse patient outcomes.9,10

In seriously ill patients with suspected bacterial sepsis, initial empirical therapy often means high-dose, broad-spectrum “cover”, justified by evidence that the mortality increases rapidly with every hour’s delay in starting effective therapy.11 For example, recommended empirical therapy for patients with neutropenia who develop fever is to give piperacillin–tazobactam or a fourth-generation cephalosporin.12 The need for immediate, effective therapy in severe sepsis is often extrapolated to milder (suspected) infections, with non-specific symptoms, for which therapy may not be necessary or could be delayed until test results are available to guide it.

Whether to treat and the appropriate choice of empirical therapy are not straightforward decisions, even with the help of prescribing guidelines. However, starting empirical therapy does not mean the patient is committed to a fixed treatment course. Too often, initial therapy is continued without review, even when diagnostic tests indicate an alternative diagnosis (non-infective condition or viral infection) for which no antibiotic is needed or a narrower spectrum agent would suffice. For example, Streptococcus pneumoniae isolated from a blood culture from a patient with severe community-acquired pneumonia is an indication to change from commonly prescribed empirical therapy — ceftriaxone plus azithromycin — to benzylpenicillin alone.12

Duration of treatment and resistance

There is a common misconception that resistance will emerge if a prescribed antibiotic course is not completed. Premature cessation of antibiotic therapy will not increase the risk that resistance will emerge. For most infections, the recommended duration of therapy (5–14 days, depending on syndrome) is based on expert opinion and convention, rather than solid evidence. However, for many syndromes associated with bacteraemia, there is no difference in outcome when shorter courses are used.13,14 In practice the optimal duration of therapy depends on clinical syndrome, the causative organism, whether source control is possible and the patient’s response to therapy.14 For example, only 3–5 days of treatment is needed for meningococcal meningitis, compared with 10–14 days for pneumococcal meningitis.12 Additional studies are needed to validate shorter courses of antibiotic therapy for many other infections.

Resistance is much more likely to occur with long antibiotic courses, which are rarely indicated except when the site of infection is relatively inaccessible (in biofilm in sites such as a cardiac valve or foreign body or in an abscess); these infections often cannot be cured without surgical removal of the source or drainage of pus. There is no risk — and every advantage — in stopping a course of an antibiotic immediately a bacterial infection has been excluded or is unlikely; and minimal risk if signs and symptoms of a mild infection have resolved.

REVIEW dolor de piernas Pentoxifilina acido fucilico

Alexander Fleming fue el primero en sugerir que el moho Penicillium debería tener una sustancia antibacteriana y el primero en aislar su sustancia activa, a la que denominó penicilina, pero no fue el primero en aprovecharse de sus propiedades.

Topical steroid addiction in atopic dermatitis

Las cremas a base de corticoesteroides que se prescriben para tratar eccemas o dermatitis no solo no los curan, sino que podrían agravar el problema o incluso provocarlo a medio y largo plazo.

De hecho, uno de cada ocho afectados podrían dejar de sufrir el eccema si dejaran de utilizar la crema, según un estudio publicado en la revista Drug, health and patient safetyporpor un equipo de investigadores japoneses.

• 1 cucharadita de cúrcuma en polvo
• ½ cucharadita de bicarbonato de sodio
• ½ cucharadita de arcilla, la mejor es la rhassoul, pero puedes usar la que tengas
• ½ cucharadita de miel
• ½ cucharadita de jugo de limón
• 2 gotitas de tu aceite facial o aceite de almendras
• ½ cucharadita de vinagre de manzana orgánico (si no lo tienes, sólo omítelo)

Nobel laureate Richard Roberts says capitalism and health care do not mix

Asia should steer clear of the US funding model for health care, Nobel Prize winning scientist Richard Roberts tells Richard Lord

Richard Lord Published: 9:37am, 24 Feb, 2014 Updated: 9:37am, 24 Feb, 2014

The biochemist and molecular biologist’s credentials are as good as they come: he won the 1993 Nobel Prize in Physiology or Medicine for work into the mechanism of gene splicing that made much of the modern biotechnology and gene-science industry possible.

If you’re just using health care to make money, you will treat the wrong diseases richard Roberts 

Frank Suárez cancer

a crime against humanity 2015 Richard j Roberts When Monsanto first tried to introduce GMO seeds into Europe there was a backlash by the Green parties and their political allies, who feared that American agro-business was about to take over their food supply. Thus began a massive campaign not against the true targ…

mama de Frank vivía en el piso 12

eliminan de wikipedia a Frank Suárez.

REVIEW El mismo día de su muerte metabolismotv publico un vídeo en Youtube que luego fue eliminado 25 de febrero de 2021 Hablemos de los batidos de proteínas – pregúntale a Frank #28

desde un principio su muerte fue investigada cómo suicidio. Investigan como suicidio muerte de reconocido especialista en metabolismo Frank Suárez

su mama habla excelente de el. Lo llama su tesoro. Dice que gracias a seguir sus consejos ella goza de buena salud

REVIEW algunos dicen que él vivía en el sexto piso. Algunos medios de comunicación dicen que él vivía en el noveno

REVIEW dicen los familiares que hace un año año había empezado a tomar antidepresivos y hace 6 meses había suspendido. Según ellos se encontraba solo y aislado

Bencilpenicilina C₁₆H₁₈N₂O₄S

murio luc montagnier y no se sabe porque fue internado y causa de muerte 10 de febrero de 2022

Nigella Sativa Seed Oil, Nigella Sativa (Black Cumin) Seed Oil. El comino negro es una especie de planta herbácea de la familia de las ranunculaceae y es nativa principalmente del Oriente Medio, así como India, Turquía y Grecia.

Ivermectin alternative.

Comparative efficacy of ivermectin and Nigella sativa against helminths in Aseel chickens (Gallus gallus domesticus)

C Angel et al. J Helminthol. 2019 Sep. In this study, we evaluated the in vivo comparative efficacy of ivermectin and Nigella sativa extract against helminths in Aseel chickens, and the effects of helminths on blood parameters before and after treatment in Aseel chickens. Forty naturally infected adult Aseel chickens were randomly divided into four groups (n = 10 each): group A (ivermectin at 300 μg/kg); group B (N. sativa extract at 200 mg/kg); group C (ivermectin at 300 μg/kg + N. sativa extract at 200 mg/kg); group D was kept as a positive control to monitor time-related changes. On day 28 post treatment, the mean percentages of faecal egg-count reduction (FECR %) in groups A, B and C were recorded as 93.58, 88.09 and 100.00%, respectively. Further data analysis showed significantly higher efficacy in group C (100 ± 0.00%) than in groups A and B (P < 0.001). Highly significant (P < 0.001) improvements in mean percentage values of packed cell volume (PCV %) were recorded in groups A and C on days 14 and 28 post treatment. Meanwhile, the improvements in mean values of haemoglobin (Hb) concentration in groups A, B and C were highly significant (P < 0.001) when compared to that of group D on day 28 post treatment. The synergistic combination of ivermectin and N. sativa extract possessed greater efficacy than either ivermectin or N. sativa extract used alone. Furthermore, both PCV % and Hb concentration values gradually increased in the treated groups compared to the control group, in which PCV % and Hb concentration gradually decreased throughout the trial. Keywords: Aseel chicken; Nigella sativa; efficacy; helminths; ivermectin; nematode

vitamin d3 1000 3000 iu day vitamin c 500 1000 mg 2 x day quercetin 250 mg day zinc 30 40 mg day (elemental zinc) melatonin 6 mg before bedtime flaccid Alliance imask+ prevention and early outpatient treatment protocol

REVIEW la hija o esposa de su hijo dijo “no digas nada”

Autobiography of Mark Twain, Vol. 2 (2013)

• How easy it is to make people believe a lie, and hard it is to undo that work again!
  • p. 302
    • Misquote: It’s easier to fool people than to convince them that they have been fooled.

La Operación Highjump (‘Operación Gran Salto’ en español), cuya denominación oficial era The United States Navy Antarctic Developments Program, 1946-47 o Programa de Desarrollos Antárticos de la Armada de los Estados Unidos, consistió en un grupo de maniobras militares que tenían por objeto probar equipos militares y tropa en condiciones antárticas. La operación fue organizada por el contraalmirante Richard E. Byrd, de la Armada de los Estados Unidos, y tendría continuidad un año después con la Operación Windmill.

The Byrd Station is a former research station established by the United States during the International Geophysical Year by U.S. Navy Seabees during Operation Deep Freeze II in West Antarctica.^[1]

^[1]“The Antarctic Sun: Byrd History, June 12, 2009”. The Antarctic Sun.

El doctor Hodkinson es un médico que radica en Canadá y que es patólogo desde 1976, según un certificado del Colegio Real de dicho país. Algo así como la institución médica que da constancia de que los estudiantes de medicina sí pasaron el examen, para titularse como médicos.

REVIEW Hodkinson actualmente es integrante de una empresa médica privada llamada “medmaldoctors”, que según la descripción de su sitio en internet ofrece asesorías sobre temas médicos y legalidad para entes privados. 

Ya que Hodkinson anteriormente fue miembro de la Sección de Médicos del Laboratorio de Alberta (una asociación que acabó desde hace 25 años), los integrantes de esta emitieron un post en Twitter eludiendo la postura del médico y diciendo que “no se comparte ninguna de las opiniones del individuo en cuestión”. 

Is the Covid ‘Vaccine’ Causing Cancer? (Exclusive Interview With Dr. Roger Hodkinson)

Renee Nal February 11, 2022 1 comment 5 min read

Dr. Roger Hodkinson: Potential weakening of the immune system after receiving the Covid vaccine “could result in a tsunami of conditions.”

Renowned Canadian Pathologist Dr. Roger Hodkinson joined RAIR Foundation USA in Ottawa to discuss the science of the coronavirus “vaccines”. The compelling conversation took place amidst the massive Freedom Convoy, where truckers in Canada have inspired the world with their stand against “vaccine” mandates.

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jerry l tennant

Jerry L. Tennant Healing is Voltage: The Handbook, 3rd Edition 3rd EdiciónISBN-13: 978-1453649169, ISBN-10: 1453649166

Learn about Dr. Jerry Tennant MD, MD(H), PSc.D How do you describe a Renaissance man? Genius, scholar, inventor, humanitarian, innovator, healer, teacher, entrepreneur, historian — these are just a few of the terms that describe Dr. Jerry Tennant whose remarkable life, dedicated to healing and innovation, has changed the paradigm of western medicine.

it is not Thomas jendge and he did not commit suicide it is Guido hofmann

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Varios medios de comunicación alemanes ya han tildado a Hofmann como un orador de la conspiración y escéptico del coronavirus. 

Verschwörungs-Redner Guido Hofmann warnt in Pforzheim vor Söder und Merkel Er ist der Arzt, dem Masken-Gegner und Corona-Zweifler vertrauen: Guido Hofmann, 58-jähriger Gynäkologe aus dem Taunus, ist ein gefragter Redner der Querdenker-Szene. Jetzt warnte er in Pforzheim vor psychopathischen Politikern. Statt einer Pandemie sieht er eine Weltverschwörung.