A review of some of the latest low-resourcs emergency medicine evidence Implementing WHO guidelines for unwell newborns. Management of possible serious bacterial infection in young infants where referral is not possible in the context of existing health system structure in Ibadan, South-west Nigeria Ayede A et al. Aim To test the feasibility of implementing an outpatient protocol for suspected neonatal sepsis when referral isn’t possible. Rationale The WHO has developed guidelines that recommend a simplified outpatient antibiotic regime; however the implementation of these guidelines has not been examined. Design An implementation study design (this I have not come across before but they used a reconcised framework of RE-AIM; Reach, efficacy,…
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Is shorter, lower dose amoxicillin safe in kids discharged with pneumonia in a UK setting?
A review of some of the latest low-resources emergency medicine evidence Is shorter, lower dose amoxicillin safe in kids discharged with pneumonia in a UK setting? Effect of Amoxicillin Dose and Treatment Duration on the Need for Antibiotic Re-treatment in Children With Community-Acquired Pneumonia The CAP-IT Randomized Clinical Trial Julia A. Bielicki, PhD1; Wolfgang Stöhr, PhD2; Sam Barratt, MPH2; et al Aim To see if a shorter duration or lower dose of amoxicillin is non-inferior to a full 7 day course Rationale It is unclear which children discharged from hospital with infectious/respiratory features will benefit from antibiotics. Design 2×2 non-inferiority multi-centre randomised controlled trial. Setting Emergency departments and wards in 28 UK and Irish hospitals. Population 824 children aged…
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Duration of antibiotics in Kids with community pneumonia
A review of some of the latest low-resources emergency medicine evidence Antibiotic duration for presumed pneumonia in children Amoxicillin for 3 or 5 Days for Chest-Indrawing Pneumonia in Malawian Children Amy-Sarah Ginsburg, M.D., M.P.H., Tisungane Mvalo, M.M.E.D., Evangelyn Nkwopara, M.S., Eric D. McCollum, M.D., Melda Phiri, M.B., B.S., Robert Schmicker, M.S., Jun Hwang, M.S., Chifundo B. Ndamala, Dip., Ajib Phiri, M.D., Norman Lufesi, M.Phil., and Susanne May, Ph.D. Aim To see if 3 day course of amoxicillin is non-inferior to a 5 day course of amoxicillin for children with pneumonia and chest indrawing (marker for severity) Rationale The WHO recommends a 5 day course of amoxicillin for paediatric pneumonia with indrawing and a 3 day regime if just fast breathing.…
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CRP to safely reduce antibiotic prescribing in paediatric outpatients
A review of some of the latest low-resources emergency medicine evidence Point of care CRP to reduce antibiotic prescribing without leading to worse outcomes. Safety and Efficacy of C-reactive Protein–guided Antibiotic Use to Treat Acute Respiratory Infections in Tanzanian Children: A Planned Subgroup Analysis of a Randomized Controlled Noninferiority Trial Evaluating a Novel Electronic Clinical Decision Algorithm (ePOCT) Kristina Keitel, Josephine Samaka, John Masimba, Hosiana Temba, Zamzam Said, Frank Kagoro, Tarsis Mlaganile, Willy Sangu, Blaise Genton, Valerie D’Acremont Aim To establish if CRP testing can improve clinical outcomes AND decrease antibiotic prescribing in children under 5. Rationale Fever and cough are common presenting complaints in low-resource settings; it is very difficult to reliably diagnose those with pneumonia who need…
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The COAST trial; High flow Vs low Flow Vs permissive hypoxia in children with pneumonia; A RCT.
A review of some of the latest low-resources emergency medicine evidence High flow vs low flow oxygen vs permissive hypoxia in children with pneumonia, an RCT. Randomised controlled trial of oxygen therapy and high-flow nasal therapy in African children with pneumonia Maitland, K., Kiguli, S., Olupot-Olupot, P. et al. Intensive Care Med 47, 566–576 (2021). https://doi.org/10.1007/s00134-021-06385-3 Aim To establish if high flow nasal oxygen can prevent mortality in children with pneumonia and to establish if any oxygen administration is beneficial in children with pneumonia and moderate hypoxia (80-91%) Rationale Pneumonia is a common killer in patients under 5. It is unclear whether oxygen can prevent acute deaths in these patients. It is also unclear…