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10.1016/j.acap.2009.02.002 http://scihub22266oqcxt.onion/10.1016/j.acap.2009.02.002 19450778/?report=reader!4394390!19450778     free     free     free Deprecated: Implicit conversion from float 211.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 211.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 211.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 211.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 211.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 211.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 245.2 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534       Acad+Pediatr 2009 ; 9 (3): 179-84 Nephropedia Template TP {{tp|p=19450778|t=2009. Antibiotic selection for purulent skin and soft-tissue infections in ambulatory care: a decision-analytic approach |pdf=|usr=}}{{19450778}} gab.com Text Antibiotic selection for purulent skin and soft-tissue infections in ambulatory care: a decision-analytic approach JO: Acad Pediatr http://www.kidney.de/pget.php?&tw=1&pmid=19450778 #FOAvip OBJECTIVE: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has caused a nationwide epidemic of skin and soft-tissue infections in ambulatory pediatrics. Antibiotic treatment recommendations suggest incorporating local epidemiology for the prevalence of CA-MRSA. We sought to identify the antibiotic strategy with the highest probability of activity and to identify threshold values for epidemiologic variables including bacterial prevalence and antibiotic resistance. METHODS: We used decision analysis to evaluate 3 empiric antibiotic strategies: clindamycin, trimethoprim/sulfamethoxazole (T/S), and cephalexin. We calculated the probability of activity against the bacteria causing the infection (CA-MRSA, methicillin-sensitive S. aureus and group A Streptococcus [GAS]) by incorporating estimates of prevalence and antibiotic resistance to determine the optimal strategy. Sensitivity analysis was used to identify thresholds for prevalence and antibiotic resistance where 2 strategies were equal. RESULTS: Clindamycin (0.95) and T/S (0.89) had substantially higher probability of activity than cephalexin (0.28) using baseline estimates for bacterial prevalence and antibiotic resistance. Cephalexin was the optimal antibiotic only when CA-MRSA prevalence was <10%. The probability of activity for clindamycin and T/S was highly sensitive to changes in the values for bacterial prevalence (both CA-MRSA and GAS) and CA-MRSA resistance to clindamycin. CONCLUSIONS: Empiric treatment of skin and soft-tissue infections with either clindamycin or T/S maximizes the probability that the antibiotic will be active when CA-MRSA prevalence is >10%. Deciding between T/S and clindamycin requires consideration of antibiotic resistance and prevalence of GAS. This model can be customized to local communities and illustrates the importance of ongoing epidemiologic surveillance in primary care settings. Twit Text FOAVip Antibiotic selection for purulent skin and soft-tissue infections in ambulatory care: a decision-analytic approach ????Acad Pediatr http://www.kidney.de/pget.php?&tw=1&pmid=19450778 #FOAvip Twit Text # Free Paper on # # # # # LINK http://www.kidney.de/pget.php?&tw=1&pmid=19450778 #FOAvip English Wikipedia <ref>{{Cite pmid|19450778}}</ref> Antibiotic selection for purulent skin and soft-tissue infections in ambulatory care: a decision-analytic approach #MMPMID19450778 Hersh AL; Weintrub PS; Cabana MD Acad Pediatr 2009[May]; 9 (3): 179-84 PMID19450778show ga OBJECTIVE: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has caused a nationwide epidemic of skin and soft-tissue infections in ambulatory pediatrics. Antibiotic treatment recommendations suggest incorporating local epidemiology for the prevalence of CA-MRSA. We sought to identify the antibiotic strategy with the highest probability of activity and to identify threshold values for epidemiologic variables including bacterial prevalence and antibiotic resistance. METHODS: We used decision analysis to evaluate 3 empiric antibiotic strategies: clindamycin, trimethoprim/sulfamethoxazole (T/S), and cephalexin. We calculated the probability of activity against the bacteria causing the infection (CA-MRSA, methicillin-sensitive S. aureus and group A Streptococcus [GAS]) by incorporating estimates of prevalence and antibiotic resistance to determine the optimal strategy. Sensitivity analysis was used to identify thresholds for prevalence and antibiotic resistance where 2 strategies were equal. RESULTS: Clindamycin (0.95) and T/S (0.89) had substantially higher probability of activity than cephalexin (0.28) using baseline estimates for bacterial prevalence and antibiotic resistance. Cephalexin was the optimal antibiotic only when CA-MRSA prevalence was <10%. The probability of activity for clindamycin and T/S was highly sensitive to changes in the values for bacterial prevalence (both CA-MRSA and GAS) and CA-MRSA resistance to clindamycin. CONCLUSIONS: Empiric treatment of skin and soft-tissue infections with either clindamycin or T/S maximizes the probability that the antibiotic will be active when CA-MRSA prevalence is >10%. Deciding between T/S and clindamycin requires consideration of antibiotic resistance and prevalence of GAS. This model can be customized to local communities and illustrates the importance of ongoing epidemiologic surveillance in primary care settings. |*Decision Support Techniques[MESH] |Ambulatory Care/*standards/trends[MESH] |Analysis of Variance[MESH] |Anti-Bacterial Agents/*therapeutic use[MESH] |Cephalexin/therapeutic use[MESH] |Child[MESH] |Child, Preschool[MESH] |Clindamycin/therapeutic use[MESH] |Community-Acquired Infections/diagnosis/drug therapy/epidemiology[MESH] |Drug Resistance[MESH] |Drug Utilization[MESH] |Female[MESH] |Humans[MESH] |Male[MESH] |Microbial Sensitivity Tests[MESH] |Multivariate Analysis[MESH] |Probability[MESH] |Sensitivity and Specificity[MESH] |Soft Tissue Infections/diagnosis/*drug therapy/epidemiology[MESH] |Staphylococcal Skin Infections/diagnosis/*drug therapy/epidemiology[MESH]Antibiotic selection for purulent skin and soft-tissue infections in a(epmc).pdf DeepDyve Pubget Overpricing