The Journal of infection
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The Journal of infection · Jul 1998
ReviewStrategies to rationalize sepsis management--a review of 4 years' experience in Dundee.
Hospitals worldwide are facing an unprecedented crisis of rising cost of antibacterials due to the increasing rapid emergence and dissemination of antibiotic-resistant organisms, improper use of antibiotics and the use of broad spectrum parenteral agents. The last 25 years has seen the introduction of many measures to improve the quality of sepsis management, and specifically antimicrobial use. The present paper reviews the development, implementation and evaluation of some of the key strategies employed within the Dundee Teaching Hospitals NHS Trust (DTHT) to enhance recognition and assessment of sepsis and to rationalize the early and often empiric antibiotic treatment of patients in hospital with infection. Particular emphasis is given to optimizing the use of expensive parenteral agents in conjunction with promotion of oral switch therapy where appropriate.
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The Journal of infection · Jan 1998
Review Practice Guideline GuidelineAntiviral prophylaxis and treatment in chickenpox. A review prepared for the UK Advisory Group on Chickenpox on behalf of the British Society for the Study of Infection.
Prophylactic intervention with varicella-zoster immunoglobulin early in the incubation period can prevent or attenuate the disease manifestations of varicella in susceptible contacts at high risk from this infection. Detailed guidelines are issued in the UK Department of Health publication on Immunization against Infectious Disease. Sensitive immunoassays are available for investigation of antibody status and subclinical seroconversion. ⋯ Oral aciclovir is only effective if begun with 24 h of onset of rash. With that proviso. it is recommended for treatment of varicella in otherwise healthy adults and adolescents, but not for routine use in children under 13 years of age unless they are sibling contacts or have other medical conditions. Aciclovir has a high therapeutic index and good safety profile, but caution is advised with use in pregnancy.
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Septic shock due to bacterial and other infections remains an increasing cause of hospital mortality and morbidity. Early recognition and prompt management with diagnostic evaluation, antimicrobial therapy, surgery when indicated and advanced life support undoubtedly saves many lives. ⋯ However, once shock and organ failure have become established the mortality remains high and has changed little in the last few years despite improvements in intensive management. A variety of other approaches to treatment are under investigation but as yet there are insufficient data to recommend their use.
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The status of rotavirus (RV) vaccines in 1990 is reviewed with particular reference to the range of RV strains which infect human beings as well as the antibody response and immunity to naturally acquired RV infections. The requirements for an ideal vaccine are stated and the various approaches towards developing RV vaccines are described. Results of various field trials are given and finally important questions are posed which remain to be addressed if success in producing an ideal vaccine is to be achieved.