No abstract available.
Antibiotic Prophylaxis

Background: Post-exposure prophylaxis (PEP) is the most important means of preventing rabies. Intradermal PEP was developed to improve compliance, still, many recipients fail to complete this regimen Objective: To determine the non-monetary factors contributing to non-compliance to PEP among patients in the Animal Bite Treatment Center (ABTC) of San Lazaro Hospital (SLH). Methods: This was an analytical, cross-sectional study. The authors randomly reviewed patient records of SLH-ABTC for one-year period. We characterized the cases according to World Health Organization (WHO) parameters. They determined the day intervals between exposure, first consultation, PEP initiation and follow-up visits. Statistical analyses used were descriptive statistics, χ2 test for independence and binary logistic regression. Results: The authors evaluated 667 records. Patients mostly had Category III exposures (76.91%, 95%CI: 73.92%80.62%). The chances of completing active immunization were more likely among patients exposed to unvaccinated animals (OR=1.85, 95%CI: 1.21-2.84, p=0.004). The chances of receiving passive immunization were higher for injuries on the head/neck regions (OR=8.18, 95%CI: 2.4-27.9, p=0.001). Overall, compliance to PEP was 70.21% and 40.70% for Categories II and III exposures, respectively. PEP compliance was moderately dependent on the exposure category (χ2=38.14, df=1, p<0.001, φ=0.25. Conclusion Category II exposure patients had better compliance than Category III, since rabies immunoglobulins are not required. The authors did not identify any factors that significantly affected Category II regimen compliance. Among Category III patients, compliance was better if the injuries were bite-inflicted while those who were exposed from “healthy”looking animals were less likely to comply.
Rabies ; Post-Exposure Prophylaxis

Objectives: Leprosy is an infectious disease affecting the skin and nerves caused by Mycobacterium leprae. Closer physical distance was found to increase risk transmission. Thus, targeted provision of prophylactic medications to household contacts of patients with leprosy could possibly aid in decreasing its incidence in a cost-effective manner. This study aimed to determine the attitudes towards disclosure of the diagnosis of leprosy and acceptance of immuno- and chemoprophylaxis for household contacts of patients undergoing treatment in a dermatology outpatient clinic of a tertiary hospital in the Philippines. Methods: We conducted a prospective, single-center, cross-sectional and mixed methods study at a dermatology clinic of a tertiary hospital. All diagnosed leprosy patients, household contacts of leprosy patients, and individuals with no leprosy and no known contact with a leprosy case were invited. Eligible participants who gave consent were included in the cross-sectional survey, followed by in-depth interviews of selected participants. STATA 12 was used to analyze the data. Descriptive statistics were used to summarize information. Chi-square was computed to obtain a measure of association of important variables. The field notes and the verbatim transcriptions of the interviews and narratives were filed using an analytic memo system. Results: Fifty-five participants (22 Hansen’s disease patients, 13 household contacts, and 20 individuals unaffected by and unexposed to leprosy) were enrolled. Mean age of respondents was 38 years, 60% were female, and 85% were living in an urban setting. Majority of the patients with leprosy were borderline lepromatous (45%) to lepromatous type (27%) with mean treatment duration of 13 months. Overall, the respondents were willing to disclose the diagnosis of leprosy to their household members to facilitate provision of prophylaxis. They were also generally willing to receive prophylaxis despite potential side effects, expense, incomplete protection, and the need for yearly assessment for the development of leprosy. All respondents felt hopeful about the availability of medications that can prevent the development of leprosy and its complications, with some feeling anxious and only a few being embarrassed about receiving them. Conclusions Prophylactic medications were found to be generally acceptable despite some concerns. There is also a willingness to disclose the diagnosis of leprosy to facilitate the targeted provision of prophylaxis to household contacts.
Leprosy ; Post-Exposure Prophylaxis ; Attitude

Domestic human hydrophobia has not been reported since the one case of 2004 in South Korea, but still a few animal rabies occur persistently since the reemerging stage of rabies from 1993. The government has made efforts to control animal rabies in many aspects, but whether prophylactic strategy for human hydrophobia is performed adequately is in question. The rate of proper post-exposure prophylaxis for animal bite case in 'high-risk region' of rabies is very low with 20% between 2011 and 2013. The National Animal Bite Patient Surveillance targeting 'high-risk region' is missing out animal bite cases who visit directly to hospitals in 'suspect-risk region' of rabies. Little data seems to exist for pre-exposure prophylaxis of domestic hydrophobia. Danger of reoccurrence of human hydrophobia always remain in South Korea. The medical personnel needs to have greater interest on the matter and the government strengthen the management system.
Animals ; Humans ; Korea ; Post-Exposure Prophylaxis ; Rabies*

Humans ; HIV Infections/prevention & control* ; Pre-Exposure Prophylaxis

Background. Preterm infants with very low birth weight are at increased risk of invasive fungal infections. Preventive strategies are needed to improve their clinical course and survival.

Objectives. To assess the efficacy and safety of antifungal agents as prophylaxis in controlling invasive fungal infection and mortality in very low birth weight (VLBW) and extremely low birth weight (ELBW) infants in neonatal intensive care units.

Methods. We searched MEDLINE (PubMed), Cochrane databases, Google Scholar, Trip database, Herdin, and ClinicalTrials.gov without language restriction and publications from January 1988 to May 2021. We included randomized controlled trials or controlled clinical trials that compared the effect of prophylactic oral or systemic antifungal agents versus placebo in preterm infants < 37 weeks age of gestation and with birth weight lower than 1500 grams. We conducted a meta-analysis using RevMan 5.4.1 and certainty of evidence rating using GRADEpro software.

Results. A total of 14 studies (including 3,001 preterm infants with VLBW) were included. We found that prophylactic use of nystatin significantly reduced the incidence of invasive fungal infections (IFI) (pooled RR 0.16; 95% CI 0.11, 0.23; 4 RCTs, N = 1295; P < 0.00001; moderate certainty evidence) in preterm infants compared to placebo but had no significant effect on the mortality (RR 0.87; 95% CI 0.62, 1.23; 4 RCTs, N = 1295; P = 0.43; low certainty evidence). Similarly, fluconazole decreased the incidence of IFI (RR 0.38; 95% CI 0.28, 0.53; P = 0.02) and showed statistically significant reduction in mortality (RR 0.78; 95% CI 0.61, 0.99; RCTs, N = 1484; P = 0.04; high certainty evidence). The comparison of the two antifungals showed a trend favoring fluconazole, however the difference was not statistically significant in decreasing IFI (RR 1.60; 95% CI 0.68, 3.77; P = 0.28) and mortality (RR 1.62; 95% CI 0.76, 3.45; P = 0.21).

Conclusion. Administration of antifungal prophylaxis proves to be beneficial and can probably decrease invasive fungal infection and mortality. The evidence showed that Fluconazole is superior as antifungal prophylaxis compared to placebo while there is no significant difference between fluconazole and nystatin in decreasing fungal infection and mortality among preterm neonates.

Anti-Bacterial Agents ; therapeutic use ; Antibiotic Prophylaxis ; Humans ; Intraoperative Care

There are many evidence-based methods to prevent human immunodeficiency virus (HIV) transmission. This review describes recent updates on the prevention of HIV infection via sexual contact, mother-to-child transmission, and occupational exposure. The use of antiretroviral therapy to prevent HIV has been a major accomplishment. Successful strategies for preventing the sexual transmission of HIV include the implementation of treatment for prevention, pre-exposure prophylaxis, and microbicides. Mother-to-child HIV transmission can be minimized by screening and administering pre-, intra-, and postpartum prophylaxis. Adherence to universal precautions and post-exposure prophylaxis are effective preventive measures for occupational exposure. The implementation of prevention strategies based on scientific evidence should decrease the spread of this epidemic.
Acquired Immunodeficiency Syndrome ; Anti-Infective Agents ; HIV Infections* ; HIV* ; Mass Screening ; Occupational Exposure ; Post-Exposure Prophylaxis ; Postpartum Period ; Pre-Exposure Prophylaxis ; Universal Precautions

Endoscopic treatment is a minimally invasive treatment for managing patients with vesicoureteral reflux (VUR). Although several bulking agents have been used for endoscopic treatment, dextranomer/hyaluronic acid is the only bulking agent currently approved by the U.S. Food and Drug Administration for treating VUR. Endoscopic treatment of VUR has gained great popularity owing to several obvious benefits, including short operative time, short hospital stay, minimal invasiveness, high efficacy, low complication rate, and reduced cost. Initially, the success rates of endoscopic treatment have been lower than that of open antireflux surgery. However, because injection techniques have been developed, a recent study showed higher success rates of endoscopic treatment than open surgery in the treatment of patients with intermediate- and high-grade VUR. Despite the controversy surrounding its effectiveness, endoscopic treatment is considered a valuable treatment option and viable alternative to long-term antibiotic prophylaxis.
Antibiotic Prophylaxis ; Endoscopy ; Humans ; Length of Stay ; Operative Time ; United States Food and Drug Administration ; Vesico-Ureteral Reflux

BACKGROUND AND AIMS: Prophylactic antibiotics are used in an attempt to avoid the septic complications of endoscopic retrograde cholangiopancreatography (ERCP). But, there is individual tendency to choose prophylactic antibiotics due to a lack of definite guidelines for prophylactic antibiotics. Therefore, the effectiveness of ciprofloxacin to prevent post ERCP infectious complications was evaluated. METHODS: One hundred patients underwent 75 diagnostic ERCPs and 25, therapeutic ERCPs. They were classified randomly into a group of 51 prophylaxis (ciprofloxacin 200 mg i.v. 30 min before the procedure) and 49 controls. Pre- and post-ERCP blood cultures were prospectively performed and surveyed for infectious complications. RESULTS: Sepsis was detected in 4 patients in each group (p>0.05). Two cases were related to diagnostic ERCP and the remaining six cases, therapeutic ERCP (p<0.01). Bacteremia was found in 6 cases, but only two cases (Escherichia coli, Citrobacter freundii) were clinically significant. CONCLUSIONS: The frequency of sepsis following ERCP was not significantly reduced by antibiotic prophylaxis (7.8% vs. 8.2%).
Anti-Bacterial Agents ; Antibiotic Prophylaxis* ; Bacteremia ; Cholangiopancreatography, Endoscopic Retrograde* ; Ciprofloxacin ; Citrobacter ; Humans ; Prospective Studies ; Sepsis