Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Oct 2014
Review Meta AnalysisProphylaxis for Pneumocystis pneumonia (PCP) in non-HIV immunocompromised patients.
Pneumocystis pneumonia (PCP) is a disease affecting immunocompromised patients. PCP among these patients is associated with significant morbidity and mortality. ⋯ Given an event rate of 6.2% in the control groups of the included trials, prophylaxis for PCP using trimethoprim/sulfamethoxazole is highly effective among non-HIV immunocompromised patients, with a number needed to treat to prevent PCP of 19 patients (95% CI 17 to 42). Prophylaxis should be considered for patients with a similar baseline risk of PCP.
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Cochrane Db Syst Rev · Oct 2014
ReviewAntibiotics prior to amniotomy for reducing infectious morbidity in mother and infant.
Amniotomy (the deliberate rupture of membranes) was described almost two centuries ago and since then has been used both for induction and augmentation of labour - which are common obstetric practices. Trends have shown a rise in the induction rates over the last decade and data suggest that the rate of labour inductions is increasing faster than the rate of pregnancy complications. Recent years have seen the emergence of a variety of other methods of induction of labour but amniotomy combined with oxytocin infusion remains the most commonly used method of augmentation of labour. The newer agents for induction are expensive and in resource-poor settings amniotomy is still the chosen method for both induction and augmentation.As with any invasive procedure amniotomy can lead to infection, ascending from the vagina into the uterine cavity and can contribute significantly to both maternal and neonatal infectious morbidity. ⋯ High-quality trials are needed to justify or refute the routine use of antibiotics at amniotomy for prevention of infection in the mother and infant.Future studies should be conducted, especially in resource-constrained settings where amniotomy is still used as a means of induction of labour, in order to evaluate the routine use of antibiotics at amniotomy in these settings. Future research in this area should include important maternal and infant outcomes listed in this review and also consider cost effectiveness and side effects of antibiotic use, including the emergence of antibiotic-resistant strains.