Reviews of infectious diseases
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Outpatient parenteral treatment of infectious diseases has developed from primitive beginnings to its present state as the standard of care in many areas. The large infusion center described here is headed by physicians who specialize in infectious diseases and occupies a free-standing building where the pharmacy, laboratory, physicians' offices, examination rooms, and finance departments are centralized for efficiency, flexibility, and convenience. ⋯ Costs in the center run between 50% and 60% lower than those in the hospital. Reimbursement, although difficult in the past, has improved considerably, but some third-party payers, including Medicare, have not reimbursed for outpatient intravenous antibiotic therapy.
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Prompt administration of antibiotics is of the utmost importance in the treatment of wounds inflicted during a war or disaster. A single injection of a broad-spectrum drug with a long half-life should be given prophylactically to personnel on the battlefield to provide bactericidal coverage from the earliest possible moment after injury occurs. ⋯ Use of antimicrobial agents will never replace careful surgical debridement, and these drugs should be used again later only if a bacterial infection develops. Other considerations include the choice of a drug that penetrates tissue thoroughly, is simple to store and administer, is easily available, and is cost effective.
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Review Case Reports
Necrotizing tracheitis caused by Corynebacterium pseudodiphtheriticum: unique case and review.
The occasional pathogenicity of nondiphtheria corynebacteria in both immunocompetent and immunocompromised individuals is now well established. Previously described sites of infection include heart valves, wounds, urinary tract, and lungs. This report of necrotizing tracheitis caused by Corynebacterium pseudodiphtheriticum illustrates the widening spectrum of infections caused by these organisms. ⋯ Gram staining revealed gram-positive rods typical of corynebacteria, and cultures of tracheal tissue yielded C. pseudodiphtheriticum resistant to erythromycin and clindamycin. There was no clinical or laboratory evidence for exotoxin or cell-associated toxins. Treatment with intravenous penicillin resulted in resolution of the inflammatory process and eradication of the organisms, as assessed by subsequent cultures.
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Outpatient parenteral antibiotic therapy in a health maintenance organization (HMO), as carried out at the Lovelace Medical Center in Albuquerque, New Mexico, has been effective for ambulatory patients (who received their injections at one of the HMO facilities) and for nonambulatory patients (who were visited in their homes by members of the HMO's home health care team). Over a 17-month period, implementation of these procedures resulted in savings of as much as 73% per day over the costs for similar treatment of similar infections in hospitalized patients. The savings derived from treating nonambulatory patients were slightly less than those from treating ambulatory patients because of the costs for home health care personnel.