Expert opinion on pharmacotherapy
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Bacterial meningitis is still a major cause of death and disability in children worldwide. With the advent of conjugate vaccines against the three major pathogens, the burden of disease is increasingly concentrated in developing countries that cannot afford the vaccines. Antibiotic resistance is an increasing problem; in developed countries, high-level resistance to beta-lactams among Streptococcus pneumoniae necessitates the addition of vancomycin to third-generation cephalosporins. ⋯ Avoidance of secondary brain injury from hypoxia, hypotension, hypo-osmolarity and cerebral oedema, hypoglycaemia or convulsions is essential for a good outcome. The problem of bacterial meningitis will only be solved if protein-conjugate vaccines (or other effective vaccine strategies) against S. pneumonia, H. influenzae and epidemic strains of Neisseria meningitidis are available to all the world's children. Making third-generation cephalosporins affordable in the developing world is also a necessary intervention, but better antibiotics will not overcome the problems of poor access to hospitals and late presentation with established brain injury, and will inevitably bring further pressure for antimicrobial resistance.
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Expert Opin Pharmacother · Aug 2003
ReviewAntibiotic prophylaxis strategies in the prevention of ventilator-associated pneumonia.
Ventilator-associated pneumonia (VAP) is defined as a nosocomial pneumonia occurring > 48 h after endotracheal intubation. VAP may occur very early after intubation and it is usually defined as early-onset pneumonia, which occurs during the first 4 days. The occurrence of VAP is associated with an increase in morbidity and mortality. ⋯ Antibiotic prophylaxis strategies to prevent VAP can be administered over an extended period to cover all microorganisms using selective digestive decontamination regimens, or in a short-term course of no more than 24 h. Probably, the second strategy is the most useful in the prevention of VAP because it has a lower impact on the emergence of bacterial resistance. This manuscript aims to review current opinions regarding antibiotic prophylaxis strategies in the prevention of VAP.