Prevention of cardiac implantable electronic device infection
Antibiotic prophylaxis reduces the risk for cardiac implantable electronic device (CIED) infection, but whether administration of antibiotic therapy is beneficial beyond the preoperative period has not been known. A cluster randomized trial, involving more than 19,000 patients undergoing CIED procedures at 28 centers (including more than 12,000 “high-risk” patients) compared incremental treatment (preprocedural cefazolin and vancomycin, intraprocedural bacitracin pocket wash, and oral cephalexin for two days following the procedure) with conventional therapy (preprocedural cefazolin)*. There was no difference in the hospitalization rate for CIED infection within one year. Incremental perioperative antibiotics do not appear to confer benefit over conventional administration of preoperative antibiotic therapy for the prevention of CIED infection.
*Krahn AD, Longtin Y, Philippon F, et al. Prevention of Arrhythmia Device Infection Trial: The PADIT Trial. J Am Coll Cardiol. 2018 Dec 18;72(24):3098-3109.
Updated guidelines for antiretroviral use in pregnant women
The United States Department of Health and Human Services (DHHS) recently updated its guidelines on the use of antiretroviral agents in pregnant women with HIV infection*. Dolutegravir is newly listed as a preferred agent to initiate during the second and third trimester of pregnancy. However, the guidelines reiterate a conservative interim recommendation that dolutegravir not be initiated during the first trimester of pregnancy based on preliminary data from a study in Botswana raising concerns about a possible small increased risk of neural tube defects with maternal dolutegravir use around the time of conception. The recommendation will likely be clarified as further data become available.
* Department of Health and Human Services (HHS) Panel on Treatment of HIV-Infected Pregnant Women and Prevention of Perinatal Transmission. Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States. http://aidsinfo.nih.gov/guidelines/html/3/perinatal-guidelines/0/
Lactobacillus rhamnosus not effective in the treatment of acute gastroenteritis in young children
Previous meta-analyses have suggested that Lactobacillus rhamnosus shortens the duration of diarrhea in children with acute gastroenteritis. However, in two multicenter randomized placebo-controlled trials that included >1800 children age 3 to 48 months who presented to the emergency department with acute gastroenteritis, neither L. rhamnosus alone nor combined with Lactobacillus helveticus decreased the rate of moderate-to-severe gastroenteritis within 14 days, duration of diarrhea or vomiting, or the rate of unscheduled visits to a health care provider*. These findings do not support the use of L. rhamnosus for the treatment of acute gastroenteritis in young children.
*Freedman SB, Williamson-Urquhart S, Farion KJ, et al; PERC PROGUT Trial Group. Multicenter Trial of a Combination Probiotic for Children with Gastroenteritis. N Engl J Med. 2018 Nov 22;379(21):2015-2026.
*Schnadower D, Tarr PI, Casper TC, et al. Lactobacillus rhamnosus GG versus Placebo for Acute Gastroenteritis in Children. N Engl J Med. 2018 Nov 22;379(21):2002-2014.
Duration of IV therapy for infants with late-onset GBS bacteremia
For infants with group B streptococcal (GBS) bacteremia, a 10-day course of intravenous (IV) therapy is the standard, but a shorter course has been suggested by some experts. In a study based on data from an administrative database, rates of GBS disease recurrence were low overall in infants with uncomplicated late-onset (age ≥7 days) GBS bacteremia and were similar for those who received ≤8 days versus more prolonged IV antibiotic therapy*. These data should be interpreted with caution due to the inherent limitations of the dataset, which did not include robust clinical details. Additional prospective studies confirming these findings are needed before a shorter duration of IV therapy can be recommended. Given the established risk of recurrent GBS infection in neonates, we continue to suggest a 10-day course of IV antibiotic therapy for all neonates with GBS bacteremia.
* Coon ER, Srivastava R, Stoddard G, Wilkes J, Pavia AT, Shah SS. Shortened IV Antibiotic Course for Uncomplicated, Late-Onset Group B Streptococcal Bacteremia. Pediatrics. 2018 Nov;142(5).
Source: UpToDate, January 2019