Therapeutic Notes

⭕Healthcare-Associated Infections in Adults. ✅ Empiric antibiotic therapy for healthcare-associated intra-abdominal infections should be driven by local microbiologic results. ✅ To achieve empiric coverage of likely pathogens, multidrug regimens that include agents with expanded spectra of activity against gram-negative aerobic and facultative bacilli may be needed. These agents include meropenem, imipenem/cilastatin, piperacillin/ tazobactam, or metronidazole combined with either cefepime or ceftazidime. ✅ For multidrug-resistant aerobic gram-negative pathogens, aminoglycosides, colistin, polymyxin B, meropenem/vaborbactam, imipenem/relebactam, eravacycline, cefiderocol, ceftazidime/avibactam, or ceftolozane/tazobactam may be required. 🔰Therapeutic Notes🔰 🟡@WikipharmaDr 🟡

⭕High-Severity Community-Acquired Infections in Adults. ✅ The empiric use of antimicrobial regimens with broad-spectrum activity against gram-negative organisms including Pseudomonas spp., such as meropenem, imipenem/cilastatin, piperacillin–tazobactam, ciprofloxacin or levofloxacin in combination with metronidazole, or ceftazidime or cefepime in combination with metronidazole, is recommended for patients with high-severity, community-acquired intra-abdominal infection. ☑️Aztreonam plus metronidazole is an alternative, but addition of an agent effective against gram-positive is recommended. 🔰Therapeutic Notes🔰 🟡@WikipharmaDr 🟡

⭕ Community-Acquired Infections of Mild-to-Moderate Severity in Adults Antibiotics: ✅used for empiric treatment of community-acquired intra-abdominal infections should be active against enteric gramnegative aerobic and facultative bacilli and enteric gram-positive streptococci. ✅ For patients with mild-to-moderate, community-acquired infections, regimens with substantial anti-pseudomonal activity are not required. ✅ Empiric coverage of Enterococcus is not necessary in patients with mild-to-moderate community-acquired intra-abdominal infection. ✅ The use of agents listed as appropriate for high-severity, community-acquired infection and healthcare-associated infection is not recommended for patients with mild-to-moderate, community-acquired infection, because such regimens may carry a greater risk of toxicity and facilitate acquisition of more resistant organisms. 🔰Therapeutic Notes🔰 🟡@WikipharmaDr 🔴

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أنت لا تعلم معنى أن يرتكب في كل يوم مجزرة جديدة في حق قومٍ نازحين عزل؟؟ ذلك يعني أنه لا سبيل للنجاة مهما حالف الحظ أحدهم ونجا إلا أنه يعلم بأنه الشهيد القادم، إلا أنهم ما زالوا متمسكون بالحياة ينزحون إلى أماكن يعلمون أنها ستطالها يد العدو ما داموا فيها.. ذلك يعني أنه كتب على هذه الأرض أن تعيش أشد وأقسى ما يرتكب من جرائم، ذلك يعني أنهم عاشوا خذلانا دون وجود أي ذرة للأمل في نصرتهم إلا من الله، ذلك يعني مزيدا من الشهداء مزيدا من الأطفال التي ترقى أرواحهم الطريّة إلى بارئها، مزيدا من الجراح التي لا تشفى، مزيدا من النساء اللاتي يهاجرن إلى الله وقد كنّ يأملن أن يربين مزيدا من الشباب المجاهدين الشرفاء، مزيدا من الأشلاء التي لن تجد من يجمعها.. ذلك يعني مزيدا من القلق مع الشعور بالعجز قهرا حين لا نملك أن نصنع شيء من أجلهم نحن معشر الضعفاء الخانعون عند فهلوات ذواتنا و روتين ممل حد القرف، ذلك يعني مزيدا من الصمت، صمت يطبق أفواه ذوي القدرات، وأصحاب الجيوش المدججة التي حرمتها فرضية الحدود التي كانت من منجزات ذاك المحتل.. يا الله وحدك تملك تلك القدرة العجيبة في الانتقام، انتقم لنا منهم ياالله..! 💥

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In ACS management Loading dose of clopidogrel: Pre-PCI after fibrinolytic therapy: ✅300-mg LD if within 24 hr of event; ✅clopidogrel 600-mg LD if > 24 hr after event. Because : A 600-mg LD results in greater, more rapid, and more reliable platelet inhibition than a 300-mg LD. Loading dose of Aspirin : ✅Initiate 162–325 mg of ASA before PCI; after PCI, give 81 mg ASA • 2013 ACCF/AHA guideline for STEMI • 2021 AHA/ACC/SCAI Guideline for Coronary Artery Revascularization I I ✅Initiate 81–325 mg of non–enteric-coated ASA before PCI in patients already taking ASA; in patients not taking ASA, give 325 before PCI; after PCI, continue 81 mg ASA • 2014 NSTE-ACS guideline • 2021 AHA/ACC/SCAI Guideline for Cornonary Revascularization ⭕Ref. : ACCP 2023

⭕Management of hyponatremia🔆 ✅The initial goal of therapy for most patients with hyponatremia, based on the most recent European and American consensus guidelines, is to raise the serum sodium concentration by 5 mEq/L.8 ✅ Mild, asymptomatic hyponatremia (>125 mEq/L) can usually be safely managed with a sodium-containing oral rehydration solution or an increase in oral sodium intake, provided that the oral route is viable (ie, vomiting and diarrhea are controlled, evidence of functional gastrointestinal [GI] tract). ✅ IV sodium therapy is preferred in severe cases of hyponatremia or in patients with severe symptoms. In most cases, sodium chloride 0.9% is used, although the recent guidelines recommend using NaCl 3.0% in symptomatic patients. ✅ If a hypertonic saline solution (eg, ≥NaCl 3.0%) is used, it must be infused via a central venous catheter because of its high osmolarity. ✅The initial goal for treating acute hyponatremia is to prevent further decline in serum sodium concentration, reverse or prevent neurologic symptoms, and avoid excessive correction of serum sodium in patients at risk for osmotic demyelination syndrome. ✅ In patients with sodium concentration >120 mEq/L with no or mild symptoms, acute correction of serum sodium concentration may not be warranted. ✅ In symptomatic patients with serum sodium concentration <120 mEq, increase serum sodium by up to 4 to 6 mEq/L within 24 hours of baseline or until symptoms improve. ✅The risk of osmotic demyelination syndrome has been reported after correction by 9 mEq/L per day. ✅ Neurologic deficits would improve with this target rate of change in serum sodium concentration. ✅The average rate of increase in serum sodium should not exceed 1 to 2 mEq/L/hr and a total of 9 mEq/L in any given 24-hour period. ✅Excessive correction of serum sodium concentration during the course of treatment, and not just the first or second day, may result in osmotic demyelination syndrome. There is no evidence that the first day’s correction should be greater than on other days. There is no evidence that correction of serum sodium by >10 mEq/L in 24 h or 18 mEq/L in 48 hours improves outcomes in patients with acute or chronic hyponatremia..

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ESC..