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dinsdag 17 oktober 2017

The Lancet: [Review] Antimicrobial resistance among children in sub-Saharan Africa

[Review] Antimicrobial resistance among children in sub-Saharan Africa
Antimicrobial resistance is an important threat to international health. Therapeutic guidelines for empirical treatment of common life-threatening infections depend on available information regarding microbial aetiology and antimicrobial susceptibility, but sub-Saharan Africa lacks diagnostic capacity and antimicrobial resistance surveillance. We systematically reviewed studies of antimicrobial resistance among children in sub-Saharan Africa since 2005. 18 of 1075 articles reviewed met inclusion criteria, providing data from 67 451 invasive bacterial isolates from inconsistently defined populations in predominantly urban tertiary settings.
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[Comment] An effective and safe vaccine will not be enough to prepare us for the next Ebola outbreak
In The Lancet Infectious Disease, Pierre-Stéphane Gsell and colleagues1 present safety and efficacy data on the deployment of the rVSV-ZEBOV vaccine during an outbreak of Ebola virus disease in Guinea, 2016. On March 17, 2016, almost 3 months after Guinea was first declared Ebola virus disease-free, two new cases of Ebola virus disease were confirmed.2 Fortunately, members of the Ebola Ça Suffit! team were meeting in the capital, Conakry. Less than 1 week after the first cases were confirmed, the previously trained team members travelled to the epicentre of the flare and began the process of identifying contacts and contacts of contacts for vaccination.
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[Comment] Procalcitonin and antibiotic use: imperfect, yet effective
The overwhelming burden of acute respiratory infections is undeniable. An estimated 2·74 million people died of lower respiratory tract infections in 2015 worldwide.1 Despite being commonly caused by viruses, antibiotics are often used to treat these diseases. In the USA, around 40 million outpatients received antibiotics for respiratory infections in 2007–09.2,3
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[Articles] Effect of procalcitonin-guided antibiotic treatment on mortality in acute respiratory infections: a patient level meta-analysis
Use of procalcitonin to guide antibiotic treatment in patients with acute respiratory infections reduces antibiotic exposure and side-effects, and improves survival. Widespread implementation of procalcitonin protocols in patients with acute respiratory infections thus has the potential to improve antibiotic management with positive effects on clinical outcomes and on the current threat of increasing antibiotic multiresistance.
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[Corrections] Corrections
Cooper AJR, Dholakia S, Holland CV, Friend PJ. Helminths in organ transplantation. Lancet Infect Dis 2017; 17: e166–76—In this Review, diethylcarbamazine, not doxycycline, should have been stated as effective for the control of Loa loa microfilaraemia. This correction has been made to the online version as of Oct 16, 2017.
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