Chest radiography in tb detection (WHO)
WHO. Chest radiography in tuberculosis detection – Summary of current WHO recommendations and guidance on programmatic approaches
The document is a consolidated summary of WHO recommendations on the use chest radiography (CXR) in TB detection and guidance on programmatic approaches to use CXR within primary care services. CXR is an essential tool for the early detection of TB, and therefore fundamental to achieve the targets set out in WHO’s End TB Strategy. Innovation to end TB begins by maximizing the use of the tools we have, while stimulating new ones. Effective use of chest radiography provides an opportunity to rapidly reach more people ill with TB. The document also describes new technological developments in CXR, such as computer aided detection of TB (CAD) that holds promise for future use but needs to be further evaluated before WHO guidance is developed. The document provides guidance in the following areas: Chest radiography as a triage tool. Chest radiography as a diagnostic aid. Chest radiography as a screening tool. Technical specification, quality assurance and safety. Strategic planning for use of CXR in national TB control. The document was reviewed and finalized based on a WHO expert consultation. The experts also scoped the evidence on computer aided detection of TB. Computer aided detection (CAD) software can analyze digital CXR images for abnormalities associated with pulmonary TB.
The document is available here!
Antibiotics for Smaller Skin Abscesses
This week WAidid suggests the article A Placebo-Controlled Trial of Antibiotics for Smaller Skin Abscesses, recently published on the NEJM.
SUMMARYUncomplicated skin abscesses are common. Staphylococcus aureus (S. aureus), including methicillin-resistant S. aureus (MRSA) strains, causes most of skin infections. Clindamycin and trimethoprim–sulfamethoxazole (TMP-SMX) are recommended for outpatient treatment of these infections, but data on their safety and efficacy are limited.The authors report the results of their multicenter, prospective, randomized, double-blind, placebo-controlled clinical trial. Between May 2009 and January 2015, 786 outpatients participants with a single skin abscess, 5 cm in diameter or smaller, were randomly assigned to receive, in a 1.1:1 ratio, oral clindamycin (266 patients), TMP-SMX (263 patients) or placebo (257 patients) for 10 days, in addition to incision and drainage. 281 (35.8%) of the subjects enrolled were children. A total of 343 participants were fully adherent to the study regimen.S. aureus was isolated in 527 (67.0%), MRSA in 388 (49.4%), coagulase-negative staphylococci in 104 (13.2%), streptococcus species in 54 (6.9%), and other organisms in 118 (15.0%). The rates of clinical cure were 83.1% in the clindamycin group, 81.7% in the TMP-SMX group, both significantly higher than that of placebo group (P< 0.001), with no differences between the two treatment groups. This beneficial effect was restricted to participants with S. aureus infection. Children had a significantly higher cure rate with clindamycin than with TMP-SMX or placebo, greater than that seen among adults. Clindamycin may be more effective than TMP-SMX in preventing recurrences or new infections, after completion of therapy, particularly in children: the difference in the rates of interval or recurrent infections, between the TMP-SMX and clindamycin groups, was significant (P = 0.03), but the difference, between the placebo and clindamycin groups and the difference between the placebo and TMP-SMX groups, were not significant. The rate of treatment-associated adverse events was higher in the clindamycin group than in the TMP-SMX group or in the placebo group. The most common adverse events were diarrhea and nausea.The authors conclude that short-term outcomes, among patients with uncomplicated cutaneous abscesses, particularly those caused by S. aureus, are improved by antibiotic treatment with either clindamycin or TMP-SMX in addition to abscess incision and drainage, but that this benefit must be weighed against the known side-effect profile of these antimicrobials.
AUTHORS: Robert S. Daum, Loren G. Miller, Lilly Immergluck, Stephanie Fritz, C. Buddy Creech, David Young, Neha Kumar, Michele Downing, Stephanie Pettibone, Rebecca Hoagland, Samantha J. Eells, Mary G. Boyle, Trisha Chan Parker, and Henry F. Chambers
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