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LIDOCAINE INFUSIONS FOR REFRACTORY CHRONIC MIGRAINE: A RETROSPECTIVE ANALYSIS
Patients with refractory chronic migraine have poor quality of life. Intravenous infusions are indicated to rapidly ‘break the cycle’ of pain. The records of 832 hospital admissions involving continuous multiday lidocaine infusions for migraine were reviewed. In total, 609 patient admissions met criteria for refractory chronic migraine. Median pain rating decreased from baseline of 7.0 (5.0–8.0) to 1.0 (0.0–3.0) at end of hospitalization (p<0.001)
Lidocaine infusions may be associated with short-term and medium-term pain relief in refractory chronic migraine.
Full Access: BMJ
ASSOCIATION OF INAPPROPRIATE OUTPATIENT PEDIATRIC ANTIBIOTIC PRESCRIPTIONS WITH ADVERSE DRUG EVENTS AND HEALTH CARE EXPENDITURES
In this cohort study of more than 2.8 million children with commercial insurance, inappropriate antibiotics were associated with increased risk of several adverse drug events (eg, Clostridioides difficile infection, severe allergic reaction) and generally higher 30-day all-cause attributable expenditures. These findings highlight the individual- and national-level consequences of inappropriate antibiotic prescribing and further support implementation of outpatient antibiotic stewardship programs.
Full Access: JAMA
ALKALINE URINE IN THE EMERGENCY DEPARTMENT PREDICTS NITROFURANTOIN RESISTANCE
A single health system database of emergency department patients aged >18 years and older who received urinalysis between April 18, 2014, and March 7, 2017 were included in this study.
Of 67,271 urine samples analyzed, 13,456 samples grew a single bacterial species. Urine cultures growing the Proteeae group were associated with significantly more alkaline urine than other bacteriuria cultures (odds ratio [OR] 2.20, 95% confidence interval [CI] 2.06-2.36; p < 0.001). Urine pH of 8 or higher is associated with high rates of nitrofurantoin resistance.
Full Access: Pubmed
A PREDICTION MODEL FOR PEDIATRIC RADIOGRAPHIC PNEUMONIA
A single-center prospective study of patients 3 months to 18 years of age with signs of lower respiratory infection who received a CXR for suspicion of CAP was conducted. Radiographic CAP was identified in 253 (22.2%) of 1142 patients. A predictive model including age, fever duration, and decreased breath sounds has excellent discrimination for radiographic CAP. After external validation, this model may facilitate decisions around CXR or antibiotic use in CAP.
Full Access: Pubmed