Updates to Treatment Guidelines
November 2011
First Guidelines for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy. 11/10/2011. The American College of Cardiology and the American Heart Association have published the first guidelines for the diagnosis and treatment of hypertrophic cardiomyopathy (HCM), which recommend genetic testing in patients with atypical presentation of HCM (class I, level of evidence B) and may be considered to identify first-degree family members at risk of the disease (class IIa, level B). Genetic testing to assess the risk of sudden cardiac death in patients with HCM however, was considered less certain (class IIb, level B), and in those with pathogenic mutations but without the HCM phenotype, the guidelines recommend (class I, level B) serial ECG, transthoracic echocardiography (TTE), and clinical assessments at periodic intervals depending on age.
Complete Guidelines: AMA
Source: Medpage Today
October
2011
New Guidelines
for Community-Acquired Pneumonia in Infants and Children.10/01/2011. New guidelines have been prepared regarding site-of-care
management, diagnosis, antimicrobial and adjunctive surgical therapy, and
prevention of community-acquired pneumonia in infants and children who are
otherwise healthy. Source: CID
May 2011
Uncomplicated Urinary Tract Infection Guidelines Update. The Infectious Diseases Society of America has updated the
Uncomplicated Urinary Tract Infection
Guidelines with a focus on the treatment
of premenopausal, non-pregnant women with acute uncomplicated cystitis
and pyelonephritis. The
issues of in vitro resistance prevalence and the ecological adverse effects of
antimicrobial therapy were
considered as important factors in making optimal treatment choices. See updated guidelines: CID
April 2011
Guidelines for the Management of
Unstable Angina/Non-ST-Elevation Myocardial Infarction Updated. 3/28/2011. The American College of Cardiology (ACC) and the
American Heart Association (AHA) have released updated guidelines on the
management of patients with unstable angina and related non-ST-elevation
myocardial infarction (NSTEMI).
The writing committee focuses on certain areas which have had major advances in
the past three years, which include the timing of acute interventional therapy,
the timing, duration and application of dual antiplatelet therapy and triple antiplatelet
therapy, two thienopyridines that can be used as one of the two agents in dual
antiplatelet therapy, and The role and potential benefit of invasive therapies
in patients with advanced renal dysfunction.
Source: AHA
Full Article: AHA
March 2011
Updated Prescribing Guidelines for Serevent Diskus (salmeterol xinafoate inhalation powder). Manufacturer GlaxoSmithKline is advising physicians of updated prescribing guidelines for Serevent Diskus (salmeterol xinafoate inhalation powder) used to treat asthma. Updated guidelines include the following: Serevent Diskus should be used only as concomitant therapy with a long-term asthma control medication in patients aged 4 years and older who are inadequately controlled on a long-term asthma control medication alone; once asthma control is achieved and maintained, assess the patient at regular intervals and step down therapy, as there is an increased risk of asthma-related death in patients taking long-acting beta 2-adrenergic agonists (LABAs) such as salmeterol, the active ingredient in Serevent Diskus. Source: AAP
February 2011
Heart Disease Prevention Guidelines for Women Updated. 2/15/2011. Heart diseases prevention guidelines have been updated to consider personal and socioeconomic factors, as well as illnesses that increase heart disease risk in women, such as lupus, rheumatoid arthritis and pregnancy complications. Source: AHA
Updated Recommendations for Atrial Fibrillation Include Dabigatran. 2/14/2011. Updated guidelines for atrial fibrillation patients now include the newly approved drug dabigatranas a useful alternative to warfarin to prevent related stroke and blood clots in patients with either paroxysmal (recurrent episodes that stop after seven days) or permanent (an on-going episode) atrial fibrillation, and with risk factors for stroke or blood clotting who do not have a prosthetic heart valve, significant heart valve disease, severe renal failure or advanced liver disease. Source: AHA
January 2011
Widespread Screening and Routine Ultrasound for Blocked Neck Arteries Not Necessary.1/31/2011. New guidelines have determined that widespread screening or routine ultrasound for blocked neck arteries doesn't show sufficient evidence of benefit and isn't necessary unless patient has several risk factors. The guidelines also note that both carotid endarterectomy and carotid stenting are reasonable and effective ways to treat blocked neck arteries. Source: AHA
Updated Recommendations for Tdap Use. 1/14/2011. In October 2010, the Advisory Committee on Immunization Practices (ACIP) recommended expanded use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) vaccination. ACIP recommends a single Tdap dose for persons aged 11 through 18 years who have completed the recommended childhood diphtheria and tetanus toxoids and pertussis/diphtheria and tetanus toxoids and acellular pertussis (DTP/DTaP) vaccination series and for adults aged 19 through 64 years. ACIP also approved the use of Tdap regardless of interval since the last tetanus- or diphtheria-toxoid containing vaccine, in certain adults aged 65 years and older, and in undervaccinated children aged 7 through 10 years. Source: CDC
December 2010
Updated Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women. 12/17/2011. A Panel of International Experts was convened by the Infectious Diseases Society of America (IDSA) in collaboration with the European Society for Microbiology and Infectious Diseases (ESCMID) to update the 1999 Uncomplicated Urinary Tract Infection Guidelines by the IDSA. The focus of this work is treatment of women with acute uncomplicated cystitis and pyelonephritis, diagnoses limited in these guidelines to premenopausal, non-pregnant women with no known urological abnormalities or co-morbidities. The issues of in vitro resistance prevalence and the ecological adverse effects of antimicrobial therapy (collateral damage) were considered as important factors in making optimal treatment choices and thus are reflected in the rankings of recommendations. See full guidelines at: CID
13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Recommendations. 12/10/2010. The Advisory Committee on Immunization Practices (ACIP) has approved new recommendations for the use of 13-valent pneumococcal polysaccharide-protein conjugate vaccine (PCV13) which was approved in February 2010 for the prevention of invasive pneumococcal disease (IPD) and otitis media in children aged 6 weeks to 71 months. Recommendations include routine vaccination of all children aged 2-59 months, vaccination of children aged 60-71 months with underlying medical conditions, and vaccination of children who received more than one dose of PCV7 previously. Recommendations also are provided for targeted use of the 23-valent pneumococcal polysaccharide vaccine (PPSV23) in children aged 2-18 years with underlying medical conditions that increase their risk for contracting pneumococcal disease or experiencing complications of pneumococcal disease if infected. Source:CDC
November 2010
American Heart Association & American Stroke Association Guidelines for the Prevention of Stroke in Patients with Stroke or Transient Ischemic Attack. The American Heart Association and American Stroke Association are providing evidence-based recommendations to prevent ischemic stroke among survivors of ischemic stroke or transient ischemic attack, the control of risk factors, interventional approaches for atherosclerotic disease, antithrombotic treatments for cardioembolism, the use of antiplatelet agents for noncardioembolic stroke, and the prevention of recurrent stroke in a variety of other specific circumstances, including arterial dissections; patent foramen ovale; hyperhomocysteinemia; hypercoagulable states; sickle cell disease; cerebral venous sinus thrombosis; stroke among women, particularly with regard to pregnancy and the use of postmenopausal hormones; the use of anticoagulation after cerebral hemorrhage; and special approaches to the implementation of guidelines and their use in high-risk populations.
See full guidelines at: AHA
2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science. The 2010 AHA Guidelines for CPR and ECC are based on the 2010 ILCOR International Consensus on CPR and ECC Science With Treatment Recommendations. 356 resuscitation experts from 29 countries experts produced 411 scientific evidence reviews on 277 topics in resuscitation and emergency cardiovascular care during the 36-month evidence evaluation process, which included structured evidence evaluation, analysis, cataloging of the literature, and rigorous disclosure and management of potential conflicts of interest, which are detailed in Part 2. The recommendations in the 2010 Guidelines confirm the safety and effectiveness of many approaches, acknowledge ineffectiveness of others, and introduce new treatments based on intensive evidence evaluation and consensus of experts. These new recommendations do not imply that care using past guidelines is either unsafe or ineffective, and it is important to note that they will not apply to all rescuers and all victims in all situations and the leader of a resuscitation attempt may need to adapt application of these recommendations to unique circumstances.
Part 1: AHA Executive Summary
Part 2: Evidence Evaluation and Management of Potential or Perceived Conflicts of Interest
Part 3: Ethics
Part 4: CPR Overview
Part 5: Adult Basic Life Support
Part 6: Electrical Therapies
Part 7: CPR Techniques and Devices
Part 8: Adult Advanced Cardiovascular Life Support
Part 9: Post-Cardiac Arrest Care
Part 10: Acute Coronary Syndromes
Part 11: Adult Stroke
Part 12: Cardiac Arrest in Special Situations
Part 13: Pediatric Basic Life Support
Part 14: Pediatric Advanced Life Support
Part 15: Neonatal Resuscitation
Part 16: Education, Implementation, and Teams
Part 17: 2010 American Heart Association and American Red Cross Guidelines for First Aid
October 2010
Statins Being Conidered for All Men Over 55 Years. 10/01/2010. A recent study suggests that it would be cost-effective for all men over the age of 55, including lower-risk populations, to take statin medications (Lipitor, Crestor) to prevent heart attacks. Although the analysis indicates that such guidelines would be more cost-effective than screening atients for high levels of C-reactive protein, lead study author Dr. Keane Lee acknowledges limits to the study, which must first be taken into account. Source:NLA
July 2010
IDSA Guidelines Update: Intra-Abdominal Infection. These guidelines, recommended and endorsed by the American Society for Microbiology, American Society of Health System Pharmacists, Pediatric Infectious Diseases Society, and Society of Infectious Diseases Pharmacists contain evidence-based recommendations for the diagnosis and treatment of intra-abdominal infection in both adult and pediatric patients. The guidelines define the severity scoring system, and therefore course of treatment, for these patients. Source: IDSA
May 2010
IDSA Clinical Practice Guidelines Update: Clostridium difficile Infection in Adults. 05/2010. This guideline is designed to improve the diagnosis and management of Clostridium difficile infection (CDI) in adult patients. A case of CDI is defined by the presence of symptoms (usually diarrhea) and either a stool test positive for C. difficile toxins or toxigenic C. difficile, or colonoscopic or histopathologic findings revealing pseudomembranous colitis. Summary: Updates related to use of PCR and other C. diff testing methods. Treatment: 1) Metronidazole is the drug of choice for the initial episode of mild-to-moderate CDI. The dosage is 500 mg orally 3 times per day for 10-14 days. (A-I); 2) Vancomycin is the drug of choice for an initial episode of severe CDI. The dosage is 125 mg orally 4 times per day for 10-14 days. (B-I); 3) Vancomycin administered orally (and per rectum, if ileus is present) with or without intravenously administered metronidazole is the regimen of choice for the treatment of severe, complicated CDI. The vancomycin dosage is 500 mg orally 4 times per day and 500 mg in approximately 100 mL normal saline per rectum every 6 hours as a retention enema, and the metronidazole dosage is 500 mg intravenously every 8 hours. (C-III). Source: IDSA
AHA/ACCF Advisory Released: TZD Drugs and Cardiovascular Risks. The purpose of this science advisory is to summarize the currently available data concerning thiazolidinediones (TZD) and cardiovascular risk, with a focus on ischemic heart disease (IHD) events, and to provide practical recommendations to healthcare workers seeking to minimize the burden of cardiovascular disease (CVD) and other complications in their patients with type 2 diabetes mellitus. Summary of Recommendations: 1) Identification and treatment of correctable risk factors (smoking cessation, high-quality diet, weight control, and exercise); 2) Use of established secondary prevention strategies (aspirin (or clopidogrel in patients intolerant of aspirin), lipid lowering, with statins as the first-line therapy, blood pressure lowering); 3) Early and consistent attention to controlling hyperglycemia while avoiding hypoglycemia (metformin is generally first-line therapy, particularly in obese patients, TZD should not be used with an expectation of benefit with respect to IHD events, insufficient data exist to support the choice of pioglitazone over rosiglitazone, and TZD increase the risk of heart failure and should not be initiated in patients with class III/IV CHF). Source: Circulation
April 2010
NGC: Guideline Update - ASPEN Enteral Nutrition Practice Recommendations. 04/05/2010. This summary provides practice recommendations for appropriate and safe administration of medications in patients receiving enteral feedings. Each recommendation is graded base don the available evidence. Source: NGC
February 2010
New AHA Guidelines: Prevention of Torsade de Pointes in the Hospital Setting. 02/22/2010. The purpose of this scientific statement is to raise awareness among those who care for hospitalized patients about the risk, ECG monitoring, and management of drug-induced long-QT syndrome that can result in cardiac arrest from torsade de pointes (TdP). Source: AHA
NGC: Guideline Synthesis - Prevention of VTE Following Total Hip and Knee Replacement. 02/15/2010. The National Guideline Clearinghouse released its summary comparing the guidelines from the American College of Chest Physicians (ACCP), American Academy of Orthopaedic Surgeons (AAOS), and Committee on Perioperative Evaluation (CAPO), Brazilian Society of Cardiology (BSC). This is a good resource for anyone looking for a concise overview of the recommendations made by these professional organizations in this medical situation. Source: NGC (summary)
IDSA Guideline Update: Intra-abdominal Infection in Adults & Children. 02/08/2010. The Expert Panel of the Surgical Infection Society and the Infectious Diseases Society of America updated the guidelines that were previously published in 2002 and 2003. For access to the full text and pdf files please click on the link provided. Source: IDSA
CDC Guideline Update: Catheter-Associated Urinary Tract Infections. 02/08/2010. The National Guideline Clearinghouse released its summary of the recently updated guidelines for Catheter-Associated Urinary Tract Infections from the CDC. Source(s): NGC CDC
January 2010
AHA Guidelines: Management of Cardiovascular Implantable Electronic Device Infections. 01/25/2010. These guidelines provide specific guidance to clinicians on how to manage multiple scenarios related to infections associated with their implantable electronic device. These situations range from antimicrobial therapy while leaving the device in place to removal of the device with replacement and/or long-term treatment. Source: AHA
IDSA Cryptococcal Disease Management Guidelines Updated. 01/04/2010: The Infectious Disease Society of America (IDSA) Guidelines for the management of cryptococcal disease have been updated. The last update was in 2000. The 2010 guidelines offer focused discussions on the management of 3 risk groups: 1) human immunodeficiency virus (HIV)-infected individuals; 2) organ transplant recipients; 3) non-HIV infected and nontransplant hosts. In addition, 3 key management principles are also focused upon: 1) induction therapy for meningoencephalitis using fungicidal regimens, such as a polyene and flucytosine, followed by suppressive regimens using fluconazole; 2) importance of early recognition and treatment of increased intracranial pressure and/or immune reconstitution inflammatory syndrome (IRIS); and 3) the use of lipid formulations of amphotericin B regimens in patients with renal impairment. Source: IDSA
Smoking Cessation Guidelines (Sumary of the Public Health Service, University of Michigan Health System and the U.S. Preventative Services Task Force (USPSTF) was updated on the NGC website. 01/04/2010: If you are looking for a good synopsis or comparison of these three guidelines the NGC website provides a nice summary. They also provide tables related to interventions that are helpful. If you need the individual sources we have provided the direct links here for you. Source(s): NGC PHS UMHS USPSTF PubMed
Management of Drug Resistant Tuberculosis Guidelines from the World Health Organization (WHO). 01/04/2010: The summary of these guidelines which were updated in 2008 were released on the NGC webiste. They also include guidelines related to special populations that may be helpful to certain clinicians. Source: NGC
December 2009
Congenital Heart Disease 2008 Guidelines from the ACC/AHA remain the same and are still considered to be current per the National Guideline Clearinghouse. 12/14/2009: Those include: Atrial Septal Defects; Atrioventricular Septal Defect; Congenitally Corrected Transposition of the Great Arteries; Coronary Artery Abnormalities; Dextro-Transposition of the Great Arteries; Ebstein's Anomaly; Left-sided Heart Obstructive Lesions; Patent Ductus Arteriosus; Pulmonary Hypertension/Eisenmenger Physiology; Right Ventricular Outflow Tract Obstruction; Tetralology of Fallot; Tricuspid Atresia/Single Ventricle; Ventricular Septal Defect. Source: AHRQ (summary) ACC (complete document)
Prevention and Control of Seasonal influenza with Vaccines. Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009; Includes recommendations for the use of Trivalent Inactivated Influenza Vaccine (TIV) and Live Attenuated Influenza Vaccine (LAIV) during the 2009-2010 season. Released on July 2009; post to National Guideline Clearinghouse in December. Source: AHRQ (summary) CDC (complete document)
Guidelines of Care for the Management of Psoriasis and Psoriatic Arthritis: Section 3. Guidelines of Care for the Management and Treatment of Psoriasis with Topical Therapies. 12/07/2009: American Academy of Dermatology. Available on National Guideline Clearinghouse and through the AAD. Sources: AHRQ (summary) AAD (complete document)
Screening and Surveillance for the Early Detection of Colorectal Cancer and Adenomatous Polyps, 2008. 12/07/2009: American Cancer Society, US Multi-Society Task Force on Colorectal Cancer, & American College of Radiology. Sources: AHRQ (summary) ACS (complete document)
Prostate-Specific Antigetn Best Practices Statment. 12/07/2009: American Urological Association. Last updated in 2001. Recent 2009 updated added to the National Guideline Clearinghouse. Sources: AHRQ (summary) AUA (complete document)
Disclaimer: For more information please click here
©2010 Pharmacology Weekly Inc. All Rights Reserved.
Share
