Updates to Treatment Guidelines

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)



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