“…However, due to the devastated blood vessel and limited blood supply, PJI may not be sufficiently and effectively excluded, which results in a low concentration of antibiotic around the implant prostheses. 2 , 3 Moreover, increasing the dose or the time period using antibiotics may disequilibrate immune system and cause other adverse effects.…”
“…However, due to the devastated blood vessel and limited blood supply, PJI may not be sufficiently and effectively excluded, which results in a low concentration of antibiotic around the implant prostheses. 2 , 3 Moreover, increasing the dose or the time period using antibiotics may disequilibrate immune system and cause other adverse effects.…”
“…The efficacy of antibiotic-impregnated bone cement in primary joint arthroplasty remains controversial. Several studies (two meta analyses, systematic review and retrospective study) showed no decreased rate of infection of ALBC spacers compared with plain bone cement 38–42. Role of ALBC in lowering rate of superficial and deep infection remains unclear; prior studies, including both TKA and total hip arthroplasty surgeries, found a significantly lower risk of deep infections and no effect on the risk of superficial infections when ALBC was used 43.…”
Section: Discussionmentioning
confidence: 99%
“…Role of ALBC in lowering rate of superficial and deep infection remains unclear; prior studies, including both TKA and total hip arthroplasty surgeries, found a significantly lower risk of deep infections and no effect on the risk of superficial infections when ALBC was used 43. However, more recent studies showed no reductions in the rate of deep infection following primary TKA with antibiotic-loaded bone cement compared with plain cement 42 44. Further data suggests lack of cost effectiveness with use of ALBC, thus routine use in economic terms may not be justified even in the high-risk patients 45 46…”
A male patient with right total knee arthroplasty complicated by prosthetic joint infection on intravenous antimicrobials developed an acute kidney injury (AKI) with creatinine up to 7.3 mg/dL (‘normal’ range (0.5-1.2 mg/dL)) after hardware removal and tobramycin loaded polymethylmethacrylate beads and spacer placement. The AKI was initially attributed to intravenous vancomycin. Despite discontinuing vancomycin, the AKI worsened. A tobramycin level was collected and resulted at 5.5 µg/mL. Due to high suspicion for aminoglycoside-induced renal toxicity and to prevent haemodialysis, the antibiotic cement spacer with tobramycin-impregnated beads was removed. After the removal, tobramycin level rapidly decreased and renal functions improved. AKI is an increasingly recognised complication related to antibiotic-loaded bone cement (ALBC) due to the systemic absorption of antibiotics. With this case we highlight the early recognition of ALBC-induced renal toxicity necessitating explantation of ALBC and beads in order to prevent haemodialysis and emphasise monitoring aminoglycoside levels in the early postoperative period.
“…The World Health Organization (WHO) reports that people in 49 countries consumed more than 50% of antibiotics in 2019. The use of antibiotics was 89.21% [1]. Assessment of rational drug use is based on the 4T standard, namely the right indication, the right drug, the right patient, and the right dose [2].…”
Acute upper respiratory tract infection is an infectious disease caused by microorganisms, one of which is bacteria, so antibiotics are given. Rational use of antibiotics can provide benefits for recovery and does not provide harm that can cause problems or threats to the patient's health. Inappropriate administration of antibiotics can harm patients, one of which is antibiotic resistance. The purpose of this study was to obtain an overview of the rationale for prescribing antibiotics in patients with acute upper respiratory tract infections at the Baun Health Center, Kupang Regency, in 2020. This study was conducted using a descriptive non-experimental study with retrospective medical record data collection and guidelines from PERMENKES No. .5 of 2014 concerning Clinical Practice Guidelines for Doctors in Primary Health Care Facilities and KMK HK.02.02/MENKES/514/2015 concerning Clinical Practice Guidelines for Doctors in First Level Health Care Facilities to determine the accuracy of indications, drug accuracy, patient accuracy, and accuracy dose. The results showed 100% correct indication, 90.3% right drug, 100% right patient, 65% right dose, and 55.3% rational use of antibiotics.
Keywords: Acute upper respiratory tract infection, antibiotics, rationality, right indication, right drug, right patient, right dose.
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