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      Evaluation and Management of Penicillin Allergy : A Review

      1 , 2 , 3 , 4 , 5 , 1 , 6 , 7

      JAMA

      American Medical Association (AMA)

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          Abstract

          β-Lactam antibiotics are among the safest and most effective antibiotics. Many patients report allergies to these drugs that limit their use, resulting in the use of broad-spectrum antibiotics that increase the risk for antimicrobial resistance and adverse events.

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          Most cited references 74

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          Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of america.

          This document updates and expands the initial Infectious Diseases Society of America (IDSA) Fever and Neutropenia Guideline that was published in 1997 and first updated in 2002. It is intended as a guide for the use of antimicrobial agents in managing patients with cancer who experience chemotherapy-induced fever and neutropenia. Recent advances in antimicrobial drug development and technology, clinical trial results, and extensive clinical experience have informed the approaches and recommendations herein. Because the previous iteration of this guideline in 2002, we have a developed a clearer definition of which populations of patients with cancer may benefit most from antibiotic, antifungal, and antiviral prophylaxis. Furthermore, categorizing neutropenic patients as being at high risk or low risk for infection according to presenting signs and symptoms, underlying cancer, type of therapy, and medical comorbidities has become essential to the treatment algorithm. Risk stratification is a recommended starting point for managing patients with fever and neutropenia. In addition, earlier detection of invasive fungal infections has led to debate regarding optimal use of empirical or preemptive antifungal therapy, although algorithms are still evolving. What has not changed is the indication for immediate empirical antibiotic therapy. It remains true that all patients who present with fever and neutropenia should be treated swiftly and broadly with antibiotics to treat both gram-positive and gram-negative pathogens. Finally, we note that all Panel members are from institutions in the United States or Canada; thus, these guidelines were developed in the context of North American practices. Some recommendations may not be as applicable outside of North America, in areas where differences in available antibiotics, in the predominant pathogens, and/or in health care-associated economic conditions exist. Regardless of venue, clinical vigilance and immediate treatment are the universal keys to managing neutropenic patients with fever and/or infection.
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            Antimicrobial Resistance.

            The development of antibiotics is considered among the most important advances of modern science. Antibiotics have saved millions of lives. However, antimicrobial resistance (AMR) threatens this progress and presents significant risks to human health.
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              Antibiotic prescribing for adults in ambulatory care in the USA, 2007-09.

              To determine patterns of ambulatory antibiotic prescribing in US adults, including the use of broad-spectrum versus narrow-spectrum agents, to provide a description of the diagnoses for which antibiotics are prescribed and to identify patient and physician factors associated with broad-spectrum antibiotic prescribing.
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                Author and article information

                Journal
                JAMA
                JAMA
                American Medical Association (AMA)
                0098-7484
                January 15 2019
                January 15 2019
                : 321
                : 2
                : 188
                Affiliations
                [1 ]Harvard Medical School, Boston, Massachusetts
                [2 ]Infection Control Unit, Massachusetts General Hospital, Boston
                [3 ]Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston
                [4 ]Department of Allergy, Southern California Permanente Medical Group, San Diego Medical Center
                [5 ]General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
                [6 ]Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Boston
                [7 ]Edward P. Lawrence Center for Quality and Safety, Massachusetts General Hospital, Boston
                Article
                10.1001/jama.2018.19283
                30644987
                © 2019

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