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Once patients have become afebrile (nonfeverish) and are clinically improving, don’t continue prescribing intravenous antibiotics to those with uncomplicated infections and no high-risk features if ...
Choosing Wisely Australia
Internal Medicine Society of Australia and New Zealand
Patients with uncomplicated infections not requiring prolonged antibiotic therapy and with no high-risk features should be switched from intravenous (IV) to oral antibiotics once they are afebrile, clinically improving and able to tolerate oral medication. In hospital, this often occurs by day three. Exceptions to this rule are those suffering life threatening or deep-seated infections (such as suspected endocarditis, osteomyelitis or meningitis), and high risk patients (such as ...
ver más ... 2017Don’t request daily full blood counts, erythrocyte sedimentation rate (ESR) or C reactive protein (CRP) as measures of response to antibiotic treatment if patients are clinically improving.
Choosing Wisely Australia
Internal Medicine Society of Australia and New Zealand
The decision on whether or not to cease antibiotic treatment or switch from intravenous (IV) to oral antibiotics should be guided by the results of microbiological cultures indicating bacterial species and antimicrobial sensitivities, and evidence of defervescence and improved clinical status rather than by changes in the levels of white cell count (WCC) from a full blood count, C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR). However, these markers can help to predict poor ...
ver más ... 2017Avoid medication related harm in older patients (>65 years) receiving 5 or more regularly used medicines by performing a complete medication review and deprescribing whenever appropriate.
Choosing Wisely Australia
Internal Medicine Society of Australia and New Zealand
Studies show that the risk of medication-related harm rises once the number of regularly prescribed medicines exceeds five; this risk increases exponentially as the number reaches eight or more. Medicines that deserve particular attention are benzodiazepines and other sedative-hypnotics, anti-psychotics, hypoglycaemic agents, antithrombotic agents, antihypertensives, and anti-anginal agents. Trying to achieve aggressive treatment targets, such as BP <130/80 or HbA1c<7 per cent, in frail older ...
ver más ... 2017Do not routinely order abdominal X-rays for the diagnosis of nonspecific abdominal pain in children.
Choosing Wisely Australia
Paediatrics & Child Health Division
5 Retrospective studies of medical records of children and adults admitted for constipation and other forms of non-specific abdominal pain conclude that in only a very small minority (under 5%) of cases do abdominal X-rays make a difference in patient treatment. A recent study also showed that abdominal X-rays were performed more frequently in misdiagnosed children. Numerous studies yield significantly varying estimates of the sensitivity and specificity of abdominal x-rays and insufficient ...
ver más ... 2017Do not routinely treat gastroesophageal reflux disease (GORD) in infants with acid suppression therapy.
Choosing Wisely Australia
Paediatrics & Child Health Division
Gastroesophageal reflux is common in preterm infants, infants and children and uncomplicated gastroesophageal reflux typically does not require medical therapy. However, gastroesophageal reflux may evolve into gastroesophageal reflux disease (GORD), a condition where the persistent leaking of stomach contents back into the oesophagus results in heartburn and other troublesome symptoms. Proton pump inhibitors (PPI) are sometimes prescribed in cases of GORD to achieve a pronounced and longlasting ...
ver más ... 2017