Prescription-Event Monitoring Study on Safety and Efficacy of Levonadifloxacin (Oral and I.V.) in Management of Bacterial Infections: Findings of Real-World Observational Study.

Background: Levonadifloxacin is a novel broad-spectrum antibiotic belonging to the benzoquinolizine subclass of quinolones. It is available in intravenous as well as oral formulation for the treatment of infections caused by common Gram-positive bacterial pathogens including methicillin-resistant Staphylococcus aureus (MRSA). Patients and Methods: This study retrospectively assessed the real-world safety and efficacy of levonadifloxacin (oral and/or IV) in the treatment of 1229 patients across various clinical conditions. Study outcomes were clinical and microbiological success at the end of therapy. Results: The mean duration of levonadifloxacin therapy was 7.2 days, with a time to clinical improvement averaging at 4 days. Three hundred and three patients received oral therapy, 875 received IV, and 51 received a combination of IV followed by oral therapy. Patients were prescribed levonadifloxacin for skin and soft-tissue infections, diabetic foot infections, septicemia, catheter-related bloodstream infections, bone and joint infections, febrile neutropenia, and respiratory infections including COVID-19 pneumonia. High clinical success rates of 98.3%, 93.7%, and 96.1% with oral, IV, and IV followed by oral levonadifloxacin, respectively, were obtained. Only 11 mild adverse events were reported in 9 patients which included constipation, diarrhea, hyperglycemia, nausea, fatigue, and vomiting. Overall, 96.3% and 97.3% of investigators rated the efficacy and safety of levonadifloxacin as "good to excellent." Conclusions: An excellent safety and efficacy profile of levonadifloxacin was observed in this study making it a suitable treatment option for management of various bacterial infections, including those caused by resistant Gram-positive pathogens such as MRSA and quinolone-resistant S. aureus.

THIRVE in Foreign Body Bronchus Removal-A Novel Approach.

We prospectively studied novel anesthetic and surgical approach to foreign body bronchus removal using HHFNC (heated humidified high flow nasal cannula)/THRIVE technique(Transnasal Humidified Rapid-Insufflation ventilatory Exchange) in eleven cases. MacIntosh Laryngoscope was used to expose laryngeal inlet and FB was removed with an optical forcep (mounted over 2.7 mm rigid bronchoscope) without using ventilating bronchosocope. Total intravenous anaesthesia (TIVA) was given in all cases. FB was removed completely in all eleven cases. The average duration of procedure was 4.5 min. HHFNC improved the apnoea time with 6 min as maximum procedure time. Induction with Fentanyl, Intermittent Propofol injection and succinylcholine prevented excessive coughing, irritation, movement of the patient, vocal cords and posterior tracheal wall. Time management during this novel approach is crucial starting from removal of FB and check bronchoscopy.

High Flow Nasal Cannula: A Game Changer in Airway Surgery.

High flow nasal cannula (HFNC) delivers humidified oxygen at high flow. Its use during airway procedures has many advantages. The study was done to determine the duration of apnea time, safety and compatibility with laser, while using HFNC during airway procedures. A prospective study was done at a tertiary care hospital between March 2017 and August 2017 on 16 patients. HFNC was used during airway surgeries for various pathologies. There were 11 males and 5 females. The patient age ranged from 4 days to 28 years. HFNC provided an unobstructed view of the surgical field, laser could be used safely, there was an increase in the apnea window, and post-operative symptoms like throat irritation and cough were infrequent. Usage of HFNC provides an unobstructed view of the surgical field and reduces post-operative discomfort. It helps in difficult airway situations by optimizing oxygenation and increasing the apnea time.

Oral midazolam and oral butorphanol premedication.

OBJECTIVE: To evaluate the efficacy of oral midazolam and oral butorphanol for their sedative analgesic effects in children. METHODS: Sixty children, aged 2 to 10 yrs, of ASA physical status I and II, scheduled for surgical procedures of 1 to 2 hrs duration were randomized to one of the two groups. Group I: children received midazolam 0.5 mg/kg orally and Group II: children received butorphanol 0.2 mg/kg orally. Score of the children was assessed every 5 minutes till the induction of anesthesia. Intraoperative and postoperative analgesic requirement was recorded along with postoperative recovery and complications. RESULTS: The groups were identical regarding the patient's characteristics, hemodynamic variables, duration of surgery and awakening time. Less time was required for the onset and time of maximum sedation in the butorphanol group (p<0.05). Sedation scores were similar among the groups at all time intervals, while the scores were higher in the butorphanol group at the time of induction (p<0.05). Less number of children required intraoperative and postoperative rescue analgesia in the butorphanol group (p<0.05). Statistically significant difference was found among the groups in respect to complete amnesia (50% in group I vs 80% I group II, p<0.05) and recollection (40% in group I vs 10% in group II, p<0.05). CONCLUSION: Oral butorphanol is comparable to oral midazolam in children but analgesia along with sedation is an additional advantage which makes it better than midazolam without a significant increase in side effects.