Pharmacist-led Penicillin Allergy Assessment in the Emergency Department Reduced Empiric Fluoroquinolone Use.

In a retrospective, quasi-experimental study of 380 adult patients with a reported penicillin allergy who received antibiotics at a community hospital emergency department, a pharmacist-led penicillin allergy assessment via medical records review and patient interview improved guideline-preferred antibiotic use by 13% (P = .018) and reduced fluoroquinolone use by 11% (P = .035).

Non-surgical management of spontaneous splenic rupture due to Babesia microti infection.

Babesiosis is an emerging tick-borne infection. We describe 2 hospitalized patients from the United States with spontaneous splenic rupture attributable to Babesia microti infection. The first patient was a 36-year-old previously healthy man with a low-grade splenic rupture not requiring surgical intervention. The second was a 70-year-old healthy man whose splenic rupture required proximal splenic artery embolization. Since the spleen is an important organ involved in controlling Babesia infection, management of splenic rupture in an infected patient using an organ preserving approach when appropriate may be preferred.

Erythema migrans.

Erythema migrans (EM) is the most common objective manifestation of Lyme disease, accounting for about 90% of cases. Establishing the diagnosis of EM is important because appropriate treatment with oral antibiotics at an early stage of infection with Borrelia burgdorferi results in excellent outcomes. This article includes a discussion of the epidemiology of EM and its clinical, differential, and laboratory diagnosis. The treatment of EM and the prevention of Lyme disease are also discussed.

Clinical update on the diagnosis and treatment of bacterial endocarditis.

Infective endocarditis (IE) represents the top of the pyramid of the relationship between humans and bacteria in that it is a less common form of infection than other localized infections in specific organ systems, but it may carry considerable morbidity and mortality. In a time when the practice of medicine is performed at the organ-system level through subspecialists, systemic diseases causing dysfunction in multiple organ systems like IE may be difficult to diagnose. The salient features of IE may present atypically or be obscured by the presence of preexisting and coexisting diseases. Early diagnosis of IE is important because of its high risk of morbidity and mortality. Management of the patient with IE is complex and requires interventions by internists, infectious disease specialists, cardiologists, and cardiothoracic surgeons. It represents one of only a few situations where bactericidal therapy is important to treatment efficacy. As such, the development of antimicrobial resistance in bacteria has the potential to impact the management of endocarditis most significantly. This review will touch on several aspects of endocarditis, including pathogenesis and treatment.