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Query: UMLS:C0014118 (endocarditis)
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Outpatient parenteral antimicrobial therapy (OPAT) refers to the administration of a parenteral antimicrobial in a non inpatient or ambulatory setting with the explicit aim of facilitating admission avoidance or early discharge. Whilst OPAT has predominantly been the domain of the infection specialist, the internal medicine specialist has a key role in service development and delivery as a component of broader ambulatory care initiatives such as "hospital at home". Main drivers for OPAT are patient welfare, reduction of risk of health care associated infection and cost-effective use of hospital resources. The safe practice of OPAT is dependent on a team approach with careful patient selection and antimicrobial management with programmed and adaptable clinical monitoring and assessment of outcome. Gram-positive infections, including cellulitis, bone and joint infection, bacteraemia and endocarditis are key infections potentially amenable to OPAT whilst resistant Gram-negative infections are of increasing importance. Ceftriaxone, teicoplanin, daptomycin and ertapenem lend themselves well to OPAT due to daily (or less frequent) bolus administration, although any antimicrobial may be administered if the patient is trained to administer and/or an appropriate infusion device is employed. Clinical experience from NHS Greater Glasgow and Clyde is presented to illustrate the key principles of OPAT as practised in the UK. Increasingly complex patients with multiple medical needs, the relative scarcity of inpatient resources and the broader challenge of ambulatory care and "hospital at home" will ensure the internal medicine specialist will have a key role in the future development of OPAT.
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PMID:Outpatient parenteral antibiotic therapy: principles and practice. 2360 23

Slowing the emergence of antimicrobial resistance is essential to ensuring antimicrobials remain an effective treatment for infections. Professor Dame Sally Davies, the UK Chief Medical Officer, has compared the threat posed by resistance to that from global terrorism. Antimicrobial use is a key driver of antimicrobial resistance, so reducing unnecessary prescriptions is a high priority. NICE has developed guidance aimed at optimising prescribing within publically-funded health and care services. With primary care dentists responsible for 5% of all NHS antibacterial prescriptions, the dental community has a role to play in guarding the effectiveness of antibacterial drugs. This article describes three recent NICE publications that have implications for dentists. Antimicrobial Stewardship: Systems and Processes (NG 15) is an overarching guideline for the NHS aimed at commissioners and providers of health and care services, together with more specific guidance for prescribers. Prophylaxis against infective endocarditis (CG64) was reissued in 2015 following a review of the latest evidence prompted by concerns that the incidence of infective endocarditis had increased since initial publication of CG64 in 2008. Changing risk-related behaviours of the public in relation to expectations for antimicrobial prescriptions is currently in production (PHG89) . This paper outlines the key recommendations from these NICE guidelines as they relate to the dental community.
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PMID:What does NICE have to say about antimicrobial prescribing to the dental community? 2691 8

The Paediatric Congenital Heart Disease Standards and Specifications (PCHDSS) were published in May 2016 by NHS England. The standards describe in detail the cardiac care patients should expect in England. They are also the first cardiology standards to include an oral health section. The dental standards outline what oral health care patients should receive from both cardiology and dental healthcare professionals, with immediate effect. Children with congenital heart disease (CHD) are at increased risk of infective endocarditis and often have poorer oral health compared to healthy children. Children with cardiac disease can be complex to manage appropriately due to their increased dental anxiety and reduced access to dental care. The PCHDSS dental section highlights the importance of collaborative working between cardiology, primary care and paediatric dentistry. This should ensure preventive advice is delivered regularly, oral disease diagnosed early and patients managed or referred appropriately. This article will summarise CHD, the PCHDSS, its implications and discuss the oral health of children with a cardiac defect. The importance of treatment planning and dental management for this high risk group, in addition to informing readers when to refer to specialist care will also be described.
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PMID:The dental management of children with congenital heart disease following the publication of Paediatric Congenital Heart Disease Standards and Specifications. 3090 73