OBJECTIVE: Resection of the vestibular schwannoma causes acute peripheral vestibular loss. The process of central compensation starts immediately afterward. The rehabilitation goal is to support this process and restore the quality of life. MATERIALS AND METHODS: In this prospective single-center study, 67 consecutive patients underwent vestibular schwannoma resection (40 females, mean age 52 ± 12 years). The patients were divided into three groups: the prehabilitation with intratympanic gentamicin group, the virtual reality group (optokinetic stimulation via virtual reality goggles in the first ten days after the surgery), and the control group. All patients were examined with objective methods and completed questionnaires before the prehabilitation, before the surgery, at the hospital discharge, and after three months. RESULTS: Intratympanic gentamicin prehabilitation leads ipsilaterally to a significant aVOR reduction in all semicircular canals (p < 0.050), the increase of the unilateral weakness in air calorics (p = 0.026), and loss of cVEMPs responses (p = 0.017). Prehabilitation and postoperative exposure to virtual reality scenes improved the patient's perception of vertigo problems according to Dizziness Handicap Inventory (p = 0.039 and p = 0.076, respectively). These findings conform with the optokinetic testing results, which showed higher slow phase velocities at higher speeds (40 deg/s) in both targeted groups compared to the control group. CONCLUSION: Preoperative intratympanic gentamicin positively affects peripheral vestibular function, influencing balance perception after VS resection. In long-term follow-up, prehabilitation and postoperative exposure to virtual reality improve patients' quality of life in the field of vertigo problems.

• MeSH
• Anti-Bacterial Agents administration & dosage   MeSH
• Adult MeSH
• Gentamicins * administration & dosage   MeSH
• Injection, Intratympanic MeSH
• Quality of Life MeSH
• Middle Aged MeSH
• Humans MeSH
• Postoperative Care methods   MeSH
• Preoperative Care methods   MeSH
• Prospective Studies MeSH
• Aged MeSH
• Virtual Reality Exposure Therapy methods   MeSH
• Vestibular Function Tests MeSH
• Neuroma, Acoustic * surgery   MeSH
• Virtual Reality MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Comparative Study MeSH

S narůstající bakteriální rezistencí ubývají možnosti standardní léčby pneumonie. Slibným rozšířením terapie je inhalační aplikace antibiotik. Pomocí rešerše dostupné literatury jsou v tomto článku navrženy indikace a omezení inhalačních antibiotik v off-label terapii těžké pneumonie u pacientů bez cystické fibrózy, popsány optimální způsoby podání a rizika této léčby. Teoretické předpoklady a omezená data ze studií naznačují možný příznivý účinek inhalačního podání antibiotik u pacientů s multirezistentní gramnegativní pneumonií. Jde o antibiotika s omezeným průnikem do plicních struktur a zároveň významnou systémovou toxicitou limitující jejich dávkování: polymyxiny a aminoglykosidy. Doporučení odborných společností a souhrnné práce většinově podporují jejich použití u infekcí patogeny citlivými pouze k těmto antibiotikům. Způsob podání může ovlivnit depozici antibiotik v dýchacích cestách, a tím jejich účinek. Vhodné je předléčit pacienta bronchodilatanciem a v případě umělé plicní ventilace použít doporučené nastavení. Podle okolností může být použita pouze inhalační léčba, či současné podání stejného či jiného antibiotika intravenózně. V případě rizika významných systémových koncentrací podávaného antibiotika je důležité jejich monitorování. Inhalační antibiotická terapie by neměla být podána u pacientů s těžkou hypoxemií nebo rizikem bronchospasmu. Inhalační podání antibiotik je v terapii pneumonie pacientů v prostředí intenzivní péče celosvětově využívaným postupem. Jde o neschválenou terapii s omezenou oporou v literatuře a mělo by se k ní přistupovat pouze u pacientů s limitovanými možnostmi léčby po pečlivém individuálním zvážení prospěchu a rizika.

• MeSH
• Amikacin administration & dosage   pharmacology   therapeutic use   MeSH
• Anti-Bacterial Agents administration & dosage   pharmacology   therapeutic use   MeSH
• Administration, Inhalation MeSH
• Gentamicins administration & dosage   pharmacology   therapeutic use   MeSH
• Colistin administration & dosage   pharmacology   therapeutic use   MeSH
• Humans MeSH
• Pneumonia * drug therapy   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

AIMS: Preoperative chemical vestibular ablation can reduce vestibular symptoms in patients who have gone through vestibular schwannoma resection. The goal of this study was to determine whether chemical vestibular prehabituation influences the patients' post-operative perception of visual stimulation, mental status and quality of life. We also tried to find out whether increases of optokinetic nystagmus, measured by routine electronystagmography, correlate with subjective symptoms. METHODS: We preoperatively administered (2 months prior to surgery) 0.5 - 1.0 mL of 40 mg/mL nonbuffered gentamicin in three intratympanic instillations in 11 patients. Head impulse and caloric tests confirmed reduction of vestibular function in all patients. The control group consisted of 21 patients. Quality of life in both groups was evaluated using the Glasgow Benefit Inventory, the Glasgow Health Status Inventory and the Dizziness Handicap Inventory questionnaires. Visual symptoms and optokinetic sensation were evaluated using a specific questionnaire developed by our team and by measuring gains preoperatively and postoperatively in both groups using routine electronystagmography. The psychological profile was evaluated using the Zung Self-Rating Depression Scale and the Generalised Anxiety Disorder Assessment questionnaires. RESULTS: There were no statistically significant differences between both groups with regards to the results of the questionnaires. Patients who received preoperative gentamicin were less sensitive to visual stimulation (P<0.10) and many of them had a significantly higher gain in the optokinetic nystagmus than the control group in the preoperative stage. CONCLUSION: Pre-treatment with gentamicin helps to lower anxiety levels in patients and improves their general postoperative status. Pre-treated patients are also less sensitive to optokinetic stimulation. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03638310.

• MeSH
• Anti-Bacterial Agents administration & dosage   MeSH
• Sensation physiology   MeSH
• Adult MeSH
• Gentamicins administration & dosage   MeSH
• Quality of Life psychology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Postoperative Period MeSH
• Preoperative Care * MeSH
• Surveys and Questionnaires MeSH
• Aged MeSH
• Vestibule, Labyrinth surgery   MeSH
• Neuroma, Acoustic surgery   MeSH
• Visual Acuity physiology   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

OBJECTIVES: The aim was to evaluate the efficacy and tolerability of gentamicin 240 mg plus azithromycin 2 g for treatment of uncomplicated rectal and pharyngeal gonorrhoea compared to ceftriaxone 500 mg plus azithromycin 2 g, the recommended European first-line gonorrhoea treatment. METHODS: A non-inferiority, open-label, single-centre randomized controlled trial was conducted in Prague, Czech Republic. Patients, 18-75 years of age, diagnosed with uncomplicated rectal or pharyngeal gonorrhoea by nucleic acid amplification test (NAAT) were randomized to treatment with gentamicin 240 mg intramuscularly plus azithromycin 2 g orally or ceftriaxone 500 g intramuscularly plus azithromycin 2 g orally. The primary outcome was negative culture and negative NAAT, i.e. 1 week and 3 weeks, respectively, after treatment. RESULTS: Both clinical cure and microbiological clearance was achieved by 100% (95% CI 0.95-1.00) of patients in the gentamicin/azithromycin arm (n = 72; 40 rectal, 17 pharyngeal and 15 rectal+pharyngeal infections both localizations) and 100% (95% CI 0.95-1.00) in ceftriaxone/azithromycin arm (n = 71; 38 rectal, 14 pharyngeal and 19 rectal+pharyngeal infections). The absolute difference between the two arms was 0.0% (CI95% -5.1 to 5.1), thus less than the pre-specified margin of 7%. Administration of gentamicin was not more painful than ceftriaxone according to the visual analogue scale (1.8 vs. 3.4; p <0.001). Gastrointestinal adverse events were similar in the ceftriaxone arm (33/71, 46.5%) and the gentamicin arm (29/72, 40.3%), and overall in most (52/62, 83.9%) cases they were mild. CONCLUSIONS: Gentamicin 240 mg plus azithromycin 2 g is an effective alternative for treatment of extragenital gonorrhoea.

• MeSH
• Anti-Bacterial Agents administration & dosage   adverse effects   MeSH
• Administration, Oral MeSH
• Azithromycin administration & dosage   adverse effects   MeSH
• Ceftriaxone administration & dosage   adverse effects   MeSH
• Adult MeSH
• Pharynx microbiology   MeSH
• Gentamicins administration & dosage   adverse effects   MeSH
• Gonorrhea drug therapy   MeSH
• Injections, Intramuscular MeSH
• Drug Therapy, Combination MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Rectum microbiology   MeSH
• Aged MeSH
• Treatment Outcome MeSH
• Dose-Response Relationship, Drug MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Randomized Controlled Trial MeSH

• MeSH
• Anti-Bacterial Agents administration & dosage   classification   therapeutic use   MeSH
• Gentamicins administration & dosage   MeSH
• Humans MeSH
• Infant, Newborn MeSH
• Penicillin G administration & dosage   adverse effects   MeSH
• Risk Factors MeSH
• Streptococcus agalactiae * pathogenicity   MeSH
• Streptococcal Infections * diagnosis   epidemiology   drug therapy   prevention & control   MeSH
• Pregnancy MeSH
• Check Tag
• Humans MeSH
• Infant, Newborn MeSH
• Pregnancy MeSH
• Publication type
• Practice Guideline MeSH

This pilot prospective study verified the hypothesis that use of computer-assisted therapeutic drug monitoring of aminoglycosides by pharmacists leads to better safety therapeutic outcomes and cost avoidance than only concentration measurement and dose adjustments based on a physician's experience. Two groups of patients were enrolled according to the technique of monitoring. Patients (Group 1, n=52) underwent monitoring by a pharmacist using pharmacokinetic software. In a control group (Group 2, n=11), plasma levels were measured but not interpreted by the pharmacist, only by physicians. No statistically significant differences were found between the groups in factors influenced by therapy. However, the results are not statistically significant but a comparison of the groups showed a clear trend towards safety and cost avoidance, thus supporting therapeutic drug monitoring. Safety limits were achieved in 76 % and 63 % of cases in Groups 1 and 2, respectively. More patients achieved both concentrations (peak and trough) with falling eGFR in Group 1. In present pilot study, the pharmacist improved the care of patients on aminoglycoside therapy. A larger study is needed to demonstrate statistically significantly improved safety and cost avoidance of aminoglycoside therapy monitoring by the pharmacist using pharmacokinetic software.

• MeSH
• Amikacin administration & dosage   MeSH
• Aminoglycosides administration & dosage   adverse effects   pharmacokinetics   MeSH
• Anti-Bacterial Agents administration & dosage   MeSH
• Safety MeSH
• Pharmacists * MeSH
• Gentamicins administration & dosage   MeSH
• Middle Aged MeSH
• Humans MeSH
• Drug Monitoring economics   methods   MeSH
• Costs and Cost Analysis MeSH
• Kidney Diseases chemically induced   MeSH
• Pilot Projects MeSH
• Drug Therapy, Computer-Assisted methods   MeSH
• Prospective Studies MeSH
• Aged MeSH
• Drug Dosage Calculations * MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

Background: Surgical site infection (SSI) is one of the most common causes of healthcare-associated infection. Although the use of topical antibiotics to prevent SSI is not recommended by current guidelines, published studies document conflicting results and conclusions. Objectives: The objectives of this survey were to: (i) determine the extent of the use of topical antibiotics to prevent SSI in clinical practice; and (ii) gather the opinions of healthcare professionals most likely to be involved in their use. Methods: A questionnaire was circulated to members of BSAC and the European Wound Management Association (EWMA). Results: The questionnaire received 160 responses from a variety of healthcare professionals around the world. Most respondents (70%) did not have guidelines for the use of topical antibiotics for the prevention of SSI in their institution; if present, local guidance was based on national guidelines (20/31, 65%). Most respondents did not use or recommend topical antibiotics to prevent SSI; of those that did, gentamicin collagen sponges were most commonly used (24/96 responses, 25%). Over half of the surgeons (18/33, 55%) who responded to the survey did not use topical antibiotics for the prevention of SSI but, when used, contaminated surgery (8/33, 24%) was the most commonly stated indication. Conclusions: There are diverse opinions and practices among healthcare professionals about the use of topical antibiotics for the prevention of SSI. This considerable, and possibly inappropriate, variation in clinical practice needs to be addressed as part of antibiotic stewardship.

• MeSH
• Anti-Bacterial Agents administration & dosage   MeSH
• Antimicrobial Stewardship MeSH
• Antibiotic Prophylaxis methods   MeSH
• Administration, Topical * MeSH
• Gentamicins administration & dosage   MeSH
• Surgical Wound Infection prevention & control   MeSH
• Cross Infection prevention & control   MeSH
• Consensus MeSH
• Humans MeSH
• Surveys and Questionnaires MeSH
• Practice Guidelines as Topic MeSH
• Health Personnel * MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Geographicals
• Europe MeSH

BACKGROUND AND AIMS: Peroral endoscopic myotomy (POEM) is an evolving therapeutic modality for achalasia. According to the original Inoue's technique, a submucosal lavage with gentamicin has been practiced due to the fear of infection. This single-tertiary center study was intended to assess the clinical significance of the topical antibiotic lavage during POEM. METHODS: A retrospective analysis of prospectively collected data was conducted. The outcomes of patients who received the gentamicin lavage (group A) during POEM were compared to those who did not (group B). The main outcome variables were infectious adverse events, post-POEM fever, and markers of systemic inflammatory response. One day before and after POEM, all patients received systemic antibiotic prophylaxis with ceftriaxone. RESULTS: Of 124 consecutive patients having undergone POEM, 60 patients received a lavage with 80 mg of gentamicin into the submucosal tunnel before starting the myotomy, while 64 patients did not. The overall treatment success at 3 months did not differ between the two groups (group A 94.7 vs. 97.5% group B). We did not experience any significant infectious adverse events in either group. CRP and WBC levels were lower in patients with lavage versus those without [CRP: median 52.7 (IQR 34.9) vs. 69.5 (54.1); p = 0.01; WBCs: median 10.9 (IQR 3.3) vs. 12.6 (3.9); p < 0.01]. Post-procedural fever was present in 10% of patients in either group. CONCLUSIONS: During POEM, the submucosal lavage with gentamicin prior to the myotomy does not play a role in the prevention of clinically significant infectious adverse events, although the systemic inflammatory response may be decreased.

• MeSH
• Esophageal Achalasia surgery   MeSH
• Anti-Bacterial Agents administration & dosage   MeSH
• Antibiotic Prophylaxis * MeSH
• Ceftriaxone administration & dosage   MeSH
• Adult MeSH
• Natural Orifice Endoscopic Surgery methods   MeSH
• Endoscopy, Gastrointestinal methods   MeSH
• Gentamicins administration & dosage   MeSH
• Therapeutic Irrigation methods   MeSH
• Middle Aged MeSH
• Humans MeSH
• Myotomy methods   MeSH
• Retrospective Studies MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

Septic arthritis of the elbow seems to be a contraindication for total elbow arthroplasty (TEA). We here describe a 65-year-old male, American Society of Anesthesiologists (ASA) class 3 - patient, with a severely destructed right elbow due to septic arthritis with Staphylococcus aureus. His treatment consisted of multiple irrigation and debridement procedures including resection of the distal humerus, soft tissue coverage by local rotational flap and the use of a gentamicin-vancomycin loaded PMMA spacer, i.v. and oral antibiotics. After eradication of infection, a constraint cemented TEA could then successfully be performed eight months after the initial surgery and twenty-five weeks after the last debridement procedure. Twenty-one months after the TEA, the patient remained infect free and shows excellent functional results: Disabilities of the Arm, Shoulder and Hand (DASH) score: 38.3, Broberg and Morrey score: 91/100, Mayo elbow score: 95/100. To the best of our knowledge this is the first case in the literature that demonstrates TEA after septic elbow arthritis with Staphylococcus aureus. Although TEA is known as a typical surgical procedure with a low volume in numbers and higher complication rates, such as elevated infection rates compared to other types of arthroplasty, septic arthritis with Staphylococcus aureuscan successfully be performed after eradication of the infection and targeted antibiotic therapy. Key words:total elbow arthroplasty, total elbow replacement, septic arthritis, Staphylococcus aureus.

• MeSH
• Anti-Bacterial Agents administration & dosage   MeSH
• Time-to-Treatment MeSH
• Debridement methods   MeSH
• Gentamicins administration & dosage   MeSH
• Humerus surgery   MeSH
• Arthritis, Infectious * diagnosis   physiopathology   surgery   MeSH
• Humans MeSH
• Aged MeSH
• Staphylococcal Infections * diagnosis   physiopathology   surgery   MeSH
• Staphylococcus aureus isolation & purification   MeSH
• Arthroplasty, Replacement, Elbow methods   MeSH
• Vancomycin administration & dosage   MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH

• MeSH
• Medical History Taking MeSH
• Autoimmune Diseases complications   MeSH
• Bilateral Vestibulopathy * diagnosis   etiology   therapy   MeSH
• Diagnostic Techniques, Otological MeSH
• Diagnostic Imaging methods   utilization   MeSH
• Diagnosis, Differential MeSH
• Gentamicins administration & dosage   therapeutic use   MeSH
• Disease Attributes * MeSH
• Labyrinthitis diagnosis   etiology   physiopathology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Meniere Disease MeSH
• Meningoencephalitis complications   MeSH
• Vestibulocochlear Nerve physiopathology   MeSH
• Rehabilitation * methods   MeSH
• Somatosensory Disorders diagnosis   etiology   MeSH
• Statistics as Topic MeSH
• Toxic Actions MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Case Reports MeSH