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Guidelines recommend intravenous (IV) ceftriaxone at a dose of 1–2 g/d as empirical treatment in adults hospitalized with community acquired pneumonia (CAP), with the addition of macrolide. We examined whether 1 g/d of IV ceftriaxone is associated with similar clinical outcomes to those of 2 g/d. This is a single-center, retrospective, cohort study of all adult patients hospitalized at Rabin Medical Center between 2015 and 2018 with CAP. The primary outcome was 30-day all-cause mortality. Risk factors for 30-day all-cause mortality were identified by univariable and multivariable analyses, using logistic regression analysis. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. A total of 2045 patients were treated with IV ceftriaxone 1 g/d and were and compared to 1944 patients who were treated with 2 g/d. The groups were comparable in their baseline characteristics and their clinical presentation. The 30-day all-cause mortality rate was similar between the groups (301/2045 (14.7%) for 1 g/d vs. 312/1944 (16.0%) for 2 g/d, p = 0.24). The rate of C.difficile infection (CDI) was significantly decreased with 1 g/d compared to 2 g/d (4/2045 (0.2%) vs. 12/1944 (0.6%), p = 0.03) and the length of stay was significantly shorter (median 4 days interquartile range (IQR) 3–7 vs. 5 days IQR 3–8, p = 0.02). None of the blood isolates of Streptococcus pneumoniae were penicillin or ceftriaxone resistant. For hospitalized patients with CAP, IV ceftriaxone 1 g/d was associated with similar mortality rates as IV ceftriaxone 2 g/d, with a decreased rate of CDI and shorter length of stay. Ceftriaxone 1 g/d may be sufficient to treat patients with CAP in countries with low prevalence of drug resistant Streptococcus pneumoniae.

BackgroundDirect-acting oral anticoagulants (DOACs) including rivaroxaban and apixaban are preferred over vitamin K antagonists for the treatment of venous thromboembolism (VTE). We conducted a systematic review and a meta-analysis to compare the efficacy and safety of rivaroxaban versus apixaban in the treatment of VTE.MethodsWe conducted an electronic search for studies that directly compared treatment with rivaroxaban and apixaban in adult patients with VTE. The relative risks (RRs) and 95% confidence intervals (CIs) were estimated and pooled using a fixed-effect model unless significant heterogeneity was present (I2 > 40%), then random-effects model was used. The primary efficacy and safety outcomes were recurrent VTE (rVTE) and major bleeding events, respectively.ResultsNine observational studies were included in our meta-analysis, assessing 24,156 patients for apixaban and 38,847 for rivaroxaban. Pooling of data for our primary efficacy outcome showed a trend towards lower risk of rVTE with apixaban compared to rivaroxaban (RR 0.77, 95% CI 0.57–1.04, I2 = 53%). Analysis of our primary safety outcome showed a significantly lower risk of major bleeding with apixaban compared to rivaroxaban (RR 0.68, 95% CI 0.61–0.76, I2 = 0%). Apixaban was associated with significantly decreased risk of net clinical harm, clinically relevant non major bleeding (CRNMB) and any bleeding, compared to rivaroxaban (RR 0.75, 95% CI 0.61–0.92, I2 = 50%; RR 0.58, 95% CI 0.50–0.67, I2 = 7%; RR 0.64, 95% CI 0.59–0.70, I2 = 0%, respectively).ConclusionsApixaban is associated with a significantly lower risk of major bleeding compared to rivaroxaban for treatment of VTE. Given the limitations of the existing evidence, further interventional studies comparing the two drugs are needed.

Background/Objectives: Despite the established cardiovascular benefit of sodium–glucose cotransporter-2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs), these medications are under-prescribed in patients with type 2 diabetes. Our study aims to examine the effectiveness of a clinical decision support system (CDSS) in improving the recommendation rate of SGLT2i and GLP-1RA upon discharge. Methods: We developed an algorithm to automatically recommend SGLT2is and GLP-1RAs for eligible patients with type 2 diabetes upon discharge, based on current guidelines. Data were collected from electronic medical records of all eligible patients ≥18 years old hospitalized in one of five internal medicine wards at Beilinson Hospital. The primary outcome was to evaluate the rate of physician recommendation of SGLT2is and GLP-1RAs at discharge, before and after algorithm implementation. Results: Our study included 1318 patients in the pre-algorithm group and 970 in the post-algorithm group. The recommendation rate of SGLT2is and GLP-1RAs was 8.5% in the pre-algorithm group and 22.7% in the post-algorithm. The odds ratio (OR) of recommendation in the post- vs. pre-algorithm group was 3.151 (95% CI: 2.467–4.025, p < 0.0001). Recommendation rates increased in all subgroups analyzed, notably in patients hospitalized due to heart failure (recommendation rate pre-algorithm: 14.6% vs. post-algorithm: 49.02%). Conclusions: This study demonstrates the benefit of a CDSS in improving the recommendation rate of SGLT2is and GLP-1RAs in patients with type 2 diabetes upon discharge from hospitalization. Future studies should assess the impact of the algorithm on recommendation rates in other wards, medication utilization, and long-term outcomes.