Recommended treatment

Precautions in Handling. Ammonium bifluoride, like all soluble fluorides, is toxic if taken internally. Hydrofluoric acid bums may occur if the material comes in contact with moist skin. Ammonium bifluoride solutions should be thoroughly washed from the skin with mildly alkaline soap as soon as possible however, if contact has been prolonged, the affected areas should be soaked with 0.13% solution of Zephiran chloride, or 0.2% Hyamine 1622 (Lonza, Inc.) or calcium gluconate, the treatment recommended for hydrofluoric acid bums. If any of these solutions come in contact with the eyes, they should be washed with water for at least 10 min and a physician should be consulted. 

Recent consensus committees, including the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) and the World Health Organization-International Society of Hypertension (WHO-ISH) Guidelines Subcommittee, have modified traditional treatment recommendations in several important ways. 

The initial phase must contain three or more of the following drugp isoniazid, rifampin, and pyrazin-amide, along with either ethambutol or streptomycin. The CDC recommends treatment to begin as soon as possible after the diagnosis of tuberculosis. The treatment recommendation regimen is for the administration of rifampin, isoniazid, and pyrazinamide for a minimum of 2 months (8 weeks), followed by rifampin and isoniazid for 4 months (16 weeks) in areas with a low incidence of tuberculosis. In areas of high incidence of tuberculosis, the CDC recommends the addition of streptomycin or ethambutol for the first 2 months. 

To ensure lifetime compliance with the prescribed therapeutic regimen, the nurse emphasizes the importance of drug therapy, as well as other treatments recommended by the primary care provider. The nurse describes the adverse reactions that may be seen with a particular antihypertensive drug and advises the patient to contact the primary care provider if any should occur. 

Many issues surrounding neutralizing antibodies remain such as standardization of the neutralizing antibody assay, testing recommendations, and treatment recommendations for positive tests 41 Neutralizing antibodies may disappear even with continued treatment. Neutralizing antibodies exhibit cross-reactivity with the other beta interferons.41... 

Dworkin RH, Backonja M, Rowbotham MC, et al. Advances in neuropathic pain diagnosis, mechanisms, and treatment recommendations. Arch Neurol 2003 60 1524-1534. 

Lehman AF, Kreyenbuhl J, Buchanan RW, et al. The schizophrenia patient outcomes research team (PORT) updated treatment recommendations 2003. Schizophr Bull 2004 30 193-217. 

Stress the importance of adherence with the prescribed regimen, including lifestyle modifications and nonpharmacologic treatment. Recommend the most "patient-friendly" treatment regimen possible. 

See Table 67-1 for empirical treatment recommendations. cSee text for specific recommendations for use of adjunctive dexamethasone in adults with bacterial meningitis. dSee Table 67-3 for pathogen-based definitive treatment recommendations. (Adapted, with permission, ref. 14.)... 

Develop appropriate pharmacologic treatment recommendations for patients with IE. 

Identify your empirical treatment recommendations for this patient. 

If the isolate is determined to be vancomycin-resistant, it is most important to know the exact species because some of the treatment options, such as quinupristin/dalfopristin, are not active against E. faecalis. Currently, the treatment options for vancomycin-resistant enterococci (VRE) are not well established by clinical studies or patient experience. The treatment recommendations for vancomycin-resistant E. faecium include linezolid or quinupristin/dalfopristin for a minimum of 8 weeks. However, newer agents, such as daptomycin, may provide another option for treatment for either enterococci species (E. faecium and E. faecalis). Additionally, guidelines suggest the use of imipenem-cilistatin plus ampicillin or ceftriaxone plus ampicillin for the treatment of E. faecalis with a minimum of 8 weeks of therapy. Consultation with an infectious diseases specialist is recommended. 

How does this progression change your treatment recommendations ... 

What treatment do you recommend Do any further tests need to be performed before you can decide on your treatment recommendation Are there any special considerations owing to this patient s HIV infection ... 

When diagnosing and treating gonorrhea, assume co-infection with Chlamydia trachomatis treatment recommendations should cover both organisms. 

See text for alternative treatment recommendations for non-pregnant penicillin-allergic patients. 

FIGURE 87-1. Clinical pathway for non-small cell lung cancer. See text for specific treatment recommendations. 

Verify the histology and clinical stage of disease. Evaluate the patient s performance status. Is the patient a surgical candidate How does this influence treatment recommendations ... 

Following resection of liver metastases, infusion of chemotherapy through the portal vein provides an additional adjuvant treatment approach. Historically 5-FU and floxuri-dine have been the agents used most commonly for hepatic portal vein infusion owing to their high metabolism in the liver. Although some studies demonstrate a decrease in recurrence rates, the value of portal vein infusion of chemotherapy for colon cancer remains to be determined.25 Table 88-4 summarizes adjuvant treatment recommendations for colon cancer. 

Up-to-date literature citations. A comprehensive reference list for each chapter is provided on the Online Learning Center to substantiate treatment recommendations. 

Evidence-Based Treatment Recommendations for Cardiopulmonary Resuscitation... 

Vasopressin can be substituted for the first or second dose of epinephrine in patients with asystole. There is insufficient evidence to make a treatment recommendation for PEA. 

Evidence-Based Table of Selected Treatment Recommendations Variceal Bleeding in Portal Hypertension... 

Amoxicillin is the drug of choice for acute otitis media. High-dose amoxicillin (80 to 90 mg/kg/day) is recommended. Treatment recommendations for acute otitis media are found in Table 44-2 and evidence-based recommendations are found in Table 44-3. 

An important overall approach for treatment of sepsis is goal-directed therapy. Mortality can be reduced by early placement and use of a central venous catheter, increased fluid volume administration, dobutamine therapy if needed, and red blood cell transfusion, to achieve specific physiologic goals in the first 6 hours. Evidence-based treatment recommendations for sepsis and septic shock from the Surviving Sepsis campaign are presented in Table 45-3. 

Treatment recommendations from the CDC for syphilis are presented in Table 46-6. Parenteral penicillin G is the treatment of choice for all stages of syphilis. Benzathine penicillin G is the only penicillin effective for single-dose therapy. 

Treatment recommendations for Trichomonas infections are given in Table 46-12. 

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