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Bactrim vs cipro for cellulitis (Gouffart et al., 1999); and the combination of ciprofloxacin (400 mg) with trimethoprim oxazole (40 and oral vancomycin for bacterial infections (Jouret et al., 2000). However, the evidence for combined therapy in C. difficile is limited. addition, vancomycin-only combinations are also not well tolerated and the use of ciprofloxacin-tetracycline combinations will not improve patient outcomes. In contrast, vancomycin should always be used in combination with other antibiotics if indicated (e.g., for other infections) rather than because of resistance considerations. Infection control guidelines Although it was not clear, is likely that all the strains of C. difficile were initially transmitted by human fecal-oral transmission (Tallmadge, 2002). Therefore, for C. difficile prevention, it might make sense to take a multidrug approach using mixture of different agents and/or classes antibiotics (Tallmadge, 2002; Hultner and Littel, 2002). To reduce antibiotic use and the risk for emergence of new strains bacteria, guidelines for prescribing antimicrobial agents based on current studies have been recommended (Hultner and Littel, 2002). For example, antibiotics should only be prescribed based on laboratory or community-acquired isolates. Therefore, if a clinical sample of suspected case C. difficile is cultured, use a regimen of ciprofloxacin-tetracycline or metronidazole, if indicated only in cases of suspected infection caused by a resistant isolate (Hultner-Littel and Gorman, 2002; Sutter et al., 2000). For an additional measure of control, oral rehydration solution containing metronidazole (1000 mg/kg) and ciprofloxacin (400 should be administered in the event of failure to produce symptoms after intravenous antibiotic dosing (Kumar and Brown, 2001). Although oral rehydration solutions should not be given after dosing with intravenous antibiotics, it might be feasible to do so (Brown, 1999). A new guideline has recently been made for the selection of antibiotics to be used after hospital discharge (Berg et al., 2000). Patient education The role of educational efforts is important whenever antibiotics are used in the management of a serious infectious disease (Brown et al., 2005). The importance of educational efforts was illustrated recently when C. difficile reached a critical number of strains, and antibiotic resistance was reported in several different countries and from ethnic populations over the same 10 years (Tajima et al., 2003). Educational programs were therefore instituted on a national level (Japan) that were then extended to other countries (Sutton, 2003). In the United States, an educational and media campaign was initiated to educate patients as the potential health risks and dangers of C. difficile (Kapowal et al., 2002). The campaign contained a series of educational materials that emphasized the presence of other possible causes disease can be identified and treated by other treatments is not necessarily due to a diagnosis of C. difficile (Bartley and Rabinowitz, 2000). It also provided information about the potential treatment alternatives if C. difficile were to be a cause of serious illness. The campaign was continued for 15 years in different parts of the hospital, with primary focus on hospitals and community health workers, to include care workers who were exposed to patients sickened by C. difficile (Bartley and Rabinowitz, 2000). Although not all aspects of the media program were completely successful on a community level, the fact that such a media campaign was introduced suggests that education is a useful way to prevent potential resistance from rising in C. difficile. Although education efforts are often difficult to conduct, given the stigma that remains attached to bacterial infections, it has the potential to have a significant effect (Jouret et al., 2000). If there is a lack of education, people will assume that the problem is due to a lack of medical treatment or that the disease results from poor hygiene. Thus, the importance of ensuring that everyone has adequate knowledge about the prevention and treatment of infectious diseases cannot be underestimated, especially for individuals who do not see themselves as health care providers and for patients who lack education themselves. Limitations Studies that have not been designed for randomization and which are observational studies of uncertain generalizability, and therefore should be interpreted in this context. The following limitations should be taken into account when interpreting epidemiologic studies (Brown and Kelleher, 2001): Limitations with the quality of studies Although observational studies can be Inderal generic price valuable, there are limitations with the design of observational studies as.

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