- |||||||||| amoxycillin/clavulanate / Generic mfg.
Protracted bacterial bronchitis: What it is, what it isn't (Hall 303, Level 3) - Aug 27, 2024 - Abstract #MTS2024MTS_41;
A placebo-controlled RCT found that a 4-week course of amoxicillin-clavulanate for treating children with chronic wet cough and suspected PBB conferred little advantage compared with a 2-week course in achieving clinical cure by 28 days...The microbiome of children with PBB are increasing known.14 However, there are still much to be leant on the pathophysiology and pathobiology. In the lecture, current data on PBB and key differentiating features of PBB from other causes of chronic cough will be presented.
- |||||||||| amoxycillin/clavulanate / Generic mfg.
Journal: Uroabdomen secondary to spontaneous bladder rupture in a dog with dystocia. (Pubmed Central) - Aug 26, 2024
This is the first case report of a dog with uroabdomen secondary to a bladder wall rupture associated with dystocia. Early recognition of this rare phenomenon and vigilance in treatment is essential for a good prognosis and outcome.
- |||||||||| ceftriaxone / Generic mfg., ampicillin / Generic mfg., amoxycillin/clavulanate / Generic mfg.
A Rare Case Report: The Silent Lethality of Mycotic Celiac Artery Aneurysm (Exhibit Hall E) - Aug 20, 2024 - Abstract #ACG2024ACG_5629;
He was discharged on lifelong suppressive therapy of amoxicillin-clavulanic acid in the setting of an untreated mycotic celiac artery aneurysm...This case highlights the importance of vigilance in diagnosing and managing this rare but life-threatening condition. Figure: Image: CT Abdomen with Contrast Figure 1: Mycotic celiac artery aneurysm Figure 2: Pancreatic body displaced
- |||||||||| Sigmoid Diverticulitis Presenting as Pyogenic Liver Abscess (Exhibit Hall E) - Aug 20, 2024 - Abstract #ACG2024ACG_5328;
He was initially treated with piperacillin-tazobactam...The patient was discharged on amoxicillin-clavulanate for six weeks...Though rare, diverticulitis as a source of pyogenic liver abscess should be considered. Figure: A. CT abdomen and pelvis findings with pyogenic hepatic abscess on admission B. Follow up CT abdomen and pelvis showing decreased size of hepatic abscess status post drain placement C. Follow up CT abdomen and pelvis revealed peri-sigmoid fat stranding consistent with sigmoid diverticulitis and small intramural abscess.
- |||||||||| Xifaxan (rifaximin) / Alfa Wassermann, Bausch Health
Purr-ils Of The Liver: A Case of Disseminated Pasteurella In A Patient With MASH Cirrhosis (Exhibit Hall E) - Aug 20, 2024 - Abstract #ACG2024ACG_5285;
The patient was empirically started on vancomycin and cefepime before being transitioned to ceftriaxone for suspected spontaneous bacterial peritonitis (SBP)...The patient was started on lactulose and rifaximin for his hepatic encephalopathy...He had sought evaluation at urgent care then and was treated with intramuscular ceftriaxone followed by a course of amoxicillin-clavulanate and was subsequently asymptomatic until this hospital presentation...Figure: Figure 1. Healing wounds on patient's right arm from prior kitten scratches (images taken one month prior to hospital admission).
- |||||||||| Pyogenic Liver Abscesses as a Unique Complication of Recurrent Diverticulitis (Exhibit Hall E) - Aug 20, 2024 - Abstract #ACG2024ACG_5271;
Empiric piperacillin-tazobactam was initiated...He was discharged on hospital day 7 with 30 days of amoxicillin-clavulanate and a repeat CT abdomen scheduled in 3 weeks...Repeat imaging is not recommended unless symptoms persist, or the PLA is not drained (as in this patient). A future outpatient colonoscopy was recommended not only due to this patient's age, but also as some studies have shown an association between PLAs and an increased incidence of colorectal cancer.
- |||||||||| Maalox (aluminum hydroxide/simethicone/magnesium hydroxide) / Sanofi
Unique Case of Vanishing Bile Duct Syndrome Exacerbated by Noncompliance (Exhibit Hall E) - Aug 20, 2024 - Abstract #ACG2024ACG_5261;
The patient was prescribed both amoxicillin and amoxicillin-clavulanic acid within a 3 month period which points to dose-dependent cause, which differs from the more documented idiosyncratic cause. This case was unique because of the exacerbated nature of disease due to noncompliance.
- |||||||||| Falling Through The Cracks: A Case Of Cholestatic Injury With Supratherapeutic Testosterone Supplementation (Exhibit Hall E) - Aug 20, 2024 - Abstract #ACG2024ACG_5239;
He visited urgent care centers and a primary care office and was treated with acetaminophen, ibuprofen, amoxicillin/clavulanic acid, and metronidazole...He was initiated on ursodiol 300 mg twice a day with improvement of laboratory parameters...Normal appearance of the biliary tree with no choledocholithiasis or biliary ductal dilatation. No pancreatic mass identified.
- |||||||||| Invanz (ertapenem) / Merck (MSD)
Successful Treatment of a Multiloculated, Giant Pyogenic Liver Abscess Through Non-Operative Approach (Exhibit Hall E) - Aug 20, 2024 - Abstract #ACG2024ACG_5223;
He was admitted and started on vancomycin and piperacillin-tazobactam...He completed outpatient intravenous antibiotics with four weeks of ertapenem, followed by eight weeks of amoxicillin-clavulanic acid, leading to eventual normalization of his inflammatory markers and radiographic resolution of the abscess...E,F: Contrast enhanced Axial and Coronal images through the Abdomen: Near complete resolution of previously seen hypodense rim enhancing collection. Residual hypoattenuating triangular region likely represents healing/fibrous tissue.
- |||||||||| Taltz (ixekizumab) / Eli Lilly, Japan Tobacco
Ixekizumab-Induced Ulcerative Colitis With Resultant Total Colectomy (Exhibit Hall E) - Aug 20, 2024 - Abstract #ACG2024ACG_4936;
He was prescribed a course of amoxicillin and clavulanic acid as initial etiology was thought to be a combination of infectious colitis and internal hemorrhoids...Salvage therapy was initiated with infliximab on day five without appropriate response, and he subsequently developed a colonic perforation at the splenic flexure at which point total colectomy was necessary...Figure C a photomicrograph showing histologic evidence of active inflammation by increased number of plasma cells in lamina propria (red arrow) and chronic disease by architectural changes to crypts (yellow arrow). Figure D x-ray showing worsening colonic dilatation to 13.35cm.
- |||||||||| Entyvio (vedolizumab) / Takeda
Recurrent Splenic Abscesses in a Patient With Ulcerative Colitis and Pouchitis (Exhibit Hall E) - Aug 20, 2024 - Abstract #ACG2024ACG_4931;
He represented with left upper quadrant abdominal pain, leukocytosis, and multiple splenic abscesses, largest 10 mm in size (Figure 1) treated with IV ceftriaxone and metronidazole followed by outpatient course of amoxicillin/clavulanic acid...Due to recurrent splenic abscesses linked with pouchitis, confirmed by recent pouchoscopy, he began vedolizumab alongside antibiotics, with plans to discontinue the antibiotics after the abscesses have resolved...Further studies are required to clarify these mechanisms. Figure: Figure 1: Recurrent splenic abscesses
- |||||||||| Penicillin or Cannabis? A Unique Case of Drug-Induced Necrotizing Pancreatitis (Exhibit Hall E) - Aug 20, 2024 - Abstract #ACG2024ACG_4087;
We present a case of drug-induced pancreatitis caused by recent use of amoxicillin-clavulanate and heavy tetrahydrocannabinol (THC) vaping...Despite aggressive volume resuscitation and piperacillin-tazobactam, he was febrile (101?) for one week with persistent tachycardia and leukocytosis (27.8 x 10^3/uL)...The vast number of offending medications and reliance on small cases to outline their effects makes the diagnosis challenging. Toxicology screens, a thorough social history and medicine reconciliation is warranted in all patients with acute or recurrent pancreatitis when the cause is unclear.
- |||||||||| Successful Medical Management of Intramural Duodenal Abscess (Exhibit Hall E) - Aug 20, 2024 - Abstract #ACG2024ACG_3775;
Her symptoms completely resolved after 3 days and she was discharged with a 1-week course of oral amoxicillin-clavulanic acid and oral omeprazole with plan for repeat imaging...Our case highlights the successful management of duodenal abscess with antibiotic treatment without a need for an endoscopic procedure or drainage. Figure: Initial (A) and post-treatment (B) CT scans.
- |||||||||| amoxycillin/clavulanate / Generic mfg.
A Human Brewery: The Diagnostic Challenge of Auto-Brewery Syndrome (Exhibit Hall E) - Aug 20, 2024 - Abstract #ACG2024ACG_3726;
This occurred after taking amoxicillin-clavulanate for an ear infection, as well as increased carbohydrate intake in preparation for his military physical fitness test...A structured approach to diagnostic evaluation for this disorder is important for physicians, as the presence of ABS can have legal and occupational implications for patients. In our case we offered elective video monitoring of the patient, which was accepted.
- |||||||||| amoxycillin/clavulanate / Generic mfg.
Combined Endovascular and Endoscopic Removal of a Migrated IVC Filter With Closure of Duodenal Fistula (Exhibit Hall E) - Aug 20, 2024 - Abstract #ACG2024ACG_3333;
The patient was discharged home after the procedure on a 7-day course of amoxicillin-clavulanate...(A) and (B) CT abdomen/pelvis showing anterior leg of IVC filter extending into the duodenum. Endoscopic visualization; (C) IVC filter strut covered in bilious debris in the second portion of duodenum, (D) duodenal defect status post strut removal, (E) duodenal suture repair with cinch.
- |||||||||| amoxycillin/clavulanate / Generic mfg.
Recurrent Pleural Effusions From Hepatopulmonary Fistula Secondary to Perforated Diverticulitis (Exhibit Hall E) - Aug 20, 2024 - Abstract #ACG2024ACG_2538;
The patient's hospital course was prolonged due to the refractory nature of his pleural effusions, but with targeted antibiotic therapy and respiratory support, he improved and was discharged with a 6-week course of amoxicillin-clavulanate...In our case, the CT scan was crucial in identifying the hepatopulmonary fistula early, allowing us to drain the abscess promptly. Surgical decortication would have likely been pursued if the patient had not improved with time.
- |||||||||| Splenic Abscess Due to Entamoeba Histolytica (Exhibit Hall E) - Aug 20, 2024 - Abstract #ACG2024ACG_2475;
The drain was removed and he was discharged on 2 weeks of oral metronidazole and amoxicillin/clavulanic acid...Large round splenic abscess. B: Anchovy sauce aspirate from splenic abscess
- |||||||||| amoxycillin/clavulanate / Generic mfg.
It Is Not Cholecystitis, or Is It? Look Again: A Rare Incidence of Emphysematous Cholecystitis With Negative Initial Imagining (Exhibit Hall E) - Aug 20, 2024 - Abstract #ACG2024ACG_2383;
The patient's clinical condition improved and was discharged with amoxicillin-clavulanate and docusate...This step is especially important for identifying any evolving or subtle pathological changes that may have been missed initially. EC is a rapidly progressive variant of cholecystitis with mortality rate of 15% without early diagnosis and prompt treatment vs 4% in acute uncomplicated cholecystitis.
- |||||||||| Lost and Found: A Dropped Gallstone-Induced Perihepatic Abscess Post-Cholecystectomy (Exhibit Hall E) - Aug 20, 2024 - Abstract #ACG2024ACG_2287;
She was discharged with a 10-day prescription of amoxicillin-clavulanate...She was admitted and started on piperacillin/tazobactam...She was discharged on IV ceftriaxone and oral metronidazole the following day...Figure: Figure 1: A) Contrast- enhanced abdominal CT image demonstrating multilocular fluid collection in the right paracolic gutter (arrow). B) Robotic-assisted abdominal exploration; B1) Purulent fluid being suctioned (arrow); B2) One of the four stones retrieved (circle).
- |||||||||| Xifaxan (rifaximin) / Alfa Wassermann, Bausch Health
Empiric Treatment of Small Intestinal Bacterial Overgrowth in Patient With Systemic Sclerosis (Exhibit Hall E) - Aug 20, 2024 - Abstract #ACG2024ACG_2056;
She was trialed with cholestyramine, nortriptyline, psyllium, and dairy and gluten avoidance, but she reported no benefit...Glucose and lactulose breath testing are specific but not sensitive...While a single course of rifaximin may be safest, cycling antibiotics (e.g., ciprofloxacin, doxycycline, amoxicillin/clavulanic acid, and rifaximin) may also be effective. Therefore, the focus is to treat symptoms and prevent complications.
- |||||||||| amoxycillin/clavulanate / Generic mfg.
Drug-Induced Liver Injury: A Case of Amoxicillin-Clavulanate-Induced Liver Injury (Exhibit Hall E) - Aug 20, 2024 - Abstract #ACG2024ACG_1931;
Management includes immediate cessation of the offending agent with supportive care with n-acetylcysteine (NAC) and ursodiol, although there is little evidence to support their use...Case Description/ A 59-year-old male with ulcerative colitis on balsalazide presented with nausea, vomiting, fatigue, jaundice, scleral icterus, and pruritis...Figure: Cholestatic hepatitis with canalicular cholestasis, associated with hepatocellular degeneration and mild portal inflammatory infiltrates, consistent with drug-induced bile metabolism. Note: The table for this abstract can be viewed in the ePoster Gallery section of the ACG 2024 ePoster Site or in The American Journal of Gastroenterology's abstract supplement issue, both of which will be available starting October 27, 2024.
- |||||||||| amoxycillin/clavulanate / Generic mfg.
A Challenging Diagnosis of a Liver Mass: Inflammatory Pseudotumor of the Liver (Exhibit Hall E) - Aug 20, 2024 - Abstract #ACG2024ACG_1784;
A repeat CT two weeks later showed interval increase in size to 4.3cm despite a course of amoxicillin/clavulanate...Hematoxylin-Eosin, original magnification 100x), with a 0.5 cm inflammatory pseudotumor composed of lymphocytes and plasma cells (B. Hematoxylin-Eosin, original magnification 200x).
- |||||||||| amoxycillin/clavulanate / Generic mfg.
Dilly-Dallying with DILI: A Case of Recurrent Amoxicillin-Clavulanic Acid-Induced Hepatitis (Exhibit Hall E) - Aug 20, 2024 - Abstract #ACG2024ACG_1763;
Awareness of the patient's antibiotic history might have avoided overlooking the diagnosis and averted unnecessary procedures. Note: The table for this abstract can be viewed in the ePoster Gallery section of the ACG 2024 ePoster Site or in The American Journal of Gastroenterology's abstract supplement issue, both of which will be available starting October 27, 2024.
- |||||||||| Entyvio (vedolizumab) / Takeda
A Sneaky Leak: Idiopathic Spontaneous Pneumomediastinum in an Active Crohn's Patient (Exhibit Hall E) - Aug 20, 2024 - Abstract #ACG2024ACG_1491;
She reported nocturnal bowel movements, fecal urgency, and occasional pyrosis relieved by famotidine...At presentation, she had been on prednisone for 6 weeks and was pending her last vedolizumab induction dose...Her SPM was treated in conjunction with thoracic surgery conservatively with amoxicillin-clavulanic acid, and fluconazole for a total of 7 days...Figure: Figure 1 - CT of the Chest: Axial (Panel A) and sagittal (Panel B) images obtained without the administration of oral or intravenous contrast material show nonspecific pneumomediastinum with contained air seen surrounding the lower esophagus (Panels A and B, arrows). Free air is also seen extending along the anterior and superior mediastinum (Panel B, asterisks).
- |||||||||| amoxycillin/clavulanate / Generic mfg.
Unveiling the Unseen: Diagnosis of Appendicitis on Colonoscopy (Exhibit Hall E) - Aug 20, 2024 - Abstract #ACG2024ACG_1204;
The patient was asymptomatic and discharged home on amoxicillin-clavulanate...Gastroenterologists should be aware of endoscopic findings of acute appendicitis and prompt to inculcate additional diagnostic modalities and surgical consultation. Figure: Image A: Purulent exudate with inflamed appendiceal orifice seen during colonoscopy; Image B: Inflamed appendix visualized in CT abdomen and pelvis
- |||||||||| amoxycillin/clavulanate / Generic mfg.
Uncomplicated Diverticulitis Masquerading as Symptomatic Ovarian Cyst in a Young Female. (Exhibit Hall E) - Aug 20, 2024 - Abstract #ACG2024ACG_881;
She was started on amoxicillin-clavulanate and noted to have significant improvement...Guidelines for treatment are not standardized therefore early intervention and appropriate follow-up should be arranged to ensure adequate long-term care of affected patients. Figure: CT Abdomen Pelvis with contrast demonstrating peri-colonic fat stranding in the mid ascending colon to the hepatic flexure with colonic diverticula concerning for acute uncomplicated diverticulitis.
- |||||||||| amoxycillin/clavulanate / Generic mfg.
Sleeping Gut: Ischemia Colitis in a Young Adult at Night (Exhibit Hall E) - Aug 20, 2024 - Abstract #ACG2024ACG_801;
The patient was started on Amoxicillin-Clavulanate 875mg -125 mg to complete five days and outpatient follow-up with gastroenterology...This case underscores the importance of considering ischemic colitis in the differential diagnosis for younger adults for timely intervention and appropriate management. Figure: Sigmoid Colon
- |||||||||| Case Report: Clostridium ramosum Bacteremia Following Colon Perforation Post-Colonoscopy (Exhibit Hall E) - Aug 20, 2024 - Abstract #ACG2024ACG_795;
Case Description/ A 77-year-old female with past medical history notable for chronic normocytic anemia and Sjogren's syndrome on hydroxychloroquine presented with altered mental status...Patient was initiated on piperacillin/tazobactam for empiric antibiotic coverage...Patient recovered well and antibiotic coverage was de-escalated to a 10 day course of amoxicillin-clavulanic acid...Although bacterial resistance to C. ramosum is generally uncommon, early recognition and treatment of this bacteremia are crucial, especially in immunocompromised patients. Figure: Erect abdominal x-ray demonstrating lucency of the upper abdomen underlying the right diaphragm, concerning for pneumoperitoneum.
- |||||||||| azithromycin / Generic mfg., cefuroxime / Generic mfg., amoxycillin/clavulanate / Generic mfg.
Journal: Evaluation of children's antibiotics use for outpatient pneumonia treatment in Vietnam. (Pubmed Central) - Aug 8, 2024
Generic antibiotic use for single therapy should be encouraged based on rapid and accurate diagnostic testing for viruses and bacteria to reduce antibiotic resistance in developing countries. Moreover, the study result has also shown that therapies and antibiotics (class and origin) exhibited significant association with rational prescriptions for CAP treatment for pediatrics.
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