Antimicrobial resistance (AMR) is among the greatest threats to global healthcare. The World Health Organization (WHO) estimates that by 2050 ten million deaths will be attributed to AMR annually. In response, the WHO has implemented antibiotic stewardship programs which focus on optimizing antibiotic use and raise, amongst others, the issue of the preferred method of intravenous antibiotic administration. Various studies have attempted to answer this question with conflicting results. This review examined several studies assessing extended/continuous infusion compared to intermittent infusion of three beta-lactams: piperacillin-tazobactam, cefepime, and meropenem. The findings and conclusions of each study were summarized and compared to one another to provide a general overview of the current evidence. We conclude that continuous/extended infusion showed a greater clinical benefit in highly critical cases, namely sepsis and febrile neutropenia, compared to intermittent infusion. Additionally, in cases where a pathogen was identified, continuous/extended infusion showed superiority. Nonetheless, high-quality studies with larger samples are needed to demonstrate the difference between these two modes of infusion in a way that would better inform guidelines and policies, aiding in the fight against AMR.
Tuberculosis continues to represent a major occupational risk in healthcare environments, particularly for healthcare workers who have persistent contact with patients who may be infectious. Despite the high occupational burden of tuberculosis among healthcare workers, there remains a lack of focused reviews that comprehensively evaluate preventive interventions across all levels of prevention within healthcare settings. In this literature review, effective preventive interventions relevant to tuberculosis transmission have been examined. Primary preventive interventions seek to diminish exposure through protective interventions such as respirators, improvements in ventilation systems, and implementation of educational programs regarding infection control protocols. Secondary preventive interventions target early diagnosis and routine screening with efforts to detect cases and latent infections early, before they progress to active disease. Enhancements in diagnostic technology have improved both the accuracy and speed of detection, further aiding the efforts of controlling nosocomial transmission. Tertiary preventive interventions target enhancing compliance with treatment protocols, managing complications of active infection, and controlling resistant strains through individualized follow-up and interventions. Barriers like stigma and lack of resources, however, often impede such interventions’ effectiveness in many cases. This narrative literature review highlights the imperative for strengthened workplace policies, an expansion of educational programs, and continued research in new and emerging interventions like new vaccine and diagnostics technology development. All these factors aim to optimize intervention effectiveness for tuberculosis and protect the health and welfare of workers in the medical field.
Over the past two decades, the global incidence of sexually transmitted infections (STIs) such as gonorrhea, chlamydia, and syphilis have increased significantly, particularly among cisgender men who have sex with men (MSM) and transgender women (TGW). This rise in STIs has spurred interest in new preventive measures, including doxycycline post-exposure prophylaxis (DoxyPEP). Clinical trials in the United States and France have demonstrated the effectiveness of DoxyPEP in reducing both chlamydia and syphilis incidence among MSM and TGW; although, its efficacy against gonorrhea remains limited, and it was further found to be ineffective among cisgender women in Kenya. Due to the promising results, the CDC and the German STI Society have incorporated DoxyPEP into their guidelines for specific high-risk groups. However, the broader implementation of DoxyPEP presents several challenges and ethical concerns. Key issues involve the potential development of antimicrobial resistance, particularly among common STI pathogens like C. trachomatis, M. genitalium, and N. gonorrhoeae, as well as other bacteria such as S. aureus and K. pneumoniae. Additionally, questions concerning equitable healthcare access, the potential impact on adherence to safer sex practices, and broader public health implications warrant careful consideration. Addressing these challenges necessitates a careful balance between the benefits and risks of DoxyPEP, as well as the implementation of strategies to mitigate negative outcomes while maximizing the impact on public health. Lastly, future research should explore the integration of DoxyPEP with other preventive strategies, such as vaccines, to enhance its effectiveness and reduce the global burden of STIs.