With a substantial number of women using herbal products to augment their milk production, this article will review available literature illustrating efficacy and adverse effects of using these products. Embase, PubMed, and EBSCO (all databases) were searched from inception to June 2011 using terms such as ‘‘galactagogue,’’ ‘‘galactogogue,’’ ‘‘herbal,’’ and ‘‘botanical’’ and the search was subsequently narrowed to specific herbals by name. Additional articles were obtained from article reference lists. Supplemental information was obtained with Natural Standard. All abstracts retrieved were evaluated for relevance and germane articles were included. Numerous lactation-stimulating herbals have been identified in the literature with varying degrees of evidence,mostly anecdotal. Use of torbangun, milk thistle, and fenugreek may correlate with increased milk supply. Evidence regarding adverse effects, pharmacodynamic properties, and pharmacokinetic effects remains scarce. Despite the fact that postpartum women may turn to herbal galactagogues, scant clinical evidence exists to justify their effectiveness. Further clinical trials are needed in order to substantiate these findings.

Lack of standardization in antibiogram (ABGM) preparation (the overall profile of antimicrobial susceptibility results of a microbial species to a battery of antimicrobial agents) has not been addressed until recently. The objective of this study was to analyze current antibiograms using the recently published NCCLS M39-A guidelines for preparation of antibiograms to identify areas for improvement in the reporting of antibiogram susceptibility data. Antibiograms from across the United States were obtained by various methods, including direct mailings, Internet searches, and professional contacts. Each ABGM collected was analyzed using prospectively defined elements from the M39-A guidelines. Additionally, seven quality indicators were also evaluated to look for the reporting of any atypical or inappropriate susceptibility data. The 209 antibiograms collected from 149 institutions showed at least 85% compliance to 5 of the 10 M39-A elements analyzed. Clinically relevant elements not met included annual analysis, duplicate isolate notation, and the exclusion of organisms with fewer than 10 isolates. As for the quality indicators evaluated, unexpected results included the 7% of antibiograms that reported <100% vancomycin susceptibility for Staphylococcus aureus, 24% that had inconsistent betalactam susceptibility for Staphylococcus aureus, 20% that reported <100% imipenem susceptibility for Escherichia coli, and 37% that reported >0% ampicillin susceptibility for Klebsiella pneumoniae. These findings suggest that antibiograms should be reviewed thoroughly by infectious disease specialists (physicians and pharmacists), clinical microbiologists, and infection control personnel for identification of abnormal findings prior to distribution.

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Background: Infectious disease (ID) is a dynamic field with new guidelines being adopted at a rapid rate. Clinical decision support tools (CDSTs) have proven beneficial in selecting treatment options to improve outcomes. However, there is a dearth of information on the abilities of CDSTs, such as drug information databases. This study evaluated online drug information databases when answering infectious disease-specific queries.

Antibiograms are an important resource for health care providers. All clinicians involved in antibiotic selection and monitoring should become familiar with the NCCLS M39-A document “Analysis and Presentation of Cumulative Antimicrobial Susceptibility Test Data: Approved Guideline.” Providers who interpret and apply antibiogram data in clinical practice should know about susceptibility testing methods, the susceptibility breakpoint determination process, and problems associated with antibiogram data analysis. The M39-A guidelines contain more than 40 recommendations, including the following: antibiogram data should be analyzed at least annually, an attempt should be made to remove duplicate isolates, and only organisms with 10 isolates or more should be presented. Accurate antibiograms facilitate improved empiric antibiotic selection and more precise monitoring of bacterial resistance in the hospital. This article reviews common antimicrobial susceptibility testing methods and relevant issues, highlights the major NCCLS M39-A recommendations, discusses the antibiogram preparation process and challenges in data interpretation, and provides a general overview of how antibiogram data may be applied to clinical practice.