To the Editor: There are no published prospective, comparative studies examining the safety of duloxetine in pregnancy, and, to date, there are only 2 case reports describing its use in pregnancy:(1) a 29-year-old woman was treated with duloxetine for depression during the second half of pregnancy and gave birth to a full-term healthy infant, 1 and (2) an infant was observed after birth with signs of possible poor neonatal adaptation, following exposure in utero to duloxetine in late pregnancy. 2 Here, we report the results of an international collaboration designed to evaluate the safety of this medication during pregnancy. Our main objective was to determine whether the use of duloxetine during the first trimester of pregnancy is associated with an increased risk for major malformations above the baseline of 1%-3%. Method.In this observational multicenter cohort study, data on duloxetine exposure were collected prospectively from either women or their health care providers who had requested information regarding the use of duloxetine during pregnancy. These data came mainly from national teratogen information services that provide evidence-based information regarding the safety of and risks associated with drugs and other exposures during pregnancy. The data were collected from March 2010 to April 2012 and were from Canada, France, Israel, England, Italy, Australia, Switzerland, and Finland. French data were collected from several pharmacovigilance centers, which use procedures similar to those of teratogen information services, although requests are received mostly from physicians. The United Kingdom Teratology Information Service does not currently routinely collect data from women, as it is their health provider who makes the initial inquiry.During the initial contact, demographics, medical and obstetric histories, and details of drug exposure, as well as concurrent exposures to other substances, were recorded by teratogen information service staff on a standardized questionnaire. Then, shortly after birth to approximately 2 to 3 months after delivery, research assistants at the teratogen information services contacted women who had taken duloxetine during pregnancy and obtained their oral and/or written consent to complete the pregnancy outcome questionnaire.The study design included 2 comparison groups of equal numbers of women unexposed to duloxetine, who were chosen randomly: (1) women who were inquiring about exposure to other antidepressants and (2) women inquiring about an exposure not considered teratogenic, such as acetaminophen, antibiotics, or hair color. These women were matched to the duloxetine group for age and alcohol and tobacco use. The main outcome of interest was the presence or absence of major malformations (genetic and cytogenetic anomalies were excluded).This study was approved by the Research Ethics Board at The Hospital for Sick Children in Toronto, Ontario, Canada, and, for centers in the other countries, by local research ethics boards. In the United Kingdom, data collection is c...
Purpose Gram-negative bacteria (GNB) are a leading cause of bloodstream infections (BSI) and management is complicated by antibiotic resistance. The Accelerate Pheno™ system (ACC) can provide rapid organism identification and antimicrobial susceptibility testing (AST). Methods A retrospective, pre-intervention/post-intervention study was conducted to compare management of non-critically ill patients with GNB BSI before and after implementation of a bundled initiative. This bundled initiative included dissemination of a clinical decision algorithm, ACC testing on all GNB isolated from blood cultures, real-time communication of results to the Antimicrobial Stewardship Program (ASP), and prospective audit with feedback by the ASP. The pre-intervention period was January 2018 through December 2018, and the post-intervention period was May 2019 through February 2020. Results Seventy-seven and 129 patients were included in the pre-intervention and post-intervention cohorts, respectively. When compared with the pre-intervention group, the time from Gram stain to AST decreased from 46.1 to 6.9 h (p < 0.001), and the time to definitive therapy (TTDT) improved from 32.6 to 10.5 h (p < 0.001). Implementation led to shorter median total duration of antibiotic therapy (14.2 vs 9.5 days; p < 0.001) and mean hospital length of stay (7.9 vs 5.3 days; p = 0.047) without an increase in 30-day readmissions (22.1% vs 14%; p = 0.13). Conclusion Implementation of an ASP-bundled approach incorporating the ACC aimed at optimizing antibiotic therapy in the management GNB BSI in non-critically ill patients led to reduced TTDT, shorter duration of antibiotic therapy, and shorter hospital length of stay without adversely affecting readmission rates.
Most pregnant women will experience some degree of nausea or vomiting during pregnancy.Dietary and lifestyle interventions, along with appropriate drug treatment, can enable women to continue their everyday life and work with minimal disruption.Clinical guidelines for therapy are available, and early treatment has been shown to reduce the severity of symptoms.Pregnant women should be reassured that nausea and vomiting do not usually harm the fetus. Also, medicines used to treat this condition are not associated with an increased risk of birth defects, miscarriage, prematurity or other adverse outcomes in pregnancy.An evidence-based treatment algorithm developed by the Motherisk teratology information service in Canada 8 has been adapted for use in Australia
A correction to this paper has been published: https://doi.org/10.1007/s15010-021-01601-0
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.