The most appropriate therapeutic strategy for acute lower respiratory tract infections: a Delphi-based approach

Blasi, Francesco; Concia, Ercole; Prato, Bruno del; Giusti, Massimo; Mazzei, Teresita; Polistena, Barbara; Rossi, Alessandro; Stefani, Stefania; Novelli, Andréa

doi:10.1080/1120009x.2017.1291467

Cited by 17 publications

(19 citation statements)

References 47 publications

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“…The panellists were asked to anonymously express their level of agreement with each statement, using a 5-point Likert scale (1 = disagree; 2 = somewhat disagree; 3 = neither agree nor disagree; 4 = somewhat agree; 5 = agree). The use of a 5-point Likert Scale with this consensus threshold was defined a priori as described in previous studies with this modified process [29,[31][32][33][34]. Consensus was considered if either the sum of answers 1 and 2 (negative agreement), or 4 and 5 (positive agreement) exceeded 70%, as described in previous studies with this method [29,32,33,35].…”

Section: Delphi Process and Steering Committeementioning

confidence: 99%

Refining diagnosis and management of chronic venous disease: Outcomes of a modified Delphi consensus process

Aloi

Camporese

Izzo

et al. 2019

European Journal of Internal Medicine

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Chronic venous disease (CVD) is a common condition with major health consequences that is associated with poor long-term prognosis, significant socioeconomic impact, disabling symptoms and reduced quality of life. To provide practical guidance for diagnosis and management of CVD, a Delphi panel of 5 experts in steering committee and 28 angiologists/vascular surgeons met with the major aim of providing a supplement for established national and international guidelines. A total of 24 statements were voted upon in two rounds, of which consensus was reached on 22 statements, indicating a high level of overall agreement. Consensus was reached on 7 of 8 statements relative to diagnosis (CEAP classification, diagnostic tools, QoL assessment, diagnostic imaging) and on 15 of 16 statements on management (conservative treatments, compressive therapy, pharmacological therapy, surgical treatment). The results of the consensus reached are discussed herein from which it is clear that diagnostic and management approaches utilising personalised therapies tailored to the individual patient should be favoured. While it is clear that additional studies are needed on many aspects of diagnosis and management of CVD, the present Delphi survey provides some key recommendations for clinicians treating CVD that may be useful in daily practice.

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Section: Delphi Process and Steering Committeementioning

confidence: 99%

Refining diagnosis and management of chronic venous disease: Outcomes of a modified Delphi consensus process

Aloi

Camporese

Izzo

et al. 2019

European Journal of Internal Medicine

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“…Using the Delphi methodology to assess the consensus on the most appropriate strategy for acute LRTIs, 71% agreement was reached on the statement that empiric therapy with antibiotics characterized by a resistance profile above the 10–20% threshold and the non-protected β-lactams should be avoided [ 134 ]. This, together with the TOM probability study [ 132 ] points to discard macrolides as treatment considering their lack of PK/PD activity against H. influenzae , a pathogen potentially involved.…”

Section: The Role Of Cefditoren In the Treatment Of Lrtismentioning

confidence: 99%

“…This, together with the TOM probability study [ 132 ] points to discard macrolides as treatment considering their lack of PK/PD activity against H. influenzae , a pathogen potentially involved. Consensus (78% agreement) was also reached on the need to use antibiotics able to target emergent BLNAR and BLPACR isolates to prevent intra-species diffusion of resistant strains when treating AECB [ 134 ]. In vitro, cefditoren (in contrast to amoxicillin/clavulanic acid) demonstrated to counter intra-strain diffusion and spread of nonenzymatic resistance mechanisms ( fts I gene) in a pharmacodynamic simulation including several NTHi strains [ 82 ].…”

Section: The Role Of Cefditoren In the Treatment Of Lrtismentioning

confidence: 99%

“…In vitro, cefditoren (in contrast to amoxicillin/clavulanic acid) demonstrated to counter intra-strain diffusion and spread of nonenzymatic resistance mechanisms ( fts I gene) in a pharmacodynamic simulation including several NTHi strains [ 82 ]. Consensus (96% agreement) was also reached on the statement that among third-generation cephalosporins, cefditoren has a particularly balanced spectrum, the 400 mg dose every 12 h covering penicillin-resistant pneumococci [ 134 ].…”

Section: The Role Of Cefditoren In the Treatment Of Lrtismentioning

confidence: 99%

“…Among others, IDSA and ATS guidelines recommend a switch to oral antibiotics for the treatment of stable hospitalized patients with CAP as soon as the patient is improving [ 135 , 136 ]. A very high consensus (93%) was reached in the Delphi-based analysis on the statement that cefditoren is the best switch for intravenous third generation cephalosporins (cefotaxime, ceftriaxone) because of the similar spectrum and the highest intrinsic activity [ 134 ]. In this sense, cefditoren has been included as recommended drug for switch therapy after intravenous treatment with third generation cephalosporins in several documents [ 137 – 139 ], in contrast to cefuroxime which does not provide the required high intrinsic activity and adequate pharmacodynamics [ 139 ].…”

Section: The Role Of Cefditoren In the Treatment Of Lrtismentioning

confidence: 99%

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Revisiting cefditoren for the treatment of community-acquired infections caused by human-adapted respiratory pathogens in adults

Giménez¹,

Aguilar²,

Granizo

2018

Multidiscip Respir Med

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Fifteen years after its licensure, this revision assesses the role of cefditoren facing the current pharmacoepidemiology of resistances in respiratory human-adapted pathogens (Streptococcus pneumoniae, Streptococcus pyogenes, Haemophilus influenzae and Moraxella catarrhalis). In the era of post- pneumococcal conjugate vaccines and in an environment of increasing diffusion of the ftsI gene among H. influenzae isolates, published studies on the cefditoren in vitro microbiological activity, pharmacokinetic/pharmcodynamic (PK/PD) activity and clinical efficacy are reviewed. Based on published data, an overall analysis is performed for PK/PD susceptibility interpretation. Further translation of PK/PD data into clinical/microbiological outcomes obtained in clinical trials carried out in the respiratory indications approved for cefditoren in adults (tonsillitis, sinusitis, acute exacerbation of chronic bronchitis and community-acquired pneumonia) is commented. Finally, the role of cefditoren within the current antibiotic armamentarium for the treatment of community respiratory tract infections in adults is discussed based on the revised information on its intrinsic activity, pharmacodynamic adequacy and clinical/bacteriological efficacy. Cefditoren remains an option to be taken into account when selecting an oral antibiotic for the empirical treatment of respiratory infections in the community caused by human-adapted pathogens, even when considering changes in the pharmacoepidemiology of resistances over the last two decades.

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Establishing diagnostic criteria and treatment of subsegmental pulmonary embolism: A Delphi analysis of experts

Exter¹,

Kroft²,

Gonsalves³

et al. 2020

Research and Practice in Thrombosis and Haemostasis

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Background Improved imaging techniques have increased the incidence of subsegmental pulmonary embolism (ssPE). Indirect evidence is suggesting that ssPE may represent a more benign presentation of venous thromboembolism not necessarily requiring anticoagulant treatment. However, correctly diagnosing ssPE is challenging with reported low interobserver agreement, partly due to the lack of widely accepted diagnostic criteria. Objectives We sought to derive uniform diagnostic criteria for ssPE, guided by expert consensus. Methods Based on an extensive literature review and expert opinion of a Delphi steering committee, two surveys including statements regarding diagnostic criteria and management options for ssPE were established. These surveys were conducted electronically among two panels, respectively: expert thoracic radiologists and clinical venous thromboembolism specialists. The Delphi method was used to achieve consensus after multiple survey rounds. Consensus was defined as a level of agreement >70%. Results Twenty‐nine of 40 invited radiologists (73%) and 40 of 51 clinicians (78%) participated. Following two survey rounds by the expert radiologists, consensus was achieved on 15 of 16 statements, including on the established diagnostic criteria for ssPE (96% agreement): a contrast defect in a subsegmental artery, that is, the first arterial branch division of any segmental artery independent of artery diameter, visible in at least two subsequent axial slices, using a computed tomography scanner with a desired maximum collimator width of ≤1 mm. These criteria were approved by 83% of the clinical venous thromboembolism (VTE) specialists. The clinical expert panel favored anticoagulant treatment in case of prior VTE, antiphospholipid syndrome, pregnancy, cancer, and proximal deep vein thrombosis. Conclusion The results of this analysis provide standard radiological criteria for ssPE that may be applicable in both clinical trials and practice.

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The most appropriate therapeutic strategy for acute lower respiratory tract infections: a Delphi-based approach

Cited by 17 publications

References 47 publications

Refining diagnosis and management of chronic venous disease: Outcomes of a modified Delphi consensus process

Refining diagnosis and management of chronic venous disease: Outcomes of a modified Delphi consensus process

Revisiting cefditoren for the treatment of community-acquired infections caused by human-adapted respiratory pathogens in adults

Establishing diagnostic criteria and treatment of subsegmental pulmonary embolism: A Delphi analysis of experts

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