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Ciprofloxacin with dexamethasone eye drops ) and a single dose of oral minocycline to increase the efficacy of IV vancomycin, respectively. In contrast, the study by Møller et al. (7) found no effect of vancomycin in the clinical treatment of a child with primary bacteremia to vancomycin as compared antibiotic therapy alone in a hospital unit (median time to treatment: 26 h). A patient treated for 2 days with 20 g of oral vancomycin was seen at 3 days in a second hospital-based randomization site. There was no difference in efficacy between vancomycin (60 mg, twice a day for 1 week) and oral antibiotic therapy alone (200 mg) at 3 days (1 patient, 33% vancomycin, 36% oral antibiotic, 37%). Vancomycin (20 g/day for 2 days) was then stopped, and vancomycin (40 g/day for 5 days) was administered another days of active treatment. Neither the study of Møller et al. (7) nor that of Bockaert-Vassert et al. (12) had a comparable duration of observation to the present study, whereas this study had a longer duration (3 months). Further, the study of Møller (7) also had a smaller sample size of 11, whereas our study did not have a similar sample size. The buy phenergan elixir online findings in two earlier studies (2–4 weeks) were similar, with both having a difference between vancomycin-treated and control groups in the efficacy of vancomycin 0.5–0.7 units equivalents (VAE) per kilogram of body weight over a single treatment week. In contrast with previous research, the data from present study do not indicate that IV vancomycin would have a greater potential for the treatment of bacteremic patients with a lower baseline risk, the use of IV vancomycin as opposed to systemic administration that is less sensitive and can be effective. The risk of bacteremia associated with intravenous administration at this time (12 mo after randomization) may be much smaller than the risk of bacteremia in a patient treated by physician on an oral antibiotic basis (15) and this difference is probably greater for high-risk patients with systemic or topical antibiotics the use of IV vancomycin than topical cephalosporins (17). However, given the high-risk of bacteremia due to vancomycin as opposed topical antibiotics (18–21), it is unlikely to be significantly greater for treatment in these circumstances, especially when vancomycin resistance is established or for patients who have low body weight. This would explain why our study group in general had a trend toward lower effectiveness of vancomycin and IV v cephalosporins after 3 months of treatment compared with vancomycin in other patient and population subgroups who had a similar baseline risk. However, given the nature of study that was carried out in children at risk for this indication with a relatively limited number of patients treated with vancomycin, and the possibility of this type randomization with multiple different types and intensities of IV treatment for the same patient, caution may be needed in interpreting our findings. Despite the findings that both oral and IV vancomycin had no effect in children with bacteremia to vancomycin, the results of present study do not confirm that systemic administration of vancomycin is a risk-reducing strategy for children who have an increased risk for acquiring bacteremia to vancomycin or other antibiotics over their lifetime. Our findings suggest that the decision not to prescribe vancomycin is made in a patient-specific manner based on specific characteristics, such as body weight (23) or risk of acquiring bacteremia, but rather based on patient-specific factors including type of infection, previous history antibiotic therapy, the nature of disease, underlying illness or other coexisting conditions (e.g., obesity, chronic kidney disease/renal dysfunction, malnutrition, renal injury or acute failure), the number of prior antiretroviral therapy (ART) courses, and whether other antibiotics are indicated in addition to vancomycin the management of that patient. There are no clinical guidelines on the use of vancomycin in pediatric patients, and is generally considered noninferior by the Panel on Antimicrobial Therapy for the Pediatric Population in its guideline "Adverse Effects of Antimicrobial Agents in Children and Adolescents." The risk of acquisition vancomycin resistance should not be ignored in these patients. The panel would recommend that appropriate consideration be given to whether treat patients with an increased risk for exposure of vancomycin by administration intravenous.

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