Cambridge University Press



Supplementary. Multifaceted intervention for improving discharge antimicrobial prescription in the emergency departmentAuthors: Yasuaki Tagashira MD, PhD, Manaka Goto MD, Reiko Kondo MD, Hitoshi Honda MD, PhDSupplementary Table 1. A list of indications and appropriate antimicrobial prescriptions for infectious diseases encountered in the emergency department DiagnosisSummary of antibiotic treatment indicationsDrug, dosageReferencesSinusitisPrescribe antimicrobial agents to adults with acute bacterial sinusitis (diagnosed strictly per criteria) with 1) Onset with persistent symptoms or signs compatible with acute rhinosinusitis lasting >10 days without any evidence of clinical improvement, 2) Onset with severe symptoms or signs of high fever (>39°C [102°F]) and purulent nasal discharge or facial pain lasting at least 3–4 consecutive days at the beginning of illness, 3) Onset with worsening symptoms or signs characterized by a new onset of fever, headache or increase in nasal discharge following a typical viral upper respiratory tract infection (URI) lasting 5–6 days despite initial improvement of symptomsAmoxicillin-clavulanate 500/125 mg orally three times daily or 875/125 mg orally twice dailyAmoxicillin 500 mg orally three times dailyDoxycycline 100 mg orally twice dailyFor patients with a history of penicillin allergy:Doxycycline 100 mg orally twice dailyLevofloxacin 500 mg orally once dailyMoxifloxacin 400 mg orally once dailyChow et al.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5DaG93PC9BdXRob3I+PFllYXI+MjAxMjwvWWVhcj48UmVj

TnVtPjIxOTwvUmVjTnVtPjxEaXNwbGF5VGV4dD48c3R5bGUgZmFjZT0ic3VwZXJzY3JpcHQiPjE8

L3N0eWxlPjwvRGlzcGxheVRleHQ+PHJlY29yZD48cmVjLW51bWJlcj4yMTk8L3JlYy1udW1iZXI+

PGZvcmVpZ24ta2V5cz48a2V5IGFwcD0iRU4iIGRiLWlkPSJ0ZGRydzV2YWZlcDVkMGVhZmF2eHh2

OWZhNWV4cnByc3N2dmQiIHRpbWVzdGFtcD0iMTU2MzUxOTkwMCI+MjE5PC9rZXk+PC9mb3JlaWdu

LWtleXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10eXBlPjxjb250

cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5DaG93LCBBLiBXLjwvYXV0aG9yPjxhdXRob3I+QmVu

bmluZ2VyLCBNLiBTLjwvYXV0aG9yPjxhdXRob3I+QnJvb2ssIEkuPC9hdXRob3I+PGF1dGhvcj5C

cm96ZWssIEouIEwuPC9hdXRob3I+PGF1dGhvcj5Hb2xkc3RlaW4sIEUuIEouPC9hdXRob3I+PGF1

dGhvcj5IaWNrcywgTC4gQS48L2F1dGhvcj48YXV0aG9yPlBhbmtleSwgRy4gQS48L2F1dGhvcj48

YXV0aG9yPlNlbGV6bmljaywgTS48L2F1dGhvcj48YXV0aG9yPlZvbHR1cm8sIEcuPC9hdXRob3I+

PGF1dGhvcj5XYWxkLCBFLiBSLjwvYXV0aG9yPjxhdXRob3I+RmlsZSwgVC4gTS4sIEpyLjwvYXV0

aG9yPjxhdXRob3I+SW5mZWN0aW91cyBEaXNlYXNlcyBTb2NpZXR5IG9mLCBBbWVyaWNhPC9hdXRo

b3I+PC9hdXRob3JzPjwvY29udHJpYnV0b3JzPjxhdXRoLWFkZHJlc3M+RGl2aXNpb24gb2YgSW5m

ZWN0aW91cyBEaXNlYXNlcywgRGVwYXJ0bWVudCBvZiBNZWRpY2luZSwgVW5pdmVyc2l0eSBvZiBC

cml0aXNoIENvbHVtYmlhLCBWYW5jb3V2ZXIsIENhbmFkYS4gdG9ueWNob3dAbWFpbC51YmMuY2E8

L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRsZT5JRFNBIGNsaW5pY2FsIHByYWN0aWNlIGd1aWRl

bGluZSBmb3IgYWN1dGUgYmFjdGVyaWFsIHJoaW5vc2ludXNpdGlzIGluIGNoaWxkcmVuIGFuZCBh

ZHVsdHM8L3RpdGxlPjxzZWNvbmRhcnktdGl0bGU+Q2xpbiBJbmZlY3QgRGlzPC9zZWNvbmRhcnkt

dGl0bGU+PC90aXRsZXM+PHBlcmlvZGljYWw+PGZ1bGwtdGl0bGU+Q2xpbiBJbmZlY3QgRGlzPC9m

dWxsLXRpdGxlPjwvcGVyaW9kaWNhbD48cGFnZXM+ZTcyLWUxMTI8L3BhZ2VzPjx2b2x1bWU+NTQ8

L3ZvbHVtZT48bnVtYmVyPjg8L251bWJlcj48a2V5d29yZHM+PGtleXdvcmQ+QWRvbGVzY2VudDwv

a2V5d29yZD48a2V5d29yZD5BZHVsdDwva2V5d29yZD48a2V5d29yZD5BZ2VkPC9rZXl3b3JkPjxr

ZXl3b3JkPkFnZWQsIDgwIGFuZCBvdmVyPC9rZXl3b3JkPjxrZXl3b3JkPkFudGktSW5mZWN0aXZl

IEFnZW50cy9hZG1pbmlzdHJhdGlvbiAmYW1wOyBkb3NhZ2U8L2tleXdvcmQ+PGtleXdvcmQ+QmFj

dGVyaWFsIEluZmVjdGlvbnMvZGlhZ25vc2lzL2RydWcgdGhlcmFweTwva2V5d29yZD48a2V5d29y

ZD5DaGlsZDwva2V5d29yZD48a2V5d29yZD5DaGlsZCwgUHJlc2Nob29sPC9rZXl3b3JkPjxrZXl3

b3JkPkZlbWFsZTwva2V5d29yZD48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdvcmQ+SW5m

YW50PC9rZXl3b3JkPjxrZXl3b3JkPk1hbGU8L2tleXdvcmQ+PGtleXdvcmQ+TWlkZGxlIEFnZWQ8

L2tleXdvcmQ+PGtleXdvcmQ+Umhpbml0aXMvKmRpYWdub3Npcy8qZHJ1ZyB0aGVyYXB5PC9rZXl3

b3JkPjxrZXl3b3JkPlNpbnVzaXRpcy8qZGlhZ25vc2lzLypkcnVnIHRoZXJhcHk8L2tleXdvcmQ+

PGtleXdvcmQ+WW91bmcgQWR1bHQ8L2tleXdvcmQ+PC9rZXl3b3Jkcz48ZGF0ZXM+PHllYXI+MjAx

MjwveWVhcj48cHViLWRhdGVzPjxkYXRlPkFwcjwvZGF0ZT48L3B1Yi1kYXRlcz48L2RhdGVzPjxp

c2JuPjE1MzctNjU5MSAoRWxlY3Ryb25pYykmI3hEOzEwNTgtNDgzOCAoTGlua2luZyk8L2lzYm4+

PGFjY2Vzc2lvbi1udW0+MjI0MzgzNTA8L2FjY2Vzc2lvbi1udW0+PHVybHM+PHJlbGF0ZWQtdXJs

cz48dXJsPmh0dHBzOi8vd3d3Lm5jYmkubmxtLm5paC5nb3YvcHVibWVkLzIyNDM4MzUwPC91cmw+

PC9yZWxhdGVkLXVybHM+PC91cmxzPjxlbGVjdHJvbmljLXJlc291cmNlLW51bT4xMC4xMDkzL2Np

ZC9jaXIxMDQzPC9lbGVjdHJvbmljLXJlc291cmNlLW51bT48L3JlY29yZD48L0NpdGU+PC9FbmRO

b3RlPn==

ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5DaG93PC9BdXRob3I+PFllYXI+MjAxMjwvWWVhcj48UmVj

TnVtPjIxOTwvUmVjTnVtPjxEaXNwbGF5VGV4dD48c3R5bGUgZmFjZT0ic3VwZXJzY3JpcHQiPjE8

L3N0eWxlPjwvRGlzcGxheVRleHQ+PHJlY29yZD48cmVjLW51bWJlcj4yMTk8L3JlYy1udW1iZXI+

PGZvcmVpZ24ta2V5cz48a2V5IGFwcD0iRU4iIGRiLWlkPSJ0ZGRydzV2YWZlcDVkMGVhZmF2eHh2

OWZhNWV4cnByc3N2dmQiIHRpbWVzdGFtcD0iMTU2MzUxOTkwMCI+MjE5PC9rZXk+PC9mb3JlaWdu

LWtleXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10eXBlPjxjb250

cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5DaG93LCBBLiBXLjwvYXV0aG9yPjxhdXRob3I+QmVu

bmluZ2VyLCBNLiBTLjwvYXV0aG9yPjxhdXRob3I+QnJvb2ssIEkuPC9hdXRob3I+PGF1dGhvcj5C

cm96ZWssIEouIEwuPC9hdXRob3I+PGF1dGhvcj5Hb2xkc3RlaW4sIEUuIEouPC9hdXRob3I+PGF1

dGhvcj5IaWNrcywgTC4gQS48L2F1dGhvcj48YXV0aG9yPlBhbmtleSwgRy4gQS48L2F1dGhvcj48

YXV0aG9yPlNlbGV6bmljaywgTS48L2F1dGhvcj48YXV0aG9yPlZvbHR1cm8sIEcuPC9hdXRob3I+

PGF1dGhvcj5XYWxkLCBFLiBSLjwvYXV0aG9yPjxhdXRob3I+RmlsZSwgVC4gTS4sIEpyLjwvYXV0

aG9yPjxhdXRob3I+SW5mZWN0aW91cyBEaXNlYXNlcyBTb2NpZXR5IG9mLCBBbWVyaWNhPC9hdXRo

b3I+PC9hdXRob3JzPjwvY29udHJpYnV0b3JzPjxhdXRoLWFkZHJlc3M+RGl2aXNpb24gb2YgSW5m

ZWN0aW91cyBEaXNlYXNlcywgRGVwYXJ0bWVudCBvZiBNZWRpY2luZSwgVW5pdmVyc2l0eSBvZiBC

cml0aXNoIENvbHVtYmlhLCBWYW5jb3V2ZXIsIENhbmFkYS4gdG9ueWNob3dAbWFpbC51YmMuY2E8

L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRsZT5JRFNBIGNsaW5pY2FsIHByYWN0aWNlIGd1aWRl

bGluZSBmb3IgYWN1dGUgYmFjdGVyaWFsIHJoaW5vc2ludXNpdGlzIGluIGNoaWxkcmVuIGFuZCBh

ZHVsdHM8L3RpdGxlPjxzZWNvbmRhcnktdGl0bGU+Q2xpbiBJbmZlY3QgRGlzPC9zZWNvbmRhcnkt

dGl0bGU+PC90aXRsZXM+PHBlcmlvZGljYWw+PGZ1bGwtdGl0bGU+Q2xpbiBJbmZlY3QgRGlzPC9m

dWxsLXRpdGxlPjwvcGVyaW9kaWNhbD48cGFnZXM+ZTcyLWUxMTI8L3BhZ2VzPjx2b2x1bWU+NTQ8

L3ZvbHVtZT48bnVtYmVyPjg8L251bWJlcj48a2V5d29yZHM+PGtleXdvcmQ+QWRvbGVzY2VudDwv

a2V5d29yZD48a2V5d29yZD5BZHVsdDwva2V5d29yZD48a2V5d29yZD5BZ2VkPC9rZXl3b3JkPjxr

ZXl3b3JkPkFnZWQsIDgwIGFuZCBvdmVyPC9rZXl3b3JkPjxrZXl3b3JkPkFudGktSW5mZWN0aXZl

IEFnZW50cy9hZG1pbmlzdHJhdGlvbiAmYW1wOyBkb3NhZ2U8L2tleXdvcmQ+PGtleXdvcmQ+QmFj

dGVyaWFsIEluZmVjdGlvbnMvZGlhZ25vc2lzL2RydWcgdGhlcmFweTwva2V5d29yZD48a2V5d29y

ZD5DaGlsZDwva2V5d29yZD48a2V5d29yZD5DaGlsZCwgUHJlc2Nob29sPC9rZXl3b3JkPjxrZXl3

b3JkPkZlbWFsZTwva2V5d29yZD48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdvcmQ+SW5m

YW50PC9rZXl3b3JkPjxrZXl3b3JkPk1hbGU8L2tleXdvcmQ+PGtleXdvcmQ+TWlkZGxlIEFnZWQ8

L2tleXdvcmQ+PGtleXdvcmQ+Umhpbml0aXMvKmRpYWdub3Npcy8qZHJ1ZyB0aGVyYXB5PC9rZXl3

b3JkPjxrZXl3b3JkPlNpbnVzaXRpcy8qZGlhZ25vc2lzLypkcnVnIHRoZXJhcHk8L2tleXdvcmQ+

PGtleXdvcmQ+WW91bmcgQWR1bHQ8L2tleXdvcmQ+PC9rZXl3b3Jkcz48ZGF0ZXM+PHllYXI+MjAx

MjwveWVhcj48cHViLWRhdGVzPjxkYXRlPkFwcjwvZGF0ZT48L3B1Yi1kYXRlcz48L2RhdGVzPjxp

c2JuPjE1MzctNjU5MSAoRWxlY3Ryb25pYykmI3hEOzEwNTgtNDgzOCAoTGlua2luZyk8L2lzYm4+

PGFjY2Vzc2lvbi1udW0+MjI0MzgzNTA8L2FjY2Vzc2lvbi1udW0+PHVybHM+PHJlbGF0ZWQtdXJs

cz48dXJsPmh0dHBzOi8vd3d3Lm5jYmkubmxtLm5paC5nb3YvcHVibWVkLzIyNDM4MzUwPC91cmw+

PC9yZWxhdGVkLXVybHM+PC91cmxzPjxlbGVjdHJvbmljLXJlc291cmNlLW51bT4xMC4xMDkzL2Np

ZC9jaXIxMDQzPC9lbGVjdHJvbmljLXJlc291cmNlLW51bT48L3JlY29yZD48L0NpdGU+PC9FbmRO

b3RlPn==

ADDIN EN.CITE.DATA 1PharyngitisPrescribe antimicrobial agents only to patients with proven acute group A streptococcal pharyngitis or patients with high likelihood of streptococcal infection (e.g. 4 Centor criteria)Penicillin V 250 mg orally four times daily or 500 mg orally twice daily (N/A in Japan)Amoxicillin 1000 mg orally once daily or 500 mg orally twice dailyFor patients with a history of penicillin allergy:Cephalexin 500 mg orally twice dailyClindamycin 300 mg orally three times dailyAzithromycin 500 mg orally once daily Clarithromycin 250 mg orally twice dailyChoby et al. ADDIN EN.CITE <EndNote><Cite><Author>Choby</Author><Year>2009</Year><RecNum>4665</RecNum><DisplayText><style face="superscript">2</style></DisplayText><record><rec-number>4665</rec-number><foreign-keys><key app="EN" db-id="tsr25ttv2a95wkedadt5fvvkwpdswrzs225a" timestamp="1499672919">4665</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Choby, B. A.</author></authors></contributors><auth-address>Department of Family Medicine, University of Tennessee College of Medicine-Chattanooga, UT Family Practice Center, 37403, USA. beth.choby@</auth-address><titles><title>Diagnosis and treatment of streptococcal pharyngitis</title><secondary-title>Am Fam Physician</secondary-title></titles><periodical><full-title>Am Fam Physician</full-title></periodical><pages>383-90</pages><volume>79</volume><number>5</number><edition>2009/03/12</edition><keywords><keyword>Algorithms</keyword><keyword>Anti-Bacterial Agents/*therapeutic use</keyword><keyword>Humans</keyword><keyword>Nephritis/etiology</keyword><keyword>Pharyngitis/drug therapy/*microbiology</keyword><keyword>Practice Guidelines as Topic</keyword><keyword>Rheumatic Fever/etiology</keyword><keyword>Streptococcal Infections/complications/*diagnosis/*drug therapy</keyword><keyword>Streptococcus pyogenes/*isolation &amp; purification</keyword></keywords><dates><year>2009</year><pub-dates><date>Mar 01</date></pub-dates></dates><isbn>0002-838X (Print)&#xD;0002-838X (Linking)</isbn><accession-num>19275067</accession-num><urls><related-urls><url> Sore Throat Guideline Group et al.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Hcm91cDwvQXV0aG9yPjxZZWFyPjIwMTI8L1llYXI+PFJl

Y051bT4yMTY8L1JlY051bT48RGlzcGxheVRleHQ+PHN0eWxlIGZhY2U9InN1cGVyc2NyaXB0Ij4z

PC9zdHlsZT48L0Rpc3BsYXlUZXh0PjxyZWNvcmQ+PHJlYy1udW1iZXI+MjE2PC9yZWMtbnVtYmVy

Pjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0idGRkcnc1dmFmZXA1ZDBlYWZhdnh4

djlmYTVleHJwcnNzdnZkIiB0aW1lc3RhbXA9IjE1NjM1MTk5MDAiPjIxNjwva2V5PjwvZm9yZWln

bi1rZXlzPjxyZWYtdHlwZSBuYW1lPSJKb3VybmFsIEFydGljbGUiPjE3PC9yZWYtdHlwZT48Y29u

dHJpYnV0b3JzPjxhdXRob3JzPjxhdXRob3I+RXNjbWlkIFNvcmUgVGhyb2F0IEd1aWRlbGluZSBH

cm91cDwvYXV0aG9yPjxhdXRob3I+UGVsdWNjaGksIEMuPC9hdXRob3I+PGF1dGhvcj5Hcmlnb3J5

YW4sIEwuPC9hdXRob3I+PGF1dGhvcj5HYWxlb25lLCBDLjwvYXV0aG9yPjxhdXRob3I+RXNwb3Np

dG8sIFMuPC9hdXRob3I+PGF1dGhvcj5IdW92aW5lbiwgUC48L2F1dGhvcj48YXV0aG9yPkxpdHRs

ZSwgUC48L2F1dGhvcj48YXV0aG9yPlZlcmhlaWosIFQuPC9hdXRob3I+PC9hdXRob3JzPjwvY29u

dHJpYnV0b3JzPjx0aXRsZXM+PHRpdGxlPkd1aWRlbGluZSBmb3IgdGhlIG1hbmFnZW1lbnQgb2Yg

YWN1dGUgc29yZSB0aHJvYXQ8L3RpdGxlPjxzZWNvbmRhcnktdGl0bGU+Q2xpbiBNaWNyb2Jpb2wg

SW5mZWN0PC9zZWNvbmRhcnktdGl0bGU+PC90aXRsZXM+PHBlcmlvZGljYWw+PGZ1bGwtdGl0bGU+

Q2xpbiBNaWNyb2Jpb2wgSW5mZWN0PC9mdWxsLXRpdGxlPjwvcGVyaW9kaWNhbD48cGFnZXM+MS0y

ODwvcGFnZXM+PHZvbHVtZT4xOCBTdXBwbCAxPC92b2x1bWU+PGVkaXRpb24+MjAxMi8wNC8yNzwv

ZWRpdGlvbj48a2V5d29yZHM+PGtleXdvcmQ+QWNldGFtaW5vcGhlbi90aGVyYXBldXRpYyB1c2U8

L2tleXdvcmQ+PGtleXdvcmQ+QW50aS1CYWN0ZXJpYWwgQWdlbnRzL3RoZXJhcGV1dGljIHVzZTwv

a2V5d29yZD48a2V5d29yZD5DaGxhbXlkb3BoaWxhIEluZmVjdGlvbnMvZGlhZ25vc2lzL2RydWcg

dGhlcmFweS9wYXRob2xvZ3k8L2tleXdvcmQ+PGtleXdvcmQ+Q2hsYW15ZG9waGlsYSBwbmV1bW9u

aWFlL3BhdGhvZ2VuaWNpdHk8L2tleXdvcmQ+PGtleXdvcmQ+RGlzZWFzZSBNYW5hZ2VtZW50PC9r

ZXl3b3JkPjxrZXl3b3JkPkh1bWFuczwva2V5d29yZD48a2V5d29yZD5JYnVwcm9mZW4vdGhlcmFw

ZXV0aWMgdXNlPC9rZXl3b3JkPjxrZXl3b3JkPk15Y29wbGFzbWEgcG5ldW1vbmlhZS9wYXRob2dl

bmljaXR5PC9rZXl3b3JkPjxrZXl3b3JkPk5hc29waGFyeW54L3BhdGhvbG9neTwva2V5d29yZD48

a2V5d29yZD5QYWxhdGluZSBUb25zaWwvcGF0aG9sb2d5PC9rZXl3b3JkPjxrZXl3b3JkPlBlbmlj

aWxsaW4gVi90aGVyYXBldXRpYyB1c2U8L2tleXdvcmQ+PGtleXdvcmQ+KlBoYXJ5bmdpdGlzL2Rp

YWdub3Npcy9kcnVnIHRoZXJhcHkvbWljcm9iaW9sb2d5PC9rZXl3b3JkPjxrZXl3b3JkPlBoYXJ5

bngvcGF0aG9sb2d5PC9rZXl3b3JkPjxrZXl3b3JkPlN0cmVwdG9jb2NjYWwgSW5mZWN0aW9ucy9k

aWFnbm9zaXMvZHJ1ZyB0aGVyYXB5L3BhdGhvbG9neTwva2V5d29yZD48a2V5d29yZD5TdHJlcHRv

Y29jY3VzIHB5b2dlbmVzL3BhdGhvZ2VuaWNpdHk8L2tleXdvcmQ+PC9rZXl3b3Jkcz48ZGF0ZXM+

PHllYXI+MjAxMjwveWVhcj48cHViLWRhdGVzPjxkYXRlPkFwcjwvZGF0ZT48L3B1Yi1kYXRlcz48

L2RhdGVzPjxpc2JuPjE0NjktMDY5MSAoRWxlY3Ryb25pYykmI3hEOzExOTgtNzQzWCAoTGlua2lu

Zyk8L2lzYm4+PGFjY2Vzc2lvbi1udW0+MjI0MzI3NDY8L2FjY2Vzc2lvbi1udW0+PHVybHM+PHJl

bGF0ZWQtdXJscz48dXJsPmh0dHBzOi8vd3d3Lm5jYmkubmxtLm5paC5nb3YvcHVibWVkLzIyNDMy

NzQ2PC91cmw+PC9yZWxhdGVkLXVybHM+PC91cmxzPjxlbGVjdHJvbmljLXJlc291cmNlLW51bT4x

MC4xMTExL2ouMTQ2OS0wNjkxLjIwMTIuMDM3NjYueDwvZWxlY3Ryb25pYy1yZXNvdXJjZS1udW0+

PC9yZWNvcmQ+PC9DaXRlPjwvRW5kTm90ZT5=

ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Hcm91cDwvQXV0aG9yPjxZZWFyPjIwMTI8L1llYXI+PFJl

Y051bT4yMTY8L1JlY051bT48RGlzcGxheVRleHQ+PHN0eWxlIGZhY2U9InN1cGVyc2NyaXB0Ij4z

PC9zdHlsZT48L0Rpc3BsYXlUZXh0PjxyZWNvcmQ+PHJlYy1udW1iZXI+MjE2PC9yZWMtbnVtYmVy

Pjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0idGRkcnc1dmFmZXA1ZDBlYWZhdnh4

djlmYTVleHJwcnNzdnZkIiB0aW1lc3RhbXA9IjE1NjM1MTk5MDAiPjIxNjwva2V5PjwvZm9yZWln

bi1rZXlzPjxyZWYtdHlwZSBuYW1lPSJKb3VybmFsIEFydGljbGUiPjE3PC9yZWYtdHlwZT48Y29u

dHJpYnV0b3JzPjxhdXRob3JzPjxhdXRob3I+RXNjbWlkIFNvcmUgVGhyb2F0IEd1aWRlbGluZSBH

cm91cDwvYXV0aG9yPjxhdXRob3I+UGVsdWNjaGksIEMuPC9hdXRob3I+PGF1dGhvcj5Hcmlnb3J5

YW4sIEwuPC9hdXRob3I+PGF1dGhvcj5HYWxlb25lLCBDLjwvYXV0aG9yPjxhdXRob3I+RXNwb3Np

dG8sIFMuPC9hdXRob3I+PGF1dGhvcj5IdW92aW5lbiwgUC48L2F1dGhvcj48YXV0aG9yPkxpdHRs

ZSwgUC48L2F1dGhvcj48YXV0aG9yPlZlcmhlaWosIFQuPC9hdXRob3I+PC9hdXRob3JzPjwvY29u

dHJpYnV0b3JzPjx0aXRsZXM+PHRpdGxlPkd1aWRlbGluZSBmb3IgdGhlIG1hbmFnZW1lbnQgb2Yg

YWN1dGUgc29yZSB0aHJvYXQ8L3RpdGxlPjxzZWNvbmRhcnktdGl0bGU+Q2xpbiBNaWNyb2Jpb2wg

SW5mZWN0PC9zZWNvbmRhcnktdGl0bGU+PC90aXRsZXM+PHBlcmlvZGljYWw+PGZ1bGwtdGl0bGU+

Q2xpbiBNaWNyb2Jpb2wgSW5mZWN0PC9mdWxsLXRpdGxlPjwvcGVyaW9kaWNhbD48cGFnZXM+MS0y

ODwvcGFnZXM+PHZvbHVtZT4xOCBTdXBwbCAxPC92b2x1bWU+PGVkaXRpb24+MjAxMi8wNC8yNzwv

ZWRpdGlvbj48a2V5d29yZHM+PGtleXdvcmQ+QWNldGFtaW5vcGhlbi90aGVyYXBldXRpYyB1c2U8

L2tleXdvcmQ+PGtleXdvcmQ+QW50aS1CYWN0ZXJpYWwgQWdlbnRzL3RoZXJhcGV1dGljIHVzZTwv

a2V5d29yZD48a2V5d29yZD5DaGxhbXlkb3BoaWxhIEluZmVjdGlvbnMvZGlhZ25vc2lzL2RydWcg

dGhlcmFweS9wYXRob2xvZ3k8L2tleXdvcmQ+PGtleXdvcmQ+Q2hsYW15ZG9waGlsYSBwbmV1bW9u

aWFlL3BhdGhvZ2VuaWNpdHk8L2tleXdvcmQ+PGtleXdvcmQ+RGlzZWFzZSBNYW5hZ2VtZW50PC9r

ZXl3b3JkPjxrZXl3b3JkPkh1bWFuczwva2V5d29yZD48a2V5d29yZD5JYnVwcm9mZW4vdGhlcmFw

ZXV0aWMgdXNlPC9rZXl3b3JkPjxrZXl3b3JkPk15Y29wbGFzbWEgcG5ldW1vbmlhZS9wYXRob2dl

bmljaXR5PC9rZXl3b3JkPjxrZXl3b3JkPk5hc29waGFyeW54L3BhdGhvbG9neTwva2V5d29yZD48

a2V5d29yZD5QYWxhdGluZSBUb25zaWwvcGF0aG9sb2d5PC9rZXl3b3JkPjxrZXl3b3JkPlBlbmlj

aWxsaW4gVi90aGVyYXBldXRpYyB1c2U8L2tleXdvcmQ+PGtleXdvcmQ+KlBoYXJ5bmdpdGlzL2Rp

YWdub3Npcy9kcnVnIHRoZXJhcHkvbWljcm9iaW9sb2d5PC9rZXl3b3JkPjxrZXl3b3JkPlBoYXJ5

bngvcGF0aG9sb2d5PC9rZXl3b3JkPjxrZXl3b3JkPlN0cmVwdG9jb2NjYWwgSW5mZWN0aW9ucy9k

aWFnbm9zaXMvZHJ1ZyB0aGVyYXB5L3BhdGhvbG9neTwva2V5d29yZD48a2V5d29yZD5TdHJlcHRv

Y29jY3VzIHB5b2dlbmVzL3BhdGhvZ2VuaWNpdHk8L2tleXdvcmQ+PC9rZXl3b3Jkcz48ZGF0ZXM+

PHllYXI+MjAxMjwveWVhcj48cHViLWRhdGVzPjxkYXRlPkFwcjwvZGF0ZT48L3B1Yi1kYXRlcz48

L2RhdGVzPjxpc2JuPjE0NjktMDY5MSAoRWxlY3Ryb25pYykmI3hEOzExOTgtNzQzWCAoTGlua2lu

Zyk8L2lzYm4+PGFjY2Vzc2lvbi1udW0+MjI0MzI3NDY8L2FjY2Vzc2lvbi1udW0+PHVybHM+PHJl

bGF0ZWQtdXJscz48dXJsPmh0dHBzOi8vd3d3Lm5jYmkubmxtLm5paC5nb3YvcHVibWVkLzIyNDMy

NzQ2PC91cmw+PC9yZWxhdGVkLXVybHM+PC91cmxzPjxlbGVjdHJvbmljLXJlc291cmNlLW51bT4x

MC4xMTExL2ouMTQ2OS0wNjkxLjIwMTIuMDM3NjYueDwvZWxlY3Ryb25pYy1yZXNvdXJjZS1udW0+

PC9yZWNvcmQ+PC9DaXRlPjwvRW5kTm90ZT5=

ADDIN EN.CITE.DATA 3Suppurative otitis mediaAntimicrobial therapy is not recommended immediately except in cases of immunocompromised patients, patients with persistent symptoms or those with suppurative otitis media.Amoxicillin 500 mg orally three times dailyAmoxicillin-clavulanate 500/125 mg orally three times daily or 875/125 mg orally twice dailyFor patients with a history of penicillin allergy:Cefdinir 300 mg orally twice dailyCefpodoxime 200 mg orally twice dailyCeftriaxone 1 g once dailyCefuroxime 500 mg orally twice dailyNeff, M. J. et al. ADDIN EN.CITE <EndNote><Cite><Author>Neff</Author><Year>2004</Year><RecNum>217</RecNum><DisplayText><style face="superscript">4</style></DisplayText><record><rec-number>217</rec-number><foreign-keys><key app="EN" db-id="tddrw5vafep5d0eafavxxv9fa5exrprssvvd" timestamp="1563519900">217</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Neff, M. J.</author><author>American Academy of, Pediatrics</author><author>American Academy of Family, Physicians</author></authors></contributors><titles><title>AAP, AAFP release guideline on diagnosis and management of acute otitis media</title><secondary-title>Am Fam Physician</secondary-title></titles><periodical><full-title>Am Fam Physician</full-title></periodical><pages>2713-5</pages><volume>69</volume><number>11</number><edition>2004/06/19</edition><keywords><keyword>Acute Disease</keyword><keyword>Anti-Bacterial Agents/therapeutic use</keyword><keyword>Child</keyword><keyword>Humans</keyword><keyword>Otitis Media/*diagnosis/drug therapy/*therapy</keyword></keywords><dates><year>2004</year><pub-dates><date>Jun 01</date></pub-dates></dates><isbn>0002-838X (Print)&#xD;0002-838X (Linking)</isbn><accession-num>15202704</accession-num><urls><related-urls><url> guideline [NG91] ADDIN EN.CITE <EndNote><Cite><Year>2018</Year><RecNum>4987</RecNum><DisplayText><style face="superscript">5</style></DisplayText><record><rec-number>4987</rec-number><foreign-keys><key app="EN" db-id="tsr25ttv2a95wkedadt5fvvkwpdswrzs225a" timestamp="1530875341">4987</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors></contributors><titles><title>National Institute for Health and Care Execellence Otitis media (acute): antimicrobial prescribing (NICE Guideline 91)</title></titles><dates><year>2018</year></dates><urls><related-urls><url> therapy is recommended.1) Previously healthy patients with no antimicrobial use within the previous 3 months:Azithromycin 500 mg orally once daily or one 2 g dose orally Clarithromycin 500 mg orally twice daily Doxycycline 100 mg orally twice daily2) Presence of comorbidities, such as chronic heart, lung, liver, or renal disease; diabetes mellitus; alcoholism; malignancies; asplenia; immunosuppressive conditions or use of immunosuppressive drugs; use of antimicrobials within the previous 3 months (in which case an alternative from a different class should be selected):Levofloxacin 750 mg orally once daily or moxifloxacin 400 mg orally once dailyAmoxicillin-clavulanate 500/125 mg orally three times daily or 875/125 mg orally twice daily or ceftriaxone 1-2 g once daily and either azithromycin 500 mg orally once daily or one dose of azithromycin 2 g orally or clarithromycin 500 mg orally twice dailyMandell et al. PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NYW5kZWxsPC9BdXRob3I+PFllYXI+MjAwNzwvWWVhcj48

UmVjTnVtPjIxMzwvUmVjTnVtPjxEaXNwbGF5VGV4dD48c3R5bGUgZmFjZT0ic3VwZXJzY3JpcHQi

PjY8L3N0eWxlPjwvRGlzcGxheVRleHQ+PHJlY29yZD48cmVjLW51bWJlcj4yMTM8L3JlYy1udW1i

ZXI+PGZvcmVpZ24ta2V5cz48a2V5IGFwcD0iRU4iIGRiLWlkPSJ0ZGRydzV2YWZlcDVkMGVhZmF2

eHh2OWZhNWV4cnByc3N2dmQiIHRpbWVzdGFtcD0iMTU2MzUxOTkwMCI+MjEzPC9rZXk+PC9mb3Jl

aWduLWtleXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10eXBlPjxj

b250cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5NYW5kZWxsLCBMLiBBLjwvYXV0aG9yPjxhdXRo

b3I+V3VuZGVyaW5rLCBSLiBHLjwvYXV0aG9yPjxhdXRob3I+QW56dWV0bywgQS48L2F1dGhvcj48

YXV0aG9yPkJhcnRsZXR0LCBKLiBHLjwvYXV0aG9yPjxhdXRob3I+Q2FtcGJlbGwsIEcuIEQuPC9h

dXRob3I+PGF1dGhvcj5EZWFuLCBOLiBDLjwvYXV0aG9yPjxhdXRob3I+RG93ZWxsLCBTLiBGLjwv

YXV0aG9yPjxhdXRob3I+RmlsZSwgVC4gTS4sIEpyLjwvYXV0aG9yPjxhdXRob3I+TXVzaGVyLCBE

LiBNLjwvYXV0aG9yPjxhdXRob3I+TmllZGVybWFuLCBNLiBTLjwvYXV0aG9yPjxhdXRob3I+VG9y

cmVzLCBBLjwvYXV0aG9yPjxhdXRob3I+V2hpdG5leSwgQy4gRy48L2F1dGhvcj48YXV0aG9yPklu

ZmVjdGlvdXMgRGlzZWFzZXMgU29jaWV0eSBvZiwgQW1lcmljYTwvYXV0aG9yPjxhdXRob3I+QW1l

cmljYW4gVGhvcmFjaWMsIFNvY2lldHk8L2F1dGhvcj48L2F1dGhvcnM+PC9jb250cmlidXRvcnM+

PGF1dGgtYWRkcmVzcz5NY01hc3RlciBVbml2ZXJzaXR5IE1lZGljYWwgU2Nob29sLCBIYW1pbHRv

biwgT250YXJpbywgQ2FuYWRhLiBsbWFuZGVsbEBtY21hc3Rlci5jYTwvYXV0aC1hZGRyZXNzPjx0

aXRsZXM+PHRpdGxlPkluZmVjdGlvdXMgRGlzZWFzZXMgU29jaWV0eSBvZiBBbWVyaWNhL0FtZXJp

Y2FuIFRob3JhY2ljIFNvY2lldHkgY29uc2Vuc3VzIGd1aWRlbGluZXMgb24gdGhlIG1hbmFnZW1l

bnQgb2YgY29tbXVuaXR5LWFjcXVpcmVkIHBuZXVtb25pYSBpbiBhZHVsdHM8L3RpdGxlPjxzZWNv

bmRhcnktdGl0bGU+Q2xpbiBJbmZlY3QgRGlzPC9zZWNvbmRhcnktdGl0bGU+PC90aXRsZXM+PHBl

cmlvZGljYWw+PGZ1bGwtdGl0bGU+Q2xpbiBJbmZlY3QgRGlzPC9mdWxsLXRpdGxlPjwvcGVyaW9k

aWNhbD48cGFnZXM+UzI3LTcyPC9wYWdlcz48dm9sdW1lPjQ0IFN1cHBsIDI8L3ZvbHVtZT48a2V5

d29yZHM+PGtleXdvcmQ+QW50aS1CYWN0ZXJpYWwgQWdlbnRzL3RoZXJhcGV1dGljIHVzZTwva2V5

d29yZD48a2V5d29yZD5Db21tdW5pdHktQWNxdWlyZWQgSW5mZWN0aW9ucy9kaWFnbm9zaXMvKmRy

dWcgdGhlcmFweS9wcmV2ZW50aW9uICZhbXA7IGNvbnRyb2w8L2tleXdvcmQ+PGtleXdvcmQ+RGlh

Z25vc2lzLCBEaWZmZXJlbnRpYWw8L2tleXdvcmQ+PGtleXdvcmQ+SGVhbHRoIE1hbnBvd2VyPC9r

ZXl3b3JkPjxrZXl3b3JkPkh1bWFuczwva2V5d29yZD48a2V5d29yZD5QbmV1bW9uaWEsIEJhY3Rl

cmlhbC9kaWFnbm9zaXMvKmRydWcgdGhlcmFweS9wcmV2ZW50aW9uICZhbXA7IGNvbnRyb2w8L2tl

eXdvcmQ+PGtleXdvcmQ+U29jaWV0aWVzLCBNZWRpY2FsPC9rZXl3b3JkPjxrZXl3b3JkPlN0cmVw

dG9jb2NjdXMgcG5ldW1vbmlhZS9pc29sYXRpb24gJmFtcDsgcHVyaWZpY2F0aW9uPC9rZXl3b3Jk

PjxrZXl3b3JkPlVuaXRlZCBTdGF0ZXM8L2tleXdvcmQ+PGtleXdvcmQ+VmFjY2luYXRpb248L2tl

eXdvcmQ+PC9rZXl3b3Jkcz48ZGF0ZXM+PHllYXI+MjAwNzwveWVhcj48cHViLWRhdGVzPjxkYXRl

Pk1hciAwMTwvZGF0ZT48L3B1Yi1kYXRlcz48L2RhdGVzPjxpc2JuPjE1MzctNjU5MSAoRWxlY3Ry

b25pYykmI3hEOzEwNTgtNDgzOCAoTGlua2luZyk8L2lzYm4+PGFjY2Vzc2lvbi1udW0+MTcyNzgw

ODM8L2FjY2Vzc2lvbi1udW0+PHVybHM+PHJlbGF0ZWQtdXJscz48dXJsPmh0dHBzOi8vd3d3Lm5j

YmkubmxtLm5paC5nb3YvcHVibWVkLzE3Mjc4MDgzPC91cmw+PC9yZWxhdGVkLXVybHM+PC91cmxz

PjxlbGVjdHJvbmljLXJlc291cmNlLW51bT4xMC4xMDg2LzUxMTE1OTwvZWxlY3Ryb25pYy1yZXNv

dXJjZS1udW0+PC9yZWNvcmQ+PC9DaXRlPjwvRW5kTm90ZT4A

ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NYW5kZWxsPC9BdXRob3I+PFllYXI+MjAwNzwvWWVhcj48

UmVjTnVtPjIxMzwvUmVjTnVtPjxEaXNwbGF5VGV4dD48c3R5bGUgZmFjZT0ic3VwZXJzY3JpcHQi

PjY8L3N0eWxlPjwvRGlzcGxheVRleHQ+PHJlY29yZD48cmVjLW51bWJlcj4yMTM8L3JlYy1udW1i

ZXI+PGZvcmVpZ24ta2V5cz48a2V5IGFwcD0iRU4iIGRiLWlkPSJ0ZGRydzV2YWZlcDVkMGVhZmF2

eHh2OWZhNWV4cnByc3N2dmQiIHRpbWVzdGFtcD0iMTU2MzUxOTkwMCI+MjEzPC9rZXk+PC9mb3Jl

aWduLWtleXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10eXBlPjxj

b250cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5NYW5kZWxsLCBMLiBBLjwvYXV0aG9yPjxhdXRo

b3I+V3VuZGVyaW5rLCBSLiBHLjwvYXV0aG9yPjxhdXRob3I+QW56dWV0bywgQS48L2F1dGhvcj48

YXV0aG9yPkJhcnRsZXR0LCBKLiBHLjwvYXV0aG9yPjxhdXRob3I+Q2FtcGJlbGwsIEcuIEQuPC9h

dXRob3I+PGF1dGhvcj5EZWFuLCBOLiBDLjwvYXV0aG9yPjxhdXRob3I+RG93ZWxsLCBTLiBGLjwv

YXV0aG9yPjxhdXRob3I+RmlsZSwgVC4gTS4sIEpyLjwvYXV0aG9yPjxhdXRob3I+TXVzaGVyLCBE

LiBNLjwvYXV0aG9yPjxhdXRob3I+TmllZGVybWFuLCBNLiBTLjwvYXV0aG9yPjxhdXRob3I+VG9y

cmVzLCBBLjwvYXV0aG9yPjxhdXRob3I+V2hpdG5leSwgQy4gRy48L2F1dGhvcj48YXV0aG9yPklu

ZmVjdGlvdXMgRGlzZWFzZXMgU29jaWV0eSBvZiwgQW1lcmljYTwvYXV0aG9yPjxhdXRob3I+QW1l

cmljYW4gVGhvcmFjaWMsIFNvY2lldHk8L2F1dGhvcj48L2F1dGhvcnM+PC9jb250cmlidXRvcnM+

PGF1dGgtYWRkcmVzcz5NY01hc3RlciBVbml2ZXJzaXR5IE1lZGljYWwgU2Nob29sLCBIYW1pbHRv

biwgT250YXJpbywgQ2FuYWRhLiBsbWFuZGVsbEBtY21hc3Rlci5jYTwvYXV0aC1hZGRyZXNzPjx0

aXRsZXM+PHRpdGxlPkluZmVjdGlvdXMgRGlzZWFzZXMgU29jaWV0eSBvZiBBbWVyaWNhL0FtZXJp

Y2FuIFRob3JhY2ljIFNvY2lldHkgY29uc2Vuc3VzIGd1aWRlbGluZXMgb24gdGhlIG1hbmFnZW1l

bnQgb2YgY29tbXVuaXR5LWFjcXVpcmVkIHBuZXVtb25pYSBpbiBhZHVsdHM8L3RpdGxlPjxzZWNv

bmRhcnktdGl0bGU+Q2xpbiBJbmZlY3QgRGlzPC9zZWNvbmRhcnktdGl0bGU+PC90aXRsZXM+PHBl

cmlvZGljYWw+PGZ1bGwtdGl0bGU+Q2xpbiBJbmZlY3QgRGlzPC9mdWxsLXRpdGxlPjwvcGVyaW9k

aWNhbD48cGFnZXM+UzI3LTcyPC9wYWdlcz48dm9sdW1lPjQ0IFN1cHBsIDI8L3ZvbHVtZT48a2V5

d29yZHM+PGtleXdvcmQ+QW50aS1CYWN0ZXJpYWwgQWdlbnRzL3RoZXJhcGV1dGljIHVzZTwva2V5

d29yZD48a2V5d29yZD5Db21tdW5pdHktQWNxdWlyZWQgSW5mZWN0aW9ucy9kaWFnbm9zaXMvKmRy

dWcgdGhlcmFweS9wcmV2ZW50aW9uICZhbXA7IGNvbnRyb2w8L2tleXdvcmQ+PGtleXdvcmQ+RGlh

Z25vc2lzLCBEaWZmZXJlbnRpYWw8L2tleXdvcmQ+PGtleXdvcmQ+SGVhbHRoIE1hbnBvd2VyPC9r

ZXl3b3JkPjxrZXl3b3JkPkh1bWFuczwva2V5d29yZD48a2V5d29yZD5QbmV1bW9uaWEsIEJhY3Rl

cmlhbC9kaWFnbm9zaXMvKmRydWcgdGhlcmFweS9wcmV2ZW50aW9uICZhbXA7IGNvbnRyb2w8L2tl

eXdvcmQ+PGtleXdvcmQ+U29jaWV0aWVzLCBNZWRpY2FsPC9rZXl3b3JkPjxrZXl3b3JkPlN0cmVw

dG9jb2NjdXMgcG5ldW1vbmlhZS9pc29sYXRpb24gJmFtcDsgcHVyaWZpY2F0aW9uPC9rZXl3b3Jk

PjxrZXl3b3JkPlVuaXRlZCBTdGF0ZXM8L2tleXdvcmQ+PGtleXdvcmQ+VmFjY2luYXRpb248L2tl

eXdvcmQ+PC9rZXl3b3Jkcz48ZGF0ZXM+PHllYXI+MjAwNzwveWVhcj48cHViLWRhdGVzPjxkYXRl

Pk1hciAwMTwvZGF0ZT48L3B1Yi1kYXRlcz48L2RhdGVzPjxpc2JuPjE1MzctNjU5MSAoRWxlY3Ry

b25pYykmI3hEOzEwNTgtNDgzOCAoTGlua2luZyk8L2lzYm4+PGFjY2Vzc2lvbi1udW0+MTcyNzgw

ODM8L2FjY2Vzc2lvbi1udW0+PHVybHM+PHJlbGF0ZWQtdXJscz48dXJsPmh0dHBzOi8vd3d3Lm5j

YmkubmxtLm5paC5nb3YvcHVibWVkLzE3Mjc4MDgzPC91cmw+PC9yZWxhdGVkLXVybHM+PC91cmxz

PjxlbGVjdHJvbmljLXJlc291cmNlLW51bT4xMC4xMDg2LzUxMTE1OTwvZWxlY3Ryb25pYy1yZXNv

dXJjZS1udW0+PC9yZWNvcmQ+PC9DaXRlPjwvRW5kTm90ZT4A

ADDIN EN.CITE.DATA 6COPD exacerbationAntimicrobial agents should be given to patients with acute exacerbations who have three cardinal symptoms: increase in dyspnea, sputum volume, and sputum purulence.Amoxicillin-clavulanate 500/125 mg orally three times daily or 875/125 mg orally twice dailyAzithromycin 500 mg orally once daily or one 2 g dose orally Clarithromycin 500 mg orally twice dailyDoxycycline 100 mg orally twice dailyVogelmeier et al.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Wb2dlbG1laWVyPC9BdXRob3I+PFllYXI+MjAxNzwvWWVh

cj48UmVjTnVtPjIyNDwvUmVjTnVtPjxEaXNwbGF5VGV4dD48c3R5bGUgZmFjZT0ic3VwZXJzY3Jp

cHQiPjc8L3N0eWxlPjwvRGlzcGxheVRleHQ+PHJlY29yZD48cmVjLW51bWJlcj4yMjQ8L3JlYy1u

dW1iZXI+PGZvcmVpZ24ta2V5cz48a2V5IGFwcD0iRU4iIGRiLWlkPSJ0ZGRydzV2YWZlcDVkMGVh

ZmF2eHh2OWZhNWV4cnByc3N2dmQiIHRpbWVzdGFtcD0iMTU2MzUxOTk1NiI+MjI0PC9rZXk+PC9m

b3JlaWduLWtleXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10eXBl

Pjxjb250cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5Wb2dlbG1laWVyLCBDLiBGLjwvYXV0aG9y

PjxhdXRob3I+Q3JpbmVyLCBHLiBKLjwvYXV0aG9yPjxhdXRob3I+TWFydGluZXosIEYuIEouPC9h

dXRob3I+PGF1dGhvcj5Bbnp1ZXRvLCBBLjwvYXV0aG9yPjxhdXRob3I+QmFybmVzLCBQLiBKLjwv

YXV0aG9yPjxhdXRob3I+Qm91cmJlYXUsIEouPC9hdXRob3I+PGF1dGhvcj5DZWxsaSwgQi4gUi48

L2F1dGhvcj48YXV0aG9yPkNoZW4sIFIuPC9hdXRob3I+PGF1dGhvcj5EZWNyYW1lciwgTS48L2F1

dGhvcj48YXV0aG9yPkZhYmJyaSwgTC4gTS48L2F1dGhvcj48YXV0aG9yPkZyaXRoLCBQLjwvYXV0

aG9yPjxhdXRob3I+SGFscGluLCBELiBNLjwvYXV0aG9yPjxhdXRob3I+TG9wZXogVmFyZWxhLCBN

LiBWLjwvYXV0aG9yPjxhdXRob3I+TmlzaGltdXJhLCBNLjwvYXV0aG9yPjxhdXRob3I+Um9jaGUs

IE4uPC9hdXRob3I+PGF1dGhvcj5Sb2RyaWd1ZXotUm9pc2luLCBSLjwvYXV0aG9yPjxhdXRob3I+

U2luLCBELiBELjwvYXV0aG9yPjxhdXRob3I+U2luZ2gsIEQuPC9hdXRob3I+PGF1dGhvcj5TdG9j

a2xleSwgUi48L2F1dGhvcj48YXV0aG9yPlZlc3RibywgSi48L2F1dGhvcj48YXV0aG9yPldlZHpp

Y2hhLCBKLiBBLjwvYXV0aG9yPjxhdXRob3I+QWd1c3RpLCBBLjwvYXV0aG9yPjwvYXV0aG9ycz48

L2NvbnRyaWJ1dG9ycz48YXV0aC1hZGRyZXNzPjEgVW5pdmVyc2l0eSBvZiBNYXJidXJnLCBNZW1i

ZXIgb2YgdGhlIEdlcm1hbiBDZW50ZXIgZm9yIEx1bmcgUmVzZWFyY2ggKERaTCksIE1hcmJ1cmcs

IEdlcm1hbnkuJiN4RDsyIExld2lzIEthdHogU2Nob29sIG9mIE1lZGljaW5lIGF0IFRlbXBsZSBV

bml2ZXJzaXR5LCBQaGlsYWRlbHBoaWEsIFBlbm5zeWx2YW5pYS4mI3hEOzMgTmV3IFlvcmstUHJl

c2J5dGVyaWFuIEhvc3BpdGFsLCBXZWlsbCBDb3JuZWxsIE1lZGljYWwgQ2VudGVyLCBOZXcgWW9y

aywgTmV3IFlvcmsuJiN4RDs0IFVuaXZlcnNpdHkgb2YgVGV4YXMgSGVhbHRoIFNjaWVuY2UgQ2Vu

dGVyLCBTYW4gQW50b25pbywgVGV4YXMuJiN4RDs1IFNvdXRoIFRleGFzIFZldGVyYW5zIEhlYWx0

aCBDYXJlIFN5c3RlbSwgU2FuIEFudG9uaW8sIFRleGFzLiYjeEQ7NiBOYXRpb25hbCBIZWFydCBh

bmQgTHVuZyBJbnN0aXR1dGUsIEltcGVyaWFsIENvbGxlZ2UsIExvbmRvbiwgVW5pdGVkIEtpbmdk

b20uJiN4RDs3IE1jR2lsbCBVbml2ZXJzaXR5IEhlYWx0aCBDZW50cmUsIE1jR2lsbCBVbml2ZXJz

aXR5LCBNb250cmVhbCwgUXVlYmVjLCBDYW5hZGEuJiN4RDs4IEJyaWdoYW0gYW5kIFdvbWVuJmFw

b3M7cyBIb3NwaXRhbCwgQm9zdG9uLCBNYXNzYWNodXNldHRzLiYjeEQ7OSBTdGF0ZSBLZXkgTGFi

IGZvciBSZXNwaXJhdG9yeSBEaXNlYXNlLCBHdWFuZ3pob3UgSW5zdGl0dXRlIG9mIFJlc3BpcmF0

b3J5IERpc2Vhc2UsIEZpcnN0IEFmZmlsaWF0ZWQgSG9zcGl0YWwgb2YgR3Vhbmd6aG91IE1lZGlj

YWwgVW5pdmVyc2l0eSwgR3Vhbmd6aG91LCBDaGluYS4mI3hEOzEwIFVuaXZlcnNpdHkgb2YgTGV1

dmVuLCBMZXV2ZW4sIEJlbGdpdW0uJiN4RDsxMSBVbml2ZXJzaXR5IG9mIE1vZGVuYSBhbmQgUmVn

Z2lvIEVtaWxpYSwgTW9kZW5hLCBJdGFseS4mI3hEOzEyIEZhY3VsdHkgb2YgTWVkaWNpbmUsIEZs

aW5kZXJzIFVuaXZlcnNpdHksIEJlZGZvcmQgUGFyaywgU291dGggQXVzdHJhbGlhLCBBdXN0cmFs

aWEuJiN4RDsxMyBSb3lhbCBEZXZvbiBhbmQgRXhldGVyIEhvc3BpdGFsLCBFeGV0ZXIsIFVuaXRl

ZCBLaW5nZG9tLiYjeEQ7MTQgVW5pdmVyc2lkYWQgZGUgbGEgUmVwdWJsaWNhLCBIb3NwaXRhbCBN

YWNpZWwsIE1vbnRldmlkZW8sIFVydWd1YXkuJiN4RDsxNSBIb2trYWlkbyBVbml2ZXJzaXR5IFNj

aG9vbCBvZiBNZWRpY2luZSwgU2FwcG9ybywgSmFwYW4uJiN4RDsxNiBIb3BpdGFsIENvY2hpbiAo

QXNzaXN0YW5jZSBQdWJsaXF1ZS1Ib3BpdGF1eCBkZSBQYXJpcyksIFVuaXZlcnNpdHkgUGFyaXMg

RGVzY2FydGVzLCBQYXJpcywgRnJhbmNlLiYjeEQ7MTcgVGhvcmF4IEluc3RpdHV0ZSwgSG9zcGl0

YWwgQ2xpbmljIFVuaXZlcnNpdGF0IGRlIEJhcmNlbG9uYSwgQmFyY2Vsb25hLCBTcGFpbi4mI3hE

OzE4IFN0LiBQYXVsJmFwb3M7cyBIb3NwaXRhbCwgVW5pdmVyc2l0eSBvZiBCcml0aXNoIENvbHVt

YmlhLCBWYW5jb3V2ZXIsIEJyaXRpc2ggQ29sdW1iaWEsIENhbmFkYS4mI3hEOzE5IFVuaXZlcnNp

dHkgb2YgTWFuY2hlc3RlciwgTWFuY2hlc3RlciwgVW5pdGVkIEtpbmdkb20uJiN4RDsyMCBVbml2

ZXJzaXR5IEhvc3BpdGFsLCBCaXJtaW5naGFtLCBVbml0ZWQgS2luZ2RvbTsgYW5kLiYjeEQ7MjEg

SG9zcGl0YWwgQ2xpbmljLCBVbml2ZXJzaXRhdCBkZSBCYXJjZWxvbmEsIENlbnRybyBkZSBJbnZl

c3RpZ2FjaW9uIEJpb21lZGljYSBlbiBSZWQgZGUgRW5mZXJtZWRhZGUgUmVzcGlyYXRvcmlhcywg

QmFyY2Vsb25hLCBTcGFpbi48L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRsZT5HbG9iYWwgU3Ry

YXRlZ3kgZm9yIHRoZSBEaWFnbm9zaXMsIE1hbmFnZW1lbnQsIGFuZCBQcmV2ZW50aW9uIG9mIENo

cm9uaWMgT2JzdHJ1Y3RpdmUgTHVuZyBEaXNlYXNlIDIwMTcgUmVwb3J0LiBHT0xEIEV4ZWN1dGl2

ZSBTdW1tYXJ5PC90aXRsZT48c2Vjb25kYXJ5LXRpdGxlPkFtIEogUmVzcGlyIENyaXQgQ2FyZSBN

ZWQ8L3NlY29uZGFyeS10aXRsZT48L3RpdGxlcz48cGVyaW9kaWNhbD48ZnVsbC10aXRsZT5BbSBK

IFJlc3BpciBDcml0IENhcmUgTWVkPC9mdWxsLXRpdGxlPjwvcGVyaW9kaWNhbD48cGFnZXM+NTU3

LTU4MjwvcGFnZXM+PHZvbHVtZT4xOTU8L3ZvbHVtZT48bnVtYmVyPjU8L251bWJlcj48a2V5d29y

ZHM+PGtleXdvcmQ+Q09QRCBkaWFnbm9zaXM8L2tleXdvcmQ+PGtleXdvcmQ+Q09QRCBtYW5hZ2Vt

ZW50PC9rZXl3b3JkPjxrZXl3b3JkPkNPUEQgcHJldmVudGlvbjwva2V5d29yZD48a2V5d29yZD5j

aHJvbmljIG9ic3RydWN0aXZlIHB1bG1vbmFyeSBkaXNlYXNlPC9rZXl3b3JkPjwva2V5d29yZHM+

PGRhdGVzPjx5ZWFyPjIwMTc8L3llYXI+PHB1Yi1kYXRlcz48ZGF0ZT5NYXIgMDE8L2RhdGU+PC9w

dWItZGF0ZXM+PC9kYXRlcz48aXNibj4xNTM1LTQ5NzAgKEVsZWN0cm9uaWMpJiN4RDsxMDczLTQ0

OVggKExpbmtpbmcpPC9pc2JuPjxhY2Nlc3Npb24tbnVtPjI4MTI4OTcwPC9hY2Nlc3Npb24tbnVt

Pjx1cmxzPjxyZWxhdGVkLXVybHM+PHVybD5odHRwczovL3d3dy5uY2JpLm5sbS5uaWguZ292L3B1

Ym1lZC8yODEyODk3MDwvdXJsPjwvcmVsYXRlZC11cmxzPjwvdXJscz48ZWxlY3Ryb25pYy1yZXNv

dXJjZS1udW0+MTAuMTE2NC9yY2NtLjIwMTcwMS0wMjE4UFA8L2VsZWN0cm9uaWMtcmVzb3VyY2Ut

bnVtPjwvcmVjb3JkPjwvQ2l0ZT48L0VuZE5vdGU+AG==

ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Wb2dlbG1laWVyPC9BdXRob3I+PFllYXI+MjAxNzwvWWVh

cj48UmVjTnVtPjIyNDwvUmVjTnVtPjxEaXNwbGF5VGV4dD48c3R5bGUgZmFjZT0ic3VwZXJzY3Jp

cHQiPjc8L3N0eWxlPjwvRGlzcGxheVRleHQ+PHJlY29yZD48cmVjLW51bWJlcj4yMjQ8L3JlYy1u

dW1iZXI+PGZvcmVpZ24ta2V5cz48a2V5IGFwcD0iRU4iIGRiLWlkPSJ0ZGRydzV2YWZlcDVkMGVh

ZmF2eHh2OWZhNWV4cnByc3N2dmQiIHRpbWVzdGFtcD0iMTU2MzUxOTk1NiI+MjI0PC9rZXk+PC9m

b3JlaWduLWtleXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10eXBl

Pjxjb250cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5Wb2dlbG1laWVyLCBDLiBGLjwvYXV0aG9y

PjxhdXRob3I+Q3JpbmVyLCBHLiBKLjwvYXV0aG9yPjxhdXRob3I+TWFydGluZXosIEYuIEouPC9h

dXRob3I+PGF1dGhvcj5Bbnp1ZXRvLCBBLjwvYXV0aG9yPjxhdXRob3I+QmFybmVzLCBQLiBKLjwv

YXV0aG9yPjxhdXRob3I+Qm91cmJlYXUsIEouPC9hdXRob3I+PGF1dGhvcj5DZWxsaSwgQi4gUi48

L2F1dGhvcj48YXV0aG9yPkNoZW4sIFIuPC9hdXRob3I+PGF1dGhvcj5EZWNyYW1lciwgTS48L2F1

dGhvcj48YXV0aG9yPkZhYmJyaSwgTC4gTS48L2F1dGhvcj48YXV0aG9yPkZyaXRoLCBQLjwvYXV0

aG9yPjxhdXRob3I+SGFscGluLCBELiBNLjwvYXV0aG9yPjxhdXRob3I+TG9wZXogVmFyZWxhLCBN

LiBWLjwvYXV0aG9yPjxhdXRob3I+TmlzaGltdXJhLCBNLjwvYXV0aG9yPjxhdXRob3I+Um9jaGUs

IE4uPC9hdXRob3I+PGF1dGhvcj5Sb2RyaWd1ZXotUm9pc2luLCBSLjwvYXV0aG9yPjxhdXRob3I+

U2luLCBELiBELjwvYXV0aG9yPjxhdXRob3I+U2luZ2gsIEQuPC9hdXRob3I+PGF1dGhvcj5TdG9j

a2xleSwgUi48L2F1dGhvcj48YXV0aG9yPlZlc3RibywgSi48L2F1dGhvcj48YXV0aG9yPldlZHpp

Y2hhLCBKLiBBLjwvYXV0aG9yPjxhdXRob3I+QWd1c3RpLCBBLjwvYXV0aG9yPjwvYXV0aG9ycz48

L2NvbnRyaWJ1dG9ycz48YXV0aC1hZGRyZXNzPjEgVW5pdmVyc2l0eSBvZiBNYXJidXJnLCBNZW1i

ZXIgb2YgdGhlIEdlcm1hbiBDZW50ZXIgZm9yIEx1bmcgUmVzZWFyY2ggKERaTCksIE1hcmJ1cmcs

IEdlcm1hbnkuJiN4RDsyIExld2lzIEthdHogU2Nob29sIG9mIE1lZGljaW5lIGF0IFRlbXBsZSBV

bml2ZXJzaXR5LCBQaGlsYWRlbHBoaWEsIFBlbm5zeWx2YW5pYS4mI3hEOzMgTmV3IFlvcmstUHJl

c2J5dGVyaWFuIEhvc3BpdGFsLCBXZWlsbCBDb3JuZWxsIE1lZGljYWwgQ2VudGVyLCBOZXcgWW9y

aywgTmV3IFlvcmsuJiN4RDs0IFVuaXZlcnNpdHkgb2YgVGV4YXMgSGVhbHRoIFNjaWVuY2UgQ2Vu

dGVyLCBTYW4gQW50b25pbywgVGV4YXMuJiN4RDs1IFNvdXRoIFRleGFzIFZldGVyYW5zIEhlYWx0

aCBDYXJlIFN5c3RlbSwgU2FuIEFudG9uaW8sIFRleGFzLiYjeEQ7NiBOYXRpb25hbCBIZWFydCBh

bmQgTHVuZyBJbnN0aXR1dGUsIEltcGVyaWFsIENvbGxlZ2UsIExvbmRvbiwgVW5pdGVkIEtpbmdk

b20uJiN4RDs3IE1jR2lsbCBVbml2ZXJzaXR5IEhlYWx0aCBDZW50cmUsIE1jR2lsbCBVbml2ZXJz

aXR5LCBNb250cmVhbCwgUXVlYmVjLCBDYW5hZGEuJiN4RDs4IEJyaWdoYW0gYW5kIFdvbWVuJmFw

b3M7cyBIb3NwaXRhbCwgQm9zdG9uLCBNYXNzYWNodXNldHRzLiYjeEQ7OSBTdGF0ZSBLZXkgTGFi

IGZvciBSZXNwaXJhdG9yeSBEaXNlYXNlLCBHdWFuZ3pob3UgSW5zdGl0dXRlIG9mIFJlc3BpcmF0

b3J5IERpc2Vhc2UsIEZpcnN0IEFmZmlsaWF0ZWQgSG9zcGl0YWwgb2YgR3Vhbmd6aG91IE1lZGlj

YWwgVW5pdmVyc2l0eSwgR3Vhbmd6aG91LCBDaGluYS4mI3hEOzEwIFVuaXZlcnNpdHkgb2YgTGV1

dmVuLCBMZXV2ZW4sIEJlbGdpdW0uJiN4RDsxMSBVbml2ZXJzaXR5IG9mIE1vZGVuYSBhbmQgUmVn

Z2lvIEVtaWxpYSwgTW9kZW5hLCBJdGFseS4mI3hEOzEyIEZhY3VsdHkgb2YgTWVkaWNpbmUsIEZs

aW5kZXJzIFVuaXZlcnNpdHksIEJlZGZvcmQgUGFyaywgU291dGggQXVzdHJhbGlhLCBBdXN0cmFs

aWEuJiN4RDsxMyBSb3lhbCBEZXZvbiBhbmQgRXhldGVyIEhvc3BpdGFsLCBFeGV0ZXIsIFVuaXRl

ZCBLaW5nZG9tLiYjeEQ7MTQgVW5pdmVyc2lkYWQgZGUgbGEgUmVwdWJsaWNhLCBIb3NwaXRhbCBN

YWNpZWwsIE1vbnRldmlkZW8sIFVydWd1YXkuJiN4RDsxNSBIb2trYWlkbyBVbml2ZXJzaXR5IFNj

aG9vbCBvZiBNZWRpY2luZSwgU2FwcG9ybywgSmFwYW4uJiN4RDsxNiBIb3BpdGFsIENvY2hpbiAo

QXNzaXN0YW5jZSBQdWJsaXF1ZS1Ib3BpdGF1eCBkZSBQYXJpcyksIFVuaXZlcnNpdHkgUGFyaXMg

RGVzY2FydGVzLCBQYXJpcywgRnJhbmNlLiYjeEQ7MTcgVGhvcmF4IEluc3RpdHV0ZSwgSG9zcGl0

YWwgQ2xpbmljIFVuaXZlcnNpdGF0IGRlIEJhcmNlbG9uYSwgQmFyY2Vsb25hLCBTcGFpbi4mI3hE

OzE4IFN0LiBQYXVsJmFwb3M7cyBIb3NwaXRhbCwgVW5pdmVyc2l0eSBvZiBCcml0aXNoIENvbHVt

YmlhLCBWYW5jb3V2ZXIsIEJyaXRpc2ggQ29sdW1iaWEsIENhbmFkYS4mI3hEOzE5IFVuaXZlcnNp

dHkgb2YgTWFuY2hlc3RlciwgTWFuY2hlc3RlciwgVW5pdGVkIEtpbmdkb20uJiN4RDsyMCBVbml2

ZXJzaXR5IEhvc3BpdGFsLCBCaXJtaW5naGFtLCBVbml0ZWQgS2luZ2RvbTsgYW5kLiYjeEQ7MjEg

SG9zcGl0YWwgQ2xpbmljLCBVbml2ZXJzaXRhdCBkZSBCYXJjZWxvbmEsIENlbnRybyBkZSBJbnZl

c3RpZ2FjaW9uIEJpb21lZGljYSBlbiBSZWQgZGUgRW5mZXJtZWRhZGUgUmVzcGlyYXRvcmlhcywg

QmFyY2Vsb25hLCBTcGFpbi48L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRsZT5HbG9iYWwgU3Ry

YXRlZ3kgZm9yIHRoZSBEaWFnbm9zaXMsIE1hbmFnZW1lbnQsIGFuZCBQcmV2ZW50aW9uIG9mIENo

cm9uaWMgT2JzdHJ1Y3RpdmUgTHVuZyBEaXNlYXNlIDIwMTcgUmVwb3J0LiBHT0xEIEV4ZWN1dGl2

ZSBTdW1tYXJ5PC90aXRsZT48c2Vjb25kYXJ5LXRpdGxlPkFtIEogUmVzcGlyIENyaXQgQ2FyZSBN

ZWQ8L3NlY29uZGFyeS10aXRsZT48L3RpdGxlcz48cGVyaW9kaWNhbD48ZnVsbC10aXRsZT5BbSBK

IFJlc3BpciBDcml0IENhcmUgTWVkPC9mdWxsLXRpdGxlPjwvcGVyaW9kaWNhbD48cGFnZXM+NTU3

LTU4MjwvcGFnZXM+PHZvbHVtZT4xOTU8L3ZvbHVtZT48bnVtYmVyPjU8L251bWJlcj48a2V5d29y

ZHM+PGtleXdvcmQ+Q09QRCBkaWFnbm9zaXM8L2tleXdvcmQ+PGtleXdvcmQ+Q09QRCBtYW5hZ2Vt

ZW50PC9rZXl3b3JkPjxrZXl3b3JkPkNPUEQgcHJldmVudGlvbjwva2V5d29yZD48a2V5d29yZD5j

aHJvbmljIG9ic3RydWN0aXZlIHB1bG1vbmFyeSBkaXNlYXNlPC9rZXl3b3JkPjwva2V5d29yZHM+

PGRhdGVzPjx5ZWFyPjIwMTc8L3llYXI+PHB1Yi1kYXRlcz48ZGF0ZT5NYXIgMDE8L2RhdGU+PC9w

dWItZGF0ZXM+PC9kYXRlcz48aXNibj4xNTM1LTQ5NzAgKEVsZWN0cm9uaWMpJiN4RDsxMDczLTQ0

OVggKExpbmtpbmcpPC9pc2JuPjxhY2Nlc3Npb24tbnVtPjI4MTI4OTcwPC9hY2Nlc3Npb24tbnVt

Pjx1cmxzPjxyZWxhdGVkLXVybHM+PHVybD5odHRwczovL3d3dy5uY2JpLm5sbS5uaWguZ292L3B1

Ym1lZC8yODEyODk3MDwvdXJsPjwvcmVsYXRlZC11cmxzPjwvdXJscz48ZWxlY3Ryb25pYy1yZXNv

dXJjZS1udW0+MTAuMTE2NC9yY2NtLjIwMTcwMS0wMjE4UFA8L2VsZWN0cm9uaWMtcmVzb3VyY2Ut

bnVtPjwvcmVjb3JkPjwvQ2l0ZT48L0VuZE5vdGU+AG==

ADDIN EN.CITE.DATA 7UTI*Antimicrobial therapy is recommended.Acute uncomplicated cystitis:Trimethoprim-sulfamethoxazole 160/800 mg orally twice dailyNitrofurantoin monohydrate/macrocrystals 100 mg orally twice daily (N/A in Japan)Pivmecillinam 400 mg orally twice daily (N/A in Japan)Acute pyelonephritis:Initial 1-time dose of a long-acting parenteral antimicrobial and trimethoprim-sulfamethoxazole 160/800 mg orally twice daily Gupta et al.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HdXB0YTwvQXV0aG9yPjxZZWFyPjIwMTE8L1llYXI+PFJl

Y051bT4yMTI8L1JlY051bT48RGlzcGxheVRleHQ+PHN0eWxlIGZhY2U9InN1cGVyc2NyaXB0Ij44

PC9zdHlsZT48L0Rpc3BsYXlUZXh0PjxyZWNvcmQ+PHJlYy1udW1iZXI+MjEyPC9yZWMtbnVtYmVy

Pjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0idGRkcnc1dmFmZXA1ZDBlYWZhdnh4

djlmYTVleHJwcnNzdnZkIiB0aW1lc3RhbXA9IjE1NjM1MTk5MDAiPjIxMjwva2V5PjwvZm9yZWln

bi1rZXlzPjxyZWYtdHlwZSBuYW1lPSJKb3VybmFsIEFydGljbGUiPjE3PC9yZWYtdHlwZT48Y29u

dHJpYnV0b3JzPjxhdXRob3JzPjxhdXRob3I+R3VwdGEsIEsuPC9hdXRob3I+PGF1dGhvcj5Ib290

b24sIFQuIE0uPC9hdXRob3I+PGF1dGhvcj5OYWJlciwgSy4gRy48L2F1dGhvcj48YXV0aG9yPld1

bGx0LCBCLjwvYXV0aG9yPjxhdXRob3I+Q29sZ2FuLCBSLjwvYXV0aG9yPjxhdXRob3I+TWlsbGVy

LCBMLiBHLjwvYXV0aG9yPjxhdXRob3I+TW9yYW4sIEcuIEouPC9hdXRob3I+PGF1dGhvcj5OaWNv

bGxlLCBMLiBFLjwvYXV0aG9yPjxhdXRob3I+UmF6LCBSLjwvYXV0aG9yPjxhdXRob3I+U2NoYWVm

ZmVyLCBBLiBKLjwvYXV0aG9yPjxhdXRob3I+U29wZXIsIEQuIEUuPC9hdXRob3I+PGF1dGhvcj5J

bmZlY3Rpb3VzIERpc2Vhc2VzIFNvY2lldHkgb2YsIEFtZXJpY2E8L2F1dGhvcj48YXV0aG9yPkV1

cm9wZWFuIFNvY2lldHkgZm9yLCBNaWNyb2Jpb2xvZ3k8L2F1dGhvcj48YXV0aG9yPkluZmVjdGlv

dXMsIERpc2Vhc2VzPC9hdXRob3I+PC9hdXRob3JzPjwvY29udHJpYnV0b3JzPjxhdXRoLWFkZHJl

c3M+RGVwYXJ0bWVudCBvZiBNZWRpY2luZSwgVmV0ZXJhbnMgQWZmYWlycyBCb3N0b24gSGVhbHRo

IENhcmUgU3lzdGVtLCBCb3N0b24gVW5pdmVyc2l0eSBTY2hvb2wgb2YgTWVkaWNpbmUsIEJvc3Rv

biwgTWFzc2FjaHVzZXR0cywgVVNBLiBrYWxwYW5hLmd1cHRhQHZhLmdvdjwvYXV0aC1hZGRyZXNz

Pjx0aXRsZXM+PHRpdGxlPkludGVybmF0aW9uYWwgY2xpbmljYWwgcHJhY3RpY2UgZ3VpZGVsaW5l

cyBmb3IgdGhlIHRyZWF0bWVudCBvZiBhY3V0ZSB1bmNvbXBsaWNhdGVkIGN5c3RpdGlzIGFuZCBw

eWVsb25lcGhyaXRpcyBpbiB3b21lbjogQSAyMDEwIHVwZGF0ZSBieSB0aGUgSW5mZWN0aW91cyBE

aXNlYXNlcyBTb2NpZXR5IG9mIEFtZXJpY2EgYW5kIHRoZSBFdXJvcGVhbiBTb2NpZXR5IGZvciBN

aWNyb2Jpb2xvZ3kgYW5kIEluZmVjdGlvdXMgRGlzZWFzZXM8L3RpdGxlPjxzZWNvbmRhcnktdGl0

bGU+Q2xpbiBJbmZlY3QgRGlzPC9zZWNvbmRhcnktdGl0bGU+PC90aXRsZXM+PHBlcmlvZGljYWw+

PGZ1bGwtdGl0bGU+Q2xpbiBJbmZlY3QgRGlzPC9mdWxsLXRpdGxlPjwvcGVyaW9kaWNhbD48cGFn

ZXM+ZTEwMy0yMDwvcGFnZXM+PHZvbHVtZT41Mjwvdm9sdW1lPjxudW1iZXI+NTwvbnVtYmVyPjxr

ZXl3b3Jkcz48a2V5d29yZD5BY3V0ZSBEaXNlYXNlPC9rZXl3b3JkPjxrZXl3b3JkPkFudGktQmFj

dGVyaWFsIEFnZW50cy9waGFybWFjb2xvZ3kvKnRoZXJhcGV1dGljIHVzZTwva2V5d29yZD48a2V5

d29yZD5CYWN0ZXJpYS9kcnVnIGVmZmVjdHMvaXNvbGF0aW9uICZhbXA7IHB1cmlmaWNhdGlvbjwv

a2V5d29yZD48a2V5d29yZD5CYWN0ZXJpYWwgSW5mZWN0aW9ucy9kaWFnbm9zaXMvKmRydWcgdGhl

cmFweTwva2V5d29yZD48a2V5d29yZD5DeXN0aXRpcy9kaWFnbm9zaXMvKmRydWcgdGhlcmFweTwv

a2V5d29yZD48a2V5d29yZD5EcnVnIFJlc2lzdGFuY2UsIEJhY3RlcmlhbDwva2V5d29yZD48a2V5

d29yZD5GZW1hbGU8L2tleXdvcmQ+PGtleXdvcmQ+SHVtYW5zPC9rZXl3b3JkPjxrZXl3b3JkPlB5

ZWxvbmVwaHJpdGlzL2RpYWdub3Npcy8qZHJ1ZyB0aGVyYXB5PC9rZXl3b3JkPjwva2V5d29yZHM+

PGRhdGVzPjx5ZWFyPjIwMTE8L3llYXI+PHB1Yi1kYXRlcz48ZGF0ZT5NYXIgMDE8L2RhdGU+PC9w

dWItZGF0ZXM+PC9kYXRlcz48aXNibj4xNTM3LTY1OTEgKEVsZWN0cm9uaWMpJiN4RDsxMDU4LTQ4

MzggKExpbmtpbmcpPC9pc2JuPjxhY2Nlc3Npb24tbnVtPjIxMjkyNjU0PC9hY2Nlc3Npb24tbnVt

Pjx1cmxzPjxyZWxhdGVkLXVybHM+PHVybD5odHRwczovL3d3dy5uY2JpLm5sbS5uaWguZ292L3B1

Ym1lZC8yMTI5MjY1NDwvdXJsPjwvcmVsYXRlZC11cmxzPjwvdXJscz48ZWxlY3Ryb25pYy1yZXNv

dXJjZS1udW0+MTAuMTA5My9jaWQvY2lxMjU3PC9lbGVjdHJvbmljLXJlc291cmNlLW51bT48L3Jl

Y29yZD48L0NpdGU+PC9FbmROb3RlPn==

ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HdXB0YTwvQXV0aG9yPjxZZWFyPjIwMTE8L1llYXI+PFJl

Y051bT4yMTI8L1JlY051bT48RGlzcGxheVRleHQ+PHN0eWxlIGZhY2U9InN1cGVyc2NyaXB0Ij44

PC9zdHlsZT48L0Rpc3BsYXlUZXh0PjxyZWNvcmQ+PHJlYy1udW1iZXI+MjEyPC9yZWMtbnVtYmVy

Pjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0idGRkcnc1dmFmZXA1ZDBlYWZhdnh4

djlmYTVleHJwcnNzdnZkIiB0aW1lc3RhbXA9IjE1NjM1MTk5MDAiPjIxMjwva2V5PjwvZm9yZWln

bi1rZXlzPjxyZWYtdHlwZSBuYW1lPSJKb3VybmFsIEFydGljbGUiPjE3PC9yZWYtdHlwZT48Y29u

dHJpYnV0b3JzPjxhdXRob3JzPjxhdXRob3I+R3VwdGEsIEsuPC9hdXRob3I+PGF1dGhvcj5Ib290

b24sIFQuIE0uPC9hdXRob3I+PGF1dGhvcj5OYWJlciwgSy4gRy48L2F1dGhvcj48YXV0aG9yPld1

bGx0LCBCLjwvYXV0aG9yPjxhdXRob3I+Q29sZ2FuLCBSLjwvYXV0aG9yPjxhdXRob3I+TWlsbGVy

LCBMLiBHLjwvYXV0aG9yPjxhdXRob3I+TW9yYW4sIEcuIEouPC9hdXRob3I+PGF1dGhvcj5OaWNv

bGxlLCBMLiBFLjwvYXV0aG9yPjxhdXRob3I+UmF6LCBSLjwvYXV0aG9yPjxhdXRob3I+U2NoYWVm

ZmVyLCBBLiBKLjwvYXV0aG9yPjxhdXRob3I+U29wZXIsIEQuIEUuPC9hdXRob3I+PGF1dGhvcj5J

bmZlY3Rpb3VzIERpc2Vhc2VzIFNvY2lldHkgb2YsIEFtZXJpY2E8L2F1dGhvcj48YXV0aG9yPkV1

cm9wZWFuIFNvY2lldHkgZm9yLCBNaWNyb2Jpb2xvZ3k8L2F1dGhvcj48YXV0aG9yPkluZmVjdGlv

dXMsIERpc2Vhc2VzPC9hdXRob3I+PC9hdXRob3JzPjwvY29udHJpYnV0b3JzPjxhdXRoLWFkZHJl

c3M+RGVwYXJ0bWVudCBvZiBNZWRpY2luZSwgVmV0ZXJhbnMgQWZmYWlycyBCb3N0b24gSGVhbHRo

IENhcmUgU3lzdGVtLCBCb3N0b24gVW5pdmVyc2l0eSBTY2hvb2wgb2YgTWVkaWNpbmUsIEJvc3Rv

biwgTWFzc2FjaHVzZXR0cywgVVNBLiBrYWxwYW5hLmd1cHRhQHZhLmdvdjwvYXV0aC1hZGRyZXNz

Pjx0aXRsZXM+PHRpdGxlPkludGVybmF0aW9uYWwgY2xpbmljYWwgcHJhY3RpY2UgZ3VpZGVsaW5l

cyBmb3IgdGhlIHRyZWF0bWVudCBvZiBhY3V0ZSB1bmNvbXBsaWNhdGVkIGN5c3RpdGlzIGFuZCBw

eWVsb25lcGhyaXRpcyBpbiB3b21lbjogQSAyMDEwIHVwZGF0ZSBieSB0aGUgSW5mZWN0aW91cyBE

aXNlYXNlcyBTb2NpZXR5IG9mIEFtZXJpY2EgYW5kIHRoZSBFdXJvcGVhbiBTb2NpZXR5IGZvciBN

aWNyb2Jpb2xvZ3kgYW5kIEluZmVjdGlvdXMgRGlzZWFzZXM8L3RpdGxlPjxzZWNvbmRhcnktdGl0

bGU+Q2xpbiBJbmZlY3QgRGlzPC9zZWNvbmRhcnktdGl0bGU+PC90aXRsZXM+PHBlcmlvZGljYWw+

PGZ1bGwtdGl0bGU+Q2xpbiBJbmZlY3QgRGlzPC9mdWxsLXRpdGxlPjwvcGVyaW9kaWNhbD48cGFn

ZXM+ZTEwMy0yMDwvcGFnZXM+PHZvbHVtZT41Mjwvdm9sdW1lPjxudW1iZXI+NTwvbnVtYmVyPjxr

ZXl3b3Jkcz48a2V5d29yZD5BY3V0ZSBEaXNlYXNlPC9rZXl3b3JkPjxrZXl3b3JkPkFudGktQmFj

dGVyaWFsIEFnZW50cy9waGFybWFjb2xvZ3kvKnRoZXJhcGV1dGljIHVzZTwva2V5d29yZD48a2V5

d29yZD5CYWN0ZXJpYS9kcnVnIGVmZmVjdHMvaXNvbGF0aW9uICZhbXA7IHB1cmlmaWNhdGlvbjwv

a2V5d29yZD48a2V5d29yZD5CYWN0ZXJpYWwgSW5mZWN0aW9ucy9kaWFnbm9zaXMvKmRydWcgdGhl

cmFweTwva2V5d29yZD48a2V5d29yZD5DeXN0aXRpcy9kaWFnbm9zaXMvKmRydWcgdGhlcmFweTwv

a2V5d29yZD48a2V5d29yZD5EcnVnIFJlc2lzdGFuY2UsIEJhY3RlcmlhbDwva2V5d29yZD48a2V5

d29yZD5GZW1hbGU8L2tleXdvcmQ+PGtleXdvcmQ+SHVtYW5zPC9rZXl3b3JkPjxrZXl3b3JkPlB5

ZWxvbmVwaHJpdGlzL2RpYWdub3Npcy8qZHJ1ZyB0aGVyYXB5PC9rZXl3b3JkPjwva2V5d29yZHM+

PGRhdGVzPjx5ZWFyPjIwMTE8L3llYXI+PHB1Yi1kYXRlcz48ZGF0ZT5NYXIgMDE8L2RhdGU+PC9w

dWItZGF0ZXM+PC9kYXRlcz48aXNibj4xNTM3LTY1OTEgKEVsZWN0cm9uaWMpJiN4RDsxMDU4LTQ4

MzggKExpbmtpbmcpPC9pc2JuPjxhY2Nlc3Npb24tbnVtPjIxMjkyNjU0PC9hY2Nlc3Npb24tbnVt

Pjx1cmxzPjxyZWxhdGVkLXVybHM+PHVybD5odHRwczovL3d3dy5uY2JpLm5sbS5uaWguZ292L3B1

Ym1lZC8yMTI5MjY1NDwvdXJsPjwvcmVsYXRlZC11cmxzPjwvdXJscz48ZWxlY3Ryb25pYy1yZXNv

dXJjZS1udW0+MTAuMTA5My9jaWQvY2lxMjU3PC9lbGVjdHJvbmljLXJlc291cmNlLW51bT48L3Jl

Y29yZD48L0NpdGU+PC9FbmROb3RlPn==

ADDIN EN.CITE.DATA 8Acute gastroenteritis(treatment for travelers’ diarrhea) **Antimicrobial therapy is not recommended, except in cases of Travelers’ diarrhea where the likelihood of bacterial pathogens is high enough to justify the potential side effects of antibiotics.Levofloxacin 500 mg orally once daily Ciprofloxacin 750 mg orally once daily Ofloxacin 400 mg orally once dailyAzithromycin 1 g orally once or 500 mg orally once dailyRiddle et al. ADDIN EN.CITE <EndNote><Cite><Author>Riddle</Author><Year>2016</Year><RecNum>223</RecNum><DisplayText><style face="superscript">9</style></DisplayText><record><rec-number>223</rec-number><foreign-keys><key app="EN" db-id="tddrw5vafep5d0eafavxxv9fa5exrprssvvd" timestamp="1563519956">223</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Riddle, M. S.</author><author>DuPont, H. L.</author><author>Connor, B. A.</author></authors></contributors><auth-address>Enteric Diseases Department, Naval Medical Research Center, Silver Spring, Maryland, USA.&#xD;University of Texas Health Science Center at Houston, Houston, Texas, USA.&#xD;Weill Medical College of Cornell University, New York, New York, USA.</auth-address><titles><title>ACG Clinical Guideline: Diagnosis, Treatment, and Prevention of Acute Diarrheal Infections in Adults</title><secondary-title>Am J Gastroenterol</secondary-title></titles><periodical><full-title>Am J Gastroenterol</full-title></periodical><pages>602-22</pages><volume>111</volume><number>5</number><edition>2016/04/14</edition><keywords><keyword>Acute Disease</keyword><keyword>Adult</keyword><keyword>Algorithms</keyword><keyword>Diarrhea/*diagnosis/etiology/*therapy</keyword><keyword>Humans</keyword><keyword>United States</keyword></keywords><dates><year>2016</year><pub-dates><date>May</date></pub-dates></dates><isbn>1572-0241 (Electronic)&#xD;0002-9270 (Linking)</isbn><accession-num>27068718</accession-num><urls><related-urls><url> infectionAntimicrobial therapy is recommended.Antibiotics active against enteric gram-negative aerobic, facultative bacilli, and enteric gram-positive streptococci and coverage for obligate anaerobic bacilli should be provided for distal small bowel, appendiceal, and colonic infections.Solomkin et al.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Tb2xvbWtpbjwvQXV0aG9yPjxZZWFyPjIwMTA8L1llYXI+

PFJlY051bT4yMTg8L1JlY051bT48RGlzcGxheVRleHQ+PHN0eWxlIGZhY2U9InN1cGVyc2NyaXB0

Ij4xMDwvc3R5bGU+PC9EaXNwbGF5VGV4dD48cmVjb3JkPjxyZWMtbnVtYmVyPjIxODwvcmVjLW51

bWJlcj48Zm9yZWlnbi1rZXlzPjxrZXkgYXBwPSJFTiIgZGItaWQ9InRkZHJ3NXZhZmVwNWQwZWFm

YXZ4eHY5ZmE1ZXhycHJzc3Z2ZCIgdGltZXN0YW1wPSIxNTYzNTE5OTAwIj4yMTg8L2tleT48L2Zv

cmVpZ24ta2V5cz48cmVmLXR5cGUgbmFtZT0iSm91cm5hbCBBcnRpY2xlIj4xNzwvcmVmLXR5cGU+

PGNvbnRyaWJ1dG9ycz48YXV0aG9ycz48YXV0aG9yPlNvbG9ta2luLCBKLiBTLjwvYXV0aG9yPjxh

dXRob3I+TWF6dXNraSwgSi4gRS48L2F1dGhvcj48YXV0aG9yPkJyYWRsZXksIEouIFMuPC9hdXRo

b3I+PGF1dGhvcj5Sb2R2b2xkLCBLLiBBLjwvYXV0aG9yPjxhdXRob3I+R29sZHN0ZWluLCBFLiBK

LjwvYXV0aG9yPjxhdXRob3I+QmFyb24sIEUuIEouPC9hdXRob3I+PGF1dGhvcj5PJmFwb3M7TmVp

bGwsIFAuIEouPC9hdXRob3I+PGF1dGhvcj5DaG93LCBBLiBXLjwvYXV0aG9yPjxhdXRob3I+RGVs

bGluZ2VyLCBFLiBQLjwvYXV0aG9yPjxhdXRob3I+RWFjaGVtcGF0aSwgUy4gUi48L2F1dGhvcj48

YXV0aG9yPkdvcmJhY2gsIFMuPC9hdXRob3I+PGF1dGhvcj5IaWxmaWtlciwgTS48L2F1dGhvcj48

YXV0aG9yPk1heSwgQS4gSy48L2F1dGhvcj48YXV0aG9yPk5hdGhlbnMsIEEuIEIuPC9hdXRob3I+

PGF1dGhvcj5TYXd5ZXIsIFIuIEcuPC9hdXRob3I+PGF1dGhvcj5CYXJ0bGV0dCwgSi4gRy48L2F1

dGhvcj48L2F1dGhvcnM+PC9jb250cmlidXRvcnM+PGF1dGgtYWRkcmVzcz5EZXBhcnRtZW50IG9m

IFN1cmdlcnksIHRoZSBVbml2ZXJzaXR5IG9mIENpbmNpbm5hdGkgQ29sbGVnZSBvZiBNZWRpY2lu

ZSwgQ2luY2lubmF0aSwgT2hpbyA0NTI2Ny0wNTU4LCBVU0EuIGpvc2VwaC5zb2xvbWtpbkB1Yy5l

ZHU8L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRsZT5EaWFnbm9zaXMgYW5kIG1hbmFnZW1lbnQg

b2YgY29tcGxpY2F0ZWQgaW50cmEtYWJkb21pbmFsIGluZmVjdGlvbiBpbiBhZHVsdHMgYW5kIGNo

aWxkcmVuOiBndWlkZWxpbmVzIGJ5IHRoZSBTdXJnaWNhbCBJbmZlY3Rpb24gU29jaWV0eSBhbmQg

dGhlIEluZmVjdGlvdXMgRGlzZWFzZXMgU29jaWV0eSBvZiBBbWVyaWNhPC90aXRsZT48c2Vjb25k

YXJ5LXRpdGxlPkNsaW4gSW5mZWN0IERpczwvc2Vjb25kYXJ5LXRpdGxlPjwvdGl0bGVzPjxwZXJp

b2RpY2FsPjxmdWxsLXRpdGxlPkNsaW4gSW5mZWN0IERpczwvZnVsbC10aXRsZT48L3BlcmlvZGlj

YWw+PHBhZ2VzPjEzMy02NDwvcGFnZXM+PHZvbHVtZT41MDwvdm9sdW1lPjxudW1iZXI+MjwvbnVt

YmVyPjxlZGl0aW9uPjIwMDkvMTIvMjY8L2VkaXRpb24+PGtleXdvcmRzPjxrZXl3b3JkPipBYmRv

bWVuPC9rZXl3b3JkPjxrZXl3b3JkPkFkdWx0PC9rZXl3b3JkPjxrZXl3b3JkPkFudGktQmFjdGVy

aWFsIEFnZW50cy8qdGhlcmFwZXV0aWMgdXNlPC9rZXl3b3JkPjxrZXl3b3JkPkJhY3RlcmlhbCBJ

bmZlY3Rpb25zL2NvbXBsaWNhdGlvbnMvKmRpYWdub3Npcy8qZHJ1ZyB0aGVyYXB5L21pY3JvYmlv

bG9neTwva2V5d29yZD48a2V5d29yZD5DaGlsZDwva2V5d29yZD48a2V5d29yZD5IdW1hbnM8L2tl

eXdvcmQ+PGtleXdvcmQ+U2V2ZXJpdHkgb2YgSWxsbmVzcyBJbmRleDwva2V5d29yZD48L2tleXdv

cmRzPjxkYXRlcz48eWVhcj4yMDEwPC95ZWFyPjxwdWItZGF0ZXM+PGRhdGU+SmFuIDE1PC9kYXRl

PjwvcHViLWRhdGVzPjwvZGF0ZXM+PGlzYm4+MTUzNy02NTkxIChFbGVjdHJvbmljKSYjeEQ7MTA1

OC00ODM4IChMaW5raW5nKTwvaXNibj48YWNjZXNzaW9uLW51bT4yMDAzNDM0NTwvYWNjZXNzaW9u

LW51bT48dXJscz48cmVsYXRlZC11cmxzPjx1cmw+aHR0cHM6Ly93d3cubmNiaS5ubG0ubmloLmdv

di9wdWJtZWQvMjAwMzQzNDU8L3VybD48L3JlbGF0ZWQtdXJscz48L3VybHM+PGVsZWN0cm9uaWMt

cmVzb3VyY2UtbnVtPjEwLjEwODYvNjQ5NTU0PC9lbGVjdHJvbmljLXJlc291cmNlLW51bT48L3Jl

Y29yZD48L0NpdGU+PC9FbmROb3RlPgB=

ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Tb2xvbWtpbjwvQXV0aG9yPjxZZWFyPjIwMTA8L1llYXI+

PFJlY051bT4yMTg8L1JlY051bT48RGlzcGxheVRleHQ+PHN0eWxlIGZhY2U9InN1cGVyc2NyaXB0

Ij4xMDwvc3R5bGU+PC9EaXNwbGF5VGV4dD48cmVjb3JkPjxyZWMtbnVtYmVyPjIxODwvcmVjLW51

bWJlcj48Zm9yZWlnbi1rZXlzPjxrZXkgYXBwPSJFTiIgZGItaWQ9InRkZHJ3NXZhZmVwNWQwZWFm

YXZ4eHY5ZmE1ZXhycHJzc3Z2ZCIgdGltZXN0YW1wPSIxNTYzNTE5OTAwIj4yMTg8L2tleT48L2Zv

cmVpZ24ta2V5cz48cmVmLXR5cGUgbmFtZT0iSm91cm5hbCBBcnRpY2xlIj4xNzwvcmVmLXR5cGU+

PGNvbnRyaWJ1dG9ycz48YXV0aG9ycz48YXV0aG9yPlNvbG9ta2luLCBKLiBTLjwvYXV0aG9yPjxh

dXRob3I+TWF6dXNraSwgSi4gRS48L2F1dGhvcj48YXV0aG9yPkJyYWRsZXksIEouIFMuPC9hdXRo

b3I+PGF1dGhvcj5Sb2R2b2xkLCBLLiBBLjwvYXV0aG9yPjxhdXRob3I+R29sZHN0ZWluLCBFLiBK

LjwvYXV0aG9yPjxhdXRob3I+QmFyb24sIEUuIEouPC9hdXRob3I+PGF1dGhvcj5PJmFwb3M7TmVp

bGwsIFAuIEouPC9hdXRob3I+PGF1dGhvcj5DaG93LCBBLiBXLjwvYXV0aG9yPjxhdXRob3I+RGVs

bGluZ2VyLCBFLiBQLjwvYXV0aG9yPjxhdXRob3I+RWFjaGVtcGF0aSwgUy4gUi48L2F1dGhvcj48

YXV0aG9yPkdvcmJhY2gsIFMuPC9hdXRob3I+PGF1dGhvcj5IaWxmaWtlciwgTS48L2F1dGhvcj48

YXV0aG9yPk1heSwgQS4gSy48L2F1dGhvcj48YXV0aG9yPk5hdGhlbnMsIEEuIEIuPC9hdXRob3I+

PGF1dGhvcj5TYXd5ZXIsIFIuIEcuPC9hdXRob3I+PGF1dGhvcj5CYXJ0bGV0dCwgSi4gRy48L2F1

dGhvcj48L2F1dGhvcnM+PC9jb250cmlidXRvcnM+PGF1dGgtYWRkcmVzcz5EZXBhcnRtZW50IG9m

IFN1cmdlcnksIHRoZSBVbml2ZXJzaXR5IG9mIENpbmNpbm5hdGkgQ29sbGVnZSBvZiBNZWRpY2lu

ZSwgQ2luY2lubmF0aSwgT2hpbyA0NTI2Ny0wNTU4LCBVU0EuIGpvc2VwaC5zb2xvbWtpbkB1Yy5l

ZHU8L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRsZT5EaWFnbm9zaXMgYW5kIG1hbmFnZW1lbnQg

b2YgY29tcGxpY2F0ZWQgaW50cmEtYWJkb21pbmFsIGluZmVjdGlvbiBpbiBhZHVsdHMgYW5kIGNo

aWxkcmVuOiBndWlkZWxpbmVzIGJ5IHRoZSBTdXJnaWNhbCBJbmZlY3Rpb24gU29jaWV0eSBhbmQg

dGhlIEluZmVjdGlvdXMgRGlzZWFzZXMgU29jaWV0eSBvZiBBbWVyaWNhPC90aXRsZT48c2Vjb25k

YXJ5LXRpdGxlPkNsaW4gSW5mZWN0IERpczwvc2Vjb25kYXJ5LXRpdGxlPjwvdGl0bGVzPjxwZXJp

b2RpY2FsPjxmdWxsLXRpdGxlPkNsaW4gSW5mZWN0IERpczwvZnVsbC10aXRsZT48L3BlcmlvZGlj

YWw+PHBhZ2VzPjEzMy02NDwvcGFnZXM+PHZvbHVtZT41MDwvdm9sdW1lPjxudW1iZXI+MjwvbnVt

YmVyPjxlZGl0aW9uPjIwMDkvMTIvMjY8L2VkaXRpb24+PGtleXdvcmRzPjxrZXl3b3JkPipBYmRv

bWVuPC9rZXl3b3JkPjxrZXl3b3JkPkFkdWx0PC9rZXl3b3JkPjxrZXl3b3JkPkFudGktQmFjdGVy

aWFsIEFnZW50cy8qdGhlcmFwZXV0aWMgdXNlPC9rZXl3b3JkPjxrZXl3b3JkPkJhY3RlcmlhbCBJ

bmZlY3Rpb25zL2NvbXBsaWNhdGlvbnMvKmRpYWdub3Npcy8qZHJ1ZyB0aGVyYXB5L21pY3JvYmlv

bG9neTwva2V5d29yZD48a2V5d29yZD5DaGlsZDwva2V5d29yZD48a2V5d29yZD5IdW1hbnM8L2tl

eXdvcmQ+PGtleXdvcmQ+U2V2ZXJpdHkgb2YgSWxsbmVzcyBJbmRleDwva2V5d29yZD48L2tleXdv

cmRzPjxkYXRlcz48eWVhcj4yMDEwPC95ZWFyPjxwdWItZGF0ZXM+PGRhdGU+SmFuIDE1PC9kYXRl

PjwvcHViLWRhdGVzPjwvZGF0ZXM+PGlzYm4+MTUzNy02NTkxIChFbGVjdHJvbmljKSYjeEQ7MTA1

OC00ODM4IChMaW5raW5nKTwvaXNibj48YWNjZXNzaW9uLW51bT4yMDAzNDM0NTwvYWNjZXNzaW9u

LW51bT48dXJscz48cmVsYXRlZC11cmxzPjx1cmw+aHR0cHM6Ly93d3cubmNiaS5ubG0ubmloLmdv

di9wdWJtZWQvMjAwMzQzNDU8L3VybD48L3JlbGF0ZWQtdXJscz48L3VybHM+PGVsZWN0cm9uaWMt

cmVzb3VyY2UtbnVtPjEwLjEwODYvNjQ5NTU0PC9lbGVjdHJvbmljLXJlc291cmNlLW51bT48L3Jl

Y29yZD48L0NpdGU+PC9FbmROb3RlPgB=

ADDIN EN.CITE.DATA 10Cutaneous and mucosal infectionsAntimicrobial therapy is recommended.Impetigo:Cephalexin 250 mg orally four times dailyErythromycin 250 mg orally four times dailyClindamycin 300-400 mg orally four times dailyAmoxicillin-clavulanate 500/125 mg orally three times daily or 875/125 mg orally twice dailySSTI: patients with no SIRS, altered mental status or hemodynamic instabilityClindamycin 300-450 mg orally four times dailyCephalexin 500 mg orally four times dailyDoxycycline/Minocycline 100 mg orally twice dailyTrimethoprim-sulfamethoxazole 160/800-320/1600 mg orally twice dailyStevens et al.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TdGV2ZW5zPC9BdXRob3I+PFllYXI+MjAxNDwvWWVhcj48

UmVjTnVtPjIxMTwvUmVjTnVtPjxEaXNwbGF5VGV4dD48c3R5bGUgZmFjZT0ic3VwZXJzY3JpcHQi

PjExPC9zdHlsZT48L0Rpc3BsYXlUZXh0PjxyZWNvcmQ+PHJlYy1udW1iZXI+MjExPC9yZWMtbnVt

YmVyPjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0idGRkcnc1dmFmZXA1ZDBlYWZh

dnh4djlmYTVleHJwcnNzdnZkIiB0aW1lc3RhbXA9IjE1NjM1MTk5MDAiPjIxMTwva2V5PjwvZm9y

ZWlnbi1rZXlzPjxyZWYtdHlwZSBuYW1lPSJKb3VybmFsIEFydGljbGUiPjE3PC9yZWYtdHlwZT48

Y29udHJpYnV0b3JzPjxhdXRob3JzPjxhdXRob3I+U3RldmVucywgRC4gTC48L2F1dGhvcj48YXV0

aG9yPkJpc25vLCBBLiBMLjwvYXV0aG9yPjxhdXRob3I+Q2hhbWJlcnMsIEguIEYuPC9hdXRob3I+

PGF1dGhvcj5EZWxsaW5nZXIsIEUuIFAuPC9hdXRob3I+PGF1dGhvcj5Hb2xkc3RlaW4sIEUuIEou

PC9hdXRob3I+PGF1dGhvcj5Hb3JiYWNoLCBTLiBMLjwvYXV0aG9yPjxhdXRob3I+SGlyc2NobWFu

biwgSi4gVi48L2F1dGhvcj48YXV0aG9yPkthcGxhbiwgUy4gTC48L2F1dGhvcj48YXV0aG9yPk1v

bnRveWEsIEouIEcuPC9hdXRob3I+PGF1dGhvcj5XYWRlLCBKLiBDLjwvYXV0aG9yPjwvYXV0aG9y

cz48L2NvbnRyaWJ1dG9ycz48YXV0aC1hZGRyZXNzPkRpdmlzaW9uIG9mIEluZmVjdGlvdXMgRGlz

ZWFzZXMsIERlcGFydG1lbnQgb2YgVmV0ZXJhbnMgQWZmYWlycywgQm9pc2UsIElkYWhvLiYjeEQ7

TWVkaWNhbCBTZXJ2aWNlLCBNaWFtaSBWZXRlcmFucyBBZmZhaXJzIEhlYWx0aCBDYXJlIFN5c3Rl

bSwgRmxvcmlkYS4mI3hEO1NhbiBGcmFuY2lzY28gR2VuZXJhbCBIb3NwaXRhbCwgVW5pdmVyc2l0

eSBvZiBDYWxpZm9ybmlhLiYjeEQ7RGl2aXNpb24gb2YgR2VuZXJhbCBTdXJnZXJ5LCBVbml2ZXJz

aXR5IG9mIFdhc2hpbmd0b24sIFNlYXR0bGUuJiN4RDtVbml2ZXJzaXR5IG9mIENhbGlmb3JuaWEs

IExvcyBBbmdlbGVzLCBTY2hvb2wgb2YgTWVkaWNpbmUsIGFuZCBSLiBNLiBBbGRlbiBSZXNlYXJj

aCBMYWJvcmF0b3J5LCBTYW50YSBNb25pY2EsIENhbGlmb3JuaWEuJiN4RDtEZXBhcnRtZW50IG9m

IENvbW11bml0eSBIZWFsdGgsIFR1ZnRzIFVuaXZlcnNpdHksIEJvc3RvbiwgTWFzc2FjaHVzZXR0

cy4mI3hEO01lZGljYWwgU2VydmljZSwgUHVnZXQgU291bmQgVmV0ZXJhbnMgQWZmYWlycyBNZWRp

Y2FsIENlbnRlciwgU2VhdHRsZSwgV2FzaGluZ3Rvbi4mI3hEO0RlcGFydG1lbnQgb2YgUGVkaWF0

cmljcywgQmF5bG9yIENvbGxlZ2Ugb2YgTWVkaWNpbmUsIEhvdXN0b24sIFRleGFzLiYjeEQ7RGVw

YXJ0bWVudCBvZiBNZWRpY2luZSwgU3RhbmZvcmQgVW5pdmVyc2l0eSwgQ2FsaWZvcm5pYS4mI3hE

O0dlaXNpbmdlciBIZWFsdGggU3lzdGVtLCBHZWlzaW5nZXIgQ2FuY2VyIEluc3RpdHV0ZSwgRGFu

dmlsbGUsIFBlbm5zeWx2YW5pYS48L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRsZT5QcmFjdGlj

ZSBndWlkZWxpbmVzIGZvciB0aGUgZGlhZ25vc2lzIGFuZCBtYW5hZ2VtZW50IG9mIHNraW4gYW5k

IHNvZnQgdGlzc3VlIGluZmVjdGlvbnM6IDIwMTQgdXBkYXRlIGJ5IHRoZSBpbmZlY3Rpb3VzIGRp

c2Vhc2VzIHNvY2lldHkgb2YgQW1lcmljYTwvdGl0bGU+PHNlY29uZGFyeS10aXRsZT5DbGluIElu

ZmVjdCBEaXM8L3NlY29uZGFyeS10aXRsZT48L3RpdGxlcz48cGVyaW9kaWNhbD48ZnVsbC10aXRs

ZT5DbGluIEluZmVjdCBEaXM8L2Z1bGwtdGl0bGU+PC9wZXJpb2RpY2FsPjxwYWdlcz4xNDctNTk8

L3BhZ2VzPjx2b2x1bWU+NTk8L3ZvbHVtZT48bnVtYmVyPjI8L251bWJlcj48ZWRpdGlvbj4yMDE0

LzA2LzIxPC9lZGl0aW9uPjxrZXl3b3Jkcz48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdv

cmQ+U2tpbiBEaXNlYXNlcywgQmFjdGVyaWFsLypkaWFnbm9zaXMvKnRoZXJhcHk8L2tleXdvcmQ+

PGtleXdvcmQ+U29mdCBUaXNzdWUgSW5mZWN0aW9ucy8qZGlhZ25vc2lzLyp0aGVyYXB5PC9rZXl3

b3JkPjxrZXl3b3JkPlVuaXRlZCBTdGF0ZXM8L2tleXdvcmQ+PC9rZXl3b3Jkcz48ZGF0ZXM+PHll

YXI+MjAxNDwveWVhcj48cHViLWRhdGVzPjxkYXRlPkp1bCAxNTwvZGF0ZT48L3B1Yi1kYXRlcz48

L2RhdGVzPjxpc2JuPjE1MzctNjU5MSAoRWxlY3Ryb25pYykmI3hEOzEwNTgtNDgzOCAoTGlua2lu

Zyk8L2lzYm4+PGFjY2Vzc2lvbi1udW0+MjQ5NDc1MzA8L2FjY2Vzc2lvbi1udW0+PHVybHM+PHJl

bGF0ZWQtdXJscz48dXJsPmh0dHBzOi8vd3d3Lm5jYmkubmxtLm5paC5nb3YvcHVibWVkLzI0OTQ3

NTMwPC91cmw+PC9yZWxhdGVkLXVybHM+PC91cmxzPjxlbGVjdHJvbmljLXJlc291cmNlLW51bT4x

MC4xMDkzL2NpZC9jaXUyOTY8L2VsZWN0cm9uaWMtcmVzb3VyY2UtbnVtPjwvcmVjb3JkPjwvQ2l0

ZT48L0VuZE5vdGU+AG==

ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TdGV2ZW5zPC9BdXRob3I+PFllYXI+MjAxNDwvWWVhcj48

UmVjTnVtPjIxMTwvUmVjTnVtPjxEaXNwbGF5VGV4dD48c3R5bGUgZmFjZT0ic3VwZXJzY3JpcHQi

PjExPC9zdHlsZT48L0Rpc3BsYXlUZXh0PjxyZWNvcmQ+PHJlYy1udW1iZXI+MjExPC9yZWMtbnVt

YmVyPjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0idGRkcnc1dmFmZXA1ZDBlYWZh

dnh4djlmYTVleHJwcnNzdnZkIiB0aW1lc3RhbXA9IjE1NjM1MTk5MDAiPjIxMTwva2V5PjwvZm9y

ZWlnbi1rZXlzPjxyZWYtdHlwZSBuYW1lPSJKb3VybmFsIEFydGljbGUiPjE3PC9yZWYtdHlwZT48

Y29udHJpYnV0b3JzPjxhdXRob3JzPjxhdXRob3I+U3RldmVucywgRC4gTC48L2F1dGhvcj48YXV0

aG9yPkJpc25vLCBBLiBMLjwvYXV0aG9yPjxhdXRob3I+Q2hhbWJlcnMsIEguIEYuPC9hdXRob3I+

PGF1dGhvcj5EZWxsaW5nZXIsIEUuIFAuPC9hdXRob3I+PGF1dGhvcj5Hb2xkc3RlaW4sIEUuIEou

PC9hdXRob3I+PGF1dGhvcj5Hb3JiYWNoLCBTLiBMLjwvYXV0aG9yPjxhdXRob3I+SGlyc2NobWFu

biwgSi4gVi48L2F1dGhvcj48YXV0aG9yPkthcGxhbiwgUy4gTC48L2F1dGhvcj48YXV0aG9yPk1v

bnRveWEsIEouIEcuPC9hdXRob3I+PGF1dGhvcj5XYWRlLCBKLiBDLjwvYXV0aG9yPjwvYXV0aG9y

cz48L2NvbnRyaWJ1dG9ycz48YXV0aC1hZGRyZXNzPkRpdmlzaW9uIG9mIEluZmVjdGlvdXMgRGlz

ZWFzZXMsIERlcGFydG1lbnQgb2YgVmV0ZXJhbnMgQWZmYWlycywgQm9pc2UsIElkYWhvLiYjeEQ7

TWVkaWNhbCBTZXJ2aWNlLCBNaWFtaSBWZXRlcmFucyBBZmZhaXJzIEhlYWx0aCBDYXJlIFN5c3Rl

bSwgRmxvcmlkYS4mI3hEO1NhbiBGcmFuY2lzY28gR2VuZXJhbCBIb3NwaXRhbCwgVW5pdmVyc2l0

eSBvZiBDYWxpZm9ybmlhLiYjeEQ7RGl2aXNpb24gb2YgR2VuZXJhbCBTdXJnZXJ5LCBVbml2ZXJz

aXR5IG9mIFdhc2hpbmd0b24sIFNlYXR0bGUuJiN4RDtVbml2ZXJzaXR5IG9mIENhbGlmb3JuaWEs

IExvcyBBbmdlbGVzLCBTY2hvb2wgb2YgTWVkaWNpbmUsIGFuZCBSLiBNLiBBbGRlbiBSZXNlYXJj

aCBMYWJvcmF0b3J5LCBTYW50YSBNb25pY2EsIENhbGlmb3JuaWEuJiN4RDtEZXBhcnRtZW50IG9m

IENvbW11bml0eSBIZWFsdGgsIFR1ZnRzIFVuaXZlcnNpdHksIEJvc3RvbiwgTWFzc2FjaHVzZXR0

cy4mI3hEO01lZGljYWwgU2VydmljZSwgUHVnZXQgU291bmQgVmV0ZXJhbnMgQWZmYWlycyBNZWRp

Y2FsIENlbnRlciwgU2VhdHRsZSwgV2FzaGluZ3Rvbi4mI3hEO0RlcGFydG1lbnQgb2YgUGVkaWF0

cmljcywgQmF5bG9yIENvbGxlZ2Ugb2YgTWVkaWNpbmUsIEhvdXN0b24sIFRleGFzLiYjeEQ7RGVw

YXJ0bWVudCBvZiBNZWRpY2luZSwgU3RhbmZvcmQgVW5pdmVyc2l0eSwgQ2FsaWZvcm5pYS4mI3hE

O0dlaXNpbmdlciBIZWFsdGggU3lzdGVtLCBHZWlzaW5nZXIgQ2FuY2VyIEluc3RpdHV0ZSwgRGFu

dmlsbGUsIFBlbm5zeWx2YW5pYS48L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRsZT5QcmFjdGlj

ZSBndWlkZWxpbmVzIGZvciB0aGUgZGlhZ25vc2lzIGFuZCBtYW5hZ2VtZW50IG9mIHNraW4gYW5k

IHNvZnQgdGlzc3VlIGluZmVjdGlvbnM6IDIwMTQgdXBkYXRlIGJ5IHRoZSBpbmZlY3Rpb3VzIGRp

c2Vhc2VzIHNvY2lldHkgb2YgQW1lcmljYTwvdGl0bGU+PHNlY29uZGFyeS10aXRsZT5DbGluIElu

ZmVjdCBEaXM8L3NlY29uZGFyeS10aXRsZT48L3RpdGxlcz48cGVyaW9kaWNhbD48ZnVsbC10aXRs

ZT5DbGluIEluZmVjdCBEaXM8L2Z1bGwtdGl0bGU+PC9wZXJpb2RpY2FsPjxwYWdlcz4xNDctNTk8

L3BhZ2VzPjx2b2x1bWU+NTk8L3ZvbHVtZT48bnVtYmVyPjI8L251bWJlcj48ZWRpdGlvbj4yMDE0

LzA2LzIxPC9lZGl0aW9uPjxrZXl3b3Jkcz48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdv

cmQ+U2tpbiBEaXNlYXNlcywgQmFjdGVyaWFsLypkaWFnbm9zaXMvKnRoZXJhcHk8L2tleXdvcmQ+

PGtleXdvcmQ+U29mdCBUaXNzdWUgSW5mZWN0aW9ucy8qZGlhZ25vc2lzLyp0aGVyYXB5PC9rZXl3

b3JkPjxrZXl3b3JkPlVuaXRlZCBTdGF0ZXM8L2tleXdvcmQ+PC9rZXl3b3Jkcz48ZGF0ZXM+PHll

YXI+MjAxNDwveWVhcj48cHViLWRhdGVzPjxkYXRlPkp1bCAxNTwvZGF0ZT48L3B1Yi1kYXRlcz48

L2RhdGVzPjxpc2JuPjE1MzctNjU5MSAoRWxlY3Ryb25pYykmI3hEOzEwNTgtNDgzOCAoTGlua2lu

Zyk8L2lzYm4+PGFjY2Vzc2lvbi1udW0+MjQ5NDc1MzA8L2FjY2Vzc2lvbi1udW0+PHVybHM+PHJl

bGF0ZWQtdXJscz48dXJsPmh0dHBzOi8vd3d3Lm5jYmkubmxtLm5paC5nb3YvcHVibWVkLzI0OTQ3

NTMwPC91cmw+PC9yZWxhdGVkLXVybHM+PC91cmxzPjxlbGVjdHJvbmljLXJlc291cmNlLW51bT4x

MC4xMDkzL2NpZC9jaXUyOTY8L2VsZWN0cm9uaWMtcmVzb3VyY2UtbnVtPjwvcmVjb3JkPjwvQ2l0

ZT48L0VuZE5vdGU+AG==

ADDIN EN.CITE.DATA 11Traumatic injury1) Open fractures; antimicrobial therapy is recommended.2) Some bite wounds; routine antimicrobial therapy is not recommended for every uninfected animal bite injury. The following conditions should be considered: patients who (a) are immunocompromised; (b) have advanced liver disease; (c) have pre-existing or resultant edema in the affected area; (d) have moderate to severe injuries, especially to the hand or face; or (e) have injuries that may have penetrated the periosteum or joint capsule.Bites wounds; Amoxicillin-clavulanate 500/125 mg orally three times daily or 875/125?mg orally twice dailyThe following regimens can be considered for adults with penicillin allergy: Clindamycin 300?mg orally four times daily and either ciprofloxacin 500?mg orally twice daily or levofloxacin 500?mg orally daily or trimethoprim-sulfamethoxazole 160/800 mg orally twice dailyOpen fracture:For type 1 fractures, systemic antibiotic coverage directed at gram-positive organisms For type 3 fractures, additional gram-negative coverage should be added.Stevens et al.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TdGV2ZW5zPC9BdXRob3I+PFllYXI+MjAxNDwvWWVhcj48

UmVjTnVtPjIxMTwvUmVjTnVtPjxEaXNwbGF5VGV4dD48c3R5bGUgZmFjZT0ic3VwZXJzY3JpcHQi

PjExPC9zdHlsZT48L0Rpc3BsYXlUZXh0PjxyZWNvcmQ+PHJlYy1udW1iZXI+MjExPC9yZWMtbnVt

YmVyPjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0idGRkcnc1dmFmZXA1ZDBlYWZh

dnh4djlmYTVleHJwcnNzdnZkIiB0aW1lc3RhbXA9IjE1NjM1MTk5MDAiPjIxMTwva2V5PjwvZm9y

ZWlnbi1rZXlzPjxyZWYtdHlwZSBuYW1lPSJKb3VybmFsIEFydGljbGUiPjE3PC9yZWYtdHlwZT48

Y29udHJpYnV0b3JzPjxhdXRob3JzPjxhdXRob3I+U3RldmVucywgRC4gTC48L2F1dGhvcj48YXV0

aG9yPkJpc25vLCBBLiBMLjwvYXV0aG9yPjxhdXRob3I+Q2hhbWJlcnMsIEguIEYuPC9hdXRob3I+

PGF1dGhvcj5EZWxsaW5nZXIsIEUuIFAuPC9hdXRob3I+PGF1dGhvcj5Hb2xkc3RlaW4sIEUuIEou

PC9hdXRob3I+PGF1dGhvcj5Hb3JiYWNoLCBTLiBMLjwvYXV0aG9yPjxhdXRob3I+SGlyc2NobWFu

biwgSi4gVi48L2F1dGhvcj48YXV0aG9yPkthcGxhbiwgUy4gTC48L2F1dGhvcj48YXV0aG9yPk1v

bnRveWEsIEouIEcuPC9hdXRob3I+PGF1dGhvcj5XYWRlLCBKLiBDLjwvYXV0aG9yPjwvYXV0aG9y

cz48L2NvbnRyaWJ1dG9ycz48YXV0aC1hZGRyZXNzPkRpdmlzaW9uIG9mIEluZmVjdGlvdXMgRGlz

ZWFzZXMsIERlcGFydG1lbnQgb2YgVmV0ZXJhbnMgQWZmYWlycywgQm9pc2UsIElkYWhvLiYjeEQ7

TWVkaWNhbCBTZXJ2aWNlLCBNaWFtaSBWZXRlcmFucyBBZmZhaXJzIEhlYWx0aCBDYXJlIFN5c3Rl

bSwgRmxvcmlkYS4mI3hEO1NhbiBGcmFuY2lzY28gR2VuZXJhbCBIb3NwaXRhbCwgVW5pdmVyc2l0

eSBvZiBDYWxpZm9ybmlhLiYjeEQ7RGl2aXNpb24gb2YgR2VuZXJhbCBTdXJnZXJ5LCBVbml2ZXJz

aXR5IG9mIFdhc2hpbmd0b24sIFNlYXR0bGUuJiN4RDtVbml2ZXJzaXR5IG9mIENhbGlmb3JuaWEs

IExvcyBBbmdlbGVzLCBTY2hvb2wgb2YgTWVkaWNpbmUsIGFuZCBSLiBNLiBBbGRlbiBSZXNlYXJj

aCBMYWJvcmF0b3J5LCBTYW50YSBNb25pY2EsIENhbGlmb3JuaWEuJiN4RDtEZXBhcnRtZW50IG9m

IENvbW11bml0eSBIZWFsdGgsIFR1ZnRzIFVuaXZlcnNpdHksIEJvc3RvbiwgTWFzc2FjaHVzZXR0

cy4mI3hEO01lZGljYWwgU2VydmljZSwgUHVnZXQgU291bmQgVmV0ZXJhbnMgQWZmYWlycyBNZWRp

Y2FsIENlbnRlciwgU2VhdHRsZSwgV2FzaGluZ3Rvbi4mI3hEO0RlcGFydG1lbnQgb2YgUGVkaWF0

cmljcywgQmF5bG9yIENvbGxlZ2Ugb2YgTWVkaWNpbmUsIEhvdXN0b24sIFRleGFzLiYjeEQ7RGVw

YXJ0bWVudCBvZiBNZWRpY2luZSwgU3RhbmZvcmQgVW5pdmVyc2l0eSwgQ2FsaWZvcm5pYS4mI3hE

O0dlaXNpbmdlciBIZWFsdGggU3lzdGVtLCBHZWlzaW5nZXIgQ2FuY2VyIEluc3RpdHV0ZSwgRGFu

dmlsbGUsIFBlbm5zeWx2YW5pYS48L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRsZT5QcmFjdGlj

ZSBndWlkZWxpbmVzIGZvciB0aGUgZGlhZ25vc2lzIGFuZCBtYW5hZ2VtZW50IG9mIHNraW4gYW5k

IHNvZnQgdGlzc3VlIGluZmVjdGlvbnM6IDIwMTQgdXBkYXRlIGJ5IHRoZSBpbmZlY3Rpb3VzIGRp

c2Vhc2VzIHNvY2lldHkgb2YgQW1lcmljYTwvdGl0bGU+PHNlY29uZGFyeS10aXRsZT5DbGluIElu

ZmVjdCBEaXM8L3NlY29uZGFyeS10aXRsZT48L3RpdGxlcz48cGVyaW9kaWNhbD48ZnVsbC10aXRs

ZT5DbGluIEluZmVjdCBEaXM8L2Z1bGwtdGl0bGU+PC9wZXJpb2RpY2FsPjxwYWdlcz4xNDctNTk8

L3BhZ2VzPjx2b2x1bWU+NTk8L3ZvbHVtZT48bnVtYmVyPjI8L251bWJlcj48ZWRpdGlvbj4yMDE0

LzA2LzIxPC9lZGl0aW9uPjxrZXl3b3Jkcz48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdv

cmQ+U2tpbiBEaXNlYXNlcywgQmFjdGVyaWFsLypkaWFnbm9zaXMvKnRoZXJhcHk8L2tleXdvcmQ+

PGtleXdvcmQ+U29mdCBUaXNzdWUgSW5mZWN0aW9ucy8qZGlhZ25vc2lzLyp0aGVyYXB5PC9rZXl3

b3JkPjxrZXl3b3JkPlVuaXRlZCBTdGF0ZXM8L2tleXdvcmQ+PC9rZXl3b3Jkcz48ZGF0ZXM+PHll

YXI+MjAxNDwveWVhcj48cHViLWRhdGVzPjxkYXRlPkp1bCAxNTwvZGF0ZT48L3B1Yi1kYXRlcz48

L2RhdGVzPjxpc2JuPjE1MzctNjU5MSAoRWxlY3Ryb25pYykmI3hEOzEwNTgtNDgzOCAoTGlua2lu

Zyk8L2lzYm4+PGFjY2Vzc2lvbi1udW0+MjQ5NDc1MzA8L2FjY2Vzc2lvbi1udW0+PHVybHM+PHJl

bGF0ZWQtdXJscz48dXJsPmh0dHBzOi8vd3d3Lm5jYmkubmxtLm5paC5nb3YvcHVibWVkLzI0OTQ3

NTMwPC91cmw+PC9yZWxhdGVkLXVybHM+PC91cmxzPjxlbGVjdHJvbmljLXJlc291cmNlLW51bT4x

MC4xMDkzL2NpZC9jaXUyOTY8L2VsZWN0cm9uaWMtcmVzb3VyY2UtbnVtPjwvcmVjb3JkPjwvQ2l0

ZT48L0VuZE5vdGU+AG==

ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TdGV2ZW5zPC9BdXRob3I+PFllYXI+MjAxNDwvWWVhcj48

UmVjTnVtPjIxMTwvUmVjTnVtPjxEaXNwbGF5VGV4dD48c3R5bGUgZmFjZT0ic3VwZXJzY3JpcHQi

PjExPC9zdHlsZT48L0Rpc3BsYXlUZXh0PjxyZWNvcmQ+PHJlYy1udW1iZXI+MjExPC9yZWMtbnVt

YmVyPjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0idGRkcnc1dmFmZXA1ZDBlYWZh

dnh4djlmYTVleHJwcnNzdnZkIiB0aW1lc3RhbXA9IjE1NjM1MTk5MDAiPjIxMTwva2V5PjwvZm9y

ZWlnbi1rZXlzPjxyZWYtdHlwZSBuYW1lPSJKb3VybmFsIEFydGljbGUiPjE3PC9yZWYtdHlwZT48

Y29udHJpYnV0b3JzPjxhdXRob3JzPjxhdXRob3I+U3RldmVucywgRC4gTC48L2F1dGhvcj48YXV0

aG9yPkJpc25vLCBBLiBMLjwvYXV0aG9yPjxhdXRob3I+Q2hhbWJlcnMsIEguIEYuPC9hdXRob3I+

PGF1dGhvcj5EZWxsaW5nZXIsIEUuIFAuPC9hdXRob3I+PGF1dGhvcj5Hb2xkc3RlaW4sIEUuIEou

PC9hdXRob3I+PGF1dGhvcj5Hb3JiYWNoLCBTLiBMLjwvYXV0aG9yPjxhdXRob3I+SGlyc2NobWFu

biwgSi4gVi48L2F1dGhvcj48YXV0aG9yPkthcGxhbiwgUy4gTC48L2F1dGhvcj48YXV0aG9yPk1v

bnRveWEsIEouIEcuPC9hdXRob3I+PGF1dGhvcj5XYWRlLCBKLiBDLjwvYXV0aG9yPjwvYXV0aG9y

cz48L2NvbnRyaWJ1dG9ycz48YXV0aC1hZGRyZXNzPkRpdmlzaW9uIG9mIEluZmVjdGlvdXMgRGlz

ZWFzZXMsIERlcGFydG1lbnQgb2YgVmV0ZXJhbnMgQWZmYWlycywgQm9pc2UsIElkYWhvLiYjeEQ7

TWVkaWNhbCBTZXJ2aWNlLCBNaWFtaSBWZXRlcmFucyBBZmZhaXJzIEhlYWx0aCBDYXJlIFN5c3Rl

bSwgRmxvcmlkYS4mI3hEO1NhbiBGcmFuY2lzY28gR2VuZXJhbCBIb3NwaXRhbCwgVW5pdmVyc2l0

eSBvZiBDYWxpZm9ybmlhLiYjeEQ7RGl2aXNpb24gb2YgR2VuZXJhbCBTdXJnZXJ5LCBVbml2ZXJz

aXR5IG9mIFdhc2hpbmd0b24sIFNlYXR0bGUuJiN4RDtVbml2ZXJzaXR5IG9mIENhbGlmb3JuaWEs

IExvcyBBbmdlbGVzLCBTY2hvb2wgb2YgTWVkaWNpbmUsIGFuZCBSLiBNLiBBbGRlbiBSZXNlYXJj

aCBMYWJvcmF0b3J5LCBTYW50YSBNb25pY2EsIENhbGlmb3JuaWEuJiN4RDtEZXBhcnRtZW50IG9m

IENvbW11bml0eSBIZWFsdGgsIFR1ZnRzIFVuaXZlcnNpdHksIEJvc3RvbiwgTWFzc2FjaHVzZXR0

cy4mI3hEO01lZGljYWwgU2VydmljZSwgUHVnZXQgU291bmQgVmV0ZXJhbnMgQWZmYWlycyBNZWRp

Y2FsIENlbnRlciwgU2VhdHRsZSwgV2FzaGluZ3Rvbi4mI3hEO0RlcGFydG1lbnQgb2YgUGVkaWF0

cmljcywgQmF5bG9yIENvbGxlZ2Ugb2YgTWVkaWNpbmUsIEhvdXN0b24sIFRleGFzLiYjeEQ7RGVw

YXJ0bWVudCBvZiBNZWRpY2luZSwgU3RhbmZvcmQgVW5pdmVyc2l0eSwgQ2FsaWZvcm5pYS4mI3hE

O0dlaXNpbmdlciBIZWFsdGggU3lzdGVtLCBHZWlzaW5nZXIgQ2FuY2VyIEluc3RpdHV0ZSwgRGFu

dmlsbGUsIFBlbm5zeWx2YW5pYS48L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRsZT5QcmFjdGlj

ZSBndWlkZWxpbmVzIGZvciB0aGUgZGlhZ25vc2lzIGFuZCBtYW5hZ2VtZW50IG9mIHNraW4gYW5k

IHNvZnQgdGlzc3VlIGluZmVjdGlvbnM6IDIwMTQgdXBkYXRlIGJ5IHRoZSBpbmZlY3Rpb3VzIGRp

c2Vhc2VzIHNvY2lldHkgb2YgQW1lcmljYTwvdGl0bGU+PHNlY29uZGFyeS10aXRsZT5DbGluIElu

ZmVjdCBEaXM8L3NlY29uZGFyeS10aXRsZT48L3RpdGxlcz48cGVyaW9kaWNhbD48ZnVsbC10aXRs

ZT5DbGluIEluZmVjdCBEaXM8L2Z1bGwtdGl0bGU+PC9wZXJpb2RpY2FsPjxwYWdlcz4xNDctNTk8

L3BhZ2VzPjx2b2x1bWU+NTk8L3ZvbHVtZT48bnVtYmVyPjI8L251bWJlcj48ZWRpdGlvbj4yMDE0

LzA2LzIxPC9lZGl0aW9uPjxrZXl3b3Jkcz48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdv

cmQ+U2tpbiBEaXNlYXNlcywgQmFjdGVyaWFsLypkaWFnbm9zaXMvKnRoZXJhcHk8L2tleXdvcmQ+

PGtleXdvcmQ+U29mdCBUaXNzdWUgSW5mZWN0aW9ucy8qZGlhZ25vc2lzLyp0aGVyYXB5PC9rZXl3

b3JkPjxrZXl3b3JkPlVuaXRlZCBTdGF0ZXM8L2tleXdvcmQ+PC9rZXl3b3Jkcz48ZGF0ZXM+PHll

YXI+MjAxNDwveWVhcj48cHViLWRhdGVzPjxkYXRlPkp1bCAxNTwvZGF0ZT48L3B1Yi1kYXRlcz48

L2RhdGVzPjxpc2JuPjE1MzctNjU5MSAoRWxlY3Ryb25pYykmI3hEOzEwNTgtNDgzOCAoTGlua2lu

Zyk8L2lzYm4+PGFjY2Vzc2lvbi1udW0+MjQ5NDc1MzA8L2FjY2Vzc2lvbi1udW0+PHVybHM+PHJl

bGF0ZWQtdXJscz48dXJsPmh0dHBzOi8vd3d3Lm5jYmkubmxtLm5paC5nb3YvcHVibWVkLzI0OTQ3

NTMwPC91cmw+PC9yZWxhdGVkLXVybHM+PC91cmxzPjxlbGVjdHJvbmljLXJlc291cmNlLW51bT4x

MC4xMDkzL2NpZC9jaXUyOTY8L2VsZWN0cm9uaWMtcmVzb3VyY2UtbnVtPjwvcmVjb3JkPjwvQ2l0

ZT48L0VuZE5vdGU+AG==

ADDIN EN.CITE.DATA 11Hoff et al. ADDIN EN.CITE <EndNote><Cite><Author>Hoff</Author><Year>2011</Year><RecNum>225</RecNum><DisplayText><style face="superscript">12</style></DisplayText><record><rec-number>225</rec-number><foreign-keys><key app="EN" db-id="tddrw5vafep5d0eafavxxv9fa5exrprssvvd" timestamp="1563519956">225</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Hoff, W. S.</author><author>Bonadies, J. A.</author><author>Cachecho, R.</author><author>Dorlac, W. C.</author></authors></contributors><auth-address>Division of Trauma, St. Luke&apos;s Hospital, Bethlehem, Pennsylvania, USA.</auth-address><titles><title>East Practice Management Guidelines Work Group: update to practice management guidelines for prophylactic antibiotic use in open fractures</title><secondary-title>J Trauma</secondary-title></titles><periodical><full-title>J Trauma</full-title></periodical><pages>751-4</pages><volume>70</volume><number>3</number><edition>2011/05/26</edition><keywords><keyword>*Antibiotic Prophylaxis</keyword><keyword>Fractures, Open/classification/*drug therapy</keyword><keyword>Humans</keyword><keyword>Wound Infection/*prevention &amp; control</keyword></keywords><dates><year>2011</year><pub-dates><date>Mar</date></pub-dates></dates><isbn>1529-8809 (Electronic)&#xD;0022-5282 (Linking)</isbn><accession-num>21610369</accession-num><urls><related-urls><url> therapy is recommended.Diseases characterized by urethritis (esp. N. gonorrhoeae and C. trachomatis): Ceftriaxone 1 g, 1 dose and azithromycin 1 g, 1 dose orally Azithromycin 1 g, 1 dose orally or doxycycline 100 mg orally twice dailyPelvic inflammatory diseases:Ceftriaxone 1 g, 1 dose and doxycycline 100 mg orally twice daily with or without metronidazole 500 mg orally twice dailyWorkowski et al. ADDIN EN.CITE <EndNote><Cite><Year>2015</Year><RecNum>222</RecNum><DisplayText><style face="superscript">13</style></DisplayText><record><rec-number>222</rec-number><foreign-keys><key app="EN" db-id="tddrw5vafep5d0eafavxxv9fa5exrprssvvd" timestamp="1563519900">222</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors></contributors><titles><title>Sexually Transmitted Diseases: Summary of 2015 CDC Treatment Guidelines</title><secondary-title>J Miss State Med Assoc</secondary-title></titles><periodical><full-title>J Miss State Med Assoc</full-title></periodical><pages>372-5</pages><volume>56</volume><number>12</number><edition>2016/03/16</edition><keywords><keyword>Centers for Disease Control and Prevention (U.S.)</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Sexually Transmitted Diseases/*drug therapy</keyword><keyword>United States</keyword></keywords><dates><year>2015</year><pub-dates><date>Dec</date></pub-dates></dates><isbn>0026-6396 (Print)&#xD;0026-6396 (Linking)</isbn><accession-num>26975162</accession-num><urls><related-urls><url> neutropeniaAntimicrobial therapy is recommended.Ciprofloxacin 400-500 mg twice daily and either amoxicillin-clavulanate 500/125 mg orally three times daily or 875/125?mg orally twice daily Freifeld et al.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5GcmVpZmVsZDwvQXV0aG9yPjxZZWFyPjIwMTE8L1llYXI+

PFJlY051bT4yMjA8L1JlY051bT48RGlzcGxheVRleHQ+PHN0eWxlIGZhY2U9InN1cGVyc2NyaXB0

Ij4xNDwvc3R5bGU+PC9EaXNwbGF5VGV4dD48cmVjb3JkPjxyZWMtbnVtYmVyPjIyMDwvcmVjLW51

bWJlcj48Zm9yZWlnbi1rZXlzPjxrZXkgYXBwPSJFTiIgZGItaWQ9InRkZHJ3NXZhZmVwNWQwZWFm

YXZ4eHY5ZmE1ZXhycHJzc3Z2ZCIgdGltZXN0YW1wPSIxNTYzNTE5OTAwIj4yMjA8L2tleT48L2Zv

cmVpZ24ta2V5cz48cmVmLXR5cGUgbmFtZT0iSm91cm5hbCBBcnRpY2xlIj4xNzwvcmVmLXR5cGU+

PGNvbnRyaWJ1dG9ycz48YXV0aG9ycz48YXV0aG9yPkZyZWlmZWxkLCBBLiBHLjwvYXV0aG9yPjxh

dXRob3I+Qm93LCBFLiBKLjwvYXV0aG9yPjxhdXRob3I+U2Vwa293aXR6LCBLLiBBLjwvYXV0aG9y

PjxhdXRob3I+Qm9lY2toLCBNLiBKLjwvYXV0aG9yPjxhdXRob3I+SXRvLCBKLiBJLjwvYXV0aG9y

PjxhdXRob3I+TXVsbGVuLCBDLiBBLjwvYXV0aG9yPjxhdXRob3I+UmFhZCwsIElJPC9hdXRob3I+

PGF1dGhvcj5Sb2xzdG9uLCBLLiBWLjwvYXV0aG9yPjxhdXRob3I+WW91bmcsIEouIEEuPC9hdXRo

b3I+PGF1dGhvcj5XaW5nYXJkLCBKLiBSLjwvYXV0aG9yPjxhdXRob3I+SW5mZWN0aW91cyBEaXNl

YXNlcyBTb2NpZXR5IG9mLCBBbWVyaWNhPC9hdXRob3I+PC9hdXRob3JzPjwvY29udHJpYnV0b3Jz

PjxhdXRoLWFkZHJlc3M+RGVwYXJ0bWVudCBvZiBNZWRpY2luZSwgVW5pdmVyc2l0eSBvZiBOZWJy

YXNrYSBNZWRpY2FsIENlbnRlciwgT21haGEsIE5lYnJhc2thLjwvYXV0aC1hZGRyZXNzPjx0aXRs

ZXM+PHRpdGxlPkNsaW5pY2FsIHByYWN0aWNlIGd1aWRlbGluZSBmb3IgdGhlIHVzZSBvZiBhbnRp

bWljcm9iaWFsIGFnZW50cyBpbiBuZXV0cm9wZW5pYyBwYXRpZW50cyB3aXRoIGNhbmNlcjogMjAx

MCB1cGRhdGUgYnkgdGhlIGluZmVjdGlvdXMgZGlzZWFzZXMgc29jaWV0eSBvZiBhbWVyaWNhPC90

aXRsZT48c2Vjb25kYXJ5LXRpdGxlPkNsaW4gSW5mZWN0IERpczwvc2Vjb25kYXJ5LXRpdGxlPjwv

dGl0bGVzPjxwZXJpb2RpY2FsPjxmdWxsLXRpdGxlPkNsaW4gSW5mZWN0IERpczwvZnVsbC10aXRs

ZT48L3BlcmlvZGljYWw+PHBhZ2VzPmU1Ni05MzwvcGFnZXM+PHZvbHVtZT41Mjwvdm9sdW1lPjxu

dW1iZXI+NDwvbnVtYmVyPjxrZXl3b3Jkcz48a2V5d29yZD5BbnRpLUluZmVjdGl2ZSBBZ2VudHMv

KmFkbWluaXN0cmF0aW9uICZhbXA7IGRvc2FnZTwva2V5d29yZD48a2V5d29yZD5BbnRpbmVvcGxh

c3RpYyBBZ2VudHMvYWRtaW5pc3RyYXRpb24gJmFtcDsgZG9zYWdlL2FkdmVyc2UgZWZmZWN0czwv

a2V5d29yZD48a2V5d29yZD5DYW5hZGE8L2tleXdvcmQ+PGtleXdvcmQ+Q29tbXVuaWNhYmxlIERp

c2Vhc2VzLypkcnVnIHRoZXJhcHk8L2tleXdvcmQ+PGtleXdvcmQ+RmV2ZXIgb2YgVW5rbm93biBP

cmlnaW4vKmRydWcgdGhlcmFweTwva2V5d29yZD48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtl

eXdvcmQ+TmVvcGxhc21zLypjb21wbGljYXRpb25zPC9rZXl3b3JkPjxrZXl3b3JkPk5ldXRyb3Bl

bmlhL2NoZW1pY2FsbHkgaW5kdWNlZC8qY29tcGxpY2F0aW9uczwva2V5d29yZD48a2V5d29yZD5V

bml0ZWQgU3RhdGVzPC9rZXl3b3JkPjwva2V5d29yZHM+PGRhdGVzPjx5ZWFyPjIwMTE8L3llYXI+

PHB1Yi1kYXRlcz48ZGF0ZT5GZWIgMTU8L2RhdGU+PC9wdWItZGF0ZXM+PC9kYXRlcz48aXNibj4x

NTM3LTY1OTEgKEVsZWN0cm9uaWMpJiN4RDsxMDU4LTQ4MzggKExpbmtpbmcpPC9pc2JuPjxhY2Nl

c3Npb24tbnVtPjIxMjU4MDk0PC9hY2Nlc3Npb24tbnVtPjx1cmxzPjxyZWxhdGVkLXVybHM+PHVy

bD5odHRwczovL3d3dy5uY2JpLm5sbS5uaWguZ292L3B1Ym1lZC8yMTI1ODA5NDwvdXJsPjwvcmVs

YXRlZC11cmxzPjwvdXJscz48ZWxlY3Ryb25pYy1yZXNvdXJjZS1udW0+MTAuMTA5My9jaWQvY2ly

MDczPC9lbGVjdHJvbmljLXJlc291cmNlLW51bT48L3JlY29yZD48L0NpdGU+PC9FbmROb3RlPn==

ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5GcmVpZmVsZDwvQXV0aG9yPjxZZWFyPjIwMTE8L1llYXI+

PFJlY051bT4yMjA8L1JlY051bT48RGlzcGxheVRleHQ+PHN0eWxlIGZhY2U9InN1cGVyc2NyaXB0

Ij4xNDwvc3R5bGU+PC9EaXNwbGF5VGV4dD48cmVjb3JkPjxyZWMtbnVtYmVyPjIyMDwvcmVjLW51

bWJlcj48Zm9yZWlnbi1rZXlzPjxrZXkgYXBwPSJFTiIgZGItaWQ9InRkZHJ3NXZhZmVwNWQwZWFm

YXZ4eHY5ZmE1ZXhycHJzc3Z2ZCIgdGltZXN0YW1wPSIxNTYzNTE5OTAwIj4yMjA8L2tleT48L2Zv

cmVpZ24ta2V5cz48cmVmLXR5cGUgbmFtZT0iSm91cm5hbCBBcnRpY2xlIj4xNzwvcmVmLXR5cGU+

PGNvbnRyaWJ1dG9ycz48YXV0aG9ycz48YXV0aG9yPkZyZWlmZWxkLCBBLiBHLjwvYXV0aG9yPjxh

dXRob3I+Qm93LCBFLiBKLjwvYXV0aG9yPjxhdXRob3I+U2Vwa293aXR6LCBLLiBBLjwvYXV0aG9y

PjxhdXRob3I+Qm9lY2toLCBNLiBKLjwvYXV0aG9yPjxhdXRob3I+SXRvLCBKLiBJLjwvYXV0aG9y

PjxhdXRob3I+TXVsbGVuLCBDLiBBLjwvYXV0aG9yPjxhdXRob3I+UmFhZCwsIElJPC9hdXRob3I+

PGF1dGhvcj5Sb2xzdG9uLCBLLiBWLjwvYXV0aG9yPjxhdXRob3I+WW91bmcsIEouIEEuPC9hdXRo

b3I+PGF1dGhvcj5XaW5nYXJkLCBKLiBSLjwvYXV0aG9yPjxhdXRob3I+SW5mZWN0aW91cyBEaXNl

YXNlcyBTb2NpZXR5IG9mLCBBbWVyaWNhPC9hdXRob3I+PC9hdXRob3JzPjwvY29udHJpYnV0b3Jz

PjxhdXRoLWFkZHJlc3M+RGVwYXJ0bWVudCBvZiBNZWRpY2luZSwgVW5pdmVyc2l0eSBvZiBOZWJy

YXNrYSBNZWRpY2FsIENlbnRlciwgT21haGEsIE5lYnJhc2thLjwvYXV0aC1hZGRyZXNzPjx0aXRs

ZXM+PHRpdGxlPkNsaW5pY2FsIHByYWN0aWNlIGd1aWRlbGluZSBmb3IgdGhlIHVzZSBvZiBhbnRp

bWljcm9iaWFsIGFnZW50cyBpbiBuZXV0cm9wZW5pYyBwYXRpZW50cyB3aXRoIGNhbmNlcjogMjAx

MCB1cGRhdGUgYnkgdGhlIGluZmVjdGlvdXMgZGlzZWFzZXMgc29jaWV0eSBvZiBhbWVyaWNhPC90

aXRsZT48c2Vjb25kYXJ5LXRpdGxlPkNsaW4gSW5mZWN0IERpczwvc2Vjb25kYXJ5LXRpdGxlPjwv

dGl0bGVzPjxwZXJpb2RpY2FsPjxmdWxsLXRpdGxlPkNsaW4gSW5mZWN0IERpczwvZnVsbC10aXRs

ZT48L3BlcmlvZGljYWw+PHBhZ2VzPmU1Ni05MzwvcGFnZXM+PHZvbHVtZT41Mjwvdm9sdW1lPjxu

dW1iZXI+NDwvbnVtYmVyPjxrZXl3b3Jkcz48a2V5d29yZD5BbnRpLUluZmVjdGl2ZSBBZ2VudHMv

KmFkbWluaXN0cmF0aW9uICZhbXA7IGRvc2FnZTwva2V5d29yZD48a2V5d29yZD5BbnRpbmVvcGxh

c3RpYyBBZ2VudHMvYWRtaW5pc3RyYXRpb24gJmFtcDsgZG9zYWdlL2FkdmVyc2UgZWZmZWN0czwv

a2V5d29yZD48a2V5d29yZD5DYW5hZGE8L2tleXdvcmQ+PGtleXdvcmQ+Q29tbXVuaWNhYmxlIERp

c2Vhc2VzLypkcnVnIHRoZXJhcHk8L2tleXdvcmQ+PGtleXdvcmQ+RmV2ZXIgb2YgVW5rbm93biBP

cmlnaW4vKmRydWcgdGhlcmFweTwva2V5d29yZD48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtl

eXdvcmQ+TmVvcGxhc21zLypjb21wbGljYXRpb25zPC9rZXl3b3JkPjxrZXl3b3JkPk5ldXRyb3Bl

bmlhL2NoZW1pY2FsbHkgaW5kdWNlZC8qY29tcGxpY2F0aW9uczwva2V5d29yZD48a2V5d29yZD5V

bml0ZWQgU3RhdGVzPC9rZXl3b3JkPjwva2V5d29yZHM+PGRhdGVzPjx5ZWFyPjIwMTE8L3llYXI+

PHB1Yi1kYXRlcz48ZGF0ZT5GZWIgMTU8L2RhdGU+PC9wdWItZGF0ZXM+PC9kYXRlcz48aXNibj4x

NTM3LTY1OTEgKEVsZWN0cm9uaWMpJiN4RDsxMDU4LTQ4MzggKExpbmtpbmcpPC9pc2JuPjxhY2Nl

c3Npb24tbnVtPjIxMjU4MDk0PC9hY2Nlc3Npb24tbnVtPjx1cmxzPjxyZWxhdGVkLXVybHM+PHVy

bD5odHRwczovL3d3dy5uY2JpLm5sbS5uaWguZ292L3B1Ym1lZC8yMTI1ODA5NDwvdXJsPjwvcmVs

YXRlZC11cmxzPjwvdXJscz48ZWxlY3Ryb25pYy1yZXNvdXJjZS1udW0+MTAuMTA5My9jaWQvY2ly

MDczPC9lbGVjdHJvbmljLXJlc291cmNlLW51bT48L3JlY29yZD48L0NpdGU+PC9FbmROb3RlPn==

ADDIN EN.CITE.DATA 14Abbreviations:COPD, chronic obstructive pulmonary disease; UTI, urinary tract infection; SSTI, skin and soft tissue infection; STD, sexually transmitted disease* Quinolones are not indicated for treatment of UTI due to quinolone resistance in E. coli exceeding > 10% at the study institution.** If symptoms are not resolved after 24 h, complete a 3-day course of antimicrobial therapySupplementary Table 2. The definition of antimicrobial appropriatenessTermDefinitionAppropriateNot meeting the following classification of misuseMisuseAntimicrobial prescription at discharge which failed to meet the criteria outlined in the pocket guide UnnecessaryThe use for non-infectious conditions, nonbacterial infections or self-limiting bacterial infections and included antimicrobial use in cases of uncertain diagnosis InappropriateThe use of an antimicrobial agent not conforming to current treatment protocols or against a pathogen resistant to the agent SuboptimalThe use of an antimicrobial that could have been?improved in one of the following categories: drug delivery route, dosage interval or dosage.Note. We referred to the previously mentioned criteria.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5GbGVtaW5nLUR1dHJhPC9BdXRob3I+PFllYXI+MjAxNjwv

WWVhcj48UmVjTnVtPjI3PC9SZWNOdW0+PERpc3BsYXlUZXh0PjxzdHlsZSBmYWNlPSJzdXBlcnNj

cmlwdCI+MTUtMTc8L3N0eWxlPjwvRGlzcGxheVRleHQ+PHJlY29yZD48cmVjLW51bWJlcj4yNzwv

cmVjLW51bWJlcj48Zm9yZWlnbi1rZXlzPjxrZXkgYXBwPSJFTiIgZGItaWQ9InRkZHJ3NXZhZmVw

NWQwZWFmYXZ4eHY5ZmE1ZXhycHJzc3Z2ZCIgdGltZXN0YW1wPSIxNTYzNTE1NDY0Ij4yNzwva2V5

PjwvZm9yZWlnbi1rZXlzPjxyZWYtdHlwZSBuYW1lPSJKb3VybmFsIEFydGljbGUiPjE3PC9yZWYt

dHlwZT48Y29udHJpYnV0b3JzPjxhdXRob3JzPjxhdXRob3I+RmxlbWluZy1EdXRyYSwgSy4gRS48

L2F1dGhvcj48YXV0aG9yPkhlcnNoLCBBLiBMLjwvYXV0aG9yPjxhdXRob3I+U2hhcGlybywgRC4g

Si48L2F1dGhvcj48YXV0aG9yPkJhcnRvY2VzLCBNLjwvYXV0aG9yPjxhdXRob3I+RW5ucywgRS4g

QS48L2F1dGhvcj48YXV0aG9yPkZpbGUsIFQuIE0uLCBKci48L2F1dGhvcj48YXV0aG9yPkZpbmtl

bHN0ZWluLCBKLiBBLjwvYXV0aG9yPjxhdXRob3I+R2VyYmVyLCBKLiBTLjwvYXV0aG9yPjxhdXRo

b3I+SHl1biwgRC4gWS48L2F1dGhvcj48YXV0aG9yPkxpbmRlciwgSi4gQS48L2F1dGhvcj48YXV0

aG9yPkx5bmZpZWxkLCBSLjwvYXV0aG9yPjxhdXRob3I+TWFyZ29saXMsIEQuIEouPC9hdXRob3I+

PGF1dGhvcj5NYXksIEwuIFMuPC9hdXRob3I+PGF1dGhvcj5NZXJlbnN0ZWluLCBELjwvYXV0aG9y

PjxhdXRob3I+TWV0bGF5LCBKLiBQLjwvYXV0aG9yPjxhdXRob3I+TmV3bGFuZCwgSi4gRy48L2F1

dGhvcj48YXV0aG9yPlBpY2NpcmlsbG8sIEouIEYuPC9hdXRob3I+PGF1dGhvcj5Sb2JlcnRzLCBS

LiBNLjwvYXV0aG9yPjxhdXRob3I+U2FuY2hleiwgRy4gVi48L2F1dGhvcj48YXV0aG9yPlN1ZGEs

IEsuIEouPC9hdXRob3I+PGF1dGhvcj5UaG9tYXMsIEEuPC9hdXRob3I+PGF1dGhvcj5Xb28sIFQu

IE0uPC9hdXRob3I+PGF1dGhvcj5aZXR0cywgUi4gTS48L2F1dGhvcj48YXV0aG9yPkhpY2tzLCBM

LiBBLjwvYXV0aG9yPjwvYXV0aG9ycz48L2NvbnRyaWJ1dG9ycz48YXV0aC1hZGRyZXNzPkNlbnRl

cnMgZm9yIERpc2Vhc2UgQ29udHJvbCBhbmQgUHJldmVudGlvbiwgQXRsYW50YSwgR2VvcmdpYS4m

I3hEO1BlZGlhdHJpYyBJbmZlY3Rpb3VzIERpc2Vhc2VzLCBVbml2ZXJzaXR5IG9mIFV0YWgsIFNh

bHQgTGFrZSBDaXR5LiYjeEQ7U2Nob29sIG9mIE1lZGljaW5lLCBVbml2ZXJzaXR5IG9mIENhbGlm

b3JuaWEsIFNhbiBGcmFuY2lzY28sIFNhbiBGcmFuY2lzY28uJiN4RDtEaXZpc2lvbiBvZiBIZWFs

dGggUG9saWN5IGFuZCBNYW5hZ2VtZW50LCBVbml2ZXJzaXR5IG9mIE1pbm5lc290YSwgTWlubmVh

cG9saXMuJiN4RDtTdW1tYSBIZWFsdGggU3lzdGVtIGFuZCBOb3J0aGVhc3QgT2hpbyBNZWRpY2Fs

IFVuaXZlcnNpdHksIEFrcm9uLiYjeEQ7Qm9zdG9uIENoaWxkcmVuJmFwb3M7cyBIb3NwaXRhbCBh

bmQgSGFydmFyZCBNZWRpY2FsIFNjaG9vbCwgQm9zdG9uLCBNYXNzYWNodXNldHRzLiYjeEQ7Q2hp

bGRyZW4mYXBvcztzIEhvc3BpdGFsIG9mIFBoaWxhZGVscGhpYSwgUGhpbGFkZWxwaGlhLCBQZW5u

c3lsdmFuaWE4VW5pdmVyc2l0eSBvZiBQZW5uc3lsdmFuaWEgUGVyZWxtYW4gU2Nob29sIG9mIE1l

ZGljaW5lLCBQaGlsYWRlbHBoaWEuJiN4RDtQZXcgQ2hhcml0YWJsZSBUcnVzdHMsIFdhc2hpbmd0

b24sIERDLiYjeEQ7QnJpZ2hhbSBhbmQgV29tZW4mYXBvcztzIEhvc3BpdGFsIGFuZCBIYXJ2YXJk

IE1lZGljYWwgU2Nob29sLCBCb3N0b24sIE1hc3NhY2h1c2V0dHMuJiN4RDtNaW5uZXNvdGEgRGVw

YXJ0bWVudCBvZiBIZWFsdGgsIFN0IFBhdWwuJiN4RDtVbml2ZXJzaXR5IG9mIFBlbm5zeWx2YW5p

YSBQZXJlbG1hbiBTY2hvb2wgb2YgTWVkaWNpbmUsIFBoaWxhZGVscGhpYS4mI3hEO0RlcGFydG1l

bnQgb2YgRW1lcmdlbmN5IE1lZGljaW5lLCBVbml2ZXJzaXR5IG9mIENhbGlmb3JuaWEtRGF2aXMs

IFNhY3JhbWVudG8uJiN4RDtEZXBhcnRtZW50IG9mIEZhbWlseSBNZWRpY2luZSwgR2VvcmdldG93

biBVbml2ZXJzaXR5IE1lZGljYWwgQ2VudGVyLCBXYXNoaW5ndG9uLCBEQy4mI3hEO0RpdmlzaW9u

IG9mIEdlbmVyYWwgSW50ZXJuYWwgTWVkaWNpbmUsIE1hc3NhY2h1c2V0dHMgR2VuZXJhbCBIb3Nw

aXRhbCwgQm9zdG9uLiYjeEQ7RGl2aXNpb24gb2YgUGVkaWF0cmljIEluZmVjdGlvdXMgRGlzZWFz

ZXMsIFdhc2hpbmd0b24gVW5pdmVyc2l0eSBTY2hvb2wgb2YgTWVkaWNpbmUsIFN0IExvdWlzLCBN

aXNzb3VyaS4mI3hEO0RlcGFydG1lbnQgb2YgT3RvbGFyeW5nb2xvZ3ktSGVhZCBhbmQgTmVjayBT

dXJnZXJ5LCBXYXNoaW5ndG9uIFVuaXZlcnNpdHkgU2Nob29sIG9mIE1lZGljaW5lLCBTdCBMb3Vp

cywgTWlzc291cmkuJiN4RDtEZXBhcnRtZW50IG9mIFZldGVyYW5zIEFmZmFpcnMsIFVuaXZlcnNp

dHkgb2YgSWxsaW5vaXMgYXQgQ2hpY2FnbywgQ2hpY2Fnby4mI3hEO09yZWdvbiBQdWJsaWMgSGVh

bHRoIERpdmlzaW9uLCBQb3J0bGFuZC4mI3hEO1BhY2lmaWMgTHV0aGVyYW4gVW5pdmVyc2l0eSwg

VGFjb21hLCBXYXNoaW5ndG9uLjwvYXV0aC1hZGRyZXNzPjx0aXRsZXM+PHRpdGxlPlByZXZhbGVu

Y2Ugb2YgSW5hcHByb3ByaWF0ZSBBbnRpYmlvdGljIFByZXNjcmlwdGlvbnMgQW1vbmcgVVMgQW1i

dWxhdG9yeSBDYXJlIFZpc2l0cywgMjAxMC0yMDExPC90aXRsZT48c2Vjb25kYXJ5LXRpdGxlPkpB

TUE8L3NlY29uZGFyeS10aXRsZT48L3RpdGxlcz48cGVyaW9kaWNhbD48ZnVsbC10aXRsZT5KQU1B

PC9mdWxsLXRpdGxlPjwvcGVyaW9kaWNhbD48cGFnZXM+MTg2NC03MzwvcGFnZXM+PHZvbHVtZT4z

MTU8L3ZvbHVtZT48bnVtYmVyPjE3PC9udW1iZXI+PGtleXdvcmRzPjxrZXl3b3JkPkFkb2xlc2Nl

bnQ8L2tleXdvcmQ+PGtleXdvcmQ+QWR1bHQ8L2tleXdvcmQ+PGtleXdvcmQ+QWdlZDwva2V5d29y

ZD48a2V5d29yZD5BbWJ1bGF0b3J5IENhcmUvKnN0YXRpc3RpY3MgJmFtcDsgbnVtZXJpY2FsIGRh

dGE8L2tleXdvcmQ+PGtleXdvcmQ+QW50aS1CYWN0ZXJpYWwgQWdlbnRzLyp0aGVyYXBldXRpYyB1

c2U8L2tleXdvcmQ+PGtleXdvcmQ+Q2hpbGQ8L2tleXdvcmQ+PGtleXdvcmQ+Q2hpbGQsIFByZXNj

aG9vbDwva2V5d29yZD48a2V5d29yZD5GZW1hbGU8L2tleXdvcmQ+PGtleXdvcmQ+SGVhbHRoIENh

cmUgU3VydmV5czwva2V5d29yZD48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdvcmQ+SW5h

cHByb3ByaWF0ZSBQcmVzY3JpYmluZy8qc3RhdGlzdGljcyAmYW1wOyBudW1lcmljYWwgZGF0YTwv

a2V5d29yZD48a2V5d29yZD5JbmZhbnQ8L2tleXdvcmQ+PGtleXdvcmQ+SW5mYW50LCBOZXdib3Ju

PC9rZXl3b3JkPjxrZXl3b3JkPk1hbGU8L2tleXdvcmQ+PGtleXdvcmQ+TWlkZGxlIEFnZWQ8L2tl

eXdvcmQ+PGtleXdvcmQ+T3RpdGlzIE1lZGlhLCBTdXBwdXJhdGl2ZS8qZHJ1ZyB0aGVyYXB5PC9r

ZXl3b3JkPjxrZXl3b3JkPlBoYXJ5bmdpdGlzL2RydWcgdGhlcmFweTwva2V5d29yZD48a2V5d29y

ZD5QcmFjdGljZSBQYXR0ZXJucywgUGh5c2ljaWFucyZhcG9zOy8qc3RhdGlzdGljcyAmYW1wOyBu

dW1lcmljYWwgZGF0YTwva2V5d29yZD48a2V5d29yZD5QcmV2YWxlbmNlPC9rZXl3b3JkPjxrZXl3

b3JkPlJlc3BpcmF0b3J5IFRyYWN0IEluZmVjdGlvbnMvZHJ1ZyB0aGVyYXB5PC9rZXl3b3JkPjxr

ZXl3b3JkPlVuaXRlZCBTdGF0ZXM8L2tleXdvcmQ+PC9rZXl3b3Jkcz48ZGF0ZXM+PHllYXI+MjAx

NjwveWVhcj48cHViLWRhdGVzPjxkYXRlPk1heSAzPC9kYXRlPjwvcHViLWRhdGVzPjwvZGF0ZXM+

PGlzYm4+MTUzOC0zNTk4IChFbGVjdHJvbmljKSYjeEQ7MDA5OC03NDg0IChMaW5raW5nKTwvaXNi

bj48YWNjZXNzaW9uLW51bT4yNzEzOTA1OTwvYWNjZXNzaW9uLW51bT48dXJscz48cmVsYXRlZC11

cmxzPjx1cmw+aHR0cHM6Ly93d3cubmNiaS5ubG0ubmloLmdvdi9wdWJtZWQvMjcxMzkwNTk8L3Vy

bD48dXJsPmh0dHA6Ly9qYW1hbmV0d29yay5jb20vam91cm5hbHMvamFtYS9mdWxsYXJ0aWNsZS8y

NTE4MjYzPC91cmw+PC9yZWxhdGVkLXVybHM+PC91cmxzPjxlbGVjdHJvbmljLXJlc291cmNlLW51

bT4xMC4xMDAxL2phbWEuMjAxNi40MTUxPC9lbGVjdHJvbmljLXJlc291cmNlLW51bT48L3JlY29y

ZD48L0NpdGU+PENpdGU+PEF1dGhvcj5TcGl2YWs8L0F1dGhvcj48WWVhcj4yMDE2PC9ZZWFyPjxS

ZWNOdW0+MzI1PC9SZWNOdW0+PHJlY29yZD48cmVjLW51bWJlcj4zMjU8L3JlYy1udW1iZXI+PGZv

cmVpZ24ta2V5cz48a2V5IGFwcD0iRU4iIGRiLWlkPSJ0ZGRydzV2YWZlcDVkMGVhZmF2eHh2OWZh

NWV4cnByc3N2dmQiIHRpbWVzdGFtcD0iMTU2NDA5OTgzNiI+MzI1PC9rZXk+PC9mb3JlaWduLWtl

eXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10eXBlPjxjb250cmli

dXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5TcGl2YWssIEUuIFMuPC9hdXRob3I+PGF1dGhvcj5Db3Nn

cm92ZSwgUy4gRS48L2F1dGhvcj48YXV0aG9yPlNyaW5pdmFzYW4sIEEuPC9hdXRob3I+PC9hdXRo

b3JzPjwvY29udHJpYnV0b3JzPjxhdXRoLWFkZHJlc3M+RGVwYXJ0bWVudCBvZiBNZWRpY2luZSwg

RGl2aXNpb24gb2YgSW5mZWN0aW91cyBEaXNlYXNlcywgVW5pdmVyc2l0eSBvZiBVdGFoIFNjaG9v

bCBvZiBNZWRpY2luZSwgU2FsdCBMYWtlIENpdHkuJiN4RDtEZXBhcnRtZW50IG9mIE1lZGljaW5l

LCBEaXZpc2lvbiBvZiBJbmZlY3Rpb3VzIERpc2Vhc2VzLCBKb2hucyBIb3BraW5zIFVuaXZlcnNp

dHkgU2Nob29sIG9mIE1lZGljaW5lLCBCYWx0aW1vcmUsIE1hcnlsYW5kLiYjeEQ7RGl2aXNpb24g

b2YgSGVhbHRoY2FyZSBRdWFsaXR5IFByb21vdGlvbiwgQ2VudGVycyBmb3IgRGlzZWFzZSBDb250

cm9sIGFuZCBQcmV2ZW50aW9uLCBBdGxhbnRhLCBHZW9yZ2lhLjwvYXV0aC1hZGRyZXNzPjx0aXRs

ZXM+PHRpdGxlPk1lYXN1cmluZyBBcHByb3ByaWF0ZSBBbnRpbWljcm9iaWFsIFVzZTogQXR0ZW1w

dHMgYXQgT3BlbmluZyB0aGUgQmxhY2sgQm94PC90aXRsZT48c2Vjb25kYXJ5LXRpdGxlPkNsaW4g

SW5mZWN0IERpczwvc2Vjb25kYXJ5LXRpdGxlPjwvdGl0bGVzPjxwZXJpb2RpY2FsPjxmdWxsLXRp

dGxlPkNsaW4gSW5mZWN0IERpczwvZnVsbC10aXRsZT48L3BlcmlvZGljYWw+PHBhZ2VzPjE2Mzkt

MTY0NDwvcGFnZXM+PHZvbHVtZT42Mzwvdm9sdW1lPjxudW1iZXI+MTI8L251bWJlcj48a2V5d29y

ZHM+PGtleXdvcmQ+YW50aWJpb3RpYzwva2V5d29yZD48a2V5d29yZD5hbnRpbWljcm9iaWFsIHN0

ZXdhcmRzaGlwPC9rZXl3b3JkPjxrZXl3b3JkPmRydWcgcmVzaXN0YW5jZTwva2V5d29yZD48a2V5

d29yZD5xdWFsaXR5PC9rZXl3b3JkPjxrZXl3b3JkPnV0aWxpemF0aW9uPC9rZXl3b3JkPjwva2V5

d29yZHM+PGRhdGVzPjx5ZWFyPjIwMTY8L3llYXI+PHB1Yi1kYXRlcz48ZGF0ZT5EZWMgMTU8L2Rh

dGU+PC9wdWItZGF0ZXM+PC9kYXRlcz48aXNibj4xNTM3LTY1OTEgKEVsZWN0cm9uaWMpJiN4RDsx

MDU4LTQ4MzggKExpbmtpbmcpPC9pc2JuPjxhY2Nlc3Npb24tbnVtPjI3NjgyMDcwPC9hY2Nlc3Np

b24tbnVtPjx1cmxzPjxyZWxhdGVkLXVybHM+PHVybD5odHRwczovL3d3dy5uY2JpLm5sbS5uaWgu

Z292L3B1Ym1lZC8yNzY4MjA3MDwvdXJsPjwvcmVsYXRlZC11cmxzPjwvdXJscz48ZWxlY3Ryb25p

Yy1yZXNvdXJjZS1udW0+MTAuMTA5My9jaWQvY2l3NjU4PC9lbGVjdHJvbmljLXJlc291cmNlLW51

bT48L3JlY29yZD48L0NpdGU+PENpdGU+PEF1dGhvcj5HeXNzZW5zPC9BdXRob3I+PFllYXI+MTk5

MjwvWWVhcj48UmVjTnVtPjU3MjwvUmVjTnVtPjxyZWNvcmQ+PHJlYy1udW1iZXI+NTcyPC9yZWMt

bnVtYmVyPjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0idGRkcnc1dmFmZXA1ZDBl

YWZhdnh4djlmYTVleHJwcnNzdnZkIiB0aW1lc3RhbXA9IjE1ODgzODMzMzkiPjU3Mjwva2V5Pjwv

Zm9yZWlnbi1rZXlzPjxyZWYtdHlwZSBuYW1lPSJKb3VybmFsIEFydGljbGUiPjE3PC9yZWYtdHlw

ZT48Y29udHJpYnV0b3JzPjxhdXRob3JzPjxhdXRob3I+R3lzc2VucywgSS4gQy48L2F1dGhvcj48

YXV0aG9yPnZhbiBkZW4gQnJvZWssIFAuIEouPC9hdXRob3I+PGF1dGhvcj5LdWxsYmVyZywgQi4g

Si48L2F1dGhvcj48YXV0aG9yPkhla3N0ZXIsIFkuPC9hdXRob3I+PGF1dGhvcj52YW4gZGVyIE1l

ZXIsIEouIFcuPC9hdXRob3I+PC9hdXRob3JzPjwvY29udHJpYnV0b3JzPjx0aXRsZXM+PHRpdGxl

Pk9wdGltaXppbmcgYW50aW1pY3JvYmlhbCB0aGVyYXB5LiBBIG1ldGhvZCBmb3IgYW50aW1pY3Jv

YmlhbCBkcnVnIHVzZSBldmFsdWF0aW9uPC90aXRsZT48c2Vjb25kYXJ5LXRpdGxlPkogQW50aW1p

Y3JvYiBDaGVtb3RoZXI8L3NlY29uZGFyeS10aXRsZT48L3RpdGxlcz48cGVyaW9kaWNhbD48ZnVs

bC10aXRsZT5KIEFudGltaWNyb2IgQ2hlbW90aGVyPC9mdWxsLXRpdGxlPjxhYmJyLTE+VGhlIEpv

dXJuYWwgb2YgYW50aW1pY3JvYmlhbCBjaGVtb3RoZXJhcHk8L2FiYnItMT48L3BlcmlvZGljYWw+

PHBhZ2VzPjcyNC03PC9wYWdlcz48dm9sdW1lPjMwPC92b2x1bWU+PG51bWJlcj41PC9udW1iZXI+

PGVkaXRpb24+MTk5Mi8xMS8wMTwvZWRpdGlvbj48a2V5d29yZHM+PGtleXdvcmQ+QW50aS1CYWN0

ZXJpYWwgQWdlbnRzL2FkbWluaXN0cmF0aW9uICZhbXA7IGRvc2FnZS8qdGhlcmFwZXV0aWMgdXNl

PC9rZXl3b3JkPjxrZXl3b3JkPkRydWcgQWRtaW5pc3RyYXRpb24gU2NoZWR1bGU8L2tleXdvcmQ+

PGtleXdvcmQ+RHJ1ZyBFdmFsdWF0aW9uL21ldGhvZHM8L2tleXdvcmQ+PGtleXdvcmQ+SHVtYW5z

PC9rZXl3b3JkPjxrZXl3b3JkPlJlc2VhcmNoIERlc2lnbjwva2V5d29yZD48L2tleXdvcmRzPjxk

YXRlcz48eWVhcj4xOTkyPC95ZWFyPjxwdWItZGF0ZXM+PGRhdGU+Tm92PC9kYXRlPjwvcHViLWRh

dGVzPjwvZGF0ZXM+PGlzYm4+MDMwNS03NDUzIChQcmludCkmI3hEOzAzMDUtNzQ1MyAoTGlua2lu

Zyk8L2lzYm4+PGFjY2Vzc2lvbi1udW0+MTQ5Mzk5MDwvYWNjZXNzaW9uLW51bT48dXJscz48cmVs

YXRlZC11cmxzPjx1cmw+aHR0cHM6Ly93d3cubmNiaS5ubG0ubmloLmdvdi9wdWJtZWQvMTQ5Mzk5

MDwvdXJsPjwvcmVsYXRlZC11cmxzPjwvdXJscz48ZWxlY3Ryb25pYy1yZXNvdXJjZS1udW0+MTAu

MTA5My9qYWMvMzAuNS43MjQ8L2VsZWN0cm9uaWMtcmVzb3VyY2UtbnVtPjwvcmVjb3JkPjwvQ2l0

ZT48L0VuZE5vdGU+

ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5GbGVtaW5nLUR1dHJhPC9BdXRob3I+PFllYXI+MjAxNjwv

WWVhcj48UmVjTnVtPjI3PC9SZWNOdW0+PERpc3BsYXlUZXh0PjxzdHlsZSBmYWNlPSJzdXBlcnNj

cmlwdCI+MTUtMTc8L3N0eWxlPjwvRGlzcGxheVRleHQ+PHJlY29yZD48cmVjLW51bWJlcj4yNzwv

cmVjLW51bWJlcj48Zm9yZWlnbi1rZXlzPjxrZXkgYXBwPSJFTiIgZGItaWQ9InRkZHJ3NXZhZmVw

NWQwZWFmYXZ4eHY5ZmE1ZXhycHJzc3Z2ZCIgdGltZXN0YW1wPSIxNTYzNTE1NDY0Ij4yNzwva2V5

PjwvZm9yZWlnbi1rZXlzPjxyZWYtdHlwZSBuYW1lPSJKb3VybmFsIEFydGljbGUiPjE3PC9yZWYt

dHlwZT48Y29udHJpYnV0b3JzPjxhdXRob3JzPjxhdXRob3I+RmxlbWluZy1EdXRyYSwgSy4gRS48

L2F1dGhvcj48YXV0aG9yPkhlcnNoLCBBLiBMLjwvYXV0aG9yPjxhdXRob3I+U2hhcGlybywgRC4g

Si48L2F1dGhvcj48YXV0aG9yPkJhcnRvY2VzLCBNLjwvYXV0aG9yPjxhdXRob3I+RW5ucywgRS4g

QS48L2F1dGhvcj48YXV0aG9yPkZpbGUsIFQuIE0uLCBKci48L2F1dGhvcj48YXV0aG9yPkZpbmtl

bHN0ZWluLCBKLiBBLjwvYXV0aG9yPjxhdXRob3I+R2VyYmVyLCBKLiBTLjwvYXV0aG9yPjxhdXRo

b3I+SHl1biwgRC4gWS48L2F1dGhvcj48YXV0aG9yPkxpbmRlciwgSi4gQS48L2F1dGhvcj48YXV0

aG9yPkx5bmZpZWxkLCBSLjwvYXV0aG9yPjxhdXRob3I+TWFyZ29saXMsIEQuIEouPC9hdXRob3I+

PGF1dGhvcj5NYXksIEwuIFMuPC9hdXRob3I+PGF1dGhvcj5NZXJlbnN0ZWluLCBELjwvYXV0aG9y

PjxhdXRob3I+TWV0bGF5LCBKLiBQLjwvYXV0aG9yPjxhdXRob3I+TmV3bGFuZCwgSi4gRy48L2F1

dGhvcj48YXV0aG9yPlBpY2NpcmlsbG8sIEouIEYuPC9hdXRob3I+PGF1dGhvcj5Sb2JlcnRzLCBS

LiBNLjwvYXV0aG9yPjxhdXRob3I+U2FuY2hleiwgRy4gVi48L2F1dGhvcj48YXV0aG9yPlN1ZGEs

IEsuIEouPC9hdXRob3I+PGF1dGhvcj5UaG9tYXMsIEEuPC9hdXRob3I+PGF1dGhvcj5Xb28sIFQu

IE0uPC9hdXRob3I+PGF1dGhvcj5aZXR0cywgUi4gTS48L2F1dGhvcj48YXV0aG9yPkhpY2tzLCBM

LiBBLjwvYXV0aG9yPjwvYXV0aG9ycz48L2NvbnRyaWJ1dG9ycz48YXV0aC1hZGRyZXNzPkNlbnRl

cnMgZm9yIERpc2Vhc2UgQ29udHJvbCBhbmQgUHJldmVudGlvbiwgQXRsYW50YSwgR2VvcmdpYS4m

I3hEO1BlZGlhdHJpYyBJbmZlY3Rpb3VzIERpc2Vhc2VzLCBVbml2ZXJzaXR5IG9mIFV0YWgsIFNh

bHQgTGFrZSBDaXR5LiYjeEQ7U2Nob29sIG9mIE1lZGljaW5lLCBVbml2ZXJzaXR5IG9mIENhbGlm

b3JuaWEsIFNhbiBGcmFuY2lzY28sIFNhbiBGcmFuY2lzY28uJiN4RDtEaXZpc2lvbiBvZiBIZWFs

dGggUG9saWN5IGFuZCBNYW5hZ2VtZW50LCBVbml2ZXJzaXR5IG9mIE1pbm5lc290YSwgTWlubmVh

cG9saXMuJiN4RDtTdW1tYSBIZWFsdGggU3lzdGVtIGFuZCBOb3J0aGVhc3QgT2hpbyBNZWRpY2Fs

IFVuaXZlcnNpdHksIEFrcm9uLiYjeEQ7Qm9zdG9uIENoaWxkcmVuJmFwb3M7cyBIb3NwaXRhbCBh

bmQgSGFydmFyZCBNZWRpY2FsIFNjaG9vbCwgQm9zdG9uLCBNYXNzYWNodXNldHRzLiYjeEQ7Q2hp

bGRyZW4mYXBvcztzIEhvc3BpdGFsIG9mIFBoaWxhZGVscGhpYSwgUGhpbGFkZWxwaGlhLCBQZW5u

c3lsdmFuaWE4VW5pdmVyc2l0eSBvZiBQZW5uc3lsdmFuaWEgUGVyZWxtYW4gU2Nob29sIG9mIE1l

ZGljaW5lLCBQaGlsYWRlbHBoaWEuJiN4RDtQZXcgQ2hhcml0YWJsZSBUcnVzdHMsIFdhc2hpbmd0

b24sIERDLiYjeEQ7QnJpZ2hhbSBhbmQgV29tZW4mYXBvcztzIEhvc3BpdGFsIGFuZCBIYXJ2YXJk

IE1lZGljYWwgU2Nob29sLCBCb3N0b24sIE1hc3NhY2h1c2V0dHMuJiN4RDtNaW5uZXNvdGEgRGVw

YXJ0bWVudCBvZiBIZWFsdGgsIFN0IFBhdWwuJiN4RDtVbml2ZXJzaXR5IG9mIFBlbm5zeWx2YW5p

YSBQZXJlbG1hbiBTY2hvb2wgb2YgTWVkaWNpbmUsIFBoaWxhZGVscGhpYS4mI3hEO0RlcGFydG1l

bnQgb2YgRW1lcmdlbmN5IE1lZGljaW5lLCBVbml2ZXJzaXR5IG9mIENhbGlmb3JuaWEtRGF2aXMs

IFNhY3JhbWVudG8uJiN4RDtEZXBhcnRtZW50IG9mIEZhbWlseSBNZWRpY2luZSwgR2VvcmdldG93

biBVbml2ZXJzaXR5IE1lZGljYWwgQ2VudGVyLCBXYXNoaW5ndG9uLCBEQy4mI3hEO0RpdmlzaW9u

IG9mIEdlbmVyYWwgSW50ZXJuYWwgTWVkaWNpbmUsIE1hc3NhY2h1c2V0dHMgR2VuZXJhbCBIb3Nw

aXRhbCwgQm9zdG9uLiYjeEQ7RGl2aXNpb24gb2YgUGVkaWF0cmljIEluZmVjdGlvdXMgRGlzZWFz

ZXMsIFdhc2hpbmd0b24gVW5pdmVyc2l0eSBTY2hvb2wgb2YgTWVkaWNpbmUsIFN0IExvdWlzLCBN

aXNzb3VyaS4mI3hEO0RlcGFydG1lbnQgb2YgT3RvbGFyeW5nb2xvZ3ktSGVhZCBhbmQgTmVjayBT

dXJnZXJ5LCBXYXNoaW5ndG9uIFVuaXZlcnNpdHkgU2Nob29sIG9mIE1lZGljaW5lLCBTdCBMb3Vp

cywgTWlzc291cmkuJiN4RDtEZXBhcnRtZW50IG9mIFZldGVyYW5zIEFmZmFpcnMsIFVuaXZlcnNp

dHkgb2YgSWxsaW5vaXMgYXQgQ2hpY2FnbywgQ2hpY2Fnby4mI3hEO09yZWdvbiBQdWJsaWMgSGVh

bHRoIERpdmlzaW9uLCBQb3J0bGFuZC4mI3hEO1BhY2lmaWMgTHV0aGVyYW4gVW5pdmVyc2l0eSwg

VGFjb21hLCBXYXNoaW5ndG9uLjwvYXV0aC1hZGRyZXNzPjx0aXRsZXM+PHRpdGxlPlByZXZhbGVu

Y2Ugb2YgSW5hcHByb3ByaWF0ZSBBbnRpYmlvdGljIFByZXNjcmlwdGlvbnMgQW1vbmcgVVMgQW1i

dWxhdG9yeSBDYXJlIFZpc2l0cywgMjAxMC0yMDExPC90aXRsZT48c2Vjb25kYXJ5LXRpdGxlPkpB

TUE8L3NlY29uZGFyeS10aXRsZT48L3RpdGxlcz48cGVyaW9kaWNhbD48ZnVsbC10aXRsZT5KQU1B

PC9mdWxsLXRpdGxlPjwvcGVyaW9kaWNhbD48cGFnZXM+MTg2NC03MzwvcGFnZXM+PHZvbHVtZT4z

MTU8L3ZvbHVtZT48bnVtYmVyPjE3PC9udW1iZXI+PGtleXdvcmRzPjxrZXl3b3JkPkFkb2xlc2Nl

bnQ8L2tleXdvcmQ+PGtleXdvcmQ+QWR1bHQ8L2tleXdvcmQ+PGtleXdvcmQ+QWdlZDwva2V5d29y

ZD48a2V5d29yZD5BbWJ1bGF0b3J5IENhcmUvKnN0YXRpc3RpY3MgJmFtcDsgbnVtZXJpY2FsIGRh

dGE8L2tleXdvcmQ+PGtleXdvcmQ+QW50aS1CYWN0ZXJpYWwgQWdlbnRzLyp0aGVyYXBldXRpYyB1

c2U8L2tleXdvcmQ+PGtleXdvcmQ+Q2hpbGQ8L2tleXdvcmQ+PGtleXdvcmQ+Q2hpbGQsIFByZXNj

aG9vbDwva2V5d29yZD48a2V5d29yZD5GZW1hbGU8L2tleXdvcmQ+PGtleXdvcmQ+SGVhbHRoIENh

cmUgU3VydmV5czwva2V5d29yZD48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdvcmQ+SW5h

cHByb3ByaWF0ZSBQcmVzY3JpYmluZy8qc3RhdGlzdGljcyAmYW1wOyBudW1lcmljYWwgZGF0YTwv

a2V5d29yZD48a2V5d29yZD5JbmZhbnQ8L2tleXdvcmQ+PGtleXdvcmQ+SW5mYW50LCBOZXdib3Ju

PC9rZXl3b3JkPjxrZXl3b3JkPk1hbGU8L2tleXdvcmQ+PGtleXdvcmQ+TWlkZGxlIEFnZWQ8L2tl

eXdvcmQ+PGtleXdvcmQ+T3RpdGlzIE1lZGlhLCBTdXBwdXJhdGl2ZS8qZHJ1ZyB0aGVyYXB5PC9r

ZXl3b3JkPjxrZXl3b3JkPlBoYXJ5bmdpdGlzL2RydWcgdGhlcmFweTwva2V5d29yZD48a2V5d29y

ZD5QcmFjdGljZSBQYXR0ZXJucywgUGh5c2ljaWFucyZhcG9zOy8qc3RhdGlzdGljcyAmYW1wOyBu

dW1lcmljYWwgZGF0YTwva2V5d29yZD48a2V5d29yZD5QcmV2YWxlbmNlPC9rZXl3b3JkPjxrZXl3

b3JkPlJlc3BpcmF0b3J5IFRyYWN0IEluZmVjdGlvbnMvZHJ1ZyB0aGVyYXB5PC9rZXl3b3JkPjxr

ZXl3b3JkPlVuaXRlZCBTdGF0ZXM8L2tleXdvcmQ+PC9rZXl3b3Jkcz48ZGF0ZXM+PHllYXI+MjAx

NjwveWVhcj48cHViLWRhdGVzPjxkYXRlPk1heSAzPC9kYXRlPjwvcHViLWRhdGVzPjwvZGF0ZXM+

PGlzYm4+MTUzOC0zNTk4IChFbGVjdHJvbmljKSYjeEQ7MDA5OC03NDg0IChMaW5raW5nKTwvaXNi

bj48YWNjZXNzaW9uLW51bT4yNzEzOTA1OTwvYWNjZXNzaW9uLW51bT48dXJscz48cmVsYXRlZC11

cmxzPjx1cmw+aHR0cHM6Ly93d3cubmNiaS5ubG0ubmloLmdvdi9wdWJtZWQvMjcxMzkwNTk8L3Vy

bD48dXJsPmh0dHA6Ly9qYW1hbmV0d29yay5jb20vam91cm5hbHMvamFtYS9mdWxsYXJ0aWNsZS8y

NTE4MjYzPC91cmw+PC9yZWxhdGVkLXVybHM+PC91cmxzPjxlbGVjdHJvbmljLXJlc291cmNlLW51

bT4xMC4xMDAxL2phbWEuMjAxNi40MTUxPC9lbGVjdHJvbmljLXJlc291cmNlLW51bT48L3JlY29y

ZD48L0NpdGU+PENpdGU+PEF1dGhvcj5TcGl2YWs8L0F1dGhvcj48WWVhcj4yMDE2PC9ZZWFyPjxS

ZWNOdW0+MzI1PC9SZWNOdW0+PHJlY29yZD48cmVjLW51bWJlcj4zMjU8L3JlYy1udW1iZXI+PGZv

cmVpZ24ta2V5cz48a2V5IGFwcD0iRU4iIGRiLWlkPSJ0ZGRydzV2YWZlcDVkMGVhZmF2eHh2OWZh

NWV4cnByc3N2dmQiIHRpbWVzdGFtcD0iMTU2NDA5OTgzNiI+MzI1PC9rZXk+PC9mb3JlaWduLWtl

eXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10eXBlPjxjb250cmli

dXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5TcGl2YWssIEUuIFMuPC9hdXRob3I+PGF1dGhvcj5Db3Nn

cm92ZSwgUy4gRS48L2F1dGhvcj48YXV0aG9yPlNyaW5pdmFzYW4sIEEuPC9hdXRob3I+PC9hdXRo

b3JzPjwvY29udHJpYnV0b3JzPjxhdXRoLWFkZHJlc3M+RGVwYXJ0bWVudCBvZiBNZWRpY2luZSwg

RGl2aXNpb24gb2YgSW5mZWN0aW91cyBEaXNlYXNlcywgVW5pdmVyc2l0eSBvZiBVdGFoIFNjaG9v

bCBvZiBNZWRpY2luZSwgU2FsdCBMYWtlIENpdHkuJiN4RDtEZXBhcnRtZW50IG9mIE1lZGljaW5l

LCBEaXZpc2lvbiBvZiBJbmZlY3Rpb3VzIERpc2Vhc2VzLCBKb2hucyBIb3BraW5zIFVuaXZlcnNp

dHkgU2Nob29sIG9mIE1lZGljaW5lLCBCYWx0aW1vcmUsIE1hcnlsYW5kLiYjeEQ7RGl2aXNpb24g

b2YgSGVhbHRoY2FyZSBRdWFsaXR5IFByb21vdGlvbiwgQ2VudGVycyBmb3IgRGlzZWFzZSBDb250

cm9sIGFuZCBQcmV2ZW50aW9uLCBBdGxhbnRhLCBHZW9yZ2lhLjwvYXV0aC1hZGRyZXNzPjx0aXRs

ZXM+PHRpdGxlPk1lYXN1cmluZyBBcHByb3ByaWF0ZSBBbnRpbWljcm9iaWFsIFVzZTogQXR0ZW1w

dHMgYXQgT3BlbmluZyB0aGUgQmxhY2sgQm94PC90aXRsZT48c2Vjb25kYXJ5LXRpdGxlPkNsaW4g

SW5mZWN0IERpczwvc2Vjb25kYXJ5LXRpdGxlPjwvdGl0bGVzPjxwZXJpb2RpY2FsPjxmdWxsLXRp

dGxlPkNsaW4gSW5mZWN0IERpczwvZnVsbC10aXRsZT48L3BlcmlvZGljYWw+PHBhZ2VzPjE2Mzkt

MTY0NDwvcGFnZXM+PHZvbHVtZT42Mzwvdm9sdW1lPjxudW1iZXI+MTI8L251bWJlcj48a2V5d29y

ZHM+PGtleXdvcmQ+YW50aWJpb3RpYzwva2V5d29yZD48a2V5d29yZD5hbnRpbWljcm9iaWFsIHN0

ZXdhcmRzaGlwPC9rZXl3b3JkPjxrZXl3b3JkPmRydWcgcmVzaXN0YW5jZTwva2V5d29yZD48a2V5

d29yZD5xdWFsaXR5PC9rZXl3b3JkPjxrZXl3b3JkPnV0aWxpemF0aW9uPC9rZXl3b3JkPjwva2V5

d29yZHM+PGRhdGVzPjx5ZWFyPjIwMTY8L3llYXI+PHB1Yi1kYXRlcz48ZGF0ZT5EZWMgMTU8L2Rh

dGU+PC9wdWItZGF0ZXM+PC9kYXRlcz48aXNibj4xNTM3LTY1OTEgKEVsZWN0cm9uaWMpJiN4RDsx

MDU4LTQ4MzggKExpbmtpbmcpPC9pc2JuPjxhY2Nlc3Npb24tbnVtPjI3NjgyMDcwPC9hY2Nlc3Np

b24tbnVtPjx1cmxzPjxyZWxhdGVkLXVybHM+PHVybD5odHRwczovL3d3dy5uY2JpLm5sbS5uaWgu

Z292L3B1Ym1lZC8yNzY4MjA3MDwvdXJsPjwvcmVsYXRlZC11cmxzPjwvdXJscz48ZWxlY3Ryb25p

Yy1yZXNvdXJjZS1udW0+MTAuMTA5My9jaWQvY2l3NjU4PC9lbGVjdHJvbmljLXJlc291cmNlLW51

bT48L3JlY29yZD48L0NpdGU+PENpdGU+PEF1dGhvcj5HeXNzZW5zPC9BdXRob3I+PFllYXI+MTk5

MjwvWWVhcj48UmVjTnVtPjU3MjwvUmVjTnVtPjxyZWNvcmQ+PHJlYy1udW1iZXI+NTcyPC9yZWMt

bnVtYmVyPjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0idGRkcnc1dmFmZXA1ZDBl

YWZhdnh4djlmYTVleHJwcnNzdnZkIiB0aW1lc3RhbXA9IjE1ODgzODMzMzkiPjU3Mjwva2V5Pjwv

Zm9yZWlnbi1rZXlzPjxyZWYtdHlwZSBuYW1lPSJKb3VybmFsIEFydGljbGUiPjE3PC9yZWYtdHlw

ZT48Y29udHJpYnV0b3JzPjxhdXRob3JzPjxhdXRob3I+R3lzc2VucywgSS4gQy48L2F1dGhvcj48

YXV0aG9yPnZhbiBkZW4gQnJvZWssIFAuIEouPC9hdXRob3I+PGF1dGhvcj5LdWxsYmVyZywgQi4g

Si48L2F1dGhvcj48YXV0aG9yPkhla3N0ZXIsIFkuPC9hdXRob3I+PGF1dGhvcj52YW4gZGVyIE1l

ZXIsIEouIFcuPC9hdXRob3I+PC9hdXRob3JzPjwvY29udHJpYnV0b3JzPjx0aXRsZXM+PHRpdGxl

Pk9wdGltaXppbmcgYW50aW1pY3JvYmlhbCB0aGVyYXB5LiBBIG1ldGhvZCBmb3IgYW50aW1pY3Jv

YmlhbCBkcnVnIHVzZSBldmFsdWF0aW9uPC90aXRsZT48c2Vjb25kYXJ5LXRpdGxlPkogQW50aW1p

Y3JvYiBDaGVtb3RoZXI8L3NlY29uZGFyeS10aXRsZT48L3RpdGxlcz48cGVyaW9kaWNhbD48ZnVs

bC10aXRsZT5KIEFudGltaWNyb2IgQ2hlbW90aGVyPC9mdWxsLXRpdGxlPjxhYmJyLTE+VGhlIEpv

dXJuYWwgb2YgYW50aW1pY3JvYmlhbCBjaGVtb3RoZXJhcHk8L2FiYnItMT48L3BlcmlvZGljYWw+

PHBhZ2VzPjcyNC03PC9wYWdlcz48dm9sdW1lPjMwPC92b2x1bWU+PG51bWJlcj41PC9udW1iZXI+

PGVkaXRpb24+MTk5Mi8xMS8wMTwvZWRpdGlvbj48a2V5d29yZHM+PGtleXdvcmQ+QW50aS1CYWN0

ZXJpYWwgQWdlbnRzL2FkbWluaXN0cmF0aW9uICZhbXA7IGRvc2FnZS8qdGhlcmFwZXV0aWMgdXNl

PC9rZXl3b3JkPjxrZXl3b3JkPkRydWcgQWRtaW5pc3RyYXRpb24gU2NoZWR1bGU8L2tleXdvcmQ+

PGtleXdvcmQ+RHJ1ZyBFdmFsdWF0aW9uL21ldGhvZHM8L2tleXdvcmQ+PGtleXdvcmQ+SHVtYW5z

PC9rZXl3b3JkPjxrZXl3b3JkPlJlc2VhcmNoIERlc2lnbjwva2V5d29yZD48L2tleXdvcmRzPjxk

YXRlcz48eWVhcj4xOTkyPC95ZWFyPjxwdWItZGF0ZXM+PGRhdGU+Tm92PC9kYXRlPjwvcHViLWRh

dGVzPjwvZGF0ZXM+PGlzYm4+MDMwNS03NDUzIChQcmludCkmI3hEOzAzMDUtNzQ1MyAoTGlua2lu

Zyk8L2lzYm4+PGFjY2Vzc2lvbi1udW0+MTQ5Mzk5MDwvYWNjZXNzaW9uLW51bT48dXJscz48cmVs

YXRlZC11cmxzPjx1cmw+aHR0cHM6Ly93d3cubmNiaS5ubG0ubmloLmdvdi9wdWJtZWQvMTQ5Mzk5

MDwvdXJsPjwvcmVsYXRlZC11cmxzPjwvdXJscz48ZWxlY3Ryb25pYy1yZXNvdXJjZS1udW0+MTAu

MTA5My9qYWMvMzAuNS43MjQ8L2VsZWN0cm9uaWMtcmVzb3VyY2UtbnVtPjwvcmVjb3JkPjwvQ2l0

ZT48L0VuZE5vdGU+

ADDIN EN.CITE.DATA 15-17Supplementary Table 3. Baseline characteristics of patients with APD in the emergency department (N=2,835)CharacteristicsPre-intervention period(N=1,555)Interventionperiod(N=1,280)PvalueDemographicsAge, year, median (range) 45 (13-98) 51 (14-95)<0.001 ≤ 40 653 (42.0) 454 (35.5) Ref. 40-65 491 (31.6) 387 (30.2)0.17 ≥ 65 411 (26.4) 439 (34.3)<0.001Female gender 852 (54.9)731 (57.1)0.22Residential status prior to ED visit Home 1550 (99.7)1,262 (98.6)Ref. Nursing home 5 (0.3)18 (1.4)0.001Post-travel visit 5 (0.3)0 (0)N/AAntimicrobial allergy 28 (1.8)70 (5.8)<0.001Comorbidity/past medical history Congestive heart failure 23 (1.5)30 (2.3)0.09 History of myocardial infarction 42 (2.7)25 (2.0)0.19 History of asthma 129 (8.3)109 (8.5)0.83 Chronic lung disease 20 (1.3)49 (3.8)<0.001 Active solid organ malignancy 106 (6.8)53 (4.1)0.002 Diabetes mellitus 115 (7.4)100 (7.8)0.68 Hypertension 234 (15.0)245 (19.1)0.004 Peptic ulcer disease 39 (2.5)8 (0.6)<0.001 Cerebrovascular disease 56 (3.6)50 (3.9)0.67 Chronic liver disease 18 (1.2)34 (2.7)0.003 Chronic kidney disease 14 (0.9)8 (0.6)0.41 Connective tissue disease 47 (3.0)49 (3.8)0.24 Dementia 28 (1.8)19 (1.5)0.51 Psychiatric illness 67 (4.3)67 (5.2)0.25 Systemic steroid use (≥ 5 mg) in the last 28 days 37 (2.4)26 (2.0)0.53 Chemotherapy in the last 28 days 33 (2.1)29 (2.3)0.80 HIV 3 (0.2)1 (0.1)0.42Time of visit to the ED Daytime (8:00-16:59) 795 (51.1)624 (48.8)Ref. Night (17:00-23:59) 540 (34.8)437 (34.1)0.72 Late-night (0:00-7:59) 220 (14.1)219 (17.1)0.03Day of ED visit Weekday (Monday through Friday) 808 (52.0)651 (50.9)Ref. Weekend (Saturday and Sunday) or holiday 747 (48.0) 629 (49.1)0.56Seasonality April-September (spring and summer) 811 (52.1)544 (42.5)Ref. October-March (autumn and winter) 744 (47.9)736 (57.5)0.004NOTE. Data are presented as a number (%) unless otherwise specified.Abbreviations: ED, emergency department; COPD, chronic obstructive pulmonary diseaseSupplementary Table 4. Characteristics of physicians prescribing discharge antimicrobials in the emergency department (N=2,835)CharacteristicsPre-intervention period(N=1,555)Intervention period(N=1,280)Department Emergency Department927 (59.6)832 (65.0) Department of Medicine a167 (10.7)128 (10.0) Department of Surgery b421 (27.1)320 (25.0)Occupational status of prescribing physicians Resident958 (61.6)832 (65.0) Physician in a medical subspecialty c269 (17.3)128 (10.0) Physician in a surgical subspecialty c328 (21.1)320 (25.0)Prescribing physician’s post graduate year ≤ 3418 (26.9)459 (35.9) 4-7774 (47.8)561 (43.8) ≥ 8363 (23.3)260 (20.3)Sex Male991 (63.7)840 (65.6) Female564 (36.3)440 (34.4)NOTE. Data are presented as a number (%) unless otherwise specified.a Medical department includes the department of general medicine and the pulmonary, gastroenterology, nephrology, and infectious diseases departments.b Surgical department includes the departments of general surgery, otorhinolaryngology, urology, obstetrics/gynecology, oral surgery, orthopedics, plastic surgery, neurosurgery, and dermatology.c Physicians in subspecialties include subspecialty fellows and attending physicians.Supplementary Table 5. Interrupted time-series analysis of changes in APD trendsRegression interceptPre-intervention trend Changeafter the start of interventionPChange intrend during intervention periodPNumber of antimicrobial prescriptions43.70 (37.73 to 49.73)-0.19(-0.98 to 0.59)-8.57(-15.92 to 1.22)0.03+1.08(0.10 to 2.07)0.03Proportion of appropriate prescriptions40.70(33.26 to 48.23)+1.18(0.23 to 2.11)+18.07(9.68 to 26.50)<0.01+0.24(-1.19 to 1.24)0.97Proportion of overall misuse prescriptions59.26(51.77 to 66.74)-1.18(-2.12 to -0.23)-18.01(-26.43 to -9.69)<0.01-0.03(-1.24 to 1.19)0.97Unnecessary prescriptions31.19(25.44 to 36.94)-0.38(-1.22 to 0.46)-16.41(-23.90 to -8.92)<0.001+0.13(-0.96 to 1.22)0.81 Inappropriate prescriptions24.84(22.58 to 27.10)-0.76(-1.19 to 0.34)-3.08(-6.87 to 0.70)0.10+0.03(0.58 to 0.64)0.92 Suboptimal prescriptions3.23(1.64 to 4.82)-0.03(-0.25 to 0.19)+1.49(-1.26 to 4.23)0.27-0.19(-0.54 to 0.16)0.28Data are presented as mean monthly prescriptions per 1,000 visits with 95% confidence intervals unless otherwise specified. Supplementary Table 6. Details of prescribing patterns in 250 physicians in the emergency departmentNumber of physicians(N =250)Number of discharge antimicrobial prescriptions per physician, median (range) 4 (1-32)Number of physicians with at least one episode of misuse of discharge antimicrobial prescription139 (55.6)Number of physicians prescribing antimicrobials appropriately on the next prescribing occasion 97/139 (69.8)Number of physicians with more than two episodes of misuse of discharge antimicrobial prescription 59 (23.6)Number of physicians with at least one episode of unnecessary discharge antimicrobial prescription 72 (28.8)Number of physicians prescribing antimicrobials appropriately on the next prescribing occasion36/72 (50.0)Number of physicians with more than two episodes of unnecessary discharge antimicrobial prescription 22 (8.8)Number of physicians with at least one episode of inappropriate discharge antimicrobial prescription 84 (33.6)Number of physicians prescribing antimicrobials appropriately on the next prescribing occasion47/84 (56.0)Number of physicians with more than two episodes of inappropriate discharge antimicrobial prescription 24 (16.0)Number of physicians with at least one episode of suboptimal discharge antimicrobial prescription 28 (11.2)Number of physicians prescribing antimicrobials appropriately on the next prescribing occasion14/28 (50.0)Number of physicians with more than two episodes of suboptimal discharge antimicrobial prescription10 (4.0)Supplementary Table 7. Diagnosis for discharge antimicrobial prescriptions in the ED (N=2,835)Physician’s diagnosisPre-intervention period(N=1,555)Per 1,000 visitsInterventionperiod(N=1,280)Per 1,000 visits Sinusitis 34 (2.2)0.918 (1.4)0.5 Pharyngitis103 (6.6)2.896 (7.5)2.8 Acute tonsillitis 19 (1.2)0.534 (2.7)1.0 Other upper respiratory tract infections 10 (0.6)0.2 1 (0.1)0.03 Acute otitis media 42 (2.7)1.224 (1.9)0.7 Acute otitis externa 8 (0.5)0.22(0.2)0.06 Odontogenic infection 18 (1.2)0.531 (2.4)0.9 Neck infection 1 (0.1) 0.031 (0.1)0.03 Bronchitis 23 (1.5)0.711 (0.9)0.3 Asthma attack2 (0.1) 0.061 (0.1)0.03 Pneumonia277 (17.8)7.6216 (16.9) 6.4 COPD exacerbation7 (0.5)0.220 (1.6) 0.6 Urinary tract infection213 (13.7)5.9210 (16.4) 6.2 Sexually transmitted disease22 (1.4)0.617 (1.3) 0.5 Other genitourinary infections 9 (0.6)0.28 (0.6) 0.2 Skin and soft tissue infection233 (15.0)6.4267 (20.9) 7.9 Prophylaxis for wound infection after traumatic injury162 (10.4)4.561 (4.8) 1.8 Animal bite90 (5.8)2.589 (7.0) 2.6 Intra-abdominal infection118 (7.6)3.299 (7.8) 3.0 Gastroenteritis38 (2.4)1.013 (1.0) 0.4“Just in case use” despite low likelihood of bacterial infection 92 (5.9)2.540 (3.1) 1.2 Febrile neutropenia6 (0.4)0.24 (0.3)0.12Others *28 (1.8)0.817 (1.3)0.5NOTE.Data are presented as a number (%) unless otherwise specified.Abbreviations: COPD, chronic obstructive pulmonary disease* Others include miscellaneous bacterial infections (N=9 in the pre-intervention period, N=11 in the intervention period), sialadenitis (N=7, N=3), lymphangitis (N=6, N=0), bursitis (N=4, N=3), and septic arthritis (N=2, N=0). Supplementary Figure 1. Description of the study population.References ADDIN EN.REFLIST 1.Chow AW, Benninger MS, Brook I, et al. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin Infect Dis. Apr 2012;54(8):e72-e112.2.Choby BA. Diagnosis and treatment of streptococcal pharyngitis. Am Fam Physician. Mar 01 2009;79(5):383-390.3.Group ESTG, Pelucchi C, Grigoryan L, et al. Guideline for the management of acute sore throat. Clin Microbiol Infect. Apr 2012;18 Suppl 1:1-28.4.Neff MJ, American Academy of P, American Academy of Family P. AAP, AAFP release guideline on diagnosis and management of acute otitis media. Am Fam Physician. Jun 01 2004;69(11):2713-2715.5.National Institute for Health and Care Execellence Otitis media (acute): antimicrobial prescribing (NICE Guideline 91). 2018.6.Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. Mar 01 2007;44 Suppl 2:S27-72.7.Vogelmeier CF, Criner GJ, Martinez FJ, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report. GOLD Executive Summary. Am J Respir Crit Care Med. Mar 01 2017;195(5):557-582.8.Gupta K, Hooton TM, Naber KG, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. Mar 01 2011;52(5):e103-120.9.Riddle MS, DuPont HL, Connor BA. ACG Clinical Guideline: Diagnosis, Treatment, and Prevention of Acute Diarrheal Infections in Adults. Am J Gastroenterol. May 2016;111(5):602-622.10.Solomkin JS, Mazuski JE, Bradley JS, et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin Infect Dis. Jan 15 2010;50(2):133-164.11.Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. Clin Infect Dis. Jul 15 2014;59(2):147-159.12.Hoff WS, Bonadies JA, Cachecho R, Dorlac WC. East Practice Management Guidelines Work Group: update to practice management guidelines for prophylactic antibiotic use in open fractures. J Trauma. Mar 2011;70(3):751-754.13.Sexually Transmitted Diseases: Summary of 2015 CDC Treatment Guidelines. J Miss State Med Assoc. Dec 2015;56(12):372-375.14.Freifeld AG, Bow EJ, Sepkowitz KA, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of america. Clin Infect Dis. Feb 15 2011;52(4):e56-93.15.Fleming-Dutra KE, Hersh AL, Shapiro DJ, et al. Prevalence of Inappropriate Antibiotic Prescriptions Among US Ambulatory Care Visits, 2010-2011. JAMA. May 3 2016;315(17):1864-1873.16.Spivak ES, Cosgrove SE, Srinivasan A. Measuring Appropriate Antimicrobial Use: Attempts at Opening the Black Box. Clin Infect Dis. Dec 15 2016;63(12):1639-1644.17.Gyssens IC, van den Broek PJ, Kullberg BJ, Hekster Y, van der Meer JW. Optimizing antimicrobial therapy. A method for antimicrobial drug use evaluation. The Journal of antimicrobial chemotherapy. Nov 1992;30(5):724-727. ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download