Do we need to combine meropenem with colistin in multidrug-resistant infections?

Colistin is often used as combination therapy in multidrug-resistant infections. The antibiotics used in combination with colistin include meropenem, rifampicin, and minocycline. Combination therapy is favored for several theoretical reasons. Colistin levels in the lung have often resulted in subtherapeutic levels in animal models. Heteroresistance, a phenomenon by which subsets of bacteria may be resistant,… Continue reading Do we need to combine meropenem with colistin in multidrug-resistant infections?

The BICAR study – does bicarbonate therapy help in metabolic acidosis?

In the BICAR-ICU study Jaber et al. randomized critically ill patients with metabolic acidosis with pH less than 7.2 and bicarbonate less than 22 mmol/L to receive 4.2% bicarbonate, targeting a pH of 7.3. They compared outcomes with a control group that did not receive bicarbonate. Three hundred and eighty-nine patients were enrolled, with 195… Continue reading The BICAR study – does bicarbonate therapy help in metabolic acidosis?

Platelet transfusion in Dengue Fever

Following the monsoon rains, we see several cases of Dengue in our ICUs. Many of these patients develop severe thrombocytopenia, with the counts often dropping below 20,000. I feel most clinicians would strongly consider prophylactic platelet transfusion (without any evidence of clinical bleeding) when the count drops to between 10–20,000. However, there is a reasonably… Continue reading Platelet transfusion in Dengue Fever