5-minute Updates

Guidelines for many infections commonly treated in the community setting are now available in Firstline. Adult guidelines are housed in NS Health Firstline while pediatric and obstetric guidelines are housed in the IWK Firstline app. Moving between the two is an easy process. 

Click on the link below for more information.

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Background

• Point prevalence surveys done by the Antimicrobial Stewardship team have shown that only 75-80% of antimicrobial orders written have a documented indication.
• When OPOR comes into effect, all orders for antimicrobials will require you to select an indication from a drop-down menu before filing the prescription.

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CLINICAL QUESTION: Is 7-days of antibiotics non-inferior to 14-days for (most) bacteremia?.

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Firstline has been available to users within Nova Scotia Health since March 2020 and has over 3000 unique users. Initially, the focus was on acute care guidelines, but over the next few months, we will be expanding to include guidelines for community-based infections.

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• In 2019, about 7.7 million deaths worldwide were associated with 33 different bacterial infections.
  • Almost 5 million of these deaths were associated with antimicrobial resistance (AMR).
• A report released in November 2024 by the World Health Organization (WHO) evaluated the role of vaccines in AMR.

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• As per the Therapeutic Interchange Policy, medication orders for ceftriaxone 2 grams IV q24h were previously interchanged to 1 gram IV q24h for most indications*. 
• Determining the appropriateness of an order for ceftriaxone 2 grams from the pharmacy dispensary is challenging. 
• In addition, certain populations (e.g., obesity, critical illness) may be at higher risk of treatment failure with 1 gram dosing.

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Clinical Laboratory Standards Institute (CLSI) updates for 2023 were released in April, and there are several changes regarding choice and dosing of antimicrobials at NS Health. Firstline and the AMS website have been updated to reflect these changes. Information on the specific changes is attached. If you have any questions, please reach out to the AMS team.

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The NS Health Antimicrobial Stewardship Program was only in existence for 9 months when Accreditation occurred in 2017. There have been many changes since then. This is a brief outline of these changes with the corresponding tests for compliance.

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For full guidance on community acquired pneumonia (CAP) please refer to the information on the AMS website or Firstline app.

This information for adults only. Please refer to IWK Firstline app for pediatrics

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For full guidance please refer to the information on the AMS website or Firstline app.

This information for adults only, please refer to IWK Firstline app for pediatrics.

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