Aims: Intravenous ibuprofen (IVIB) has been approved in the treatment of postoperative pain and fever in adults, but the application of multiple- or single- dosage IVIB remains divergent in clinical practice. This study aims to evaluate the efficacy and safety of IVIB in the management of postoperative pain and fever in adults who were unable to take oral medicine. Methods: A systematic review and meta-analysis was conducted based on randomized controlled trials (RCTs) regarding postoperative pain and fever management comparing IVIB with placebo, or other analgesic and antipyretic agents from 8 databases. Risk of bias and quality of evidence assessment were performed. The primary outcomes mainly included visual analogue scale (VAS) score within postoperative 24h and the reduction of temperature. Results: Twenty-three RCTs with 3716 participants were included. For postoperative pain, moderate-to-low certainty evidence indicated that IVIB was associated with lower postoperative VAS scores than placebo, with MD ranging between -3.53 (95% CI, -4.32 to -2.75) at 0 minute to -0.96 (95% CI, -1.35 to -0.57) at 24 hours. Compared to intravenous acetaminophen, IVIB appeared lower VAS scores (MD, -1.54 at 0min; -0.36 at 24h). For fever, IVIB appeared satisfactory antipyretic efficiency in a short period of time, but there was no difference between IVIB and intravenous acetaminophen. Moderate-to-low certainty evidence indicated that IVIB was well tolerated in both pain and fever management. Conclusions: Moderate-to-low certainty evidence supported that adults with postoperative pain and fever who were unable to take oral medicine would benefit from IVIB.

Background: Infections are common complications after stroke and associated with unfavorable outcomes. We evaluated the efficacy and safety of prophylactic antibiotics for post-acute stroke infection. Methods: We searched PubMed, Embase, the Cochrane Library, SinoMed, China National Knowledge Infrastructure, and WanFangData from inception to February 15th, 2022. We calculated the pooled risk ratio (RR) and mean differences (MDs) with 95% confidence interval (CI), evaluated the risk of bias and conducted sensitivity analysis with RevMan version 5.4.1 and Stata version 14.0 software. The overall quality of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Results: Twelve studies (4809 participants) were included in this meta-analysis. There was no significant difference in the mortality rate [RR 1.03 (95% Cl: 0.91-1.16)], pneumonia [RR 0.94 (95% CI: 0.79-1.11)], and the incidence of adverse events between the prophylactic antibiotics and control groups. Prophylactic antibiotics significantly reduced the incidence of infections [RR 0.72 (95% Cl: 0.58-0.89)], and urinary tract infections [RR 0.39 (95% Cl: 0.3-0.49)] in patients with acute stroke. We performed a subgroup analysis and found a decreasing trend in pneumonia in patients with early prophylactic use of antibiotics within 24 hours after admission [RR 0.81 (95%CI: 0.62-1.07)] as compared with those using prophylactic use of antibiotics within 48 hours after admission [RR 0.94 (95%CI: 0.79-1.11)]. Conclusions: Prophylactic antibiotics did not significantly reduce the mortality rate and pneumonia in patients with acute stroke but reduced the incidence of infections and urinary tract infections.

Objectives: A lot of medication risks related to high-dose methotrexate (HDMTX) therapy still remain to be identified and standardized. This study aims to establish an evidence-based practice guideline for individualized medication of HDMTX. Methods: The practice guideline was launched by the Division of Therapeutic Drug Monitoring, Chinese Pharmacological Society. The guideline was developed following the WHO handbook for guideline development and the methodology of evidence-based medicine (EBM). The guideline was initially registered in the International Practice Guidelines Registry Platform (IPGRP-2017CN021). Systematic reviews were conducted to synthesis available evidence. A multicenter cross-sectional study was conducted by questionnaires to evaluate patients’ perception and willingness on individualized medication of HDMTX. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to rate the quality of evidence and to grade the strength of recommendations. Results: Multidisciplinary working groups were included in this guideline, including clinicians, pharmacists, methodologists, pharmacologists and pharmacoeconomic specialists. A total of 124 patients were involved to integrate patient values and preferences. Finally, the guideline presents 28 recommendations, regarding evaluation prior to medication (renal function, liver function, pleural effusion, comedications, genetic testing), pre-treatment and routine dosing regimen, therapeutic drug monitoring (necessity, method, timing, target concentration), leucovorin rescue (initial timing, dosage regimen and optimization), management of toxicities. Of them, 12 are strong recommendations. Conclusions: We developed an evidence-based practice guideline with respect to HDMTX medication using a rigorous and multidisciplinary approach. This guideline provides comprehensive and practical recommendations involving the whole process of HDMTX medication to health care providers.

Antibiotic concentration in pancreas tissue is very important for the treatment of severe acute pancreatitis (SAP) with infection. We report a case of a 44-year-old female with SAP on treatment of vancomycin. The time courses of vancomycin concentration in serum and pancreas tissue of the patient was described. This case demonstrated that it took about 30 minutes for vancomycin to get through from serum to pancreas tissue and about 76% of vancomycin could move into pancreas tissue for SAP patients.