Becker's Hospital Review

79 FINANCE CMO / CARE DELIVERY there's maybe some bias there, but I do think there does seem to be a preponderance of women." In the Chicago area, Dr. Karnik and Dr. Wasse have observed the same at UChicago Medicine and Rush, respectively. While she's seen both men and women, Dr. Karnik said there's been a mild trend of more women seeking care at UChicago's recovery clinic. "It's really hard to know if there is an actual causation, right? Between if you're a woman you're going to feel more side effects versus if there are any other confounding factors," Dr. Karnik explained. "Maybe cer- tain people are just more vocal presenting their symptoms… it's hard to really tease out." Some experts have hypotheiszed that sex-based differences in the body's immune response are behind the higher prevalence of wom- en experiencing prolonged symptoms. "It may be that the immune response is different in women, so you then have a continued inflam- matory reaction that then leads to a higher likelihood of having long COVID-19," said Dr. Chris Brightling, respiratory medicine profes- sor at the University of Leicester in the U.K. and chief investigator of the country's national research effort on the long term effects of COVID-19. 3. ere are long-haulers of all ages. While older people with COVID-19 were more likely to require hospitalization during earlier stages of the pandemic, long-haulers range in age. At Rush, there are two age ranges of patients predominantly seen at the clinic: those aged 30 to 40 and those over the age of 65, Dr. Wasse said. Dr. Cerrone and Dr. O also referenced that a wider age range of peo- ple are experiencing persistent symptoms. Early data has indicated that an increasing number of children develop long-term problems. While formal data on the condition is still incomplete, Britain's Office for National Statistics in February re- leased figures that showed about 13 percent of children under 11 who contract COVID-19 still had at least one symptom aer five weeks. at figure jumped to 15 percent among children aged 12-16. 4. ere are a range of lingering symptoms. "It is definitely not a one-size-fits-all condition," Dr. O said. However, there are a number of common symptoms patients are presenting with, some of which are similar to those experienced during acute COVID-19 illness, and others that are new. Nearly all of the long COVID-19 clinic physicians Becker's spoke to mentioned neurocognitive symptoms such as brain fog, impaired concentration, fatigue and headaches. Insomnia and sleep disturbanc- es are also common, Dr. Lyons and Dr. O said. Pulmonary symptoms including shortness of breath and chronic cough have been just as common. At Atlantic's long COVID-19 pro- gram, Dr. Cerrone said there's been a subset of patients whose oxygen levels drop despite related testing not indicating any problems. "All the testing is negative, but when we walk them, aer about four or five minutes their oxygen levels just drop." Four of the six COVID-19 recovery clinic leaders also pointed out heart palpitations. Finally, depression and anxiety have been prominent. "We have found that patients benefit from a multi-disciplinary ap- proach to assess individual symptoms," Dr. O said of Cedars-Sinai's recovery program. "We compose a treatment plan that may incorpo- rate medications and/or therapy to improve function while recovery from COVID-19 continues." n American College of Physicians: Shorten antibiotic duration for these 4 bacterial infections By Erica Carbajal I n an effort to combat antibiotic resistance, the American College of Physicians outlined best practices to shorten the duration of antibiotic prescriptions for several com- mon bacterial infections in a report published April 6 in Annals of Internal Medicine. The recommendations address the following bacterial in- fections: acute bronchitis with chronic obstructive pulmo- nary disease exacerbations, community-acquired pneu- monia, urinary tract infections and cellulitis. Here is the guidance, as outlined in the report: • For patients with COPD exacerbations and acute uncom- plicated bronchitis who have clinical signs of a bacterial infection, antibiotic treatment duration should be limit- ed to five days. • For patients with community-acquired pneumonia, anti- biotic treatment should last a minimum of five days. After that, extending the use of antibiotics should be guided by validated measures of clinical stability, such as a re- turn of normal vital signs and the ability to eat. • For women with uncomplicated bacterial cystitis, antibi- otic duration should last five days if treating with nitrofu- rantoin, three days with trimethoprim-sulfamethoxazole, or a single dose when treating with fosfomycin. • For men and women with uncomplicated pyelonephri- tis, clinicians should limit either fluoroquinolones to five to seven days, or trimethoprim-sulfamethoxazole for 14 days based on antibiotic susceptibility. • For patients with nonpurulent cellulitis, prescribe a course of antibiotics active against streptococci for five to six days for those able to self-monitor and who can follow-up with primary care. n

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