RESUMO
This study intends to explore the responses of local government during the COVID-19-induced lockdown in the rural areas, with particular emphasis on Bangladesh. By adopting a qualitative phenomenological research approach and employing multi-method data collection techniques (for instance, Key Informant Interview (KII), Focus Group Discussion (FGD), participant observation, and content analysis), this study found that the local governments managed the crisis of the pandemic relatively well with its limited manpower and funding through adequate preparedness and prevention strategies; effective emergency responses; and consolidated post-lockdown measures. The study revealed that the Bangladesh local government promptly took some essential actions, such as preparedness and prevention, arrangement of home quarantine and isolation, the training program for readiness, and disseminated crucial information to the local people during the pandemic, such as using masks, hand washing and sanitizing, and social distancing. Besides, the local government delivered relief, such as food and non-food items and financial support. Furthermore, the rural local government took post-lockdown responses to tackle pandemic in rural Bangladesh. Nevertheless, the service delivery individuals from local governance encountered numerous challenges, like scarcity of manpower, less support, and superstition, while providing services during the pandemic.
RESUMO
The widespread use of carbapenems has caused a notable spread of carbapenem-resistant Klebsiella pneumoniae (CRKP). The incidence of CRKP-associated infections is rising significantly in neonatal intensive care units (NICUs), which poses a grave challenge to clinical treatment. This paper is to highlight the drug treatment of CRKP with purulent meningitis in children and explore the safety of levofloxacin in children. We retrospectively analyzed the clinical data of combination therapy with levofloxacin and aztreonam in a newborn with purulent meningitis caused by CRKP. As clinical pharmacists, we evaluated the risks and benefits of quinolones for anti-infective treatment in newborns, helped clinicians adjust the anti-infective protocol of levofloxacin combined with aztreonam and provided pharmaceutical care throughout the course of treatment. In the end, the child had no fever, no dyspnea, and no obvious abnormalities in brain color Doppler ultrasound. The intracranial infection was finally controlled, and the child improved and was discharged, with no apparent neurological, skeletal, joint, tendon, or cardiac adverse events. For newborns with CRKP-associated purulent meningitis, fluoroquinolones combined with other drugs such as polymyxin, tigecycline, aminoglycosides, minocycline, that Klebsiella pneumoniae is susceptible to (when no safe and effective anti-infective alternatives are available) can reduce the mortality rate of newborns with purulent meningitis caused by carbapenem-resistant gram-negative bacteria. We analyzed the drug resistance mechanisms of CRKP, the selection of antibiotic agents, the safety of quinolones in children, the permeability of the blood-brain barrier to quinolones, and the selection of the quinolone dose. Personalized combination therapy improves treatment outcomes and reduces adverse reactions, especially in patients with resistant bacteria infection.
