Management of Staphylococcus aureus Infections - December 15, 2005 -- American Family Physician
More than half of all patients who develop S. aureus infections while in the hospital are found to have MRSA (methicillin resistant Staph. aureus). Vancomycin is the drug of choice in the treatment of MRSA. With the development of vancomycin resistant strains, it is important for physicians and patients to be aware of alternatives to vancomycin. Luckily, there are several alternatives available.
A fairly recent review article from American Family Physician (AFP), summarizes these alternatives. Linezolid (Zyvox) can be used for all types of MRSA infections, but is especially useful in treating hospital acquired MRSA pneumonia. One article found that it was actually superior to Vancomycin in this setting. Daptomycin (Cubicin) can be used for all complicated MRSA infections EXCEPT pneumonia.
Patients who develop simple MRSA skin infections outside of the hospital can usually be treated with trimethoprim/sulfamethoxazole (Bactrim), doxycycline, or possibly a fluoroquinolone such as gati- or levofloxicin.
In patients found to have methacillin susceptible S. aureus (MSSA), the treatment should be easier. Oral dicloxacillin or IV nafcillin or oxacillin (known as semi-synthetic penicillins) are preferred. Oral cephalexin (Keflex) or IV cefazolin (Ancef) (known as 1st generation cephalosporins) are a good alternative. In this setting, Vancomycin should be reserved for patients who are allergic to penicillins.
The article goes on to describe aspects of treatment specific to the various body systems that may be infected by S. aureus. ...very good reading.
Friday, March 23, 2007
Friday, March 02, 2007
Multifactorial approach effective for treatment of IBS
Treatment of Irritable Bowel Syndrome - December 15, 2005 -- American Family Physician
Using an algorithm adapted from a New England Journal of Medicine article, a recent review in AFP promotes a multi factorial approach to the treatment of Irritable Bowel Syndrome (IBS). In addition to relaxation, stress reduction, education, and exercise, patients with mild IBS usually respond to dicyclomine (an antispasmodic) and peppermint. Patients with constipation do especially well with the addition of guar gum, fiber, exercise, and/or laxatives. Those who suffer from diarrhea or pain usually respond to the addition of immodium and TCAs (tricyclic antidepressants). Other treatments, including, 5-HT3 antagonists (Alosetron), 5-HT4 agonists (Tegaserod, or Zelnorm), Cisapride, probiotics, or cognitive-behavioral therapy, can be tried if other therapies fail.
Peppermint is especially interesting because it works well in several ways. It is an antispasmodic, anesthetic, and relieves nausea. As an herbal, it can be given over the counter or as a tea. Importantly, it may be acceptable to many patients who are hesitant to start a new 'medication'.
For those with constipation, guar gum is interesting for much the same reason as pepperment. It too can be given over the counter, and, importantly, patients tend to actually like it better than fiber.
Patients with diarrhea have two very good choices. We all know immodium, but it is important to know that it does suprisingly well in the treatment of IBS. In addition, TCAs such as desipramine (my favorate), amitryptyline, and clomipramine, work very well in low doses. Patients should know that the mechanism of action for TCA's is likely seperate from that which is involved in the antidepressant quality of the drugs (and thus you are NOT saying that they are crazy when prescribing the medication).
In short, patients with IBS have no reason to go untreated. There exist multiple good therapies, and good understanding and treatment of the illness is achievable.
Using an algorithm adapted from a New England Journal of Medicine article, a recent review in AFP promotes a multi factorial approach to the treatment of Irritable Bowel Syndrome (IBS). In addition to relaxation, stress reduction, education, and exercise, patients with mild IBS usually respond to dicyclomine (an antispasmodic) and peppermint. Patients with constipation do especially well with the addition of guar gum, fiber, exercise, and/or laxatives. Those who suffer from diarrhea or pain usually respond to the addition of immodium and TCAs (tricyclic antidepressants). Other treatments, including, 5-HT3 antagonists (Alosetron), 5-HT4 agonists (Tegaserod, or Zelnorm), Cisapride, probiotics, or cognitive-behavioral therapy, can be tried if other therapies fail.
Peppermint is especially interesting because it works well in several ways. It is an antispasmodic, anesthetic, and relieves nausea. As an herbal, it can be given over the counter or as a tea. Importantly, it may be acceptable to many patients who are hesitant to start a new 'medication'.
For those with constipation, guar gum is interesting for much the same reason as pepperment. It too can be given over the counter, and, importantly, patients tend to actually like it better than fiber.
Patients with diarrhea have two very good choices. We all know immodium, but it is important to know that it does suprisingly well in the treatment of IBS. In addition, TCAs such as desipramine (my favorate), amitryptyline, and clomipramine, work very well in low doses. Patients should know that the mechanism of action for TCA's is likely seperate from that which is involved in the antidepressant quality of the drugs (and thus you are NOT saying that they are crazy when prescribing the medication).
In short, patients with IBS have no reason to go untreated. There exist multiple good therapies, and good understanding and treatment of the illness is achievable.
Thursday, March 01, 2007
Dipstick sufficient, no imaging necessary for uncomplicated childhood UTI's
Urinary Tract Infection in Children - December 15, 2005 -- American Family Physician
A review article in American Family Physician reports that children with uncomplicated UTI's show no benefit from imaging work-ups. While it may be true that imaging may reveal relatively common vesicourethral reflux or, less commonly, subsequent renal scarring leading to potential adult hypertension, effective treatments for these conditions are wonting, and clinical efficacy for the tests has not been shown. Older children with classic symptoms of UTI were best served by initial urine cultures and empiric antibiotics, while infants with unexplained fever and older children with nonclassic symptoms did best with initial dipstick testing.
A negative dipstick result can effectively rule out UTI. Physicians are free to treat positive cultures for as long as they want, as long as it lasts more than one day. Cranberry juice has not been shown to be effective in preventing UTI's. Although circumcision has been shown to reduce the incidence of UTI's, the benefit (from this aspect alone) is clearly insufficient to warrant the procedure.
A review article in American Family Physician reports that children with uncomplicated UTI's show no benefit from imaging work-ups. While it may be true that imaging may reveal relatively common vesicourethral reflux or, less commonly, subsequent renal scarring leading to potential adult hypertension, effective treatments for these conditions are wonting, and clinical efficacy for the tests has not been shown. Older children with classic symptoms of UTI were best served by initial urine cultures and empiric antibiotics, while infants with unexplained fever and older children with nonclassic symptoms did best with initial dipstick testing.
A negative dipstick result can effectively rule out UTI. Physicians are free to treat positive cultures for as long as they want, as long as it lasts more than one day. Cranberry juice has not been shown to be effective in preventing UTI's. Although circumcision has been shown to reduce the incidence of UTI's, the benefit (from this aspect alone) is clearly insufficient to warrant the procedure.
Tuesday, February 20, 2007
Washington's addiction to money
The "Beltway Cut"
A good article from Cato org. breaks down Bush's latest budget proposal. The short of it is that Washington still stubbornly refuses to actually reduce spending, choosing instead to rely on empty statistical manipulation. What is clear from this is that, this administration at least, is still incapable of cutting the cord with pet projects and special interest groups. Their analysis has clearly lead them to the belief that by continually increasing the cost of programs, they gain tighter control of the nation's purse strings and, thus, more influence on the levers of power. And though this equation that is almost ubiquitous amongst world leaders, it is clearly unhealthy for a nation and economy.
A good article from Cato org. breaks down Bush's latest budget proposal. The short of it is that Washington still stubbornly refuses to actually reduce spending, choosing instead to rely on empty statistical manipulation. What is clear from this is that, this administration at least, is still incapable of cutting the cord with pet projects and special interest groups. Their analysis has clearly lead them to the belief that by continually increasing the cost of programs, they gain tighter control of the nation's purse strings and, thus, more influence on the levers of power. And though this equation that is almost ubiquitous amongst world leaders, it is clearly unhealthy for a nation and economy.
Sunday, February 18, 2007
Digital Memories
Science & Technology at Scientific American.com: A Digital Life -- [ INFORMATION TECHNOLOGY ] -- New systems may allow people to record everything they see and hear--and even things they c
The sign of a truly great idea is often it's uncanny ability to make the rest of us think, "I already thought of that!" Thus, the MyLifeBits project, which records the activities and experiences of an ordinary person and makes them searchable, strikes many of us as something we all have been striving for. And what an idea! In this manner, we may all achieve immortality! We can organize and review our life in a way never before seen, and link it up to share with others long after we have gone. Wow.
The sign of a truly great idea is often it's uncanny ability to make the rest of us think, "I already thought of that!" Thus, the MyLifeBits project, which records the activities and experiences of an ordinary person and makes them searchable, strikes many of us as something we all have been striving for. And what an idea! In this manner, we may all achieve immortality! We can organize and review our life in a way never before seen, and link it up to share with others long after we have gone. Wow.
Sunday, February 11, 2007
How Wal-mart may save us all
Coverage & Access | Wal-Mart, SEIU Outline Themes To Meet Health Coverage Goal by 2012 - Kaisernetwork.org
One of the more intriguing unusual developments in the evolving health care reform debate is Walmart's push to extend care to all workers. Of course no one is under the illusion that Wal-mart has suddenly developed a heart. The company is clearly still feeling the sting of continued assaults by various labor and left-wing critics. But in case anyone felt that Wal-mart had finally become too big to come up with new and creative solutions to it's problems, they have once again placed themselves in a leading role.
The above article, cited on NPR, PBS, and FoxNews today says that Wal-mart has teamed up with a leading union organization to develop a plan of universal health care reform. At any other time, and by any other author, such a report would likely deserve no attention at all. But Wal-mart, by virtue of it's shear size, can reshape the field of play with such moves. One can look at the effect of Walmarts policy shifts on various other industries for perspective (Wal-mart's decision, for instance, to install solar panels on their stores is reportedly expected to place the solar industry on several year's back order).
In addition, the timing, coming on the heals of moves by several states' (Massachusetts and California most notably) decision to extend health care to all citizens, may just be the push congress needs to finally get off their ass. Our nation's uninsured, the working/nonworking poor, and most of all, those debt laden 20-somethings among us, can only dream...
One of the more intriguing unusual developments in the evolving health care reform debate is Walmart's push to extend care to all workers. Of course no one is under the illusion that Wal-mart has suddenly developed a heart. The company is clearly still feeling the sting of continued assaults by various labor and left-wing critics. But in case anyone felt that Wal-mart had finally become too big to come up with new and creative solutions to it's problems, they have once again placed themselves in a leading role.
The above article, cited on NPR, PBS, and FoxNews today says that Wal-mart has teamed up with a leading union organization to develop a plan of universal health care reform. At any other time, and by any other author, such a report would likely deserve no attention at all. But Wal-mart, by virtue of it's shear size, can reshape the field of play with such moves. One can look at the effect of Walmarts policy shifts on various other industries for perspective (Wal-mart's decision, for instance, to install solar panels on their stores is reportedly expected to place the solar industry on several year's back order).
In addition, the timing, coming on the heals of moves by several states' (Massachusetts and California most notably) decision to extend health care to all citizens, may just be the push congress needs to finally get off their ass. Our nation's uninsured, the working/nonworking poor, and most of all, those debt laden 20-somethings among us, can only dream...
Saturday, February 10, 2007
Louisiana charity health care stays ahead of the curve
FOXNews.com - Louisiana Offers Cervical Cancer Vaccination Order to Protect Girls From HPV - Politics | Republican Party | Democratic Party | Political Spectrum
Louisiana is providing free vaccinations to girls in it's charity healthcare system. The system, which replaces the county hospital system of many other states, is an odd mixture of aging infrastructure and underinvestment, combined with well thought out public health initiatives. This latest campaign, vaccinating girls against HPV infections will ensure that, at least on this matter, being poor in a poor state doesn't mean you get substandard healthcare. More importantly, it will save lives.
Louisiana is providing free vaccinations to girls in it's charity healthcare system. The system, which replaces the county hospital system of many other states, is an odd mixture of aging infrastructure and underinvestment, combined with well thought out public health initiatives. This latest campaign, vaccinating girls against HPV infections will ensure that, at least on this matter, being poor in a poor state doesn't mean you get substandard healthcare. More importantly, it will save lives.
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