Updates
Updates
Azithromycin for PCP Prophylaxis!
Source: Dunne MW, et al. Lancet 1999;354:891-895.
Both in vitro and animal studies demonstrate that macrolide and azalide antibiotics are active against Pneumocystis carinii pneumonia (PCP). Azithro-mycin, in combination with sulphamethoxazole, was more active against PCP in immunosuppressed rats than either agent used alone. With this in mind, Dunne and colleagues (including myself and others from the California Collaborative Treatment Group) examined the effect of azithromycin, administered as prophylaxis for Mycobacterium avium complex (MAC) infection in patients with AIDS, on their additional risk of PCP.
A total of 693 patients with CD4 cell counts less than 100/mm3 were randomly assigned to receive azithromycin 1200 mg weekly, rifabutin 300 mg daily, or the combination. Patients were followed for up to two years. A total of 78 subjects had 85 episodes of PCP; 48 (56%) were primary. The diagnosis was confirmed by cytology in 52% of cases. The remainder were based on empiric criteria and response to anti-PCP therapy.
In addition to a substantial reduction in the risk of MAC infection, as well as a 50% reduction in the incidence of other bacterial infections such as sinusitis and bronchitis, patients receiving azithromycin had a 45% lower risk of PCP compared with those receiving rifabutin alone. More than twice as many episodes of PCP occurred in patients receiving rifabutin alone compared with the azithromycin group.
Administration of azithromycin 1200 mg weekly, in combination with TMP-SMX, is a cost-effective, well-tolerated way to achieve systemic prophylaxis against MAC, PCP, respiratory pathogens, as well as, possibly, toxoplasmosis in HIV-infected patients at risk. Experience suggests that splitting the dose on two consecutive days may be beneficial in patients with gastrointestinal intolerance to the once weekly dose. The 1000 mg packet used for patients with sexually transmitted disease may be another relatively cheap and easy option.
Ever Want to Be a Ship’s Doctor?
Source: Dahl E. J Travel Med 1999; 6:168-171.
Ever dreamed of being a cruise physician on a large ship? As this article demonstrates, it’s no picnic. Physicians and nurses on cruise ships are essentially on call 24 hours per day, often by themselves, handle an astonishing number and array of medical problems, and perform more medical consultations than their shoreside counterparts. Dahl, who is a medical consultant for a large cruise line based out of Los Angeles, cataloged his experience during a 103-day westward cruise from Los Angeles to Fort Lauderdale. The ship docked in 30 ports on five continents. Passengers typically cruised in segments of 16-25 days.
The medical staff consisted of one physician (who was always on call) and two nurse anesthetists. A total of 3033 consultations (206 per week) were performed, 77% of which required the physician’s attention, with an average of three consultations per passenger. Skin problems were the most frequent complaint among the crew (26%), while respiratory illness was more common among passengers (29%). Gastroenteritis requiring medical attention occurred in 16% of passengers and 13% of crew; half of the cases occurred after visiting India. Cardiovascular complications occurred in 7% of passengers, including one death due to myocardial infarction (MI). Twelve subjects (8 passengers, 4 crew) required observation in sick bay for such ailments as heart failure (n = 2), COPD (n = 2), leg fracture (n = 2), severe gastroenteritis requiring rehydration (n = 2), and one case each of pneumonia and MI, chest pain, migraine, and appendicitis; four patients required hospitalization ashore. In addition, 31 crew and three passengers required specialty medical care ashore, and 12 required dental care ashore. Notably, a lack of adequate medical insurance coverage complicated several medical evacuations and reboarding after illness.
While the ship’s crew, most of whom were young service providers, required more frequent medical attention, the passengers, most of whom were elderly, required more extensive care and more diagnostic studies. Being a ship’s doctor may present an exciting challenge different from the usual medical practice but, as this study shows, it is a full-time, labor intensive job.
Salmonellaand Pig’s Ear Dog Treats
Source: ProMED mail, September 10, 1999; www.healthnet.org.
Health authorities in canada have reported 16 cases of Salmonella infection in people who handled pig’s ear treats for dogs. Pig’s ears are dried and flavored, and cost about $20 for about 30 jumbo ears (4 lbs.). While it was not known whether one or more manufacturers were involved, the cases have thus far been limited to the province of Alberta. Dog owners in Alberta were urged to avoid using the treats or to wash their hands carefully after handling the ears. This latter bit of advice may not be sufficient, as dogs may also be susceptible to Salmonella infection. Although no other similar outbreaks have been reported, I learned from my veterinarian that, the risk of Salmonella aside, they generally discourage pig’s ears for dogs because of the risk of intestinal obstruction when not adequately chewed.
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.