Mar 20, 2013
Review: Hold the line on vancomycin as first-line agent for MRSA
Vancomycin should remain the standard of care for most infections caused by methicillin-resistant Staphylococcus aureus (MRSA), as per 2011 treatment guidelines from the Infectious Diseases Society of America (IDSA), even though reports of treatment failure in cases with high but susceptible vancomycin minimum inhibitory concentrations (MICs) are not uncommon, say the authors of a review yesterday in Clinical Infectious Diseases. The authors point out that cases of persistant MRSA may not represent vancomycin failure at all but rather factors in the poorly understood natural history of MRSA bacteremia, the presence of a residual source of infection, altered pathogen virulence, and/or MIC "creep." Among the drawbacks of substituting other agents for vancomycin is the danger of developing resistance; vancomycin was in widespread use for 40 years before resistance emerged, the authors say, whereas resistance to the newer agents daptomycin and linezolid arose shortly after their introduction. Another drawback of the newer drugs is cost: Although there have been reports of shortened patient stays when treatment with the more expensive alternatives to vancomycin are used, this could be due to improved patient management more than to choice of antibiotic, the authors say.
Mar 19 Clin Infect Dis abstract
Big city populations shoulder TB burden in Americas
At a special event yesterday in advance of World TB Day, health officials from the Pan American Health Organization (PAHO) and the World Health Organization (WHO) called for more intensive efforts to curb tuberculosis (TB) in the Americas, especially in vulnerable populations in large cities. The region made progress in battling the disease from 1990 to 2011, with deaths declining 61% and infections dropping 62%, which PAHO said has been achieved with a global strategy based on timely diagnosis and universal treatment with the proper medications. However, many of the region's countries face obstacles in reducing the burden of the disease because of the spread of multidrug-resistant TB, coinfections with HIV/AIDS, and weaknesses in healthcare systems, according to a PAHO/WHO press release. The disease is concentrated in vulnerable groups such as ethnic minorities, migrant groups, and those with poor access to medical care. PAHO said in 2011 there were about 260,000 new TB cases and about 30,000 deaths. It estimated that about 60,000 cases went undiagnosed that year. To address the challenges, PAHO and WHO, with support from the US Agency for International Development (USAID), are implementing a TB initiative in large Latin American and Caribbean cities that focuses on the education, employment, urban development, and health needs of the most vulnerable communities.
Mar 19 PAHO/WHO press release
Ontario doctors issue warning, urge action about antibiotic resistance
Ontario doctors today warned that they are having a more difficult time treating antibiotic-resistant infections, and they called on federal and provincial governments to address the issue. The Ontario Medical Society (OMA) outlined its concerns in a 15-page policy paper titled "When Antibiotics Stop Working." Doug Weir, MD, president of the OMA, said in a press release. "Patients are at risk of becoming sicker, taking longer to recover and in some cases dying from previously treatable diseases." The OMA had several key recommendations, including developing a system to monitor veterinary antibiotics in Ontario, establishing an independent group that can develop antibiotic use guidelines for the province's doctors, instituting a prescription requirement for animal antibiotics, and closing a loophole that allows farmers to import their own antibiotics.
Mar 20 OMA press release
Mar 20 OMA report
Mumps hits students in Richmond
The University of Richmond is experiencing a rare outbreak of mumps, according to WWBT in Richmond and campus officials. The Virginia Health Department had laboratory confirmation in 5 to 10 of the cases as of yesterday, and another 10 students showed symptoms suggesting the disease. Although most US children are vaccinated for mumps through the measles, mumps, and rubella (MMR) vaccine, rare cases do occur, the story said. Foreign travel could be to blame. Symptoms include fever, headache, muscle aches, and sometimes loss of appetite, swollen cheeks, and inflammation of internal organs. The disease is spread through droplets of bodily fluids, mainly saliva, from coughing and sneezing. Students, parents, faculty, and staff have been informed of the outbreak through e-mail and given guidance on lowering the risk of transmission.
Mar 18 (updated Mar 19) WWBT story
Mar 18 University of Richmond health advisory