Archive for March 7, 2009

Tuberculosis in Patients with Human Immunodeficiency Virus Infection

N Engl J Medicine 4 Feb 1999; V.340 N.5 p.367-73.

Diane V. Havlir, M.D., and Peter F. Barnes, M.D.

From the Department of Medicine, University of California at San Diego, San Diego (D.V.H.); and the Center for Pulmonary and Infectious Disease Control, University of Texas Health Center, Tyler (P.F.B.).

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March 7, 2009 at 6:29 pm Leave a comment

Treatment of Tuberculosis

American Journal of Respiratory and Critical Care Medicine 15 Feb 2003 V.167 N.4 p.603-62

American Thoracic Society Documents

American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America

This Official Joint Statement of the American Thoracic Society, Centers for Disease Control and Prevention, and the Infectious Diseases Society of America was approved by the ATS Board of Directors October 2002, The Centers for Disease Control and Prevention October 2002, and the Council of the IDSA October 2002.

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March 7, 2009 at 6:27 pm Leave a comment

Management of Tuberculosis in the United States

N Engl J Medicine 19 July 2001; V.345 N.3 p.189-200

Review Article

Peter M. Small, M.D., and Paula I. Fujiwara, M.D., M.P.H.

From the Division of Infectious Diseases and Geographic Medicine, Stanford University Medical Center, Stanford, Calif. (P.M.S.); the Tuberculosis Control Program, New York City Department of Health, New York (P.I.F.); and the Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta (P.I.F.).

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March 7, 2009 at 6:25 pm Leave a comment

Procalcitonin-Guided Antibiotic Use vs a Standard Approach for Acute Respiratory Tract Infections in Primary Care

Archives of Internal Medicine 13 October 2008 V.168 N.18 p.2000-2007

Original Investigation

Matthias Briel, MD; Philipp Schuetz, MD; Beat Mueller, MD; Jim Young, PhD; Ursula Schild, RN; Charly Nusbaumer, PhD; Pierre Périat, MD; Heiner C. Bucher, MD, MPH; Mirjam Christ-Crain, MD

Department of Internal Medicine, Basel Institute for Clinical Epidemiology (Drs Briel, Young, and Bucher), Department of Internal Medicine, Clinic of Endocrinology, Diabetes, and Clinical Nutrition, (Drs Schuetz, Mueller, and Christ-Crain and Ms Schild), and Department of Chemical Pathology (Dr Nusbaumer), University Hospital Basel, Basel, Switzerland; and private general practice, Basel-Riehen, Switzerland (Dr Périat).

Background Acute respiratory tract infections are the most common reason for antibiotic therapy in primary care despite their mainly viral etiology. A laboratory test measuring procalcitonin levels in blood specimens was suggested as a tool to reduce unnecessary prescribing of antibiotics. We consider whether antibiotic therapy guided by procalcitonin reduces the use of antibiotics without increasing the restrictions experienced by patients by more than 1 day.

Methods Fifty-three primary care physicians recruited 458 patients, each patient with an acute respiratory tract infection and, in the physician’s opinion, in need of antibiotics. Patients were centrally randomized to either a procalcitonin-guided approach to antibiotic therapy or to a standard approach. For patients randomized to procalcitonin-guided therapy, the use of antibiotics was more or less strongly discouraged (procalcitonin level, 0.1 or 0.25 µg/L, respectively) or recommended (procalcitonin level, >0.25 µg/L). Follow-up data were collected at 7 days by treating physicians and at 14 and 28 days by blinded interviewers.

Results Adjusted for baseline characteristics, the mean increase at 14 days in days in which activities were restricted was 0.14 with procalcitonin-guided therapy (95% confidence interval [CI], –0.53 to 0.81 days), which met our criterion of an increase in days in which activities were restricted by no more than 1 day. With procalcitonin-guided therapy, the antibiotic prescription rate was 72% lower (95% CI, 66%-78%) than with standard therapy. Both approaches led to a similar proportion of patients reporting symptoms of ongoing or relapsing infection at 28 days (adjusted odds ratio, 1.0 [95% CI, 0.7-1.5]).

Conclusions As an adjunct to guidelines, procalcitonin-guided therapy markedly reduces antibiotic use for acute respiratory tract infections in primary care without compromising patient outcome. In practice, this could be achieved with 1 to 2 procalcitonin measurements in patients for whom the physician intends to prescribe antibiotics.


March 7, 2009 at 3:00 pm Leave a comment

Procalcitonin-Guided Antibiotic Use vs a Standard Approach for Acute Respiratory Tract Infections in Primary Care

Archives of Internal Medicine 13 October 2008 V.168 N.18 p.2007-2008

Invited Commentary

David N. Schwartz, MD

Clinicians treating respiratory tract infections in ambulatory settings must reconcile patients’ frequent expectations for prescriptions for antibiotics (whether perceived or actual1) with evidence that antibiotics confer little, if any, benefit for these common and mostly viral syndromes.2-3 Lingering concerns about primary bacterial infection, whether self-limited (eg, Mycoplasma pneumoniae), life-threatening (eg, Neisseria meningiditis4), clinically occult, or an impending bacterial superinfection1 (eg, bacterial sinusitis or pneumonia), also militate against withholding antibiotics. No wonder, then, that the decision to prescribe antibiotics provokes more discomfort among office-based general practitioners than the use of any other class of drugs.5

An accurate test for the presence or absence of bacterial infection would therefore be welcomed by many clinicians6 and, potentially, could lead to marked reductions in antibiotic prescriptions for respiratory tract infections. Although commonly used, C-reactive protein is insufficiently sensitive to rule out bacterial infection,7 as are the erythrocyte . .


March 7, 2009 at 2:59 pm Leave a comment

Infective endocarditis prophylaxis before dental procedures: New guidelines spark controversy

Cleveland Clinic Journal of Medicine Feb 2008

Infective endocarditis prophylaxis before dental procedures: New guidelines spark controversy

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March 7, 2009 at 2:57 pm Leave a comment


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