Archive for September 1, 2012

Clinical practice. Acute bacterial sinusitis.

N Engl J Med. 2004 Aug 26 V.351 N.9  P.902-10.

Piccirillo JF.

Clinical Outcomes Research Office, Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis 63110, USA.

A 43-year-old man has a two-week history of nasal congestion, postnasal drip, and fatigue. He has used an over-the-counter nasal decongestant and acetaminophen, without relief. During the past few days, facial pain and pressure have developed and have not responded to decongestants. In addition, his nasal discharge has turned from clear to yellow. How should he be treated? ……


September 1, 2012 at 4:09 pm

HIV-associated tuberculosis: clinical update.

Clin Infect Dis. 2010 May 15 V.50 N.10  P.1377-86.

Swaminathan S, Padmapriyadarsini C, Narendran G.

Tuberculosis Research Centre, Indian Council of Medical Research, Chennai, India.


The human immunodeficiency virus (HIV) epidemic has led to an increase in the incidence of tuberculosis globally, particularly in sub-Saharan Africa. Coinfection with HIV leads to difficulties in both the diagnosis and treatment of tuberculosis. Because of the poor performance of sputum smear microscopy in HIV-infected patients, more sensitive tests-such as liquid culture systems, nucleic acid amplification assays, and detection of mycobacterial products in various body fluids-are being investigated. The treatment of coinfected patients requires antituberculosis and antiretroviral drugs to be administered concomitantly; challenges include pill burden and patient compliance, drug interactions, overlapping toxic effects, and immune reconstitution syndrome. Both multidrug-resistant and extensively drug-resistant tuberculosis can spread rapidly among an immunocompromised population, with resulting high mortality rates. Current guidelines recommend starting antiretroviral treatment within a few weeks of antituberculosis therapy for patients with CD4 cell counts <350 cells/microL; however, important questions about the drug regimens and timing of antiretroviral therapy remain. Ongoing trials may answer many of these unresolved questions.


September 1, 2012 at 4:07 pm

Update in HIV medicine for the generalist.

J Gen Intern Med. 2011 May V.26 N.5  P.538-42.

Chaudhry AA, Berkenblit G, Gifford AL, Cofrancesco J Jr, Sosman J, Sullivan LE.

Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA.



September 1, 2012 at 4:04 pm

Safety, efficacy, and pharmacokinetics of rilpivirine: systematic review with an emphasis on resource-limited settings.

HIV AIDS (Auckl). 2011 V.3  P.35-44.

Ford N, Lee J, Andrieux-Meyer I, Calmy A.

Médecins Sans Frontières, Geneva, Switzerland.


The vast majority of people living with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome reside in the developing world, in settings characterized by limited health budgets, critical shortages of doctors, limited laboratory monitoring, a substantial burden of HIV in children, and high rates of coinfection, in particular tuberculosis. Therefore, the extent to which new antiretrovirals will contribute to improvements in the management of HIV globally will depend to a large extent on their affordability, ease of use, low toxicity profile, availability as pediatric formulations, and compatibility with tuberculosis and other common drugs. We undertook a systematic review of the available evidence regarding drug interactions, and the efficacy and safety of rilpivirine (also known as TMC-278), and assessed our findings in view of the needs and constraints of resource-limited settings. The main pharmacokinetic interactions relevant to HIV management reported to date include reduced bioavailability of rilpivirine when coadministered with rifampicin, rifabutin or acid suppressing agents, and reduced bioavailability of ketoconazole. Potential recommendations for dose adjustment to compensate for these interactions have not been elaborated. Trials comparing rilpivirine and efavirenz found similar outcomes up to 96 weeks in intent-to-treat analysis; failure of rilpivirine was mainly virological, whereas failure among those exposed to efavirenz was mainly related to the occurrence of adverse events. Around half of the patients who fail rilpivirine develop non-nucleoside reverse transcriptase inhibitor resistance mutations. The incidence of Grade 2-4 events was lower for rilpivirine compared with efavirenz. Grade 3-4 adverse events potentially related to the drugs were infrequent and statistically similar for both drugs. No dose-response relationship was observed for efficacy or safety, and the lowest dose (25 mg) was selected for further clinical development. The potential low cost and dose of the active pharmaceutical ingredient means that rilpivirine can potentially be manufactured at a low price. Moreover, its long half-life suggests the potential for monthly dosing via nonoral routes, with promising early results from studies of a long-acting injectable formulation. These characteristics make rilpivirine an attractive drug for resource-limited settings. Future research should assess the potential to improve robustness and assess the clinical significance of interaction with antituberculosis drugs.


September 1, 2012 at 4:03 pm

New option for management of HIV-1 infection in treatment-naive patients: once-daily, fixed-dose combination of rilpivirine-emtricitabine-tenofovir.

HIV AIDS (Auckl). 2012  V.4  P.61-71.

Patel N, Miller CD.

Albany College of Pharmacy and Health Sciences, Albany, NY, USA.


Fixed-dose combination tablets have become an important therapy option for patients infected with the human immunodeficiency virus. Fixed-dose combination rilpivirine-tenofovir-emtricitabine is a recently approved therapy option that has been extensively studied within the treatment-naïve population. When compared with efavirenz-based therapy, improved tolerability with rilpivirine-based therapy was balanced by higher rates of virologic failure to provide similar overall efficacy rates within the intention-to-treat analysis. As a result, providers will need to balance the potential for improved tolerability with fixed-dose combination rilpivirine-tenofovir-emtricitabine against a higher potential for virologic failure, particularly among patients with baseline viral loads above 100,000 copies/mL. Current treatment guidelines have recommended that fixed-dose combination rilpivirine-tenofovir-emtricitabine be an alternative therapy option for treatment-naïve patients and advise caution in those patients with high viral loads at baseline. Similar to other non-nucleoside reverse transcriptase inhibitor-based regimens, there are a number of drug interaction concerns with fixed-dose combination rilpivirine-tenofovir-emtricitabine that will necessitate monitoring and, in some cases, appropriate management. Additionally, the emergence of drug resistance to fixed-dose combination rilpivirine-tenofovir-emtricitabine has been well documented in clinical studies and close attention will be necessary in order to protect current and future therapy options. Overall, fixed-dose combination rilpivirine-tenofovir-emtricitabine is poised to provide an important therapy option for patients when appropriately applied.


September 1, 2012 at 4:01 pm

Spontaneous bacterial empyema caused by Streptococcus pneumoniae.

Isr Med Assoc J. 2012 Mar  V.14 N.3  P.190-1.

Nitzan O, Elias M, Raz R, Saliba WR.

Infectious Disease Unit, HaEmek Medical Center, Afula, Israel.


September 1, 2012 at 4:00 pm

Pleural infection-current diagnosis and management.

J Thorac Dis. 2012 Apr 1  V.4 N.2  P.186-93.

Rosenstengel A.

Clinical Pleural Fellow, Respiratory Dept, Sir Charles Gairdner Hospital, Perth WA 6009, Australia.


Pleural infection is a common and increasing clinical problem in thoracic medicine, resulting in significant morbidity and mortality. In recent years there has been a marked increase in interests and publications relating to evolving interventions and management options for pleural infection and empyema. Recently published research data as well as guidelines have suggested better approaches of radiological assessment, updated management algorithms for pleural infection, intrapleural adjunct therapies and re-examined the roles of biomarkers, pleural drainage techniques, and the role of surgery. This review highlights some of the recent advances and recommendations relevant to clinical care of pleural infection.


September 1, 2012 at 3:59 pm


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