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Flu Vaccine May Lower Stroke Risk
Influenza vaccination may be associated with reduced stroke risk.
In a case-control study, only 19% of 370 consecutive patients with stroke or TIA had been vaccinated against flu during the most recent vaccination campaign, compared with 31% of 370 age- and sex-matched controls, reported Armin J. Grau, M.D., of the neurology department at the University of Heidelberg, Germany, and colleagues (Stroke 2005;36:1501–6).
After adjustment for several potential confounders, influenza vaccination was associated with a significantly reduced overall risk of stroke and TIA (odds ratio 0.46). The effects were significant for ischemic stroke and for three subject groups: men, those over age 65 years, and those with previous vascular disease. Nonsignificant trends toward reduced risk were found for hemorrhagic stroke, women, and those aged 65 and younger.
Meningococcal Meningitis Rx
Single-dose ceftriaxone should be considered as a first-line treatment alternative to oily chloramphenicol for epidemic meningococcal meningitis, according to N. Nathan, M.D., of Paris, and colleagues.
In a randomized, open-label, noninferiority trial that compared the two drugs for treating suspected meningococcal disease, the treatment failure rate at 72 hours was 9% in both groups (247 patients who received ceftriaxone and 256 who received chloramphenicol).
Case fatality rates were similar in the two groups, at 6% for ceftriaxone and 5% for chloramphenicol, as were clinical failure rates, which were 3% for ceftriaxone and 4% for chloramphenicol (Lancet 2005;366:308–12).
Chloramphenicol is the drug currently recommended by the World Health Organization for treatment of epidemic meningococcal meningitis, but the continued production of the drug is uncertain; ceftriaxone appears to be an efficacious, easy-to-use, low-cost alternative treatment, the investigators concluded.
Pulmonary TB Infectivity
Two negative sputum smears appear to be as informative as three or more for assessing the probability of pulmonary tuberculosis transmission, a recent study shows.
The findings bring into question the current Centers for Disease Control and Prevention recommendation that respiratory isolation for pulmonary TB patients should be discontinued only if a patient is on efficacious therapy, is showing response, and has three consecutive negative sputum smears, reported George Mixides, M.D., of the Baylor College of Medicine, Houston, and his colleagues.
The retrospective analysis involved 122 index cases with only negative acid-fast bacilli smear results: 40 had only one or two such results, and 82 had three or more such results or at least one bronchoscopic specimen. Tuberculin skin test results of patient contacts were also obtained (Chest 2005;128:108–15).
Positive skin test results in contacts were independently associated with male gender and younger age of index patients, and Hispanic ethnicity of contacts. The smear category (one or two smears vs. three or more) of the index case was not independently associated with TB transmission.
Among those in the three-plus smear category, the first two specimens yielded 90% of all culture results positive for Mycobacterium tuberculosis, the investigators noted.
Ethambutol and Ocular Toxicity
Ethambutol, a component of multidrug treatment regimens for Mycobacterium avium complex lung disease, is associated with ocular toxicity, a study shows.
A total of 229 patients with M. avium complex lung disease received a mean of 16 months of multidrug therapy that included ethambutol during the study. Of those, 97 (42%) consulted an ophthalmologist, and 24 (10%) stopped using the drug at least temporarily, David E. Griffith, M.D., of the University of Texas Health Center in Tyler, and his colleagues reported.
The toxicity—which typically affected the optic nerve causing blurred vision, decreased visual acuity, and central blind or dark spots—was reversed in all patients upon discontinuation of treatment. Toxicity appears to be avoided with intermittent, rather than daily, treatment: 8 of 139 patients receiving daily therapy were diagnosed with ethambutol ocular toxicity, compared with 0 of 90 patients on intermittent therapy (Am. J. Respir. Crit. Care Med. 2005;172:250–3).
Inasmuch as ethambutol is a critical component of routine therapy for M. avium complex disease, and because there are few effective alternative drugs, maintaining patients on this drug should be a high priority. Intermittent treatment, such as every other day rather than daily, could be a treatment option for those who develop ocular toxicity during therapy, the investigators noted.
Flu Vaccine May Lower Stroke Risk
Influenza vaccination may be associated with reduced stroke risk.
In a case-control study, only 19% of 370 consecutive patients with stroke or TIA had been vaccinated against flu during the most recent vaccination campaign, compared with 31% of 370 age- and sex-matched controls, reported Armin J. Grau, M.D., of the neurology department at the University of Heidelberg, Germany, and colleagues (Stroke 2005;36:1501–6).
After adjustment for several potential confounders, influenza vaccination was associated with a significantly reduced overall risk of stroke and TIA (odds ratio 0.46). The effects were significant for ischemic stroke and for three subject groups: men, those over age 65 years, and those with previous vascular disease. Nonsignificant trends toward reduced risk were found for hemorrhagic stroke, women, and those aged 65 and younger.
Meningococcal Meningitis Rx
Single-dose ceftriaxone should be considered as a first-line treatment alternative to oily chloramphenicol for epidemic meningococcal meningitis, according to N. Nathan, M.D., of Paris, and colleagues.
In a randomized, open-label, noninferiority trial that compared the two drugs for treating suspected meningococcal disease, the treatment failure rate at 72 hours was 9% in both groups (247 patients who received ceftriaxone and 256 who received chloramphenicol).
Case fatality rates were similar in the two groups, at 6% for ceftriaxone and 5% for chloramphenicol, as were clinical failure rates, which were 3% for ceftriaxone and 4% for chloramphenicol (Lancet 2005;366:308–12).
Chloramphenicol is the drug currently recommended by the World Health Organization for treatment of epidemic meningococcal meningitis, but the continued production of the drug is uncertain; ceftriaxone appears to be an efficacious, easy-to-use, low-cost alternative treatment, the investigators concluded.
Pulmonary TB Infectivity
Two negative sputum smears appear to be as informative as three or more for assessing the probability of pulmonary tuberculosis transmission, a recent study shows.
The findings bring into question the current Centers for Disease Control and Prevention recommendation that respiratory isolation for pulmonary TB patients should be discontinued only if a patient is on efficacious therapy, is showing response, and has three consecutive negative sputum smears, reported George Mixides, M.D., of the Baylor College of Medicine, Houston, and his colleagues.
The retrospective analysis involved 122 index cases with only negative acid-fast bacilli smear results: 40 had only one or two such results, and 82 had three or more such results or at least one bronchoscopic specimen. Tuberculin skin test results of patient contacts were also obtained (Chest 2005;128:108–15).
Positive skin test results in contacts were independently associated with male gender and younger age of index patients, and Hispanic ethnicity of contacts. The smear category (one or two smears vs. three or more) of the index case was not independently associated with TB transmission.
Among those in the three-plus smear category, the first two specimens yielded 90% of all culture results positive for Mycobacterium tuberculosis, the investigators noted.
Ethambutol and Ocular Toxicity
Ethambutol, a component of multidrug treatment regimens for Mycobacterium avium complex lung disease, is associated with ocular toxicity, a study shows.
A total of 229 patients with M. avium complex lung disease received a mean of 16 months of multidrug therapy that included ethambutol during the study. Of those, 97 (42%) consulted an ophthalmologist, and 24 (10%) stopped using the drug at least temporarily, David E. Griffith, M.D., of the University of Texas Health Center in Tyler, and his colleagues reported.
The toxicity—which typically affected the optic nerve causing blurred vision, decreased visual acuity, and central blind or dark spots—was reversed in all patients upon discontinuation of treatment. Toxicity appears to be avoided with intermittent, rather than daily, treatment: 8 of 139 patients receiving daily therapy were diagnosed with ethambutol ocular toxicity, compared with 0 of 90 patients on intermittent therapy (Am. J. Respir. Crit. Care Med. 2005;172:250–3).
Inasmuch as ethambutol is a critical component of routine therapy for M. avium complex disease, and because there are few effective alternative drugs, maintaining patients on this drug should be a high priority. Intermittent treatment, such as every other day rather than daily, could be a treatment option for those who develop ocular toxicity during therapy, the investigators noted.
Flu Vaccine May Lower Stroke Risk
Influenza vaccination may be associated with reduced stroke risk.
In a case-control study, only 19% of 370 consecutive patients with stroke or TIA had been vaccinated against flu during the most recent vaccination campaign, compared with 31% of 370 age- and sex-matched controls, reported Armin J. Grau, M.D., of the neurology department at the University of Heidelberg, Germany, and colleagues (Stroke 2005;36:1501–6).
After adjustment for several potential confounders, influenza vaccination was associated with a significantly reduced overall risk of stroke and TIA (odds ratio 0.46). The effects were significant for ischemic stroke and for three subject groups: men, those over age 65 years, and those with previous vascular disease. Nonsignificant trends toward reduced risk were found for hemorrhagic stroke, women, and those aged 65 and younger.
Meningococcal Meningitis Rx
Single-dose ceftriaxone should be considered as a first-line treatment alternative to oily chloramphenicol for epidemic meningococcal meningitis, according to N. Nathan, M.D., of Paris, and colleagues.
In a randomized, open-label, noninferiority trial that compared the two drugs for treating suspected meningococcal disease, the treatment failure rate at 72 hours was 9% in both groups (247 patients who received ceftriaxone and 256 who received chloramphenicol).
Case fatality rates were similar in the two groups, at 6% for ceftriaxone and 5% for chloramphenicol, as were clinical failure rates, which were 3% for ceftriaxone and 4% for chloramphenicol (Lancet 2005;366:308–12).
Chloramphenicol is the drug currently recommended by the World Health Organization for treatment of epidemic meningococcal meningitis, but the continued production of the drug is uncertain; ceftriaxone appears to be an efficacious, easy-to-use, low-cost alternative treatment, the investigators concluded.
Pulmonary TB Infectivity
Two negative sputum smears appear to be as informative as three or more for assessing the probability of pulmonary tuberculosis transmission, a recent study shows.
The findings bring into question the current Centers for Disease Control and Prevention recommendation that respiratory isolation for pulmonary TB patients should be discontinued only if a patient is on efficacious therapy, is showing response, and has three consecutive negative sputum smears, reported George Mixides, M.D., of the Baylor College of Medicine, Houston, and his colleagues.
The retrospective analysis involved 122 index cases with only negative acid-fast bacilli smear results: 40 had only one or two such results, and 82 had three or more such results or at least one bronchoscopic specimen. Tuberculin skin test results of patient contacts were also obtained (Chest 2005;128:108–15).
Positive skin test results in contacts were independently associated with male gender and younger age of index patients, and Hispanic ethnicity of contacts. The smear category (one or two smears vs. three or more) of the index case was not independently associated with TB transmission.
Among those in the three-plus smear category, the first two specimens yielded 90% of all culture results positive for Mycobacterium tuberculosis, the investigators noted.
Ethambutol and Ocular Toxicity
Ethambutol, a component of multidrug treatment regimens for Mycobacterium avium complex lung disease, is associated with ocular toxicity, a study shows.
A total of 229 patients with M. avium complex lung disease received a mean of 16 months of multidrug therapy that included ethambutol during the study. Of those, 97 (42%) consulted an ophthalmologist, and 24 (10%) stopped using the drug at least temporarily, David E. Griffith, M.D., of the University of Texas Health Center in Tyler, and his colleagues reported.
The toxicity—which typically affected the optic nerve causing blurred vision, decreased visual acuity, and central blind or dark spots—was reversed in all patients upon discontinuation of treatment. Toxicity appears to be avoided with intermittent, rather than daily, treatment: 8 of 139 patients receiving daily therapy were diagnosed with ethambutol ocular toxicity, compared with 0 of 90 patients on intermittent therapy (Am. J. Respir. Crit. Care Med. 2005;172:250–3).
Inasmuch as ethambutol is a critical component of routine therapy for M. avium complex disease, and because there are few effective alternative drugs, maintaining patients on this drug should be a high priority. Intermittent treatment, such as every other day rather than daily, could be a treatment option for those who develop ocular toxicity during therapy, the investigators noted.