From August "Emergency Medicine Today", American College of Emergency Medicine

 Adverse effects from antibiotics send thousands to EDs annually, research indicates.

MedPage Today (8/13, Gever) reported that "[a]dverse effects from antibiotics led to more than 140,000 emergency [department] visits in the U.S. annually from 2004 through 2006, accounting for one-fifth of all such drug-related events," according to research published online in Clinical Infectious Diseases. Investigators "analyzed adverse-event data from the National Electronic Injury Surveillance System and Cooperative Adverse Drug Event Surveillance projects, developed by the CDC, the FDA, and the Consumer Product Safety Commission." The researchers "also used data on outpatient antibiotic prescription volume from several national surveys of ambulatory care providers." The "[d]ata...revealed a total of 6,614 visits related to outpatient antibiotic therapy, which was extrapolated to an annual national volume of 142,505 visits." The researchers found that "[a]llergic reactions accounted for an estimated 78.7 percent of antibiotic-related events." The investigators added that the "[a]ntibiotic classes most commonly involved with adverse events were the penicillins, fluoroquinolones, and cephalosporins, which were involved in 36.9 percent, 13.5 percent, and 12.2 percent of visits, respectively."

Resistance mechanisms among gram negative organisms have become more numerous and complex. This review article found on the Medscape web site is a nice synopsis for the interested reader. Paste this link into your web browser to download:

http://www.medscape.com/viewarticle/572674?src=mp&spon=17&uac=70149SJ

Medscape (4/21, Berrie) reported that "[t]he oxazolidinone antibiotic linezolid is at least as effective as vancomycin for the treatment of patients with complicated skin and soft tissue infections (cSSTIs) that are proven to be caused by methicillin-resistant Staphylococcus aureus (MRSA), according to" a study presented in Barcelona at the 18th European Congress of Clinical Microbiology and Infectious Diseases. Kamal M. F. Itani, M.D., of the Philadelphia Veteran's Affairs Medical Center, Pennsylvania, and colleagues randomly assigned more than 1,000 "patients...to receive either linezolid (n=544), 600 mg intravenously (IV) or orally every 12 hours, or vancomycin (n=533) IV every 12 hours." These "treatments were continued for seven to 14 days." Dr. Itani said that "[l]inezolid proved to be at least as effective as vancomycin, with higher numerical success rates at" the end of the study "for the treatment of cSSTIs caused by MRSA."

Study suggests MRSA screening at hospital admission may not curb infection rates. Reuters (3/12, Stern) reports that testing "all incoming hospital patients for" methicillin-resistant Staphylococcus aureus (MRSA) "and isolating those infected did not curtail its spread, and proved costly," according to a study published in the Mar. 12 issue of the Journal of the American Medical Association.

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CDC is requesting that states report all cases of influenza-related pediatric mortality during the 2007-2008 influenza season. This health advisory contains updated information about influenza and bacterial co-infections in children and provides interim testing and treatment recommendations.

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Some antibiotics may be ineffective against acute sinusitis, study indicates. The AP (12/5, Tanner) reports that according to a study published in today's issue of the Journal of the American Medical Association, "people suffering from facial pain and a runny nose with greenish or yellowish mucus generally improved within about two weeks -- whether they took the standard antibiotic amoxicillin, steroid nose spray [budesonide], or fake medicine." This finding may have important implications for antibiotics, "particularly the penicillin-like drug amoxicillin," which "are among the most commonly prescribed medicines for sinus infections." Dr. Vincenza Snow, a Philadelphia internist and director of clinical programs and quality of care at the American College of Physicians, points out that "while antibiotics are designed to treat bacteria, these drugs aren't always very effective at treating bacterial sinus infections because the medicine has a tough time reaching the sinuses."

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HealthDay (1/22, Preidt) reports that, according to a study appearing online in the Proceedings of the National Academy of Sciences, a "single strain of an evolving bacterium has been responsible for most of the community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections." Researchers as the National Institute of Allergy and Infectious Diseases "said their findings resolve debate about the molecular evolution of CA-MRSA in the United States and rule out the possibility that multiple strains of USA300 emerged randomly with similar characteristics." After "analyzing the genomes of USA300 collected from 10 patients infected in different parts of the United States between 2002 and 2005," the team found that "[e]ight of the 10 samples had almost identical genomes, indicating they were from a common strain." Moreover, "two of the eight almost identical USA300 samples caused far fewer deaths in laboratory mice than the other samples," which may lend support to "an emerging belief that tiny genetic changes among evolving strains have a major impact on disease severity and the potential for development of drug resistance."

The Centers for Disease Control and Prevention are spearheading an effort to increase awareness of the value of influenza vaccination. They have just completed the National Influenza Vaccination Week. Click here for more information.

The Chicago Tribune (11/14, Deardorff) reports, "Garlic, well known for its natural antibiotic properties, contains an ingredient that has been shown to effectively kill methicillin-resistant Staphylococcus aureus (MRSA)," according to several studies. The Chinese first mentioned garlic "2,000 years ago in...medical literature," and Aristotle and Hippocrates also used the pungent remedy. Ron Cutler of the University of East London "published research in 2004" that showed the compound allicin, which is found in garlic, "kills several different strains of MRSA." Garlic "can be used as an antiseptic and antibacterial because it stops micro-organisms such as bacteria from reproducing." Another advantage of garlic is that "unlike modern antibiotics, the body does not seem to build up a resistance to garlic," according to researchers. Currently, investigators, "including Cutler, are working to develop so-called stabilized allicin products, including spraying liquids, creams and oral capsules."

This information sheet from the AAP addresses concerns of parents and school officials regarding pupils who have been diagnosed with skin infection from MRSA. Recommendations are provided for dealing with the infected pupil. Note that like the CDC, the AAP does not recommend exclusion from school. Click here to read more.