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FDA Approves Tetanus/Diphtheria/Pertussis Vaccine For Adults Over 65

BoostrixMost of us are familiar with the need to achieve immunization against tetanus (“lockjaw”) and diphtheria. Fewer are familiar with the need to immunize against pertussis (“whooping cough”). Boostrix is a vaccine used to achieve immunity against all three. Until recently, there had not been a vaccine approved by the Food and Drug Administration (FDA) against pertussis intended for use in elders (ages 65 years and older). On July 8, 2011, the FDA approved Boostrix for use in this population of seniors.

The link to the FDA announcement is

Whooping cough is not a trivial disease. It is a highly communicable infectious disease caused by the bacterium Bordetella pertussis. It is transmitted by respiratory secretions or large droplets from the respiratory tract of an infected person. In children, whooping cough is typified by Read more »

This post, FDA Approves Tetanus/Diphtheria/Pertussis Vaccine For Adults Over 65, was originally published on by Paul Auerbach, M.D..

One Of The Most Common Infections Of Childhood: Otitis Media

A doctor examining the inside of a young girl's ear while her mother looks on.Ear infections are the bane of childhood and can spoil many outdoor adventures. One of the most common infections of childhood, they provoke long nights of miserable children, sleepless parents, and unhappiness all around. They may be recurrent, and can also progress (rarely) to more serious medical problems, such as meningitis.

What Are Ear Infections?

Acute otitis (inflammation of the ear) media (“middle”) infection is caused by bacteria or viruses. When it occurs, there is redness and inflammation of the eardrum, frequently with a collection of  blood, serum, or pus behind the drum. To know whether or not this has occurred, and to precisely determine the anatomic diagnosis and severity, one needs to see the eardrum, which is what the healthcare provider does with an otoscope.

With otitis media (middle ear infection), there is no drainage from the external ear canal (unless the eardrum ruptures, which is unusual in an adult and more common in a child) and the victim has a fever, sometimes with an accompanying sore throat. In many cases, the victim has a history of prior similar ear infections. Most often, otitis media occurs in children; when it occurs in an adult, it may be associated with a sinus infection or functional obstruction of the eustachian tube (the pressure-release mechanism from the middle ear into the throat).

It is interesting to note that children who chew Read more »

This post, One Of The Most Common Infections Of Childhood: Otitis Media, was originally published on by Paul Auerbach, M.D..

Heartburn Bugs Have Become Antibiotic-Resistant

H. pylori dominated the GI news in the 1990s, and despite it disappearing from the front pages, it remains a common and important clinical problem. The dominant recommended initial treatment strategy has been a clarithromycin-based PPI triple therapy, with either amoxicillin or metronidazole as the third drug. This approach was based on clinical studies, ease of use, and tolerability factors. Bismuth-based quadruple therapy (a bismuth agent, metronidazole, tetracycline, and a PPI), despite demonstrating excellent activity, was usually relegated to second-line therapy because of the complexity of the dosing as well as compliance and tolerability issues.

However, duringthe last decade, the widespread use of macrolides in the general population has led to rising resistance to clarithromycin (by 30% or more of H. pylori strains in some areas), and when clarithromycin resistance is present, the efficacy of clarithromycin-containing triple therapy falls from about 80% to 50% or even lower. However, clarithromycin resistance does not affect the efficacy of bismuth-based quadruple therapy, and that efficacy of those regimens remains at about 90% when patients are compliant with the treatment.

So the questions for you to consider are:
1) Do you know what the clarithromycin resistance rate in H. pylori is in your community?
2) What first-line H. pylori treatment regimen do you use?
3) Are you planning to change your H. pylori treatment strategy now that clarithromycin resistance rates are rising?

Let us know what you think.

*This blog post was originally published at Gut Check on Gastroenterology*

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