All GLG News Analyses Filed Under: Infectious Disease

Misleading Headline

October 13, 2008

Analysis by: GLG Expert Contributor

Analysis of:C. Difficile And Antibiotics Not Necessarily Linked, Study Finds | www.sciencedaily.com

The headline is misleading. C. Dif. diarrhea is well established consequence of antibiotics induced imbalance in the colon. The cited study did not disprove that. What the study actually showed that C. Dif. diarrhea can be also induced by other, unknown so far, factors as well as by antibiotics.

C. difficile not linked to antibiotics will change how I order stool studies

October 13, 2008

Analysis by: GLG Expert Contributor

Analysis of:C. Difficile And Antibiotics Not Necessarily Linked, Study Finds | www.sciencedaily.com

C. difficile is only linked to antibiotic use about half the time.  In addition c. difficile can complicate IBS more that previously thought.  This may be why antibiotics that cover c. difficile have been useful in treating irritable bowel syndrome.  

When Your Neighbor Takes an Antibiotic, So Do You

October 13, 2008

Analysis by: GLG Expert Contributor

Analysis of:C. Difficile And Antibiotics Not Necessarily Linked, Study Finds | www.sciencedaily.com

This study did not conclude that antibiotic use does not precipitate C. difficile infections.  What it found was that the individuals who are infected with C. diff did not necessarily take antibiotics in the six weeks preceding their infection.  In my mind, rather than demonstrating that C. diff is not necessarily antibiotic-related, it suggests two things that we sort of already knew: 1) the C. diff problem is so bad that individuals not treated with antibiotics are still at some risk for the disease if their community contacts have been exposed; and 2) in many cases of C. diff, there is not a neat and immediate connection between administration of antibiotics and development of symptoms -- a person can take antibiotics and not become symptomatic from C. diff infection for several weeks or months.

Superinfection

October 6, 2008

Analysis by: GLG Expert Contributor

Analysis of:'Superbugs' That Strike the Sickest Patients | online.wsj.com

With new Medicare payment guidelines for what will be paid- these infections will clearly need addressing. A nosocomial infection can lenghten the hospital stay. If Medicare doesn't pay for this, many institutions be be hard pressed to stay solvent.

Antimicrobial resistant bacteria not "superbugs"

October 6, 2008

Analysis by: GLG Expert Contributor

Analysis of:'Superbugs' That Strike the Sickest Patients | online.wsj.com

Articles with the terms "superbug", "known as gram-negative bacteria" , "so called gram-positve category" and "ultra resistant" do not give the reader much confidence in the "facts and figures" that are presented in the publication.   Hospital microbiology labs, infectious disease specialists, epidemiologist and infection control groups need to design more clinical trials to determine if acquired resistance is truly more significant in nosocomial infections versus environmental bacteria with more innate resistance such as the Pseudomonas sp., Acinetobacter sp., Enterobacter sp., etc. 

Pitfalls of prophylactic HIV drug usage.

August 8, 2008

Analysis by: GLG Expert Contributor

Analysis of:Researchers Look to Pill, Taken Daily, to Avert H.I.V. | www.nytimes.com

The use of prophylactic drugs for HIV while nominally appealing is fraught with potential dangers that require in-depth research.  With mul-tiple strains of the virus is there any drug that can give complete protec- tion?  Will the impression of protection stimulate reckless behavior that could result in additional active cases?  What is the benefit of such drug use if safe-sex procedures can be equally effective? All the available drugs are prohibitively expensive and medicating the entire U.S. sexual- ly active population is a guaranteed budget buster (I personally prefer the protection of missiles and tanks.)  Further, other chronic diseases such as cancer and heart disease which are more prevalent do not get nearly the funding of HIV/AIDS and additional drug use with skew the situation to a greater degree. Research has recently shown that consuming HIV treatment drugs over long periods has a detrimental effect on other body systems, causing their breakdown.     

HIV drugs can not be used as prevention

August 6, 2008

Analysis by: GLG Expert Contributor

Analysis of:Researchers Look to Pill, Taken Daily, to Avert H.I.V. | www.nytimes.com

1.PrEP involves a prescription drug, so it’s likely that initial programs will be clinic-based. PrEP delivery would also require periodic HIV testing. 2. In contrast to male circumcision—or hopefully one day, a vaccine—PrEP would require that people take a drug on an ongoing basis (daily or intermittently). 3. Interest in PrEP could bring more individuals into the health clinic, where they would have access to HIV testing and other services, regardless of whether they chose to use PrEP. 4. It will affect immune system in long run basis.

At What Cost Prevention?

August 6, 2008

Analysis by: GLG Expert Contributor

Analysis of:Researchers Look to Pill, Taken Daily, to Avert H.I.V. | www.nytimes.com

There is already a bounty of data to support anti-retroviral (and other) HIV medications in post-exposure prophylaxis, be it in infants born to HIV-positive mothers; intra-partum prophylaxis to HIV-positive women in active labor; and to healthcare workers (and others) exposed to HIV from accidental needlesticks and other exposures.  Pre-exposure prophylaxis is simply a broadening of post-exposure prophylaxis -- it is simply the a priori administration of HIV medications to those who might have an exposure, so that post-exposure prophylaxis is assured and begun immediately -- and so it is reasonable to assume that it will have the same infection reduction rates as current post-exposure protocols.  What will be different is the risk-benefit and cost-benefit analysis: with pre-exposure prophylaxis, you will expect a higher cost per infection prevented, and you would expect a greater side-effect toll per infection prevented.

Current use of Abacavir

August 5, 2008

Analysis by: GLG Expert Contributor

Analysis of:F.D.A. Urges Genetic Test Before Giving AIDS Drug | www.nytimes.com

we have known about the availability of this test for several months and have been using it even before the FDA recommendations or the recent guideline changes which also recommended it.This addresses to a great extent the issue surrounding HSR (hypersusceptibility reaction) which has kept some clinicians from using abacavir-containing products in the past.The genetic test is not inexpensive and is clearly not 100% accurate.  Some public clinics may choose not to use it in order to save funds for other needs (particularly if they serve populations with low incidence of the marker).  In my private practice we try to obtain it on most of our patients before they start treatment. Overall, this gives GSK a bit of a push and will encourage some increased use in abacavir.

Bigger concerns about Abacavir than HLA testing

July 28, 2008

Analysis by: GLG Expert Contributor

Analysis of:F.D.A. Urges Genetic Test Before Giving AIDS Drug | www.nytimes.com

The HLAB5701 test  is inexpensive and uncomplicated to perform  It reduces risk of the hypersenitivity reaction.  Two recent studies have raised  concerns about abacavir. -ACTG 5202 study has indicated that in persons with high viral loads epzicom (the main brand of abacavir) is less effective than truvada in initial therapy -The DAD study (Sabin C et al. Lancet 2008) has suggested an association between abacavir and heart attacks.

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