{"id":1320,"date":"2011-01-06T10:29:13","date_gmt":"2011-01-06T15:29:13","guid":{"rendered":"http:\/\/blogs.nejm.org\/?p=1320"},"modified":"2015-06-04T15:24:09","modified_gmt":"2015-06-04T19:24:09","slug":"thursday-thienamycins","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/thursday-thienamycins\/2011\/01\/06\/","title":{"rendered":"Thursday Thienamycins"},"content":{"rendered":"<p><img loading=\"lazy\" decoding=\"async\" class=\"alignright size-full wp-image-1321\" title=\"0901008P BLUE JAYS 7  WH.SOX 3\" src=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2011\/01\/alomar-roberto1.jpg\" alt=\"0901008P BLUE JAYS 7  WH.SOX 3\" width=\"235\" height=\"138\" \/>Plenty going on in the ID, HIV, and (for the middle of winter) baseball worlds:<\/p>\n<ul>\n<li>Just out in <em>CID<\/em>, there&#8217;s a comprehensive review of <a href=\"http:\/\/cid.oxfordjournals.org\/content\/early\/2011\/01\/04\/cid.ciq146.full\" target=\"_blank\">Management of MRSA<\/a> as part of the IDSA&#8217;s Practice Guidelines Series. Soft tissue infections, bacteremia, endocarditis, pneumonia, bone and joint infections, frequent relapses &#8230; \u00a0MRSA in all its painful glory. Some interesting tidbits: \u00a01) no gentamicin recommended for MRSA native-valve endocarditis or bacteremia (a pet peeve of mine, hope that practice disappears); 2) ECHO recommended for <em>all<\/em> adult patients with bacteremia, with a preference for transesophageal ECHO; 3) no systemic antimicrobials recommended as part of &#8220;decolonization&#8221; strategies in cases of recurrent MRSA soft tissue infections; 4) no mention of <a href=\"http:\/\/blogs.nejm.org\/index.php\/mrsa-in-pets\/2009\/09\/25\/\">household pets as a source of MRSA<\/a>.<\/li>\n<li>Speaking of MRSA, ceftaroline &#8212; <a href=\"http:\/\/frx.com\/news\/PressRelease.aspx?ID=1489398\" target=\"_blank\">approved late last year by the FDA<\/a> &#8212; is now actually available for use (that is, obtainable by your hospital pharmacy). \u00a0This is the first beta lactam with anti-MRSA activity, and while it has been approved for community-acquired pneumonia and complicated skin and soft tissue infections,\u00a0I strongly suspect it may eventually have another role &#8212; namely, management of MRSA bacteremia\/endocarditis, especially\u00a0refractory\u00a0cases. \u00a0After all, our current therapy for that condition is pretty dismal. \u00a0Time (and I hope a prospective clinical trial, though nothing <a href=\"http:\/\/clinicaltrials.gov\/ct2\/results?term=ceftaroline\" target=\"_blank\">here<\/a>) will tell whether ceftaroline in fact offers an advantage in this challenging situation.<\/li>\n<li>Etravirine now comes in <a href=\"http:\/\/www.aidsmeds.com\/articles\/HIV_Intelence_etravirine_1667_19646.shtml\" target=\"_blank\">a 200 mg tablet<\/a>, reducing the pill burden to 1 pill twice daily. \u00a0Although not approved for once-daily use, the pharmacokinetic profile supports giving the drug this way, so I wouldn&#8217;t be surprised to see a greater use of this NNRTI as a once-daily &#8220;key third drug&#8221; in patients without NRTI resistance. \u00a0(It&#8217;s an &#8220;unlabeled use&#8221;, but so be it.) \u00a0Turns out that although the new formulation is still uncoated, it may have reduced the quirky chalky texture of the 100 mg tablets, as tests conducted by the company show that it&#8217;s easier to swallow. \u00a0It still can be dispersed in water, if patients prefer to take it this way.<\/li>\n<li>Rifaximin, the non-absorbable cousin of rifampin, <a href=\"http:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa1004409\" target=\"_blank\">reduces symptoms of irritable bowel syndrome (IBS)<\/a>.\u00a0\u00a0\u00a0Great news &#8212; until you read the fine print, which shows that the placebo group did nearly as well (around a 40% response rate for rifaximin, vs 30% for placebo). \u00a0 Oddly, this rifaximin\/IBS study comes on the heels of <a href=\"http:\/\/www.plosone.org\/article\/info:doi\/10.1371\/journal.pone.0015591\" target=\"_blank\">this well-publicized paper<\/a>,\u00a0which showed that placebos for IBS still worked <em>even if patients knew they were taking them. <\/em>I think\u00a0we&#8217;re compelled to think again about how to leverage <a href=\"http:\/\/blogs.nejm.org\/index.php\/the-extraordinary-power-of-placebo\/2010\/03\/10\/\">the extraordinary power of the mind<\/a> to help control certain diseases.<\/li>\n<li>As expected (and deserved), <a href=\"http:\/\/mlb.mlb.com\/news\/article.jsp?ymd=20110105&amp;content_id=16392298&amp;vkey=news_mlb&amp;c_id=mlb\" target=\"_blank\">Robbie Alomar was elected to the National Baseball Hall of Fame,<\/a> receiving 90% of the votes. Does his alleged HIV positive status &#8220;<a href=\"http:\/\/www.associatedcontent.com\/article\/6185308\/roberto_alomar_poses_a_problem_for.html?cat=14\" target=\"_blank\">pose a problem&#8221;<\/a> for the Hall of Fame? \u00a0I think not &#8212; so long as he does the right thing and tells the truth, whatever that may be. Again, as I&#8217;ve <a href=\"http:\/\/blogs.nejm.org\/index.php\/worlds-collide-roberto-alomar-and-hiv\/2010\/10\/12\/\" target=\"_blank\">written before<\/a>, the acceptance speech he gives in Cooperstown this summer could be the <em>perfect<\/em> opportunity.<\/li>\n<\/ul>\n<p>Thienamycin&#8217;s real identity? \u00a0<a href=\"http:\/\/scholar.google.com\/scholar?q=imipenem&amp;um=1&amp;ie=UTF-8&amp;sa=N&amp;hl=en&amp;tab=ws\" target=\"_blank\">Read all about it<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Plenty going on in the ID, HIV, and (for the middle of winter) baseball worlds: Just out in CID, there&#8217;s a comprehensive review of Management of MRSA as part of the IDSA&#8217;s Practice Guidelines Series. Soft tissue infections, bacteremia, endocarditis, pneumonia, bone and joint infections, frequent relapses &#8230; \u00a0MRSA in all its painful glory. Some [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3],"tags":[],"class_list":["post-1320","post","type-post","status-publish","format-standard","hentry","category-health-care"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/1320","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=1320"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/1320\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=1320"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=1320"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=1320"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}