Efficacy and safety of ciprofloxacin oral suspension versus trimethoprim-sulfamethoxazole oral suspension for treatment of older women with acute urinary tract infection

OBJECTIVES: To compare the efficacy and safety of ciprofloxacin (CIP) oral suspension to trimethoprim/sulfamethoxazole (TMP/SMX) oral suspension among older women with acute urinary tract infections (UTIs). DESIGN: Prospective, randomized, open-label, multicenter study of older women (age 65 and older). SETTING: Community and nursing home. PARTICIPANTS: A total of 261 older women were evaluable for safety. Of these, 172 (86 community, 86 nursing home) were evaluable for clinical and bacteriological efficacy. INTERVENTION: Patients were randomized to a 10-day regimen of either CIP (250 mg/5 mL twice daily) or TMP/SMX (160/800 mg/20 mL twice daily). MEASUREMENTS: Clinical response 4 to 10 days posttherapy. RESULTS: For the efficacy-valid population, posttherapy clinical resolution was statistically superior following CIP (97%) versus TMP/SMX (85%) (95% CI=2.0-21.3; P= .009). Eradication of pretreatment bacterial isolates posttherapy was also higher following CIP (95%) versus TMP/SMX (84%) (95% CI=2.7-21.3; P= .019). For the intent-to-treat population, posttherapy clinical resolution was significantly higher in the CIP group (96%) than in the TMP/SMX group (87%) (95% CI=0.2-16.7; P= .025). Safety was assessed in the intent-to-treat population and the incidence of drug-related adverse events were significantly lower following CIP (17%) than following TMP/SMX (27%) (P= .047). Premature discontinuation due to these events was also less prevalent with CIP than with TMP/SMX (2% vs 11%, respectively) (P= .004). CONCLUSION: CIP suspension showed higher clinical success and bacteriological eradication rates than did TMP/SMX for both community-based and nursing home-residing older women with acute UTIs. Furthermore, CIP suspension was associated with significantly lower rates of adverse events and premature discontinuations compared with TMP/SMX suspension.     

Decreased antibody response among nursing home residents who received recalled influenza vaccine and results of revaccination, 1996-97

In November 1996, 11 lots of one U.S. manufacturer's 1996-97 trivalent influenza vaccine were voluntarily recalled because of decreasing potency of the A/Nanchang/933/95 (H3N2) component. Because the elderly are at high risk of developing influenza-related complications, we assessed the postvaccination antibody titers of nursing home residents who received recalled vaccine and assessed the antibody response to revaccination. Blood samples were collected 3 weeks after vaccination from 86 residents at three nursing homes who received recalled vaccine and 86 residents at three other nursing homes who received a different manufacturer's vaccine. Medical records were reviewed. Residents of one nursing home were later revaccinated. Blood samples were collected on the day of revaccination and again in 3 weeks. Serum was tested by hemagglutination inhibition for antibody to all three components of the 1996-97 influenza vaccine. The geometric mean antibody titer (GMT) (33 vs 55; p=0.01) and the percentage of residents with an antibody titer > or = 1:40 (52 vs 67%; p=0.04) to the A/Nanchang/933/95 component were lower among residents who received recalled vaccine compared to those who received non-recalled vaccine, but had similar GMTs against the other two vaccine components. After revaccination, the GMT to A/Nanchang/933/95 increased from 24 on the day of revaccination to 39 (p=0.01) in residents from one nursing home. Therefore, vaccination with the recalled vaccine was associated with lower postvaccination antibody titers to A/Nanchang/933/95, but not against the other two vaccine components. Revaccination was moderately effective in increasing antibody titers. With annual changes in influenza vaccine strains, routine post-release stability testing of influenza vaccine should continue.     

Incidence of retinopathy of prematurity among infants weighing 2000 g or less at birth

A retrospective study was carried out to determine the incidence of retinopathy of prematurity (ROP) among 157 neonates who weighed 2000 g or less at birth and who were examined at a referral centre for critically ill newborns between January 1983 and December 1985. Overall, 24 cases (15%) of ROP were detected, 18 (75%) among neonates with a birth weight of 1000 g or less. The incidence of ROP was more than eight times higher among neonates in this birth weight category than among those who weighed between 1001 and 2000 g. Grade I ROP accounted for 16 cases (67%), grade II for 7 cases (29%). Only one case (4%) of grade IV ROP was diagnosed, in an infant who weighed 1020 g at birth.     

Influenza. How to prevent and control nursing home outbreaks.

Influenza is an important cause of acute respiratory illness among older adults in general and within the nursing home in particular. Epidemics typically are reported in the late fall and throughout the winter. In the nursing home, vaccination may not prevent clinical illness but can reduce the risk of pneumonia, hospitalization, and death. Atypical presentations, including delirium and nonspecific functional changes, are common in older patients. Rapid diagnosis is imperative, as early antiviral treatment and prophylaxis can control a nursing home outbreak.     

Prolonged delirium without anticholinergic signs following amitriptyline overdose.

In a case of acute intoxication with a tricyclic antidepressant (amitriptyline) delirium was prolonged without there being prominent peripheral anticholinergic or electrocardiographic signs. Administration of physostigmine, repeated when necessary, reversed the delirium.     

Development of angioid streaks in association with pseudoxanthoma elasticum.

Angioid streaks were noted 6 years after the diagnosis of pseudoxanthoma elasticum in a young girl with peau d'orange discolouration of the fundi. The author discusses the evolution of angioid streaks.