Recently, many primary health providers have been bombarded with questions about the latest shingles vaccine, Shringrix made by GlaxoSmithKline.
I have seen few cases of Shingles recently – both confirmed and false ones which have prompted me to look closer at the current recommended approach – to treat or to prevent? Shingles or herpes zoster is caused by a varicella-zoster virus (VZV), also known as human herpes virus 3 (HHV3). It is the same virus that causes chicken pox in kids. But in Shingles, it is a result of latent reactivation within the sensory ganglia of the nervous system.
I realize there is so much talk and education on how we should prescribe antibiotic more appropriately. A discussion on antibiotic stewardship may sound very sexy but the public may not be able to connect to such term. In essence, antibiotic stewardship is an initiative to promote appropriate antibiotic prescribing, to improve patient outcomes and to reduce antibiotic resistance. Maybe making it personal will help – and I mean let’s look at my daughters’ antibiotic use.
Is fosfomycin the new ciprofloxacin? Recently I have seen an increased number of prescriptions for fosfomycin in some of the long term care facilities. Fosfomycin is an antibiotic commonly indicated for urinary tract infection. The Infectious disease Society of America (IDSA) has recommended it as first line option for the treatment of urinary tract infection, along with trimethoprim-sulfamethoxazole and nitrofurantoin. This is in context to the increasing resistance of E Coli to fluroquinolones and as well as other antibiotics such as Amoxicillin-Clavulate in United States. We do have a different resistance pattern in Canada.
Gloria is an 80 years old lady with a history of mild cognitive impairment, osteoporosis, hypertension, diabetes who often presents with an urinary tract infection (UTI) monthly. It is very unpleasant with the typical symptoms such as burning sensation, increased urinary frequency as well as slightly increased in irritability. Upon treatment with antibiotic, the symptoms go away quickly. Who wants to have a urinary tract infection monthly?
John Dole is a 75 year old men with a past medical history of hypertension, epilepsy and diabetes. Is current medications include:
- Metformin 1000mg po BID,
- Phenytoin 300mg po BID,
- Carbamazepine 300mg po BID
- Hydrochlorothiazide 25mg po daily
He is clinically stable. The drug levels for phenytoin and carbamazpines are within therapeutic range and his lab results are unremarkable except for a mild agranulocytosis (low white blood cell count), with ANC of 1.2 x 109 cells/L. His family physician asked me if the neutropenia is due to his medications. If so, which one?
Are you kidding me? We don’t have salbutamol nebules during the peak season where many people are experiencing shortness of breath due to pneumonia, respiratory infections or COPD/asthma exacerbation? Salbutamol is a quick acting bronchodilator medication which is often prescribed to relieve shortness of breath by opening up the airways to the lungs. It is an essential medicine.