Cost-EffectivenessCost-effectiveness studies have suggested benefit from antibiotic prophylaxis, but the assumptions inherent to these studies were inappropriate, limiting the usefulness of their conclusions. Two recent analyses were performed – one in the general population and one in patients with mitral valve prolapse. The study in the general population assumed that antibiotic prophylaxis is 100% effective, which is unlikely, and that 15% of IE (Infective Endocarditis) cases are related to dental procedures, although this number has been estimated to be closer to 4% to 10% in other studies. The mitral valve prolapse analysis also assumed 80% efficacy. Further study in this area is needed, with application of more accurate estimates of patient and physician adherence to recommendations, effectiveness of prophylaxis, and updated costs of complications of endocarditis and costs of antibiotic use.
Considering ReferralThe current recommendations for antibiotic prophylaxis of IE are designed to facilitate widespread application by primary care physicians. Some possible reasons for referral would include the work-up of an undiagnosed murmur, clarification of a congenital heart defect, or suspected penicillin allergy.*51/348/5*
Archive for the ‘Anti-Infectives’ Category
One of the most highly publicized viral diseases is hepatitis, generally defined as a virally caused inflammation of the liver. It is characterized by symptoms that include fever, headache, nausea, loss of appetite, skin rashes, pain in the upper right abdomen, dark yellow (with brownish tinge) urine, and the possibility of jaundice (the yellowing of the whites of the eyes and the skin). In some regions of the United States and among certain segments of the population, hepatitis has reached epidemic proportions. Internationally, viral hepatitis is one of the most frequently reported diseases and a major contributor to acute and chronic liver disease, accounting for high morbidity and mortality. Currently, there are seven known forms of hepatitis, with the following three indicating the highest rate of incidence:
- Hepatitis A (HAV). HAV is contracted from eating food or drinking water contaminated with human excrement.
- Each year, over 150,000 people in the United State infected, typically through something in the house sexual contact, day care attendance, or recent international travel. Infected food handlers, people who use seafood from contaminated water, and those who contaminated needles are also at risk. Fortunately, individuals infected with hepatitis A do not become chronic carriers.
- Hepatitis В (HBV). This disease, spread primarily through bodily fluids, particularly during unprotected sex, puts the infected person at risk of chronic liver disease form of liver cancer. One of the fastest growing sexually transmitted infections in the United States, with over 300,000 new cases per year, HBV infection is currently more prevalent than HIV, with over 1.2 million chronic carriers. Most people recover within 6 months, although some can become chronic carriers.
- Hepatitis С (HCV). Long referred to as non-A-non B hepatitis, hepatitis С infections are on an epidemic rise in many regions of the world, as resistant forms are emerging. Currently, it is estimated that there are 150,000 new cases of hepatitis С in the United States each year, with over 4 million people infected. The vast majority of those infected (over 85 percent) develops chronic infections, and if left untreated, they may develop cirrhosis of the liver, liver cancer, or liver failure. Liver failure due to chronic hepatitis С is the leading cause of liver transplants in the United States. Some doctors report cases in which the point of transmission is traced back to blood transfusions or organ transplants from the early 1990s.
In the United States, hepatitis continues to be a major threat in spite of a safe blood supply and massive efforts at education about hand washing (hepatitis A) and safer sex (primarily hepatitis B). Treatment of all the forms of viral hepatitis is somewhat limited. A proper diet, bed rest, and antibiotics that combat bacterial invaders, which may cause additional problems, are recommended. Vaccines for hepatitis A and В are available, although costs are somewhat high for the series of injections. Treatment for hepatitis С has been less successful, with only about 25 to 30 percent of those infected responding. Ongoing research, however, is hopeful.
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