Cellulitis in the face of antibiotic resistance
Before prescribing empiric therapy, make sure you know the organisms most likely to be involved and the resistance patterns in your area.
Print Issue: November 06, 2007
How to recognize and diagnose child abuse
Every injury presents the possibility that it was inflicted. Primary-care clinicians are the front line of defense for these most vulnerable patients.
Selzentry- Antiretroviral slows advance of HIV
Indication: HIV-1 infection in treatment-experienced adults infected with only CCR5-tropic HIV-1 detectable, who have evidence of viral replication and HIV-1 strains resistant to multiple antiretrovirals.
Xyzal- Once-a-day treatment
Companies: UCB and Sanofi Aventis Pharmacologic class: Antihistamine Active ingredient: Levocetirizine dihydrochloride 5 mg; scored tabs. Continue Reading Indications: Relief of symptoms associated with allergic rhinitis. Chronic idiopathic urticaria. Pharmacology: Levocetirizine, the l-enantiomer of cetirizine, is a histamine H1 receptor blocker. Its affinity for H1 receptors is two times stronger than that of cetirizine. Peak…
Perforomist- Inhalation solution for bronchoconstriction
Company: Dey, L.P. Pharmacologic class: Long-acting beta2-agonist Active ingredient: Formoterol (as fumarate) 20 µg/2 mL; solution for inhalation Continue Reading Indication: Long-term maintenance treatment of COPD-associated bronchoconstriction. Pharmacology: Perforomist is a solution formulation of the long-acting beta2-agonist formoterol fumarate, which is administered by inhalation via nebulization. It acts as a bronchodilator by stimulating beta2 receptors…
Brown-black eruptions
CASE #1 A 50-year-old black woman presented with several coin-shaped brown-black plaques that had first appeared on her lower legs two months before against a background of xerotic skin (asteatotic eczema). She suffered from hypertension, high cholesterol, and type 2 diabetes. Her current medications included atorvastatin (Lipitor), amlodipine (Norvasc), and glyburide (DiaBeta). The coin-shaped plaques…
Facial erosions and scalp lesions in a middle-aged man
A 55-year-old man reported a several-week history of crusted scalp lesions and red facial erosions accompanied by an irritated, burning sensation. He did not recall any pre-erosion blisters. An examination was otherwise normal, including clear mucous membranes. Punch biopsy revealed an epidermis that was superficially denuded just below the granular layer. Direct immunofluorescence (DIF) of…
Itchy, violaceous papules and nodules on the thighs
A 39-year-old African-American man had a one-month history of numerous itchy “bumps.” Multiple firm, violaceous, 4- to 7-mm papules and scattered nodules were visible on his posterior neck, forearms, back, and posterior thighs. The rash was intensely pruritic, especially at night. He was not using topical or systemic treatments at the time of presentation. He…
Three incidents of left-sided chest pain
The patient appeared to be recovering well, but a few months later, his symptoms would recur. John, 29 years old, was seen in May with a history of intermittent left-sided chest pain. He first noticed the pain after coughing while brushing his teeth one Sunday morning. When his symptoms failed to resolve over the course…
A traveler returns from Central America with a pair of stubborn lesions
On the patient’s return home, all of his insect bites healed except two. Weeks later, an incision provides some answers. Three weeks after returning from a vacation in Guatemala, 58-year-old Mr. R presented to my rural northern California health clinic with two lesions—one on his right upper arm and the other on his right lower…
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