Infectious Disease

Transmission electron micrograph of hepatitis B virus cores (green)

Hepatitis outbreaks caused by carelessness

Sloppy clinical practices have caused 33 outbreaks of hepatitis B or hepatitis C infection in the past decade, the CDC reports after its first full-scale review of its own investigations.

Is Bowen testing good for Lyme disease?

More and more patients are receiving Bowen testing for Lyme disease. Many tests return as positive, and patients are placed on long, expensive, and often problematic therapies. Is there any validity to this testing whatsoever?—John Spence, MD, Marianna, Fla. No. Bowen testing is not an FDA-approved diagnostic for Lyme disease. There is no perfect test…

Rabies virus shown with its helical nucleocapsid

Preventing rabies

When should a patient receive postexposure prophylaxis against rabies? In the case of animal bites, what if the animal cannot be found?—Felix N. Chien, DO, Newport Beach, Calif. According to the CDC, “administration of rabies postexposure prophylaxis (PEP) is a medical urgency, not a medical emergency” (MMWR Recomm Rep. 1999;48[RR 1]:1-21). Rabies exposure results from…

For MRSA abscesses that do not require antibiotic treatment, simple incision and drainage will suffi

Standard of care for MRSA infections

Over the past several years, I have seen a rise in the number of otherwise healthy adults presenting with methicillin-resistant Staphylococcus aureus (MRSA)-positive abscesses and cellulitis. What is the standard or care for treatment and prevention? While everyone employs incision and drainage as definitive treatment for simple abscess and adds MRSA-effective antibiotics for more severe…

Combo therapy for pneumonia?

Is it appropriate to use levofloxacin (Levaquin) and ceftriaxone (Rocephin) together in the treatment of community-acquired pneumonia (CAP) and/or neutropenia? Or is the combined use of these drugs redundant?—Charles E. Smith, MD, Holdrege, Neb. A third-generation cephalosporin plus a quinolone is not presently recommended for the conditions described. CAP guidelines recently issued by the American…

Replacing IV peripheral cannula for prevention of bacteremia

Level 1: Likely reliable evidenceThe necessity for routine replacement of an IV peripheral cannula to prevent bacteremia was evaluated in a high-quality randomized trial. Patients older than 18 years (N = 755) without current bacteremia or immunosuppressive therapy were randomized to IV catheter replacement only when clinically indicated vs. routine replacement every three days (BMJ.…

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