Cost-effectiveness decision analysis of intramuscular ceftriaxone versus oral cefixime in adolescents with gonococcal cervicitis

Deciphering the role of female reproductive tract microbiome in reproductive health: a review

Relevant studies increasingly indicate that female reproductive health is confronted with substantial challenges. Emerging research has revealed that the microbiome interacts with the anatomy, histology, and immunity of the female reproductive tract, which are the cornerstone of maintaining female reproductive health and preventing adverse pregnancy outcomes. Currently, the precise mechanisms underlying their interaction and impact on physiological functions of the reproductive tract remain elusive, constituting a prominent area of investigation within the field of female reproductive tract microecology. From this new perspective, we explore the mechanisms of interactions between the microbiome and the anatomy, histology, and immunity of the female reproductive tract, factors that affect the composition of the microbiome in the female reproductive tract, as well as personalized medicine approaches in managing female reproductive tract health based on the microbiome. This study highlights the pivotal role of the female reproductive tract microbiome in maintaining reproductive health and influencing the occurrence of reproductive tract diseases. These findings support the exploration of innovative approaches for the prevention, monitoring and treatment of female reproductive tract diseases based on the microbiome.

Upregulation of Glutamate Transporter 1 by Clavulanic Acid Administration and Attenuation of Allodynia and Hyperalgesia in Neuropathic Rats

Introduction:

Clavulanic acid (CLAV) is structurally similar to ceftriaxone, a potent stimulator of glial GlutamateTransporter-1 (GLT-1) expression. The present study aims at exploring the anti-nociceptive effects of CLAV, a beta-lactamase inhibitor in rats underwent sciatic nerve Chronic Constriction Injury (CCI).

Methods:

CLAV (12.5, 25, 50 mg/kg) was administered intraperitoneally after the surgery for 14 consecutive days. Behavioral pain parameters were evaluated before and 3, 5, 7, 10 and 14 days after injury. Spinal GLT-1 level was measured via western blotting at days 7 and 14.

Results:

CCI led to mechanical allodynia, cold allodynia and thermal hyperalgesia which started on postoperative days 3 and continued until the end of study. We found that CLAV (12.5 and 25 mg/kg) significantly attenuated all pain related behaviors as compared to the CCI animals treated with normal saline. Protein level of GLT-1 was down-regulated on day 14 following CCI and this phenomenon was reversed by fourteen days treatment of CLAV at the low doses of 12.5 and 25 mg/kg.

Conclusion:

These results suggest that CLAV might provide a new therapeutic strategy for neuropathic pain and its effect might be partially associated with the up-regulation of GLT-1.

Costs of Management of Occupational Exposures to Blood and Body Fluids

Objective.

To determine the cost of management of occupational exposures to blood and body fluids.

Design.

A convenience sample of 4 healthcare facilities provided information on the cost of management of occupational exposures that varied in type, severity, and exposure source infection status. Detailed information was collected on time spent reporting, managing, and following up the exposures; salaries (including benefits) for representative staff who sustained and who managed exposures; and costs (not charges) for laboratory testing of exposure sources and exposed healthcare personnel, as well as any postexposure prophylaxis taken by the exposed personnel. Resources used were stratified by the phase of exposure management: exposure reporting, initial management, and follow-up. Data for 31 exposure scenarios were analyzed. Costs were given in 2003 US dollars.

Setting.

The 4 facilities providing data were a 600-bed public hospital, a 244-bed Veterans Affairs medical center, a 437-bed rural tertiary care hospital, and a 3,500-bed healthcare system.

Results.

The overall range of costs to manage reported exposures was $71-$4,838. Mean total costs varied greatly by the infection status of the source patient. The overall mean cost for exposures to human immunodeficiency virus (HIV)-infected source patients (n = 19, including those coinfected with hepatitis B or C virus) was $2,456 (range, $907-$4,838), whereas the overall mean cost for exposures to source patients with unknown or negative infection status (n = 8) was $376 (range, $71-$860). Lastly, the overall mean cost of management of reported exposures for source patients infected with hepatitis C virus (n = 4) was $650 (range, $186-$856).

Conclusions.

Management of occupational exposures to blood and body fluids is costly, the best way to avoid these costs is by prevention of exposures.

The Cost Effectiveness of Gonorrhea Screening in Urban Emergency Departments

BACKGROUND

The prevalence of gonorrhea (GC) among adolescent and young women attending some urban emergency departments (EDs) ranges from 1% to 7%, but historically screening has not been logistically practical.

GOAL

The primary goal of the study was to assess the cost effectiveness of GC screening in women ages 15 to 29, seeking care in urban EDs, using noninvasive or rapid point-of-care tests.

STUDY

We developed a state-transition Markov model to compare the net lifetime health consequences, costs, and cost effectiveness of routine ED care (no screening for women without genitourinary symptoms) to GC screening using 1 of 5 detection methods: Gram-stained smears of endocervical swab specimens, urine-based nucleic acid amplification tests (NAATs), NAATs performed on endocervical swabs, rapid immunochromotographic strip test (RIS) performed on clinician-collected vaginal swabs, and RIS on patient-collected vaginal swabs.

RESULTS

Screening women between 15 and 29 years of age using urine-based NAATs prevented 1247 cases of pelvic inflammatory disease (PID) and saved 177 US dollars per patient compared with no screening. Compared with urine-based NAAT, screening with RIS using clinician-obtained vaginal swabs prevented an additional 220 cases of PID and had an incremental cost effectiveness ratio of 6490 US dollars per quality-adjusted life year (QALY). Results were sensitive to assumptions about loss to follow-up, gonorrhea prevalence, and test costs.

CONCLUSION

Screening females aged 15 to 29 for gonorrhea in some urban EDs will prevent substantial reproductive morbidity. Screening with rapid, point-of-care tests is cost effective compared with other well-accepted preventive interventions.

Guidance for first-line treatment of anogenital gonorrhoea infection

Gonorrhoea is currently the second most common bacterial sexually transmitted infection in England and Wales (Public Health Laboratory Service, 2002). Early initiation of treatment is important in the reduction of the onward transmission of infection and contributes to the overall control of the spread of gonorrhoea. A central tenet of this is the use of effective antimicrobial treatment. Both global and local surveillance programmes have successfully generated robust data, identifying the prevalence of antimicrobial resistance when using fluoroquinolones, formerly a first-line treatment for genital infection with Neisseria gonorrhoeae. As a result of this evidence base, the first-line treatment recommendations in England and Wales were changed. It is now recommended that anogenital gonorrhoea is treated with third generation cephalosporins, with either a 400 mg single oral dose of cefixime, or a single intramuscular dose of ceftriaxone 250 mg. This change in 2004 in first-line treatment exemplifies the application and delivery of evidence-based treatment and care.

A cost-effectiveness evaluation of testing and treatment of Chlamydia trachomatis infection among asymptomatic women infected with Neisseria gonorrhoeae

BACKGROUND

Because patients infected with Neisseria gonorrhoeae are frequently coinfected with Chlamydia trachomatis, routine dual treatment of patients with N gonorrhoeae infection is frequently practiced and has long been recommended.

GOAL

The goal of this study was to examine the cost-effectiveness of routine dual treatment of women with infection, with or without separate testing for C trachomatis, compared with an alternative of testing for both infections and restricting treatment for C trachomatis to women testing positive for C trachomatis.

STUDY DESIGN

A decision analysis compared the cost-effectiveness of these options using cases of pelvic inflammatory disease prevented as the outcome. Parameter values were taken from the literature.

RESULTS

Routine dual treatment is not an effective or cost-effective replacement for testing for C trachomatis, but it can increase the number of cases of C trachomatis treated when combined with testing. Dual treatment results in more overtreatment of infection C trachomatis than treatment based on test results.

CONCLUSIONS

Testing for both infections is more cost-effective than routine presumptive treatment for C trachomatis. Providing both presumptive treatment and testing for C trachomatis can also be cost-effective in some settings.