Retapamulin: a newer topical antibiotic

Impetigo is a common childhood skin infection. There are reports of increasing drug resistance to the currently used topical antibiotics including fusidic acid and mupirocin. Retapamulin is a newer topical agent of pleuromutilin class approved by the Food and Drug Administration for treatment of impetigo in children and has been recently made available in the Indian market. It has been demonstrated to have low potential for the development of antibacterial resistance and a high degree of potency against poly drug resistant Gram-positive bacteria found in skin infections including Staphylococcus aureus strains. The drug is safe owing to low systemic absorption and has only minimal side-effect of local irritation at the site of application.

Ertapenem

Ertapenem is a parenteral carbapenem licensed for use in adults and children more than 3 months of age. It is active against many Gram-positive and negative bacteria, including several anaerobic organisms but has a narrower spectrum of antimicrobial activity, compared with older carbapenems. It is highly stable against nearly all beta-lactamases, including AmpC and extended spectrum beta lactamases. Ertapenem can be given intramuscularly or intravenously and its favourable pharmacokinetic profile allows once daily dosing. Ertapenem has been proven to be clinically and bacteriologically efficacious in randomised controlled trials for the treatment of community acquired infections including complicated intra-abdominal infections, complicated skin and skin-structure infections, acute pelvic infections, complicated urinary tract infections, community-acquired pneumonia and for the prophylaxis of surgical-site infection following elective colorectal surgery. Ertapenem is suited for mild to moderately ill patients with community-acquired infections and for outpatient intravenous antibacterial therapy.

Current trends in the management of beta thalassemia

The management of Beta Thalassemia, the commonest form of hemolytic anemia in children, has changed significantly in the last few years. With the availability of better transfusion regimen, iron chelation therapy, proper management of complications and good supportive care, it is now possible for a thalassemic child to have a near normal life span with a good quality of life.

Might patients benefit from oral iron therapy following operative treatment of breast carcinoma?

AIMS

To assess the changes in blood haemoglobin concentration and serum iron indices as a consequence of breast operations for cancer in our unit.

METHODS

Haematological parameters were measured in 109 patients undergoing definitive operative treatment for breast carcinoma.

RESULTS

A mean fall in haemoglobin of 2.1 g (P=0.001) occurred in patients undergoing mastectomy and axillary clearance and of 1.3 g (P<0.001) in patients undergoing wide local excision and axillary clearance. The transferrin saturation (serum iron/total iron binding capacity) in both sets of patients after surgery fell on average to levels that would be expected to impair subsequent red cell production.

CONCLUSION

The changes in iron indices that occurred were unrelated to the degree of blood loss consistent with a possible inflammatory effect of the operation. Oral iron therapy is unlikely to be of benefit to operative breast patients if they have normal pre-operative iron stores.