Testing of antifungal combinations against yeasts and dermatophytes

BACKGROUND

Fungal infections of the nail are a common and chronic problem. The main pathogens responsible for onychomycosis are dermatophytes, yeasts and moulds. Despite significant improvements, approximately 20% of patients with onychomycosis still fail on antifungal therapy. The successful exploitation of drug synergy may provide a useful approach to improve cure rates.

METHODS

The minimum inhibitory concentrations (MIC(80)) were recorded for pathogens that are most frequently responsible for onychomycosis against combinations of several antifungal agents, namely, fluconazole, itraconazole, terbinafine and amorolfine. Fractional inhibitory concentrations (FICs) were then calculated from the MIC(80) results and the FIC values for each drug in the combinations added to determine the degree of synergy. A combined value of <1 was taken to suggest synergy; a value of 1-2 indicated an additive effect or indifference; and a combined FIC value of >2 was taken to suggest antagonism.

RESULTS

Overall, 46% of amorolfine combinations showed results suggestive of synergy, with the most synergistic results seen against dermatophytes (54%) and moulds (52%).

CONCLUSIONS

Some combinations of drugs may have synergistic activity in vitro; however, the importance of this in a clinical setting is yet to be established, and more studies are justified.

Comparison of the effectiveness and complications of half and full doses of pegfilgrastim in breast cancer patients

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Background: Pegfilgrastim (G-CSF) is a longer half-life synthetic growth factor used to reduce the incidence of infection following myelosuppressive chemotherapy but is associated with bone pain and hypergranulocytosis. Little data exists regarding efficacy and possible reduced toxicity with lower doses. Methods: A retrospective review identified early stage breast cancer pts who received reduced doses of G-CSF. Data collected prior to and after each dose of G-CSF included total white blood cell count (WBC), absolute granulocyte count (AGC),patient age, type and dose of chemotherapy, and stage of breast cancer. The occurrence of fever and infection was compared between the full and reduced dose groups. Pts completed a Likert scale (1–5) rating bone pain after each dose of G-CSF. Results: Thirty four pts received adjuvant treatment including adriamycin-cyclophosphamide (AC) followed by taxane (T) in 12, dose dense AC-T in 13, other regimens in 9. The median age was 53 years (range of 36 to 82). Thirty-two pts initially received 6 mcg but were reduced to 3mcg due to drug toxicity. Two pts received only 3mcg doses. There was a significant difference in the WBC post chemotherapy for the 98 treatments with 6 mcg (8400 (3000–49,600) cells/cu mm (Median (Range)) versus 116 treatments with 3 mcg (7600 (3000–18,900) cells/cu mm (p<0.02). There was no significant difference between the post chemotherapy AGC for the 6 mcg (6000 (2200–38,000) cells/cu mm versus the 3 mcg (5800 (1000–16,600) cells/cu mm. Six pts receiving 6 mcg had a post G-CSF WBC > 20,000 cells/cu mm vs none receiving 3 mcg (Fisher exact test, p<0.01). No WBC < 2,000 cells/cu mm or neutropenia of <1000 cells/cu mm was noted with either regimen. Reported fever and infection was not significantly different between the 6 and 3 mcg doses (Fever: 6 mcg 3/98 (3.1%) vs 3 mcg 5/116 (4.3%); Infections: 6 mcg 5/98 (5.1%) vs 3 mcg 7/116 (6.0%)). Bone pain was more severe after 6 mcg dose than the 3 mcg dose (P < 0.02). Conclusions: Although 6 mcg G-CSF was associated with a significantly higher total WBC, pts receiving 3 mcg G-CSF did not experience a difference in incidence of fever, infections, or neutropenia. However, lower doses were associated with significantly less bone pain and hypergranulocytosis.

No significant financial relationships to disclose.

Analysis of a bi-state, multi-district, school-based hepatitis B immunization program

A descriptive correlational research design assessed factors influencing participation and completion rates, and to determine vaccine administration costs, in a school-based Hepatitis B vaccination program. Of 18,046 students in public and private schools in the metropolitan Kansas City, Mo., area, 12,986 (73.4%) participated with approximately 75% of these students completing the vaccine series. Larger schools reported decreased participation and completion rates. Both rates were highest in schools providing educational interventions. Schools with a large population of commercially insured students reported low participation rates (65%), but high completion rates (85%). Schools with a high number of Medicaid-eligible students had high participation rates (97%), but low completion rates (67%). The vaccine cost $5.06 per dose to administer.

A new wave guide for use with a CO2 delivery system for laparoscopic surgery

This study assessed the performance of the Heraeus LaserSonics InfraGuide with the 250Z CO2 laser in 46 patients undergoing laparoscopic surgery. Procedures included vaporization of endometriosis, adhesiolysis, ovarian cystectomy, uterosacral ligament transection, salpingoplasty, fimbrioplasty, neosalpingostomy, ectopic linear salpingostomy and myomectomy. The InfraGuide system was effective in transmitting laser energy to the pelvis. Advantages and disadvantages of the accessory sheath, spot diameter, HeNe aiming beam and optical laser coupler are discussed. The InfraGuide offers the surgeon an additional useful laparoscopic instrument.