Cefazolin and ertapenem appear to rapidly clear persistent MSSA bacteremia. This uncontrolled study describes 11 patients for whom this combination treatment quickly cleared blood cultures. The authors postulate that ertapenem “rescues” the relatively attenuated activity of cefazolin against MSSA, noting that certain microenvironments (such as bacterial endocarditis vegetations) might make this reduced activity clinically relevant. That’s enough Staph bacteremia for now!
The TANGO study showed that people with viral suppression on tenofovir alafenamide (TAF)-based treatments can safely switch to DTG/3TC. Switch strategies will likey account for most of the use of this DTG/3TC regimen, since for initial treatment, it’s still easier to go with TAF/FTC/BIC or TAF/FTC plus DTG (no need to know baseline viral load, resistance, or hepatitis B status). And another dance-named study — SALSA — will expand this switch population to anyone who doesn’t have resistance to either 3TC or DTG (no baseline TAF regimen required). No reason why the results of SALSA will be any different than TANGO, but of course surprising things do happen. And no, I don’t know what either of these acronyms stands for.
Immunization for zoster may reduce the risk of stroke. In a review of Medicare data, receipt of the live zoster vaccine was associated with a 20% reduction in the risk of stroke for those younger than 80. Note that the data analyzed preceded the availability of the recombinant zoster vaccine, which is more effective in preventing shingles than the live version. Since zoster is a potential trigger of stroke, would we see an even greater decline in stroke incidence with the newer vaccine? A compelling additional motivation for immunization.
Another state has a bill to eliminate “religious” exemptions for vaccines.Strongly support these bills! These non-medical exemptions for children are particularly insidious, as clinicians out of respect may not want to question patient preferences based on religious beliefs. But the reality is that no mainstream religion actually prohibits vaccinations, which is why I put “religious” in quotes.