Appropriate prescribing of azithromycin for community-acquired pneumonia.

Azithromycin is prescribed for atypical antimicrobial cover in severe community-acquired pneumonia. Inappropriate azithromycin administration incurs unnecessary financial costs, exacerbates antimicrobial resistance and risks QTc interval prolongation leading to cardiac arrhythmias. The present study demonstrated that a majority of patients were prescribed azithromycin without having electrocardiograms to assess the QTc interval and without meeting criteria for severe community-acquired pneumonia based on CURB-65 score.

Neisseria gonorrhoeae positivity in clients presenting as asymptomatic contacts of gonorrhoea at a sexual health centre.

Background Previous guidelines at the Sydney Sexual Health Centre (SSHC) recommended empirical antibiotic treatment for asymptomatic contacts of Neisseria gonorrhoeae at the time of testing. With increasing concerns around gonorrhoea antibiotic resistance, it has been suggested that asymptomatic contacts should only be treated based on test results. METHODS: This retrospective study of data from the SSHC electronic medical record included a total of 295 gonorrhoea contacts from 1 January 2018 to 30 June 2018. The primary outcome was the proportion of asymptomatic gonorrhoea contacts with a positive gonorrhoea result from any anatomical site. Statistically significant differences in gonorrhoea positivity according to gender, sexual preference, use of PrEP, sex worker status, country of birth, preferred language and number of partners, were calculated using Fisher's exact test. RESULTS: The overall proportion of asymptomatic gonorrhoea contacts with a positive gonorrhoea result was 27.1% (95% CI: 22.1-32.6%). The proportion of gonorrhoea positivity was significantly higher in females compared to males (52.0% vs 25.7%, P < 0.01), gay and bisexual men compared to heterosexual men (28.7% vs 0%, P < 0.01) and non-users of PrEP compared to PrEP users (31.2% vs 12.5%, P < 0.05). No statistically significant differences in gonorrhoea positivity were found in subgroups divided by sex worker status, country of birth, preferred language and number of partners. CONCLUSION: The relatively low gonorrhoea positivity rate (27.1%) in asymptomatic gonorrhoea contacts at the SSHC between January and June 2018 supports guideline changes to no longer provide empirical antibiotic treatment to asymptomatic contacts.

Regional brain metabolism with cytochrome c oxidase histochemistry in a PS1/A246E mouse model of autosomal dominant Alzheimer's disease: correlations with behavior and oxidative stress.

Mitochondrial dysfunction and brain metabolic alteration are early neurofunctional aspects in Alzheimer's disease (AD). Regional brain metabolism was analyzed by cytochrome c oxidase (COX) histochemistry in PS1-A246E mouse mutants, a model of autosomal dominant AD overexpressing beta-amyloid (Abeta) peptide without amyloidosis or cell degeneration. Immunohistochemical samples were analyzed on adjacent sections for regional Abeta1-42 levels, as well as DNA oxidative damage with 8-hydroxy-2-deoxyguanosine (8-OHdG). COX activity increased in the basal forebrain nuclear complex, specific parts of the amygdala and hippocampus, as well as in striatum and connected regions. On the contrary, a hypometabolism was observed in midline thalamic, interpeduncular, and pedonculopontine nuclei. The integration of these regions in circuitries subserving emotions, arousal, and cognitive functions may explain why neurochemical alterations in specific brain regions were linearly correlated with psychomotor slowing and disinhibition previously reported in the mutant. As the PS1-A246E model appears to mimick prodromal AD, the results support the existence of mitochondrial abnormalities prior to AD-related cognitive deficits. However, since affected PS1-A246E brain regions were not primarily those altered in AD-associated histopathological features and did not systematically display either Abeta overexpression or higher 8-OHdG immunolabelling, the hypermetabolism observed seems to comprise a compensatory reaction to early mitochondrial abnormalities; furthermore, neuronal synaptic function should be considered as particularly relevant in COX activity changes.