Community mobile treatment. What it is and how it works.

In 1984, Paul Hanki of Prince George, British Columbia, Canada, developed community mobile treatment, an innovative approach to substance abuse treatment in Native communities. The feature that distinguishes community mobile treatment from most other forms of treatment is the strong emphasis on community involvement. Before an actual treatment program is implemented, the community must acknowledge that a substance abuse problem exists and be committed and involved in addressing the problem. Once a community is mobilized, a 21 to 28 day intensive alcohol and drug treatment program for substance abusers and their families is brought into the community. Since its inception in 1984, community mobile treatment has been implemented in approximately 17 Canadian communities. The few evaluations that have been conducted suggest that this approach holds much promise in reducing alcohol and drug-related problems. This article reviews the existing documentation and provides a comprehensive description of this unique approach.

Subverting bacterial resistance using high dose, low solubility antibiotics in fibrin.

Antibiotics (ABs) delivered from fibrin were evaluated for control of multi-drug resistant (MDR) Staphylococcus aureus. ABs having low aqueous solubility (< or = 1 mg/ml) were encapsulated by fibrin (composed of fibrinogen, thrombin, Factor XIIIa and calcium chloride) and examined. Electron microscopy revealed fibrin-caged, tetracycline crystals that were 0.26 to 2.8 microns in size and bound within the reticular matrix. Antibiograms documented that S. aureus ATCC 27659 was resistant to erythromycin (ERY), penicillin G (PEN), streptomycin (STR), sulfamethoxazole-trimethoprim (SXT) and tetracycline (TET). However, low solubility formulations of STR (10 mg/ml) or SXT (0.5 mg/ml), delivered from fibrin and evaluated by the agar disk diffusion assay, produced zones of growth inhibition after 18-24 h at 37 degrees C in vitro, indicating renewed susceptibility of S. aureus ATCC 27659 to these ABs. ERY, PEN and TET were unable to overcome resistance at concentrations up to 10 mg/ml. In vivo, intraperitoneal (i.p.) injection of 150 mg/kg STR delivered from fibrin resulted in 100% survival of rats with MDR S. aureus peritonitis as compared with control rats receiving i.p. STR (150 mg/kg) in 0.9% saline. The results demonstrate that some low solubility ABs delivered from fibrin are efficacious in controlling infection mediated by MDR S. aureus.