The efficacy and safety of daptomycin vs. vancomycin for the treatment of cellulitis and erysipelas.

BACKGROUND: Results from previous trials suggest that daptomycin may result in faster clinical improvement than penicillinase-resistant penicillins or vancomycin for patients with complicated skin and skin structure infections. OBJECTIVE: The objective was to evaluate whether daptomycin treatment of cellulitis or erysipelas would result in faster resolution compared with vancomycin. DESIGN: The study was a prospective, evaluator-blinded, multi-centre trial. Patients were randomised to receive daptomycin 4 mg/kg once daily or vancomycin according to standard of care for 7-14 days. PATIENTS: Adults diagnosed with cellulitis or erysipelas requiring hospitalisation and intravenous antibiotic therapy were eligible for enrolment. RESULTS: The clinical success rates were 94.0% for daptomycin and 90.2% for vancomycin (95% confidence interval for the difference, -6.7%, 14.3%). There were no statistically significant differences between treatment arms in the time to resolution or improvement in any of the predefined clinical end-points. Both daptomycin and vancomycin were well tolerated. CONCLUSIONS: There was no difference in the rate of resolution of cellulitis or erysipelas among patients treated with daptomycin or vancomycin. Daptomycin 4 mg/kg once daily appeared to be effective and safe for treating cellulitis or erysipelas.

Paradoxical contributions of EEG during protracted dying.

Estimates of the potential for recovery from severe brain damage have become more accurate as EEG and imaging techniques evolve. When all modern electrical criteria for brain death are satisfied, useful recovery is probably impossible. Many patients who have no reasonable chance of returning to a cognitive, sapient, or useful state may be nurtured throughout a prolonged final illness primarily because of brain waves that fluctuate in the 2- to 5-microV range. The incidence of such protracted dying is unknown. We illustrate diffuse low-amplitude wave forms and regional fragments recorded from a 27-year-old woman maintained on a respirator for six months after loss of brain-stem reflexes. Considering the limited noise-signal ratio of modern equipment, popular EEG criteria for death may be prematurely rigid, prolonging death in tragic circumstances.

Disability in US presidents report. Recommendations and commentaries by the Working Group. The Working Group on Presidential Disability.

If the president of the United States must decide within minutes how to respond to a dire emergency, its citizens expect him or her to be mentally competent and to act wisely. Because the presidency of the United States is now the world's most powerful office, should its incumbent become even temporarily unable to exercise good judgment, the consequences for the world could be unimaginably far-reaching.

Altered neutrophil migration during bacterial infection associated with a serum modulator of cellular motility.

The motility of polymorphonuclear leukocytes (PMNLs) from 25 patients with bacterial infection was assessed by using the migration-under-agarose assay. A spectrum of responses was observed. Random and directional motility stimulated by C5a or pressed in parallel. These responses contrasted with those of normal PMNLs preincubated with either FMLP or C5a; preincubation with one chemotaxin inhibited a subsequent response to the same stimulus but did not inhibit the response to the other. The parallel responses of patient PMNLs to C5a and FMLP suggest that the altered motility reflects a perturbation independent of a specific chemotactic receptor. Heat-inactivated serum from patients with bacterial infection, when preincubated with normal PMNLs, resulted in significant enhancement of both random and directional migration. The data indicate that bacterial infection is associated with appearance of a modulator of neutrophil motility.