Baseline lipid levels rather than the presence of reported body shape changes determine the degree of improvement in lipid levels after switching to atazanavir.

PURPOSE: To study factors influencing lipid changes after switching to atazanavir (ATV) and the effectiveness of ATV in maintaining virus suppression. METHODS: Retrospective cohort study in patients with viral suppression, comparing patients switching to ATV with those continuing combination antiretroviral therapy (cART). Outcome measures were 48-week total (TC), high-density (HDL) and low-density lipoprotein (LDL) cholesterol, and triglycerides (TG) changes, stratified for dyslipidemia and lipodystrophy and virological failure (time to first of two consecutive detectable HIV RNA). RESULTS: 225 patients switched to ATV (193 [85.8%] RTV boosted), and 3120 continued cART. In patients with baseline TC >6.2 mmol/L, those switching had greater mean (95% CI) TC decreases compared to those continuing cART (-1.26 [-1.63 to -0.89] and -0.54 [-0.64 to -0.44] mmol/L, p = .002). Likewise greater TG changes were observed in patients with high (>2.3 mmol/L) baseline TG (-1.44 [-2.05 to -0.83] and -0.54 [-0.70 to -0.38] mmol/L, p = .002). Effects were seen irrespective of presence of lipodystrophy. Patients switching to ATV had virological failure more often (17/224 [7.8%]) than those continuing cART (73/3100 [2.4%], p < .0001). CONCLUSIONS: Patients with virological suppression, including those with lipodystrophy, may benefit from switching to ATV with lipid profile improvement, especially if baseline lipid levels are high. This should be balanced against a possible higher virological failure risk.

[Optimalisation of the antibiotic policy in The Netherlands. XI. The national electronic antibiotic guide'SWAB-ID' for use in hospitals]. / Optimaliseren van het antibioticabeleid in Nederland. XI. Het nationale elektronische antibioticaboekje SWAB-ID voor ziekenhuizen.

The 'Stichting Werkgroep Antibioticabeleid' (Dutch Working Party on Antibiotic Policy) has developed an electronic national antibiotic guide for the antibiotic treatment and prophylaxis of common infectious diseases in hospitals. This guide also contains information on the most important characteristics of antimicrobial drugs. Advice on antibiotic treatment is based on existing national evidence-based guidelines, where available. Where no guideline is available, the advice is based on an inventory of the antibiotic policies of the 12 Dutch centres with an infectious disease or medical microbiology training programme. The national antibiotic guide can be accessed through the SWAB website (www.swab.nl) and can also be downloaded on PDA/PocketPC, free of charge. Every hospital antibiotic formulary committee in the Netherlands will be offered the opportunity to edit The national version for local use.

[Hypoglycemia caused by oral hypoglycemic agents: risk of relapse after normalisation of blood glucose]. / Hypoglykemie bij orale bloedglucoseverlagende middelen: kans op recidief na herstel van de glucosespiegel.

Three patients, two women aged 83 and 79 years, and one man aged 61 years, known with diabetes mellitus and using oral blood glucose-lowering drugs, presented with impaired consciousness due to hypoglycaemia. Two of them were admitted and recovered well after recurrence of hypoglycaemia in one and discontinuation of medication in both. The third patient had prolonged hypoglycaemia and died three weeks later, still unconscious, due to pneumonia. Older patients with hypoglycaemia caused by longer acting sulphonylurea derivatives should be admitted, especially if they live alone or have risk factors such as renal or hepatic insufficiency. Intravenous glucose should be given if necessary. Discontinuation of the longer acting sulphonylurea derivative or replacement with a shorter acting drug should be considered.