Browsing by Author "Louie, Thomas J"

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    Clostridium difficile in Clinical Practice: Increasing Rates, More Virulent Organisms and New Therapies on the Horizon
    (2006-01-01) Louie, Thomas J
    Clostridium difficile-associated diarrhea has recently come underincreasing scrutiny because of outbreaks of disease in eastern Canadain association with a hypervirulent ribotype 027 (NAP1) strain.Hospitals in the United States, the United Kingdom and Europe havebeen affected as well. Epidemiological studies are underway to determinethe presence of the more virulent strain of C difficile in hospitalsacross Canada. Because this strain is highly quinolone resistant, it issuspected that overuse of that class of antimicrobial agent may be aselection factor for this strain. Although C difficile-associated diarrheais usually considered a nosocomial infection, approximately one-quarterof cases occur in the community. Recurrence following successful resolutionof diarrhea occurs in one in five patients treated with metronidazoleor vancomycin; relapse is more common in patients needingretreatment. New therapies that may have equivalent or higherresponse rates and lower recurrence rates are being investigated. It ishoped that these new treatments will be a substantial improvementover current therapies. In the interim, prudent antimicrobial use andattention to infection control practices are the main preventivestrategies. Prompt testing for C difficile toxin in patients with diarrheaafter antibiotic exposure, discontinuation of unnecessary antibiotictherapy and rapid initiation of treatment should minimize complications.With the appearance of more toxigenic strains of C difficile,careful monitoring of patients to detect suboptimal clinical response isnecessary.
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    Intravenous to Oral Stepdown Antibiotic Therapy: Another Cost-Effective Strategy in an Era of Shrinking Health Care Dollars
    (1994-01-01) Louie, Thomas J
    The rapid transition from intravenous to oral antimicrobial therapy in hospitalized patients is being catalyzed by the need to gain further efficiencies in health care delivery without Compromising patient cure. The successful transition to oral therapy reduces complication from intravenous access devices. reduces cost of therapy and facilitates early discharge. both older and newer antimicrobials can be used as stepdown therapy. Although there are gaps in our information base with regards to outcome studies. the application of newer “pharmacodynamic” principles of antimicrobials action and careful selection of antimicrobials based on in vitro activity and pharmacokinetics will maximize the effectiveness of stepdown treatment of infections.