Archive for November, 2015

The Center is delighted to highlight our effective therapy for both of these common types of Hepatitis. Hepatitis B treatment for those with chronically active Hepatitis B or the Carrier State have been available for a number of years and are highly effective. Many patients clear Hepatitis B with their caute infection and do not require prolonged treatment. All patients with Hepatitis C who have a measurable viral load are candidates for therapy. The New Hep C drugs are the most exciting development in Infectious Disease since the advent of highly effective anti HIV therapy in the late 1990s–thus about 20 years.These drugs are highly effective with over 95% cure rates and unlike previous interferon based therapy are well tolerated. We have been recently partnering with the VA to treat some of the large number of such patients who come through their facility. If you are either Hepatitis B Surface antigen + or Hepatitis C antibody + please call our office to schedule an appointment so we can discuss these treatment options to see if they apply in your case.Dr. Smith

From MMWR Weekly November 13,2015/64(44); 1233-1240

Tobacco smoking is the leading cause of preventable disease and death in the USA. It results in approximately 480,000 premaure deaths and more than 300 Billion in Direct Health care Costs each year..The CDC report is an update on the “Healthy People 2020” goal of reducing cigarette smoking adults to < 12% by 2020.Smoking adults aged 18=>  decreased from 20.9% in 2005 to 16.8% in 2014–an almost 20% decrease in this 10 year period. or about a .41 decrease in the number smoking per year.At this same rate we should decrease to about 14 % in 2020 suggesting that to reach the desired goal we need to redouble our efforts and develop even more new methods to prevent addiction and to treat addiction once established. Dr Smith

It has been too long since my last Post and I promise to do better through the rest of 2015 and 2016.

New Antibiotics:

      a. Dalvance and Orbactiv (IV).—These are new MRSA Antibiotics. Their unique feature is a very long half life.They can be given 1 time in the case of orbactiv or twice 7 days apart to produce a 14 day blood level. It is intended for MSSA and MRSA Skin and Skin structure infections.The good things are:1.Long half life 2,.Eliminate the need for PICC 3. Useful for patients who have difficulty taking antibiotics by the oral route or in whom compliance is an issue or in whom are not considered good candidates for  a PICC line. The bad thing–These drugs are astronomically expensive 3-4000 .00 a course. They have a narrow sweet spot as per above–that justifies their costs–especially if it can reduce hospital re-admissions.

     b/Silvextro– IV/Oral A new me too drug from Cubist now Merck. Only + is once a day.

Only indication is for Skin and Skin structure infections Gram positive cocci. Astronomically expensive 6 tablets 2,000.00.Now that Zyvox has gone generic with rapidly dropping prices–and a broader package insert–no reason to use.

    c.Mixed bag drugs—Zerbexa and Avycaz—-(IV)  Marketed as Zosyn like drugs. May have a place for multidrug resistant organisms are present.NOt for general use. Not ssure about pricing data on these 2.

Most of these compounds are not on testing batteries for hospitals so without an ability to test for organism susceptibility their usefulness is severely compromised. I do not see them being added to many formularies because of costs and inability to test so that they can be properly utilized.

New Antifungals-Cresembla for Invasive Aspergillosis

New Antiparasitic drugs—Impavido–Leishmaniasis

New Antivirals

       a,HIV–Evotaz and Prescobix

       b.Hepatitis C– A literal explosion of excellent but very expensive drugs. They are cost effective because of their very high cure rates. 95% or greater. Most exciting ID development since the advent of highly effective HIV therapies in the 1990s–at least 20 years. Harvoni, Viekira Pak,Technivie,

Daklinsa

New vaccines—Bexsero—A new vaccine for Type B Meningococcal immunizaiton.

All in all an astonishing 23 months or so with so many new products –it will take a while to determine their places in therapy. Nevertheless as someone who has devoted much of his caeer to antibiotic research—I am delighted to see so many new products come to market.

Questions can be directed to my e mail idelvis2@comcast.net

Dr . Smith