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In This Issue of Archives of Internal Medicine
Arch Intern Med. 2002;162:741.
Lack of Penicillin Resensitization in Patients With a History of Penicillin
Allergy After Receiving Repeated Penicillin Courses
Penicillin is the most commonly reported medication allergy. While up
to 10% of patients report a history of penicillin allergy, more than 80% of
these individuals lack penicillin-specific IgE antibodies. Penicillin skin
testing is highly accurate in identifying who can safely receive the antibiotic
at the time of testing, but its predictive value for future courses is unknown
because it is uncertain whether patients with a history of penicillin allergy
are at risk of becoming resensitized. To determine the rate of resensitization,
53 patients with negative penicillin skin test results and convincing histories
of penicillin allergy were challenged over several months with 3 consecutive
10-day courses of oral penicillin. None of the patients who completed the
protocol converted from a negative to a positive skin test result, yielding
a resensitization rate of 0%. The results indicate that a negative penicillin
skin test result is predictive for subsequent oral administration of penicillin
beyond the time of testing.
(SEE ARTICLE)
Smoking and Alanine Aminotransferase Levels in Hepatitis C Virus Infection
Smoking and drinking alcohol are independently associated with elevated
alanine aminotransferase levels among individuals who are seropositive for
anti–hepatitis C virus antibody but not among those who are seropositive
for hepatitis B surface antigen. Patients who are seropositive for anti–hepatitis
C virus antibody are strongly advised not to smoke and drink alcohol to reduce
the possible risk of aggravating the liver dysfunction.
(SEE ARTICLE)
Patient and Hospital Characteristics Associated With Recommended Processes
of Care for Elderly Patients Hospitalized With Pneumonia
In a retrospective cohort analysis, Fine et al examined the patient
and hospital factors associated with performance of processes of care for
patients with pneumonia that have been linked to improved likelihood of survival.
Performance of blood culture collection within 24 hours of hospital arrival
and initial antibiotic administration within 8 hours were positively associated
with higher nurse-bed ratios and fever on presentation and were negatively
associated with hospital location in the southern region of the United States.
Timely antibiotic administration was also negatively associated with nonwhite
race. Awareness of the variations in care associated with these patient and
hospital characteristics may assist medical providers seeking to improve the
quality of care.
(SEE ARTICLE)
Association Between Thyroid Dysfunction and Total Cholesterol Level
in an Older Biracial Population
Using data gathered from 2799 participants in the Health, Aging and
Body Composition Study (a prospective cohort study of well-functioning black
and white men and women aged 70-79 years), researchers found that the overall
prevalence of previously unidentified thyroid dysfunction was low (5.8%).
Subclinical hypothyroidism was the most common abnormality, which was most
prevalent in white women. Black women had equally low rates of subclinical
hypothyroidism compared with white and black men. A similar association between
thyrotropin and cholesterol existed for both racial groups: an elevated thyrotropin
level was associated with a 9-mg/dL (0.23-mmol/L) increase in cholesterol,
and a suppressed thyrotropin level was associated with a 19-mg/dL (0.49-mmol/L)
decrease in total cholesterol.
(SEE ARTICLE)
A Community-Wide Survey of Physician Practices and Attitudes Toward
Cholesterol Management in Patients With Recent Acute Myocardial Infarction
Current attitudes and practices toward the management of high total
and low-density lipoprotein cholesterol levels in patients with recent acute
myocardial infarction (AMI) are examined in this community-wide survey of
physicians from the Worcester (Mass) Standard Metropolitan Statistical Area.
Older physicians were less likely to implement recommended guidelines for
the treatment of high cholesterol levels in patients with recent AMI. Physicians
reported that they would treat younger patients with recent AMI more aggressively
with dietary changes and lipid-lowering drug therapies than older patients.
Internal medicine and cardiology physicians reported being more aggressive
with the use of lipid-lowering drug therapy, initiating treatment at lower
total serum and low-density lipoprotein cholesterol levels compared with other
physician specialties. Surveyed physicians identified several physician and
patient factors associated with the nonuse of lipid-lowering medications.
These findings suggest that educational- and practice-based efforts remain
necessary to remove potential barriers to the implementation of effective
long-term cholesterol management in patients with recent AMI.
(SEE ARTICLE)
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