Clinical Briefs

Am Fam Physician. 2002 Jul 1;66(1):164-165.

Tetanus Vaccine Now Available for Wound Care

A limited supply of the adult and adolescent vaccine for tetanus and diphtheria—Tetanus and Diphtheria Toxoids Adsorbed For Adult Use (Td)—is now available for distribution to office-based clinicians, according to its manufacturer. The vaccine had been rationed and was available only to emergency care facilities and public health clinics for critical needs.

The limited supply will allow office-based physicians to provide Td for wound care and other critical needs in the office. Routine 10-year boosters, however, are still deferred at this time, in accord with current deferral guidelines issued by the U.S. Centers for Disease Control and Prevention (CDC).

Early last year, Wyeth Lederle announced it had stopped production of tetanus toxoid-containing products, leaving Aventis Pasteur as the only national supplier of the vaccine. A shortage in supply resulted as Aventis Pasteur worked to increase production of the vaccine, which takes at least 11 months to produce. Aventis Pasteur expects to have a normal national supply by late summer, at which time it expects the CDC to lift the booster deferral guidelines.

Office-based physicians can place orders for the vaccine through Aventis Pasteur's Web site (www.vaccineshoppe.com) or by calling 800-822-2463. The CDC guidelines were published in the May 25, 2001 issue of Morbidity and Mortality Weekly Report and can be accessed online at www.cdc.gov/mmwr/preview/mmwrhtml/mm5020a8.htm.

Nutrition and Physical Activity for Cancer Prevention

An advisory committee of the American Cancer Society (ACS) has released new guidelines on nutrition and physical activity for cancer prevention. The guidelines appear in the March/April 2002 issue of CA: A Cancer Journal for Clinicians.

The guidelines serve as a foundation for the ACS to improve the quality of life of cancer survivors and to decrease cancer incidence and mortality by affecting dietary and physical activity patterns among Americans.

The guidelines include recommendations for individual choices regarding diet and physical activity patterns. The committee states that these choices often occur within a community context that either facilitates or interferes with healthy behaviors. Therefore, the committee offers recommendations for community action as well as recommendations for individual choices for nutrition and physical activity to reduce cancer risk.

Based on the current state of the scientific evidence, the ACS committee offers the following recommendations.

Public, private, and community organizations should work to create social and physical environments that support the adoption and maintenance of healthful nutrition and physical activity behaviors:

  1. Eat a variety of healthful foods, with an emphasis on plant sources.

  2. Adopt a physically active lifestyle.

  3. Maintain a healthful weight throughout life.

  4. If you drink alcoholic beverages, limit consumption.

The ACS guidelines are consistent with guidelines from the American Heart Association for the prevention of coronary heart disease as well as for general health promotion, as defined by the U.S. Department of Health and Human Services' 2000 Dietary Guidelines for Americans.

Obesity Management Guidelines

A panel of experts assembled by the National Heart, Lung, and Blood Institute's Obesity Education Initiative, in cooperation with the National Institute of Diabetes and Digestive and Kidney Diseases, has issued guidelines to aid physicians in the identification, evaluation, and treatment of overweight and obesity in adults.

The panel states that while there is agreement in the medical community about the health risks of obesity, there is less agreement about its management. Some experts have argued against treating obesity because of the difficulty in maintaining long-term weight loss and of potentially negative consequences of the frequently seen pattern of weight cycling in obese patients. Others argue that the potential hazards of treatment do not outweigh the known hazards of being obese.

The panel provides evidence for the effects of treatment on overweight and obesity, and focuses on the role of the primary care physician in treating the overweight patient.

The panel recommends treatment be a two-step process: assessment followed by treatment management. Assessment requires determination of the degree of overweight and overall risk status. Management includes both reducing excess body weight and instituting other measures to control accompanying risk factors.

A complete copy of the guidelines and additional resource tools can be accessed online at www.nhlbi.nih.gov/guidelines/index.htm.

Antiretroviral Agent Use in Patients with HIV

The U.S. Centers for Disease Control and Prevention (CDC) has released new guidelines for using antiretroviral agents among adults and adolescents infected with the human immunodeficiency virus (HIV). The guidelines were prepared by the Panel on Clinical Practices for Treatment of HIV and update a previous set of guidelines issued in 1998. The updated guidelines appear in the May 17, 2002, issue of Morbidity and Mortality Weekly Report and are also available online at www.cdc.gov/mmwr/preview/mmwrhtml/rr5107a1.htm.

The availability of an increasing number of antiretroviral agents and the rapid evolution of new information has introduced substantial complexity into treatment regimens for persons infected with HIV.

Within the guidelines, the panel addresses the following:

  • Testing for plasma HIV ribonucleic acid (RNA) levels and CD4 cell count

  • Testing for antiretroviral drug resistance

  • Considerations for when to initiate therapy

  • Adherence to antiretroviral therapy

  • Considerations for therapy among patients with advanced disease

  • Therapy-related adverse events

  • Interruption of therapy

  • Considerations for changing therapy and available therapeutic options

  • Treatment for acute HIV infection

  • Considerations for antiretroviral therapy among adolescents

  • Considerations for antiretroviral therapy among pregnant women

  • Concerns related to transmission of HIV to others

The panel also states that treatment should be offered to all patients with symptoms ascribed to HIV infection. Recommendations for offering therapy among asymptomatic patients require analysis of real and potential risks and benefits, and should be based on the following:

  • The willingness and readiness of the patient to begin therapy

  • The degree of existing immunodeficiency as determined by the CD4 cell count

  • The risk for disease pregression as determined by the cell count and level of plasma HIV RNA

  • The potential benefits and risks of initiating therapy in an asymptomatic person

  • The likelihood of adherence to the prescribed treatment program

Treatment goals should be (1) maximal and durable suppression of viral load, (2) restoration and preservation of immunologic function, (3) improvement of quality of life, and (4) reduction of HIV-related morbidity and mortality.

FDA Approves Olmesartan

The U.S. Food and Drug Administration (FDA) recently granted marketing approval for olmesartan medoxomil (Benicar). Olmesartan is an angiotensin II receptor blocker for the treatment of hypertension. It may be used alone or in combination with other antihypertensive agents.

According to the manufacturer, olmesartan works by blocking angiotensin II receptors on the blood vessels. Effects of therapy can be seen within a week of initiation through regular blood pressure monitoring. The recommended starting dose is 20 mg taken once a day, with or without food. Olmesartan is not recommended for pregnant women.

According to the results of clinical trials, the most common side effect of olmesartan was dizziness.


Copyright © 2002 by the American Academy of Family Physicians.
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