Arch Intern Med
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Randomized Controlled Trial Clinical Trial
Long-term efficacy of intranasal mupirocin ointment. A prospective cohort study of Staphylococcus aureus carriage.
We investigated the long-term effect of a single 5-day application of intranasal mupirocin calcium ointment on Staphylococcus aureus nasal and hand colonization. The subjects were 68 healthy volunteers who were health care workers with stable S aureus nasal carriage and who had participated in a randomized, double-blind placebo-controlled clinical trial of intranasal mupirocin ointment. ⋯ A single brief treatment course of intranasal mupirocin was effective in reducing nasal S aureus carriage for up to 1 year. When S aureus was recovered after nasal decolonization, the new isolate was as likely to represent colonization with a new strain as reisolation of the original strain. Staphylococcus aureus hand carriage was significantly decreased 6 months after therapy, further implicating the nares as the primary reservoir site for hand carriage.
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Randomized Controlled Trial Comparative Study Clinical Trial
Use of a standardized heparin nomogram to achieve therapeutic anticoagulation after thrombolytic therapy in myocardial infarction. TIMI 4 investigators. Thrombolysis in Myocardial Infarction.
The recently completed Thrombolysis in Myocardial Infarction (TIMI) 4 Study compared three thrombolytic treatment regimens for acute myocardial infarction. The treatment arms included front-loaded recombinant tissue plasminogen activator (rtPA), anistreplase (APSAC), or both, in conjunction with an intravenous bolus of 5000 U of heparin, followed by 1000 U/h. To facilitate anticoagulation, a heparin nomogram was developed to maintain the therapeutic activated partial thromboplastin time at 1 1/2 to 2 times the control value. ⋯ The use of a heparin nomogram provided improved anticoagulation in patients treated with thrombolytic therapy for myocardial infarction. Weight- and age-adjusted heparin dosing may provide further improvement in anticoagulation with heparin therapy. Our findings support the need for frequent monitoring of the activated partial thromboplastin time and for a standardized approach to adjusting the heparin dosage.