Internal medicine journal
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Internal medicine journal · Apr 2008
Case ReportsCavernous sinus thrombosis and meningitis from community-acquired methicillin-resistant Staphylococcus aureus infection.
Septic cavernous sinus thrombosis is an uncommon clinical syndrome with a high morbidity and mortality. The commonest bacterial pathogen is Staphylococcus aureus. We describe the study of a patient with cavernous sinus thrombosis and meningitis caused by community-acquired methicillin-resistant S. aureus (CA-MRSA) infection. ⋯ Cure was obtained following prolonged antimicrobial therapy with vancomycin, rifampicin, cotrimoxazole and linezolid. Given the high morbidity and mortality of cavernous sinus thrombosis and the worldwide recent emergence of CA-MRSA, clinicians treating patients with this infection should consider early empirical coverage for CA-MRSA with an antimicrobial agent, such as vancomycin or linezolid, particularly in the presence of suspected facial staphylococcal skin infections. If vancomycin is used, we emphasize that high doses may be required to achieve even low levels in the cerebrospinal fluid.
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Internal medicine journal · Apr 2008
Letter Case ReportsAtypical case of Herpes simplex encephalitis.
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Internal medicine journal · Mar 2008
Empiric antibiotic prescribing for patients with community-acquired pneumonia: where can we improve?
Community acquired pneumonia is one of the most common infections for which antibiotics are prescribed in Australia. ⋯ Efforts to improve prescribing practices could be focused towards identifying patients with severe illness early and improving recognition of documented allergies.
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Internal medicine journal · Mar 2008
Recombinant activated factor VII in critical bleeding: experience from the Australian and New Zealand Haemostasis Register.
There has been increasing off-label use of recombinant activated factor VII (rFVIIa/NovoSeven; Novo Nordisk, Bagsvaerd, Denmark) for patients with critical bleeding. Given the lack of high-level evidence, the clinical indications, observed response and adverse events are important to capture. ⋯ The Haemostasis Registry cannot replace well-designed prospective randomized controlled trials, but in their absence this registry provides a basis for understanding current clinical experience of rFVIIa. Registries continue to be vital in monitoring off-label uses of medications.