Shorter courses of parenteral antibiotic therapy do not appear to influence response rates for children with acute hematogenous osteomyelitis: a systematic review

BACKGROUND: Acute hematogenous osteomyelitis (AHO) occurs primarily in children and is believed to evolve from bacteremia followed by localization of infection to the metaphysis of bones. Currently, there is no consensus on the route and duration of antimicrobial therapy to treat AHO. METHODS: We conducted a systematic review of a short versus long course of treatment for AHO due primarily to Staphylococcus aureus in children aged 3 months to 16 years. We searched Medline, Embase and the Cochrane trials registry for controlled trials. Clinical cure rate at 6 months was the primary outcome variable, and groups receiving less than 7 days of intravenous therapy were compared with groups receiving one week or longer of intravenous antimicrobials. RESULTS: 12 eligible prospective studies, one of which was randomized, were identified. The overall cure rate at 6 months for the short course of intravenous therapy was 95.2% (95% CI = 90.4, 97.7) compared to 98.8% (95% CI = 93.6, 99.8) for the longer course of therapy. There was no significant difference in the duration of oral therapy between the two groups. CONCLUSIONS: Given the potential increased morbidity and cost associated with longer courses of intravenous therapy, this finding should be confirmed through a randomized controlled equivalence trial

Azithromycin-chloroquine and the intermittent preventive treatment of malaria in pregnancy

In the high malaria-transmission settings of sub-Saharan Africa, malaria in pregnancy is an important cause of maternal, perinatal and neonatal morbidity. Intermittent preventive treatment of malaria in pregnancy (IPTp) with sulphadoxine-pyrimethamine (SP) reduces the incidence of low birth-weight, pre-term delivery, intrauterine growth-retardation and maternal anaemia. However, the public health benefits of IPTp are declining due to SP resistance. The combination of azithromycin and chloroquine is a potential alternative to SP for IPTp. This review summarizes key in vitro and in vivo evidence of azithromycin and chloroquine activity against Plasmodium falciparum and Plasmodium vivax, as well as the anticipated secondary benefits that may result from their combined use in IPTp, including the cure and prevention of many sexually transmitted diseases. Drug costs and the necessity for external financing are discussed along with a range of issues related to drug resistance and surveillance. Several scientific and programmatic questions of interest to policymakers and programme managers are also presented that would need to be addressed before azithromycin-chloroquine could be adopted for use in IPTp

Characteristics of secondary slip fronts associated with slow earthquakes in Cascadia

We implement an algorithm to automatically detect migrations of low frequency earthquakes at time scales between 30 min and 32 h during the 2003, 2004 and 2005 slow slip events in Cascadia. We interpret these migrations of seismicity as a passive manifestation of secondary slip fronts (SSFs) that propagate faster than the main front. We identify the dominant features of 383 SSFs, including time, location, duration, area, propagation velocity and estimate: their moment, stress drop, slip, and slip rate. We apply the same algorithm to continuous tremor detection in Cascadia between 2009 and 2015 and characterize 693 SSFs at time scales between 4 h and 32 h. We identify — to our knowledge for the first time — numerous 11–22.5 h long SSFs that propagate at velocities intermediate between slow slip events and previously reported SSFs. The systematic detection of SSFs fills a gap between seismically and geodetically detectable slow earthquake processes. Analysis of SSF basic features indicates a wide range of stress drops and slip rates (with medians of 5.8 kPa and 1.1 mm/h) as well as an intriguing relationship between SSF direction and duration that was observed in other contexts and could potentially help discriminate between the different physical models proposed to explain slow slip phenomena