Arthur S. Link to Professor Silver, 5 October 1955

Professional correspondenc

Arthur to Jim, 14 March 1956

Personal correspondenc

Daptomycin versus standard therapy for bacteremia and endocarditis caused by Staphylococcus aureus.

BACKGROUND: Alternative therapies for Staphylococcus aureus bacteremia and endocarditis are needed. METHODS: We randomly assigned 124 patients with S. aureus bacteremia with or without endocarditis to receive 6 mg of daptomycin intravenously per kilogram of body weight daily and 122 to receive initial low-dose gentamicin plus either an antistaphylococcal penicillin or vancomycin. The primary efficacy end point was treatment success 42 days after the end of therapy. RESULTS: Forty-two days after the end of therapy in the modified intention-to-treat analysis, a successful outcome was documented for 53 of 120 patients who received daptomycin as compared with 48 of 115 patients who received standard therapy (44.2 percent vs. 41.7 percent; absolute difference, 2.4 percent; 95 percent confidence interval, -10.2 to 15.1 percent). Our results met prespecified criteria for the noninferiority of daptomycin. The success rates were similar in subgroups of patients with complicated bacteremia, right-sided endocarditis, and methicillin-resistant S. aureus. Daptomycin therapy was associated with a higher rate of microbiologic failure than was standard therapy (19 vs. 11 patients, P=0.17). In 6 of the 19 patients with microbiologic failure in the daptomycin group, isolates with reduced susceptibility to daptomycin emerged; similarly, a reduced susceptibility to vancomycin was noted in isolates from patients treated with vancomycin. As compared with daptomycin therapy, standard therapy was associated with a nonsignificantly higher rate of adverse events that led to treatment failure due to the discontinuation of therapy (17 vs. 8, P=0.06). Clinically significant renal dysfunction occurred in 11.0 percent of patients who received daptomycin and in 26.3 percent of patients who received standard therapy (P=0.004). CONCLUSIONS: Daptomycin (6 mg per kilogram daily) is not inferior to standard therapy for S. aureus bacteremia and right-sided endocarditis. (ClinicalTrials.gov number, NCT00093067 [ClinicalTrials.gov].)

Wilson the diplomatist; a look at his major foreign policies.

Mode of access: Internet

Problems in American history. Third Edition. Volume I : Through reconstruction

New Jerseyxii, 436 p.: illus.; 23 c

White House publicity operations during the Korean War, June 1950 – June 1951

Truman was the first modern president to face the challenge of selling a limited war. Based on a wide range of primary sources, this article explores the impact that the Korean War had on Truman’s publicity operations. Whereas all wars place important new demands on presidents to speak out more frequently and forcefully, limited wars place significant constraints on what presidents can say and do. During the Korean War, Truman refused to go public at key moments, often employed rhetoric that was more restrained than at earlier moments of the Cold War, and shied away from creating new structures to coordinate the official message. Such actions also had important consequences. In 1950-51, they hampered the task of effective presidential communication, and contributed to the war’s growing unpopularity. For the longer term, they demonstrated the difficulties of selling a limited war, and hence place into sharper context the problems that beset Truman’s successors during the subsequent conflict in Vietnam