Immune-mediated hemolysis is a rare adverse effect of second- and third-generation cephalosporins, especially cefotetan (Cefotan) (PA Arndt et al, Transfusion 1999; 39:1239). A recent report serves as a reminder that life-threatening immune-mediated hemolysis rarely can follow administration of ceftriaxone (Rocephin), one of the most commonly used parenteral antibiotics in the US (A Citak et al, J Paediatr Child Health 2002; 38:209).

Tegaserod maleate (Zelnorm – Novartis), a partial serotonin 5-HT4 receptor agonist that increases gastrointestinal motility, was approved by the FDA in 2002 for short-term treatment of constipation-predominant irritable bowel syndrome in women,1 and in 2004 for treatment of chronic constipation in adults ≤65 years old. Its efficacy has not been impressive statistically, but according to Medical Letter consultants some patients with slow-transit constipation have benefited from taking the drug. Diarrhea has been its main adverse effect.2The FDA now has requested that the manufacturer stop...

Renal colic is a common problem in emergency departments. Stones <5 mm in diameter often pass spontaneously; stones >10 mm in diameter generally do not. The usual treatment for stones that do not pass is ureteroscopy with laser lithotripsy or shockwave lithotripsy. Some clinicians have suggested that off-label use of an oral alpha-adrenergic blocker such as tamsulosin (Flomax, and others) or calcium channel blocker such as nifedipine (Procardia XL, and others) could be tried first, with or without a corticosteroid. Both adrenoreceptors and calcium channels may have a role in the...

Transcatheter aortic-valve replacement (TAVR), a procedure in which a prosthetic valve is inserted into the aortic annulus by a catheter, has been approved by the FDA as an alternative to surgical aortic-valve replacement for patients with severe symptomatic aortic stenosis who are considered inoperable.

The FDA has approved a 1% cream formulation of the antiparasitic drug ivermectin (Soolantra – Galderma) for topical treatment of inflammatory lesions of rosacea. Ivermectin is available in the US in tablets (Stromectol, and generics) for treatment of onchocerciasis and other worm infestations and as a 0.5% lotion (Sklice) for treatment of head lice.

Exenatide injection (Byetta - Amylin/Lilly), a synthetic peptide that stimulates release of insulin from pancreatic beta cells, has been approved by the FDA as adjunctive therapy for patients with type 2 diabetes who have not achieved optimal glycemic control on metformin (Glucophage, and others), a sulfonylurea, such as glyburide (DiaBeta, and others), or both. Exenatide is not indicated for use with insulin.

Antibiotic treatment of group A streptococcal pharyngitis can relieve symptoms, limit transmission of infection, and prevent suppurative and nonsuppurative sequelae. Clinical findings may be unreliable, however, in establishing the diagnosis, and conventional throat cultures take overnight or longer to produce results. Rapid office tests for streptococcal pharyngitis can make the diagnosis in about 10 minutes. Since the previous Medical Letter article on this subject (Medical Letter, 27:49, 1985), many new tests have been marketed, including some that use new technologies.

HA-1A (Centoxin - Centocor), a monoclonal IgM antibody against endotoxin from gram-negative bacteria, may soon be approved for marketing by the US Food and Drug Administration. Commercially available in Europe, HA-1A has been used in the USA as an investigational drug. E5 (Xomen - Xoma), another monoclonal IgM antibody against endotoxin, is also available here for investigational use.

Intensive chemotherapy, with or without total body radiation, followed by bone marrow transplantation is now widely used in the treatment of malignant diseases. The drugs and radiation needed to try to eradicate the malignancy unavoidably destroy the bone marrow; intravenous infusion of bone marrow cells restores the marrow by repopulating it. Diseases for which bone marrow transplantation has been used include the leukemias and lymphomas, breast cancer, neuroblastoma, ovarian cancer, germ cell tumors, melanoma, multiple myeloma, and malignant gliomas (NC Gorin, Am J Clin On-col, 14...

Infliximab, a monoclonal antibody that inhibits tumor necrosis factor, has received an accelerated approval from the FDA for intravenous treatment of moderate to severe Crohn's disease refractory to other medical treatment.