Christopher G Slatore | PubMed Health

PubMed2004

Sulfonamide hypersensitivity.

Sulfonamide antibiotics can result in a wide variety of hypersensitivity reactions. No validated diagnostic tests are available for sulfonamide reactions; therefore, clinicians must rely on the combination of a careful patient history, review of medical records, and a sound knowledge base regarding the common clinical manifestations of sulfonamide hypersensitivity reactions. Although HIV-infected individuals have a high risk for hypersensitivity reactions to sulfamethoxazole, readministering the drug can usually be performed safely by using a desensitization protocol. Sulfonamide-containing medications that are not antibiotics also have the capacity for causing hypersensitivity reactions. Whether the sulfa moiety confers a risk of cross-reaction is controversial. The preponderance of available evidence suggests that sulfonamide antibiotics probably do not cross-react with sulfonamide nonantibiotics.

Cross Reactions↗

PubMed2003

Hypersensitivity reactions to non-beta-lactam antibiotics.

As alternatives to beta lactam antibiotics continue to be developed, an increasing number of patients are experiencing hypersensitivity reactions to these agents. Unfortunately, unlike penicillin, there are no validated skin testing reagents to aid in confirming the presence of specific IgE antibodies to these drugs. This review summarizes what is known about hypersensitivity reactions to non-beta lactam antibiotics, and includes practical approaches to readministering these drugs in selected situations. Sulfonamides, vancomycin, macrolides, tetracyclines, fluoroquinolones, and anti-virals are included in the discussion.

Anti-Bacterial Agents↗

PubMedDate not supplied

The effects of work-hour limitations on resident well-being, patient care, and education in an internal medicine residency program.

BACKGROUND: The Accreditation Council for Graduate Medical Education work-hour limitations (WHLs) were implemented in July 2003. Effects on resident well-being, patient care, and education are not well understood. We investigated these effects of WHLs. METHODS: Self-administered survey of internal medicine residents in a university-based residency program in Seattle, Wash. Part of this survey was identical to one completed at our institution in 2001, permitting comparison of burnout, career satisfaction, and depression before and after WHLs. We surveyed 161 internal medicine residents, with 118 respondents (response rate, 73%). We measured resident well-being using the Maslach Burnout Inventory, a validated screening questionnaire for depression, and a previously described questionnaire for career satisfaction. We developed questions about overall agreement with implementation of WHLs and effects on resident well-being, patient care, and education. RESULTS: Comparison with the 2001 survey demonstrated an increase in the proportion of residents satisfied with their career (66% to 80%; P = .02) and a decrease in the proportion meeting criteria for emotional exhaustion (53% to 40%; P = .05). Slightly more residents reported a negative effect of WHLs on patient care (37%) than they did a positive (29%) or a neutral (34%) effect, and more reported a negative effect on their education (47%) than they did a positive (32%) or a neutral (21%) effect. Overall, most residents (65%) approved of WHLs. CONCLUSIONS: Internal medicine residents approve of WHLs overall and report benefits to their well-being. However, they also report negative effects on patient care and resident education.

Burnout, Professional↗