By Carol A. Kemper, MD, FACP
MRSA Hits Footballers Hard in Texas
Source: ProMED-mail post. November 14, 2002; www.promedmail.org.
Since the beginning of the school year, about 50 kids attending a local district high school in Pasadena, Texas, have developed infections due to methicillin-resistant Staphylococcus aureus (MRSA). The outbreak has hit the football team particularly hard, and at least 1 football player has missed 13 days of school because of recurrent skin boils. Infections began occurring in the school about 2 weeks into the school year and are probably being transmitted by the close contact of the kids, especially those on the sports teams.
Close contact sports, such as football, have been blamed for outbreaks of various infections for many years, including herpes simplex, molluscum contagiosum, trichophyton, Hepatitis B, group A strep, as well as S aureus.
While many "community-acquired" cases of MRSA are still believed to have their origins in hospitals, there is increasing evidence that true community-acquired MRSA is occurring with greater frequency. Interestingly, such cases may be more likely to result in toxic shock syndrome. Recent evidence presented in abstract form at the 2001 ICAAC suggested that community isolates are more likely to express staphylococcal toxins B and C compared with nosocomial isolates.1 In addition, community isolates are more likely to have isolated resistance to the penicillin-binding proteins, but retain susceptibility to other non-beta-lactam agents, such as clindamycin, trimethoprim-sulfamethoxazole, and quinolones. In contrast, nosocomial isolates are more frequently broadly resistant to a variety of agents.
Online Pharmacies Cater to Special Interests: Cipro and Anthrax
Source: Tsai AC, et al. Am J Med. 2002;113:424-427.
On-line pharmacy retailing and mail-order prescriptions continue to grow briskly, in part due to the aging baby boomer generation’s need for drugs.
One technology consultant estimates that consumers will buy $2.8 billion worth of prescription drugs online this year, plus $900 million worth of vitamins and over-the-counter drugs. While some of this business is limited to web sites designated by health care plans, smaller sites successfully turn a profit by nimbly responding to consumer whims and filling unusual niches. Of concern, many (possibly illegal) sites provide poor-quality information and inadequate consumer safeguards, and some sell foreign unapproved versions of various drugs as highlighted by the jump in the number of web sites selling ciprofloxacin in the wake of the anthrax scare last fall.
In October 2002, Tsai and associates identified 59 web sites selling ciprofloxacin, 23 of which were created within 2 weeks of the first anthrax report October 4. Forty-eight of the sites (81%) were registered to US addresses, but the rest operated around the globe or their address could not be identified. Half of the sites (49%) sold only ciprofloxacin; The remaining sites sold other drugs (usually Viagra®). Interestingly, while most of the sites specially advertised ciprofloxacin for anthrax "prophylaxis" or treatment, only two-thirds specified the appropriate duration of post-exposure prophylaxis (60 days). Several sites sold a 3- or 7-day "package" at discount. Side effects and contraindications were not provided by 28% of sites, and 19% did not require a completed medical questionnaire in order to purchase a drug. The median cost per tablet was $6.95 (range, $5.67-11.36), a 50% mark-up over the wholesale cost in the United States at that time.
During the next 12 months, many of the sites stopped selling ciprofloxacin or vanished from the net (presumably as demand lessened); almost 1 year later, only one-fifth of the original sites were still selling ciprofloxacin. Tsai et al maintain that US regulators are ill-equipped to adequately police such fly-by-night online retailers. While the FDA did attempt to halt private shipments of ciprofloxacin into the country last year and sent "cyber" letters to 11 overseas web sites selling non-US-approved versions of drugs, these warnings are apparently largely disregarded. While 3 of the sites selling ciprofloxacin received these warning letters, 2 were still in operation 1 year later.
Dr. Kemper, Clinical Associate Professor of Medicine, Stanford University, Division of Infectious Diseases; Santa Clara Valley Medical Center, is Associate Editor of Infectious Disease Alert.
MRSA Hits Footballers Hard in Texas; Online Pharmacies Cater to Special Interests: Cipro and Anthrax
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content