Jerome F. Levine

Vancomycin: A Review

This article reviewed the past experience and updated the present data on vancomycin. In recent years, with the release of more purified preparations of vancomycin and new clinical problems facing the clinician (that is, increasing prevalence of serious methicillin-resistant staphylococcal infections; use of hemodialysis and CAPD; widespread use of prosthetic devices; aggressive chemotherapy), the indication for vancomycin use has increased dramatically. More information is needed on the distribution of vancomycin in body tissues and the incidence and mechanisms of toxicity. Close surveillance of in vitro susceptibility patterns will be necessary as widespread use of vancomycin continues to increase.

Extending the Nurse Practitioner Concurrent Intervention Model to Community-Acquired Pneumonia and Chronic Obstructive Pulmonary Disease

BACKGROUND A Nurse Practitioner (NP) Concurrent Intervention Model shown effective for controlling telemetry usage was extended to patients with community-acquired pneumonia (CAP) and patients with chronic obstructive pulmonary disease (COPD). METHODS In spring 2000, investigators at Hackensack University Medical Center and the University of Medicine and Dentistry of New Jersey-New Jersey Medical School began an intervention to increase compliance with the Centers for Medicare & Medicaid Services (CMS) performance measures for CAP. Cost-reduction efforts were introduced by using previously described criteria for switching from intravenous to oral medication and for hospital discharge. RESULTS Use of the NP intervention model for patients admitted with CAP and for COPD patients resulted in significant reductions in length of stay and cost savings. DISCUSSION Concurrent intervention by a nurse practitioner can help achieve excellent compliance with performance measures for CAP and be applied to other chronic respiratory diseases such as COPD.

Successful Treatment of Aspergillus Peritonitis in an Adult on Continuous Ambulatory Peritoneal Dialysis

This report describes the first successful treatment of an adult on continuous ambulatory peritoneal dialysis with Aspergillus peritonitis. The published literature is also reviewed. Early removal of the peritoneal catheter combined with antifungal chemotherapy appear to be necessary for cure in patients with this disease.