Joseph Timpone

Penicillin-Resistant Streptococcus pneumoniae Endocarditis: A Case Report and Review

Streptococcus pneumoniae has been a rare cause of endocarditis in the postantibiotic era. The emergence of antibiotic-resistant Pneumococcus species has been accompanied by isolated reports of penicillin-resistant S. pneumoniae (PRSP) endocarditis. We report a case of bivalvular PRSP endocarditis that was treated with vancomycin and trovafloxacin, and we review the literature on this topic.

Pharmacologic issues of antiretroviral agents and immunosuppressive regimens in HIV-infected solid organ transplant recipients.

HIV-positive patients are now undergoing solid organ transplantation at increasing rates, with successful outcomes. Transplantation in this unique patient population presents new challenges in the postoperative management of both antiretroviral regimens and immunosuppressive regimens. This review highlights the drug-drug interactions between commonly used immunosuppressive and antiretroviral agents. As more antiretroviral regimens are cautiously initiated in the posttransplant period, further research is needed to identify drug-drug interactions to minimize toxicities and improve long-term survival and graft function.

Hypophosphatemic osteomalacia associated with tenofovir use in HIV infected patients: a case series and review of the literature.

We present three cases of HIV-infected patients who developed Fanconi syndrome, hypophosphatemic osteomalacia and bone fractures while on tenofovir, a nucleotide reverse transcriptase inhibitor, commonly used as part of HIV treatment. All patients presented with bone pain, electrolyte and radiographic abnormalities which improved with discontinuation of tenofovir. Although, there have been several studies demonstrating causality between tenofovir and Fanconi syndrome, there are only six previously reported cases of patients developing osteomalacia and fractures since the introduction of tenofovir in 2001. In addition to asymptomatic osteopenia, hypophosphatemic osteomalacia is an important, reversible adverse effect of tenofovir.

Changing Patterns of Resistance to Ampicillin/Sulbactam

Objective: To report on methods to halt the increasing resistance of gram-negative organisms to ampicillin/sulbactam. Design: A before-after observational design was used to evaluate susceptibility of organisms to ampicillin/sulbactam. Setting: A university teaching hospital. Interventions: An educational program regarding appropriate prescribing of ampicillin/sulbactam and restriction of the use of ampicillin/sulbactam. Main Outcome Measures: Antimicrobial susceptibility to ampicillin/sulbactam. Results: The trend in increasing resistance was halted for Escherichia coli and Enterobacter. Emerging resistance of other organisms was not observed. Conclusions: The trend in increasing resistance was halted by restrictions on prescribing and by providing education regarding rational prescribing of ampicillin/sulbactam. We recommend that this combination not be used empirically to treat nosocomial infections or for bacteria against which ampicillin alone is effective.