Risultati per: Terapia antibiotica: breve durata vs. lunga durata

Objectives
As, cases of congenital syphilis (CS) and infectious syphilis among women more than doubled in Florida and across the nation during 2013–2019, we sought to understand what may be contributing to these increases in Florida.

Design
A two time-period observational study.

Setting
Pregnant women with reported syphilis infections and their pregnancy outcomes (2013–2014 and 2018–2019) in Florida.

Participants
1213 pregnant women with reported syphilis infections living in Florida and 341 infants meeting the CS case definition.

Outcome measures
We assessed what proportion of the increase in CS was from increases in maternal syphilis infections. We examined maternal demographics, infection characteristics and timing of diagnoses that could explain the increase in CS. Finally, we reviewed if changes in presentation or severity of CS cases occurred.

Results
During 2013–2014, 83 (21%) of 404 pregnant women with syphilis delivered babies with CS. During 2018–2019, 258 (32%) of 809 pregnant women with syphilis delivered babies with CS. Comparing CS prevention rates, it was determined that 65% of the increase in CS was due to the increases in maternal syphilis infections. The proportion of maternal cases staged as primary or secondary increased over time (7%–13%) (p

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To the Editor Henssler and colleagues address the important question of whether treatment of depression with a combination of antidepressant medications has greater efficacy than antidepressant monotherapy. They conclude that combination therapy is more effective, particularly when monoamine reuptake inhibitors, such as selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs), are combined with medications that antagonize presynaptic α2-adrenoceptors. Included in the latter category are mianserin, mirtazapine, and trazodone. However, I wonder whether trazodone at therapeutic doses does antagonize α2-adrenoceptors. Ligand binding studies of trazodone to human brain α2-adrenoceptors show varying affinities that are nevertheless consistently greater than 100 nm. In addition, Price et al found that treatment of patients with depression with trazodone (mean dose, 346 mg daily) produced little effect on presynaptic α2-adrenoceptor function as judged by neurochemical responses to the α2-adrenoceptor agonist clonidine.

To the Editor Henssler et al conducted a systematic review and meta-analysis to investigate the treatment efficacy and tolerability of combining antidepressants vs monotherapy in adult patients with acute depression. Their meta-analysis found that combination therapy was superior to monotherapy in treatment efficacy (primary outcome standardized mean difference [SMD], 0.31; 95% CI, 0.19-0.44), and among the combinations, combining a reuptake inhibitor with an antagonist of presynaptic α2-autoreceptors (RI+α2) was associated with better outcomes than other combinations (SMD, 0.37; 95% CI, 0.19-0.55). Based on the findings, the authors concluded that combining antidepressants seemed to be more effective than monotherapy and that RI+α2 appeared to be the most effective combination therapy. However, when considering the limitations of SMDs and certainty of evidence as to the effect, this conclusion might be inappropriate.

In Reply We appreciate the pharmacological and design-related input voiced in the 3 letters. It is an opportunity to clarify and emphasize key aspects of our systematic review and meta-analysis.

To the Editor Henssler et al reported the results of a systematic review and meta-analysis comparing combination antidepressant therapy with antidepressant monotherapy for the treatment of depression. Some aspects of the review should be considered when interpreting the results.

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