[1375] in iswork

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Sharper vision

daemon@ATHENA.MIT.EDU (cyrus carpenter)
Sat May 7 22:06:07 2005

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Date: Sun, 08 May 2005 00:03:23 +0200
From: "cyrus carpenter" <atny@xtcmail.com>
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To: "Grace Boyd" <iswork@mit.edu>
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-----Original Message-----
From: zackary [mailto:jeanne@jc.com]
Sent: Tuesday, March 8, 2005 3:86AM
To: corliss; sparkle@ltbkaidsk.com; jodi; oretha; elinor
Subject: post office list in top link


Forty four trials compared a broad spectrum, usually novel,  lactam with a
"routine" combination regimen. Rates of appropriate antibiotic treatment
with combination therapy and monotherapy were similar when reported.
Fatality was not significantly different. Failures were significantly more
common with combination therapy. Among all trials, we found no evidence for
any potential prevention of infection by resistant isolates with combination
therapy. 
It can be debated which design appropriately examines the clinical
interpretation of synergism, studies comparing same or different  lactams.
Synergism has been defined as a 2 log10 or greater reduction in bacterial
count with the combination versus that with each of the agents alone.86 In
studies comparing the same  lactam this is directly tested, but the effect
of increasing the antibiotic spectrum cannot be separated from a synergistic
effect. In studies comparing different  lactams the spectrum of coverage was
similar in both arms. However, synergism can be examined only indirectly. If
we assume that the aminoglycoside offers more than its additional coverage,
the combination arm should perform as well, or better, than the broader
spectrum  lactam monotherapy. With the former design we did not detect an
advantage to the combination, while with the latter we found an advantage to
monotherapy. 

And great novelists have written about the Martians and their wonderful
civilization, and-- And they all know as much about that little planet as
you do yourself, interrupted the Demon, impatiently

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