AAFP Recommendations on Influenza and PPV Vaccinations

The Commission on Clinical Policies and Research of the American Academy of Family Physicians (AAFP) has issued a statement recommending prioritization of influenza immunization. According to the AAFP commission, those persons who are at highest risk for influenza should be given priority to receive the influenza vaccine. This includes (1) persons who have medical conditions that put them at increased risk, including chronic cardiopulmonary disorders, metabolic diseases such as diabetes mellitus, hemoglobinopathies, immunosuppression, renal dysfunction, those who are residents of chronic care facilities and health care professionals, followed by (2) other persons 65 years and older, and then (3) other persons 50 years and older.

The AAFP commission has also issued recommendations on the use of the adult pneumococcal polysaccharide vaccine (PPV). The commission recommends that family physicians discuss the PPV with all patients who are 65 years or older and with other high-risk patients. However, only 54 percent of adults in this age group had received the immunization by 1997, the most recent year with available statistics.

According to the AAFP, the following persons should be considered for PPV: patients who are institutionalized (50 years or older); those who have chronic cardiac or pulmonary disease, diabetes or anatomic asplenia; and those who live in areas or settings with an increased risk of pneumococcal disease. The PPV is a once-in-a-lifetime immunization, although some patients may require a booster.

Medicare covers the PPV for patients 65 years and older, and some insurance plans cover it for younger patients.

The new “Periodic Health Examinations Summary of AAFP Policy Recommendations and Age Charts” includes recommendations for the PPV. The charts are available free of charge by calling the AAFP order department at 800-944-0000 and requesting item no. D962. The charts may also be accessed on the AAFP Web site at https://www.aafp.org/policy/camp/app-d.html.

Cocaine Abuse Among Athletes

The American College of Sports Medicine (ACSM) has released an official statement on the abuse of cocaine among athletes. The statement appears in the ACSM's Current Comments, May 2000.

The ACSM reports that the abuse of recreational drugs (e.g., alcohol, nicotine, cocaine and marijuana) among athletes far outweighs the abuse of performance-enhancing drugs (e.g., anabolic steroids). Age, genetics, family influence, peer pressure, education and mental health factors may all play a role in recreational drug use.

According to the ACSM, cocaine is generally not used to enhance performance. Also, athletes are thought to be vulnerable to recreational substance abuse because they have some combination of the following variables: fame, money, free time and a feeling of invincibility.

Most of the time, athletic ability deteriorates with the use of cocaine, reports the ACSM. Sometimes observers note behavioral changes in athletes, such as arriving at practice too early or too late, missing practice altogether or fighting with teammates. Cocaine may cause feelings of grandiosity that can distort the athlete's perception of actual performance.

Adverse health effects of cocaine use that are of particular concern to athletes include sudden death caused by rhythm disturbances of the heart, seizures or bleeding in the brain. Athletes may also experience heart attack, hyperthermia, palpitations, anxiety, shortness of breath, chest pain, sinusitis and chronic nasal drip.

Current Comments are official statements by the ACSM concerning topics of interest to the public at large. More information may be obtained by calling 317-637-9200 or by writing the ACSM at P.O. Box 1440, Indianapolis, IN 46206-1440.

Risedronate Sodium for Osteoporosis

The U.S. Food and Drug Administration has approved risedronate sodium (Actonel), 5-mg tablets, for the treatment and prevention of postmenopausal osteoporosis and glucocorticoid-induced osteoporosis.

According to the manufacturer, the risk of new vertebral fractures was reduced by 65 percent in one year among postmenopausal women taking risedronate compared with women taking supplemental calcium and, if needed, vitamin D. This one-year vertebral fracture benefit has been shown consistently in several studies of risedronate.

The manufacturer also found that risedronate was well-tolerated, even among patients with gastrointestinal diseases, including ulcers, esophagitis and heartburn, and among patients taking nonsteroidal anti-inflammatory drugs, which often cause gastrointestinal upset.

Common side effects associated with the use of risedronate include upper respiratory infection and pain in the back and joints. According to the manufacturer, patients with low blood calcium, known allergy to risedronate or an inability to stand or sit upright for at least 30 minutes should not use this medication. Use of risedronate is not recommended in patients with severe kidney disease. Patients should be instructed to take risedronate with a full glass of water and to not lie down for 30 minutes after taking the medication.

Linezolid for Gram-positive Bacteria Infection

The U.S. Food and Drug Administration (FDA) has approved linezolid (Zyvox) injection, tablets and for oral suspension in the treatment of infections caused by gram-positive bacteria. According to the manufacturer, with oral and intravenous (IV) formulations, linezolid is the first completely new class of antibiotics to reach hospitals in 35 years.

According to the manufacturer, linezolid is indicated for adults in the treatment of nosocomial and community-acquired pneumonia, complicated and uncomplicated skin and skin structure infections and vancomycin-resistant Enterococcus infections caused by indicated bacteria. The drug is also approved for use in complicated skin infections and nosocomial pneumonia caused by methicillin-resistant Staphylococcus aureus, concurrent bacteremia associated with vancomycin-resistant Enterococcus faecium and concurrent bacteremia associated with community-acquired pneumonia caused by penicillin-susceptible Streptococcus pneumoniae.

The manufacturer reports that linezolid tablets are 100 percent bioavailable, which means that physicians can use the IV and tablet forms interchangeably without adjusting dosages.

Adverse effects associated with linezolid include diarrhea, headache, nausea and vomiting. In clinical trials, these were usually mild to moderate in intensity and limited in duration. The drug is generally well tolerated. Certain patients should have periodic monitoring of their blood platelet levels while using linezolid.