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A review of published literature about benefits and harms of oral drugs for type 2 diabetes mellitus found that older agents, such as second-generation sulfonylureas and metformin, have similar or superior effects on glycemic control, lipids and other intermediate endpoints compared to newer, more expensive drugs, such as thiazolidinediones, alpha-glucosidase inhibitors and meglitinides. This is the first systematic review to compare all the drugs with one another, summarizing all available data on the full range of intermediate end-points, such as hemoglobin A1c, lipids, and body weight as well as on adverse effects and macrovascular risks. Authors say that comparative evidence is urgently needed to guide appropriate therapy, as new oral diabetes drugs continue to emerge on the market. (This review is published early online. It will appear in the Sept. 18, 2007, print edition of Annals of Internal Medicine.)
In the last 60 years, gonorrhea has become resistant to sulfonamides, penicillins, tetracyclines, and ciprofloxacin. Results of a 16-year monitoring program find it is becoming resistant to yet another antibiotic class, fluoroquinolones (Article, p. 81). The first fluoroquinolone-resistant gonorrheal bacteria were found in 1991. By 2003, 70 percent of participating clinics in the study reported them. Because of the spread of fluoroquuinolone resistance, the U.S. Centers for Disease Control no longer recommends using fluoroquinolones and now recommends cephalosporins, which are more expensive and often have to be injected.
Data from a national health survey indicate that more than two million people are infected with the sexually transmitted disease, chlamydia, (2.2 percent of people 14 to 39 years of age), whereas only about 0.24 percent of people in this age group have gonorrhea infection (Article, p. 89). Almost half the people with gonorrhea infection also had chlamydia infection. Adolescents had the highest rates of gonorrhea and chlamydia compared with other age groups. Both diseases can be successfully treated with antibiotics. Researchers say that current screening and treatment recommendations for these diseases must be “widely and consistently implemented.”