Doug Brunk

SAN DIEGO – Atomoxetine appears to be safe in children and adolescents who have attention-deficit hyperactivity disorder and comorbid Tourette's syndrome, Dr. Thomas J. Spencer reported during a poster session at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

“My clinical sense is that's a great drug for the combination,” said Dr. Spencer, a child and adolescent psychiatrist who is assistant director of the pediatric psychopharmacology unit at Massachusetts General Hospital, Boston. “That being said, if kids have really bad tics, you use neuroleptics, pretty powerful drugs. But tics often fluctuate. So if the tics are mild or moderate, or if they drift into that range,” atomoxetine is an option.

As part of a larger study of children with ADHD and comorbid tic disorders, Dr. Spencer and his associates conducted a subanalysis of 117 children with ADHD and Tourette's syndrome (Neurology 2006;65:1941–9). The mean age of the children was 11 years, and most (87%) were boys.

The children were randomized to double-blind treatment with placebo or 0.5–1.5 mg/kg per day of atomoxetine (Strattera) for about 18 weeks. There were 56 children in the placebo group and 61 in the treatment group.

According to results of the Yale Global Tic Severity Scale and the Clinical Global Impressions severity of tic/neurologic symptoms score, children who received atomoxetine had a significantly greater reduction in tic severity between baseline and end of treatment, compared with the placebo group. However, results of the Tic Symptom Self-Report total score revealed that atomoxetine treatment did not significantly reduce tic severity, compared with children in the placebo group.

Children who received atomoxetine achieved significantly better ADHD Rating Scale total and subscale scores and Clinical Global Impressions overall severity scores, compared with their counterparts in the placebo group. However, the researchers wrote in the poster that atomoxetine treatment was “associated with increased pulse rate, decreased body weight, and significantly higher rates of decreased appetite and nausea. No other clinically relevant treatment differences were seen in any other vital sign, adverse event, laboratory parameter, or electrocardiographic measure.”

The study was funded by Lilly Research Laboratories. Dr. Spencer disclosed that he is an adviser and speaker for Eli Lilly & Co. He has also received research support from the company.

Atomoxetine is approved by the FDA for treatment of ADHD in children, adolescents, and adults.

SAN DIEGO – Atomoxetine appears to be safe in children and adolescents who have attention-deficit hyperactivity disorder and comorbid Tourette's syndrome, Dr. Thomas J. Spencer reported during a poster session at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

“My clinical sense is that's a great drug for the combination,” said Dr. Spencer, a child and adolescent psychiatrist who is assistant director of the pediatric psychopharmacology unit at Massachusetts General Hospital, Boston. “That being said, if kids have really bad tics, you use neuroleptics, pretty powerful drugs. But tics often fluctuate. So if the tics are mild or moderate, or if they drift into that range,” atomoxetine is an option.

As part of a larger study of children with ADHD and comorbid tic disorders, Dr. Spencer and his associates conducted a subanalysis of 117 children with ADHD and Tourette's syndrome (Neurology 2006;65:1941–9). The mean age of the children was 11 years, and most (87%) were boys.

The children were randomized to double-blind treatment with placebo or 0.5–1.5 mg/kg per day of atomoxetine (Strattera) for about 18 weeks. There were 56 children in the placebo group and 61 in the treatment group.

According to results of the Yale Global Tic Severity Scale and the Clinical Global Impressions severity of tic/neurologic symptoms score, children who received atomoxetine had a significantly greater reduction in tic severity between baseline and end of treatment, compared with the placebo group. However, results of the Tic Symptom Self-Report total score revealed that atomoxetine treatment did not significantly reduce tic severity, compared with children in the placebo group.

Children who received atomoxetine achieved significantly better ADHD Rating Scale total and subscale scores and Clinical Global Impressions overall severity scores, compared with their counterparts in the placebo group. However, the researchers wrote in the poster that atomoxetine treatment was “associated with increased pulse rate, decreased body weight, and significantly higher rates of decreased appetite and nausea. No other clinically relevant treatment differences were seen in any other vital sign, adverse event, laboratory parameter, or electrocardiographic measure.”

The study was funded by Lilly Research Laboratories. Dr. Spencer disclosed that he is an adviser and speaker for Eli Lilly & Co. He has also received research support from the company.

Atomoxetine is approved by the FDA for treatment of ADHD in children, adolescents, and adults.

SAN DIEGO – Atomoxetine appears to be safe in children and adolescents who have attention-deficit hyperactivity disorder and comorbid Tourette's syndrome, Dr. Thomas J. Spencer reported during a poster session at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

“My clinical sense is that's a great drug for the combination,” said Dr. Spencer, a child and adolescent psychiatrist who is assistant director of the pediatric psychopharmacology unit at Massachusetts General Hospital, Boston. “That being said, if kids have really bad tics, you use neuroleptics, pretty powerful drugs. But tics often fluctuate. So if the tics are mild or moderate, or if they drift into that range,” atomoxetine is an option.

As part of a larger study of children with ADHD and comorbid tic disorders, Dr. Spencer and his associates conducted a subanalysis of 117 children with ADHD and Tourette's syndrome (Neurology 2006;65:1941–9). The mean age of the children was 11 years, and most (87%) were boys.

The children were randomized to double-blind treatment with placebo or 0.5–1.5 mg/kg per day of atomoxetine (Strattera) for about 18 weeks. There were 56 children in the placebo group and 61 in the treatment group.

According to results of the Yale Global Tic Severity Scale and the Clinical Global Impressions severity of tic/neurologic symptoms score, children who received atomoxetine had a significantly greater reduction in tic severity between baseline and end of treatment, compared with the placebo group. However, results of the Tic Symptom Self-Report total score revealed that atomoxetine treatment did not significantly reduce tic severity, compared with children in the placebo group.

Children who received atomoxetine achieved significantly better ADHD Rating Scale total and subscale scores and Clinical Global Impressions overall severity scores, compared with their counterparts in the placebo group. However, the researchers wrote in the poster that atomoxetine treatment was “associated with increased pulse rate, decreased body weight, and significantly higher rates of decreased appetite and nausea. No other clinically relevant treatment differences were seen in any other vital sign, adverse event, laboratory parameter, or electrocardiographic measure.”

The study was funded by Lilly Research Laboratories. Dr. Spencer disclosed that he is an adviser and speaker for Eli Lilly & Co. He has also received research support from the company.

Atomoxetine is approved by the FDA for treatment of ADHD in children, adolescents, and adults.

SAN DIEGO – In children with attention-deficit hyperactivity disorder and epilepsy, treatment with osmotic release oral system methylphenidate produced no serious adverse events, no increase in seizures, and a significant decrease in the ADHD Rating Scale scores, compared with children who took placebo.

The study, which is the largest placebo-controlled trial of its kind, supports the findings of two older studies of methylphenidate and children with epilepsy and ADHD, but it marks the first time that OROS MPH (Concerta) has been evaluated in this population, Dr. Joseph Gonzalez-Heydrich reported during a poster session at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

“Our study indicates that OROS MPH is effective in kids who have epilepsy plus ADHD who had been at least 1 month seizure free” prior to treatment, Dr. Gonzalez-Heydrich of the department of psychiatry at Children's Hospital, Boston, said in an interview. “It's also safe. We haven't seen any increase in seizures.”

Dr. Gonzalez-Heydrich and his associates randomized 27 children with ADHD and epilepsy to receive either OROS MPH at a target dose of 18, 36, or 54 mg/day, or placebo, then crossed them over to the other regimen. The mean age of the children was 11 years, and all were taking anticonvulsants. The children were seizure free for 1 month but reported having a seizure within 5 years of study enrollment.

Each child remained at the maximum dose of OROS MPH for up to 1 week before crossing over into the placebo arm of the study. Each week, the researchers recorded adverse events and administered the ADHD Rating Scale (ADHD-RS) and the Clinical Global Impressions Scale (CGI).

“Change in the ADHD-RS total, hyperactive, and inattentive scores all revealed a significant main effect of week of treatment and a significant interaction of treatment and week,” the researchers wrote in their poster. Improvement from baseline was greater during the treatment phase regardless of the dosage level.

The researchers also noted that active medication and higher dosage predicted a greater decrease in the CGI severity scores.

No adverse events were observed, and seizures occurred during the active treatment and placebo phases in two patients. In addition, one other patient experienced a seizure during the placebo phase but not during the active treatment phase.

During the treatment phase, a more robust response was seen in boys, compared with girls. That difference “may have something to do with the threshold for girls being referred for treatment” but it remains unclear, Dr. Gonzalez-Heydrich said.

He acknowledged that a key limitation of the study was its small sample size. “We need a larger study,” he said. “We'd also like to start including kids with more frequent seizures. Then you'd really have the power to tell whether the seizures are affected [by the treatment] or not.”

The study was funded by a grant from the National Institute of Mental Health. McNeil Pediatrics, which manufactures Concerta, provided the study drug and the matching placebo.

Dr. Gonzalez-Heydrich also disclosed that McNeil covered his expenses to present the work at the meeting.

During treatment, a more robust response was seen in boys than in girls. DR. GONZALEZ-HEYDRICH

SAN DIEGO – In children with attention-deficit hyperactivity disorder and epilepsy, treatment with osmotic release oral system methylphenidate produced no serious adverse events, no increase in seizures, and a significant decrease in the ADHD Rating Scale scores, compared with children who took placebo.

The study, which is the largest placebo-controlled trial of its kind, supports the findings of two older studies of methylphenidate and children with epilepsy and ADHD, but it marks the first time that OROS MPH (Concerta) has been evaluated in this population, Dr. Joseph Gonzalez-Heydrich reported during a poster session at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

“Our study indicates that OROS MPH is effective in kids who have epilepsy plus ADHD who had been at least 1 month seizure free” prior to treatment, Dr. Gonzalez-Heydrich of the department of psychiatry at Children's Hospital, Boston, said in an interview. “It's also safe. We haven't seen any increase in seizures.”

Dr. Gonzalez-Heydrich and his associates randomized 27 children with ADHD and epilepsy to receive either OROS MPH at a target dose of 18, 36, or 54 mg/day, or placebo, then crossed them over to the other regimen. The mean age of the children was 11 years, and all were taking anticonvulsants. The children were seizure free for 1 month but reported having a seizure within 5 years of study enrollment.

Each child remained at the maximum dose of OROS MPH for up to 1 week before crossing over into the placebo arm of the study. Each week, the researchers recorded adverse events and administered the ADHD Rating Scale (ADHD-RS) and the Clinical Global Impressions Scale (CGI).

“Change in the ADHD-RS total, hyperactive, and inattentive scores all revealed a significant main effect of week of treatment and a significant interaction of treatment and week,” the researchers wrote in their poster. Improvement from baseline was greater during the treatment phase regardless of the dosage level.

The researchers also noted that active medication and higher dosage predicted a greater decrease in the CGI severity scores.

No adverse events were observed, and seizures occurred during the active treatment and placebo phases in two patients. In addition, one other patient experienced a seizure during the placebo phase but not during the active treatment phase.

During the treatment phase, a more robust response was seen in boys, compared with girls. That difference “may have something to do with the threshold for girls being referred for treatment” but it remains unclear, Dr. Gonzalez-Heydrich said.

He acknowledged that a key limitation of the study was its small sample size. “We need a larger study,” he said. “We'd also like to start including kids with more frequent seizures. Then you'd really have the power to tell whether the seizures are affected [by the treatment] or not.”

The study was funded by a grant from the National Institute of Mental Health. McNeil Pediatrics, which manufactures Concerta, provided the study drug and the matching placebo.

Dr. Gonzalez-Heydrich also disclosed that McNeil covered his expenses to present the work at the meeting.

During treatment, a more robust response was seen in boys than in girls. DR. GONZALEZ-HEYDRICH

SAN DIEGO – In children with attention-deficit hyperactivity disorder and epilepsy, treatment with osmotic release oral system methylphenidate produced no serious adverse events, no increase in seizures, and a significant decrease in the ADHD Rating Scale scores, compared with children who took placebo.

The study, which is the largest placebo-controlled trial of its kind, supports the findings of two older studies of methylphenidate and children with epilepsy and ADHD, but it marks the first time that OROS MPH (Concerta) has been evaluated in this population, Dr. Joseph Gonzalez-Heydrich reported during a poster session at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

“Our study indicates that OROS MPH is effective in kids who have epilepsy plus ADHD who had been at least 1 month seizure free” prior to treatment, Dr. Gonzalez-Heydrich of the department of psychiatry at Children's Hospital, Boston, said in an interview. “It's also safe. We haven't seen any increase in seizures.”

Dr. Gonzalez-Heydrich and his associates randomized 27 children with ADHD and epilepsy to receive either OROS MPH at a target dose of 18, 36, or 54 mg/day, or placebo, then crossed them over to the other regimen. The mean age of the children was 11 years, and all were taking anticonvulsants. The children were seizure free for 1 month but reported having a seizure within 5 years of study enrollment.

Each child remained at the maximum dose of OROS MPH for up to 1 week before crossing over into the placebo arm of the study. Each week, the researchers recorded adverse events and administered the ADHD Rating Scale (ADHD-RS) and the Clinical Global Impressions Scale (CGI).

“Change in the ADHD-RS total, hyperactive, and inattentive scores all revealed a significant main effect of week of treatment and a significant interaction of treatment and week,” the researchers wrote in their poster. Improvement from baseline was greater during the treatment phase regardless of the dosage level.

The researchers also noted that active medication and higher dosage predicted a greater decrease in the CGI severity scores.

No adverse events were observed, and seizures occurred during the active treatment and placebo phases in two patients. In addition, one other patient experienced a seizure during the placebo phase but not during the active treatment phase.

During the treatment phase, a more robust response was seen in boys, compared with girls. That difference “may have something to do with the threshold for girls being referred for treatment” but it remains unclear, Dr. Gonzalez-Heydrich said.

He acknowledged that a key limitation of the study was its small sample size. “We need a larger study,” he said. “We'd also like to start including kids with more frequent seizures. Then you'd really have the power to tell whether the seizures are affected [by the treatment] or not.”

The study was funded by a grant from the National Institute of Mental Health. McNeil Pediatrics, which manufactures Concerta, provided the study drug and the matching placebo.

Dr. Gonzalez-Heydrich also disclosed that McNeil covered his expenses to present the work at the meeting.

During treatment, a more robust response was seen in boys than in girls. DR. GONZALEZ-HEYDRICH

SAN DIEGO – Agreement between the Children's Interview for Psychiatric Syndromes and the Schedule for Affective Disorders and Schizophrenia for School-Age Children ranges from 66% to 90%. But the ChIPS instrument is more sensitive than the K-SADS in detecting psychopathology, results of a comparative study show.

The finding marks the first independent evaluation of the DSM-IV version of the ChIPS, Dr. Jeffrey I. Hunt said in an interview during a poster session at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

“We've been using the ChIPS for the last 4 years, but we thought we needed to make sure that it was valid compared to what we think the gold standard is: the K-SADS,” said Dr. Hunt, of the department of psychiatry and human behavior at Brown University, Providence, R.I. “We had hoped that the ChIPS was as valid as the K-SADS. We found that the ChIPS is a bit more sensitive. It picks up more diagnoses than the K-SADS, and it may be overdiagnosing somewhat.”

He and his associates administered the ChIPS and the K-SADS to 100 psychiatric inpatients aged 12–18 years who were enrolled in a study exploring the cognitive risk factors for suicidality. The mean age of the patients was 15 years, and 73% were female. Most (83%) were white.

The researchers reported that the percentage of agreement between the two diagnostic tools ranged from 66% to 90%, but they described the kappa agreement as “small to moderate.” They also noted that the mean number of diagnoses endorsed on the ChIPS was 4.5, compared with a mean number of 3.15 on the K-SADS, a difference that was statistically significant.

“Because the ChIPS appears to be more sensitive and not necessarily highly specific in its diagnostic categories, it seems that the ChIPS may be better suited as a screening measure, for use in ruling out diagnoses, rather than as a diagnostic instrument,” the researchers wrote in their poster.

They wrote that further studies should be conducted with an even larger sample size to figure out whether the ChIPS is reliable with other diagnostic measures. In addition, the investigators said, comparisons of ChIPS-derived diagnoses to scores obtained by using self-report instruments or checklists are needed to investigate the divergent validity of the interview.

“In the meantime, clinicians should be aware of the sensitivity of the ChIPS in diagnosis, and use it cautiously,” they wrote.

SAN DIEGO – Agreement between the Children's Interview for Psychiatric Syndromes and the Schedule for Affective Disorders and Schizophrenia for School-Age Children ranges from 66% to 90%. But the ChIPS instrument is more sensitive than the K-SADS in detecting psychopathology, results of a comparative study show.

The finding marks the first independent evaluation of the DSM-IV version of the ChIPS, Dr. Jeffrey I. Hunt said in an interview during a poster session at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

“We've been using the ChIPS for the last 4 years, but we thought we needed to make sure that it was valid compared to what we think the gold standard is: the K-SADS,” said Dr. Hunt, of the department of psychiatry and human behavior at Brown University, Providence, R.I. “We had hoped that the ChIPS was as valid as the K-SADS. We found that the ChIPS is a bit more sensitive. It picks up more diagnoses than the K-SADS, and it may be overdiagnosing somewhat.”

He and his associates administered the ChIPS and the K-SADS to 100 psychiatric inpatients aged 12–18 years who were enrolled in a study exploring the cognitive risk factors for suicidality. The mean age of the patients was 15 years, and 73% were female. Most (83%) were white.

The researchers reported that the percentage of agreement between the two diagnostic tools ranged from 66% to 90%, but they described the kappa agreement as “small to moderate.” They also noted that the mean number of diagnoses endorsed on the ChIPS was 4.5, compared with a mean number of 3.15 on the K-SADS, a difference that was statistically significant.

“Because the ChIPS appears to be more sensitive and not necessarily highly specific in its diagnostic categories, it seems that the ChIPS may be better suited as a screening measure, for use in ruling out diagnoses, rather than as a diagnostic instrument,” the researchers wrote in their poster.

They wrote that further studies should be conducted with an even larger sample size to figure out whether the ChIPS is reliable with other diagnostic measures. In addition, the investigators said, comparisons of ChIPS-derived diagnoses to scores obtained by using self-report instruments or checklists are needed to investigate the divergent validity of the interview.

“In the meantime, clinicians should be aware of the sensitivity of the ChIPS in diagnosis, and use it cautiously,” they wrote.

SAN DIEGO – Agreement between the Children's Interview for Psychiatric Syndromes and the Schedule for Affective Disorders and Schizophrenia for School-Age Children ranges from 66% to 90%. But the ChIPS instrument is more sensitive than the K-SADS in detecting psychopathology, results of a comparative study show.

The finding marks the first independent evaluation of the DSM-IV version of the ChIPS, Dr. Jeffrey I. Hunt said in an interview during a poster session at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

“We've been using the ChIPS for the last 4 years, but we thought we needed to make sure that it was valid compared to what we think the gold standard is: the K-SADS,” said Dr. Hunt, of the department of psychiatry and human behavior at Brown University, Providence, R.I. “We had hoped that the ChIPS was as valid as the K-SADS. We found that the ChIPS is a bit more sensitive. It picks up more diagnoses than the K-SADS, and it may be overdiagnosing somewhat.”

He and his associates administered the ChIPS and the K-SADS to 100 psychiatric inpatients aged 12–18 years who were enrolled in a study exploring the cognitive risk factors for suicidality. The mean age of the patients was 15 years, and 73% were female. Most (83%) were white.

The researchers reported that the percentage of agreement between the two diagnostic tools ranged from 66% to 90%, but they described the kappa agreement as “small to moderate.” They also noted that the mean number of diagnoses endorsed on the ChIPS was 4.5, compared with a mean number of 3.15 on the K-SADS, a difference that was statistically significant.

“Because the ChIPS appears to be more sensitive and not necessarily highly specific in its diagnostic categories, it seems that the ChIPS may be better suited as a screening measure, for use in ruling out diagnoses, rather than as a diagnostic instrument,” the researchers wrote in their poster.

They wrote that further studies should be conducted with an even larger sample size to figure out whether the ChIPS is reliable with other diagnostic measures. In addition, the investigators said, comparisons of ChIPS-derived diagnoses to scores obtained by using self-report instruments or checklists are needed to investigate the divergent validity of the interview.

“In the meantime, clinicians should be aware of the sensitivity of the ChIPS in diagnosis, and use it cautiously,” they wrote.

SAN DIEGO – Between 1990 and 2001, the number of children and adolescents diagnosed with depression increased 2.4-fold, and the use of antidepressants increased from 44% to 59%, according to a nationwide study of physician office visits.

Specifically, use of selective serotonin reuptake inhibitors increased from 21% to 40% over the same time period, while use of tricyclic antidepressants fell from 21% to 3%, Linda M. Robison reported during a poster session at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

“Physicians are doing a good job as far as not prescribing the tricyclics anymore,” Ms. Robison of the Washington State University College of Pharmacy in Pullman, Wash., said in an interview. “That's what you would hope to see. Children are also being diagnosed [with depression] more than they have [been] in the past, which is probably appropriate.”

In a study led by her associate, David A. Sclar, B.Pharm, the researchers used data from the U.S. National Ambulatory Medical Care Survey to determine the population-adjusted rates of office-based physician visits that resulted in a diagnosis of depression in patients aged 5–18 years between 1990 and 2001. The diagnosis was based on International Statistical Classification of Diseases, 9th Revision.

The researchers also documented the type of antidepressant prescribed and broke the analysis into three time frames: 1990–1993; 1994–1997, and 1998–2001.

Ms. Robison and her associates found that over the 12-year time period, the population-adjusted rate of physician office visits documenting a diagnosis of depression increased 2.4-fold, from 12.9 per 1,000 patients to 31.1 per 1,000 patients.

At the same time, the number of patients who were prescribed an antidepressant increased from 44% in 1990–1993 to 59% in 1998–2001. The use of SSRIs increased from 21% in 1990–1993 to 40% in 1998–2001, while the use of tricyclic antidepressants fell from 21% to 3%.

Most office visits were made by 13− to 18-year-olds who were seen by a psychiatrist.

The study was supported by the National Alliance for Research on Schizophrenia and Depression.

SAN DIEGO – Between 1990 and 2001, the number of children and adolescents diagnosed with depression increased 2.4-fold, and the use of antidepressants increased from 44% to 59%, according to a nationwide study of physician office visits.

Specifically, use of selective serotonin reuptake inhibitors increased from 21% to 40% over the same time period, while use of tricyclic antidepressants fell from 21% to 3%, Linda M. Robison reported during a poster session at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

“Physicians are doing a good job as far as not prescribing the tricyclics anymore,” Ms. Robison of the Washington State University College of Pharmacy in Pullman, Wash., said in an interview. “That's what you would hope to see. Children are also being diagnosed [with depression] more than they have [been] in the past, which is probably appropriate.”

In a study led by her associate, David A. Sclar, B.Pharm, the researchers used data from the U.S. National Ambulatory Medical Care Survey to determine the population-adjusted rates of office-based physician visits that resulted in a diagnosis of depression in patients aged 5–18 years between 1990 and 2001. The diagnosis was based on International Statistical Classification of Diseases, 9th Revision.

The researchers also documented the type of antidepressant prescribed and broke the analysis into three time frames: 1990–1993; 1994–1997, and 1998–2001.

Ms. Robison and her associates found that over the 12-year time period, the population-adjusted rate of physician office visits documenting a diagnosis of depression increased 2.4-fold, from 12.9 per 1,000 patients to 31.1 per 1,000 patients.

At the same time, the number of patients who were prescribed an antidepressant increased from 44% in 1990–1993 to 59% in 1998–2001. The use of SSRIs increased from 21% in 1990–1993 to 40% in 1998–2001, while the use of tricyclic antidepressants fell from 21% to 3%.

Most office visits were made by 13− to 18-year-olds who were seen by a psychiatrist.

The study was supported by the National Alliance for Research on Schizophrenia and Depression.

SAN DIEGO – Between 1990 and 2001, the number of children and adolescents diagnosed with depression increased 2.4-fold, and the use of antidepressants increased from 44% to 59%, according to a nationwide study of physician office visits.

Specifically, use of selective serotonin reuptake inhibitors increased from 21% to 40% over the same time period, while use of tricyclic antidepressants fell from 21% to 3%, Linda M. Robison reported during a poster session at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

“Physicians are doing a good job as far as not prescribing the tricyclics anymore,” Ms. Robison of the Washington State University College of Pharmacy in Pullman, Wash., said in an interview. “That's what you would hope to see. Children are also being diagnosed [with depression] more than they have [been] in the past, which is probably appropriate.”

In a study led by her associate, David A. Sclar, B.Pharm, the researchers used data from the U.S. National Ambulatory Medical Care Survey to determine the population-adjusted rates of office-based physician visits that resulted in a diagnosis of depression in patients aged 5–18 years between 1990 and 2001. The diagnosis was based on International Statistical Classification of Diseases, 9th Revision.

The researchers also documented the type of antidepressant prescribed and broke the analysis into three time frames: 1990–1993; 1994–1997, and 1998–2001.

Ms. Robison and her associates found that over the 12-year time period, the population-adjusted rate of physician office visits documenting a diagnosis of depression increased 2.4-fold, from 12.9 per 1,000 patients to 31.1 per 1,000 patients.

At the same time, the number of patients who were prescribed an antidepressant increased from 44% in 1990–1993 to 59% in 1998–2001. The use of SSRIs increased from 21% in 1990–1993 to 40% in 1998–2001, while the use of tricyclic antidepressants fell from 21% to 3%.

Most office visits were made by 13− to 18-year-olds who were seen by a psychiatrist.

The study was supported by the National Alliance for Research on Schizophrenia and Depression.

SAN DIEGO – More than half of adolescents with inflammatory bowel disease met criteria for one or more DSM-IV disorders, in particular adjustment disorders and major depressive disorder, Dr. Andreas Richterich reported during a poster session at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

In addition, adolescents with a psychiatric disorder had higher levels of health-related distress, compared with those who did not have a psychiatric disorder. “What it means is, the way you cope with your illness determines your quality of life,” said Dr. Richterich, of the department of psychosomatics in children and adolescents at University Medical Center Hamburg-Eppendorf (Germany).

“So within the group of somatically ill, it's worth screening for psychiatric disorders to help them.”

In what he said is the first study of its kind, Dr. Richterich and his associates performed a cross-sectional analysis of 47 patients with IBD who were aged 12–18 years. They used the Clinical Assessment Scale for Child and Adolescent Psychopathology and questionnaires to analyze self-, parent, and physician ratings for health-related quality of life, emotional problems, and disease severity as defined by the pediatric Crohn's Disease Activity Index.

Questionnaires used in the study included the IMPACT III, a disease-specific quality of life questionnaire for children and adolescents; the Strengths and Difficulties Questionnaire (SDQ); and the European Quality of Life instrument.

The mean age of the 47 patients was 15 years, and 27 were male. There were 24 cases of Crohn's disease, 20 cases of ulcerative colitis, and 3 cases of colitis indeterminata.

Overall, 26 of the adolescents (55.3%) fulfilled criteria for one or more DSM-IV disorders. Of these, 25.6% were adjustment disorders and 17% were major depressive disorder. The rest included anxiety disorder (6.4%), learning/developmental disorders (4.2%), and attention-deficit hyperactivity disorder (2.1%). Only 15% of patients with DSM-IV disorders had ever been in contact with a child and adolescent psychiatrist or psychotherapist.

Dr. Richterich reported that there was overall agreement between patients, parents, and physicians in the measures of health-related quality of life. SDQ scores for patients with DSM-IV disorders were significantly higher, compared with patients who did not have DSM-IV disorders. Also, quality of life as measured by the IMPACT III was significantly lower in patients with DSM-IV disorders, compared with those who did not suffer from emotional problems.

There was a “dose-response” relationship between the severity of illness and level of reduced quality of life, especially among those who had mild IBD activity. “It's clear that the health-related distress rises with the [IBD] activity,” Dr. Richterich said.

Key limitations of the study, Dr. Richterich added, are the small sample size and the fact that specific questionnaires for depressive disorder and anxiety disorder were not administered.

'It's clear that the health-related distress rises with the [inflammatory bowel disease] activity.' DR. RICHTERICH

SAN DIEGO – More than half of adolescents with inflammatory bowel disease met criteria for one or more DSM-IV disorders, in particular adjustment disorders and major depressive disorder, Dr. Andreas Richterich reported during a poster session at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

In addition, adolescents with a psychiatric disorder had higher levels of health-related distress, compared with those who did not have a psychiatric disorder. “What it means is, the way you cope with your illness determines your quality of life,” said Dr. Richterich, of the department of psychosomatics in children and adolescents at University Medical Center Hamburg-Eppendorf (Germany).

“So within the group of somatically ill, it's worth screening for psychiatric disorders to help them.”

In what he said is the first study of its kind, Dr. Richterich and his associates performed a cross-sectional analysis of 47 patients with IBD who were aged 12–18 years. They used the Clinical Assessment Scale for Child and Adolescent Psychopathology and questionnaires to analyze self-, parent, and physician ratings for health-related quality of life, emotional problems, and disease severity as defined by the pediatric Crohn's Disease Activity Index.

Questionnaires used in the study included the IMPACT III, a disease-specific quality of life questionnaire for children and adolescents; the Strengths and Difficulties Questionnaire (SDQ); and the European Quality of Life instrument.

The mean age of the 47 patients was 15 years, and 27 were male. There were 24 cases of Crohn's disease, 20 cases of ulcerative colitis, and 3 cases of colitis indeterminata.

Overall, 26 of the adolescents (55.3%) fulfilled criteria for one or more DSM-IV disorders. Of these, 25.6% were adjustment disorders and 17% were major depressive disorder. The rest included anxiety disorder (6.4%), learning/developmental disorders (4.2%), and attention-deficit hyperactivity disorder (2.1%). Only 15% of patients with DSM-IV disorders had ever been in contact with a child and adolescent psychiatrist or psychotherapist.

Dr. Richterich reported that there was overall agreement between patients, parents, and physicians in the measures of health-related quality of life. SDQ scores for patients with DSM-IV disorders were significantly higher, compared with patients who did not have DSM-IV disorders. Also, quality of life as measured by the IMPACT III was significantly lower in patients with DSM-IV disorders, compared with those who did not suffer from emotional problems.

There was a “dose-response” relationship between the severity of illness and level of reduced quality of life, especially among those who had mild IBD activity. “It's clear that the health-related distress rises with the [IBD] activity,” Dr. Richterich said.

Key limitations of the study, Dr. Richterich added, are the small sample size and the fact that specific questionnaires for depressive disorder and anxiety disorder were not administered.

'It's clear that the health-related distress rises with the [inflammatory bowel disease] activity.' DR. RICHTERICH

SAN DIEGO – More than half of adolescents with inflammatory bowel disease met criteria for one or more DSM-IV disorders, in particular adjustment disorders and major depressive disorder, Dr. Andreas Richterich reported during a poster session at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

In addition, adolescents with a psychiatric disorder had higher levels of health-related distress, compared with those who did not have a psychiatric disorder. “What it means is, the way you cope with your illness determines your quality of life,” said Dr. Richterich, of the department of psychosomatics in children and adolescents at University Medical Center Hamburg-Eppendorf (Germany).

“So within the group of somatically ill, it's worth screening for psychiatric disorders to help them.”

In what he said is the first study of its kind, Dr. Richterich and his associates performed a cross-sectional analysis of 47 patients with IBD who were aged 12–18 years. They used the Clinical Assessment Scale for Child and Adolescent Psychopathology and questionnaires to analyze self-, parent, and physician ratings for health-related quality of life, emotional problems, and disease severity as defined by the pediatric Crohn's Disease Activity Index.

Questionnaires used in the study included the IMPACT III, a disease-specific quality of life questionnaire for children and adolescents; the Strengths and Difficulties Questionnaire (SDQ); and the European Quality of Life instrument.

The mean age of the 47 patients was 15 years, and 27 were male. There were 24 cases of Crohn's disease, 20 cases of ulcerative colitis, and 3 cases of colitis indeterminata.

Overall, 26 of the adolescents (55.3%) fulfilled criteria for one or more DSM-IV disorders. Of these, 25.6% were adjustment disorders and 17% were major depressive disorder. The rest included anxiety disorder (6.4%), learning/developmental disorders (4.2%), and attention-deficit hyperactivity disorder (2.1%). Only 15% of patients with DSM-IV disorders had ever been in contact with a child and adolescent psychiatrist or psychotherapist.

Dr. Richterich reported that there was overall agreement between patients, parents, and physicians in the measures of health-related quality of life. SDQ scores for patients with DSM-IV disorders were significantly higher, compared with patients who did not have DSM-IV disorders. Also, quality of life as measured by the IMPACT III was significantly lower in patients with DSM-IV disorders, compared with those who did not suffer from emotional problems.

There was a “dose-response” relationship between the severity of illness and level of reduced quality of life, especially among those who had mild IBD activity. “It's clear that the health-related distress rises with the [IBD] activity,” Dr. Richterich said.

Key limitations of the study, Dr. Richterich added, are the small sample size and the fact that specific questionnaires for depressive disorder and anxiety disorder were not administered.

'It's clear that the health-related distress rises with the [inflammatory bowel disease] activity.' DR. RICHTERICH

SAN DIEGO – Children who are hospitalized for moderate to severe physical injuries face a high risk of posttraumatic stress disorder symptoms and psychological impairment if they display certain avoidance behaviors, Dr. Christopher Petersen said in an interview during a poster session at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

Examples of such behavior include the child saying it's difficult to feel happy or staying away from reminders of the event that led to his or her injury.

The finding “confirms some of the things we know about adults that we've been trying to apply to children,” Dr. Petersen said. “That is, out of avoidance, hyperarousal, and reexperiencing, avoidance seems to be the factor that most likely goes with [psychological] impairment.”

He and his associates also found no correlation between the level of a child's physical trauma and the severity of subsequent psychological impairment or PTSD symptoms.

“We thought that the kids who had major physical trauma would be more traumatized psychologically, but that's not necessarily the case,” said Dr. Petersen of the department of psychiatry at Pennsylvania State University in Hershey. “There are other factors playing into that.”

The researchers studied 28 children who were hospitalized for moderate to severe injuries: 22 were injured in motor vehicle accidents, 5 during sports, and 1 in a fall from a second-story window.

The mean age of the children was 13 years, and more than half (16) were boys. Ten days after hospital discharge, the children completed the Child and Adolescent PTSD Checklist, and their parents completed the Columbia Impairment Scale.

Of the 13 items on the PTSD Checklist, 82% of children reported that one or more of the symptoms caused problems for them most or all of the time. The most common symptoms reported were difficulty remembering what happened (32%), trying not to think about what happened (25%), and mentally going over what happened (25%).

Only six of the children (21%) had Columbia Impairment Scale scores in the abnormal range. The mean score for all patients was 10.6, which is considered normal.

Dr. Petersen noted that the PTSD subscales of avoidance and hyperarousal were significantly correlated with the Columbia Impairment Scale score, but the reexperiencing subscale was not.

“Watch for kids who have avoidance symptoms,” he advised. “If those symptoms persist beyond 30 days, those are the kids you really need to track or get into treatment early.”

In contrast, Dr. Petersen added, young people “who are dealing with [the physical trauma] over and over again, talking about it, struggling with it, maybe getting angry or tearful–those are kids who are more likely to work through it.” The researchers also found that high levels of physical trauma severity were not associated with high levels of psychological impairment or PTSD symptoms, a finding they did not expect.

“Is that because a lot of these children may have been as traumatized by the experience in the hospital with surgeries or interventions compared to the original physical trauma, or is that because of previous traumas that they had?” Dr. Petersen asked. “We don't know.”

He and his associates are in the process of conducting the study in a larger patient population to see whether the findings bear out.

The study was funded by grants from the Penn State Children, Youth, and Families Consortium and the Penn State Children's Miracle Network.

In addition, funding was provided by a grant from the American Academy of Child and Adolescent Psychiatry that was supported by McNeil Consumer and Specialty Pharmaceuticals.

SAN DIEGO – Children who are hospitalized for moderate to severe physical injuries face a high risk of posttraumatic stress disorder symptoms and psychological impairment if they display certain avoidance behaviors, Dr. Christopher Petersen said in an interview during a poster session at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

Examples of such behavior include the child saying it's difficult to feel happy or staying away from reminders of the event that led to his or her injury.

The finding “confirms some of the things we know about adults that we've been trying to apply to children,” Dr. Petersen said. “That is, out of avoidance, hyperarousal, and reexperiencing, avoidance seems to be the factor that most likely goes with [psychological] impairment.”

He and his associates also found no correlation between the level of a child's physical trauma and the severity of subsequent psychological impairment or PTSD symptoms.

“We thought that the kids who had major physical trauma would be more traumatized psychologically, but that's not necessarily the case,” said Dr. Petersen of the department of psychiatry at Pennsylvania State University in Hershey. “There are other factors playing into that.”

The researchers studied 28 children who were hospitalized for moderate to severe injuries: 22 were injured in motor vehicle accidents, 5 during sports, and 1 in a fall from a second-story window.

The mean age of the children was 13 years, and more than half (16) were boys. Ten days after hospital discharge, the children completed the Child and Adolescent PTSD Checklist, and their parents completed the Columbia Impairment Scale.

Of the 13 items on the PTSD Checklist, 82% of children reported that one or more of the symptoms caused problems for them most or all of the time. The most common symptoms reported were difficulty remembering what happened (32%), trying not to think about what happened (25%), and mentally going over what happened (25%).

Only six of the children (21%) had Columbia Impairment Scale scores in the abnormal range. The mean score for all patients was 10.6, which is considered normal.

Dr. Petersen noted that the PTSD subscales of avoidance and hyperarousal were significantly correlated with the Columbia Impairment Scale score, but the reexperiencing subscale was not.

“Watch for kids who have avoidance symptoms,” he advised. “If those symptoms persist beyond 30 days, those are the kids you really need to track or get into treatment early.”

In contrast, Dr. Petersen added, young people “who are dealing with [the physical trauma] over and over again, talking about it, struggling with it, maybe getting angry or tearful–those are kids who are more likely to work through it.” The researchers also found that high levels of physical trauma severity were not associated with high levels of psychological impairment or PTSD symptoms, a finding they did not expect.

“Is that because a lot of these children may have been as traumatized by the experience in the hospital with surgeries or interventions compared to the original physical trauma, or is that because of previous traumas that they had?” Dr. Petersen asked. “We don't know.”

He and his associates are in the process of conducting the study in a larger patient population to see whether the findings bear out.

The study was funded by grants from the Penn State Children, Youth, and Families Consortium and the Penn State Children's Miracle Network.

In addition, funding was provided by a grant from the American Academy of Child and Adolescent Psychiatry that was supported by McNeil Consumer and Specialty Pharmaceuticals.

SAN DIEGO – Children who are hospitalized for moderate to severe physical injuries face a high risk of posttraumatic stress disorder symptoms and psychological impairment if they display certain avoidance behaviors, Dr. Christopher Petersen said in an interview during a poster session at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

Examples of such behavior include the child saying it's difficult to feel happy or staying away from reminders of the event that led to his or her injury.

The finding “confirms some of the things we know about adults that we've been trying to apply to children,” Dr. Petersen said. “That is, out of avoidance, hyperarousal, and reexperiencing, avoidance seems to be the factor that most likely goes with [psychological] impairment.”

He and his associates also found no correlation between the level of a child's physical trauma and the severity of subsequent psychological impairment or PTSD symptoms.

“We thought that the kids who had major physical trauma would be more traumatized psychologically, but that's not necessarily the case,” said Dr. Petersen of the department of psychiatry at Pennsylvania State University in Hershey. “There are other factors playing into that.”

The researchers studied 28 children who were hospitalized for moderate to severe injuries: 22 were injured in motor vehicle accidents, 5 during sports, and 1 in a fall from a second-story window.

The mean age of the children was 13 years, and more than half (16) were boys. Ten days after hospital discharge, the children completed the Child and Adolescent PTSD Checklist, and their parents completed the Columbia Impairment Scale.

Of the 13 items on the PTSD Checklist, 82% of children reported that one or more of the symptoms caused problems for them most or all of the time. The most common symptoms reported were difficulty remembering what happened (32%), trying not to think about what happened (25%), and mentally going over what happened (25%).

Only six of the children (21%) had Columbia Impairment Scale scores in the abnormal range. The mean score for all patients was 10.6, which is considered normal.

Dr. Petersen noted that the PTSD subscales of avoidance and hyperarousal were significantly correlated with the Columbia Impairment Scale score, but the reexperiencing subscale was not.

“Watch for kids who have avoidance symptoms,” he advised. “If those symptoms persist beyond 30 days, those are the kids you really need to track or get into treatment early.”

In contrast, Dr. Petersen added, young people “who are dealing with [the physical trauma] over and over again, talking about it, struggling with it, maybe getting angry or tearful–those are kids who are more likely to work through it.” The researchers also found that high levels of physical trauma severity were not associated with high levels of psychological impairment or PTSD symptoms, a finding they did not expect.

“Is that because a lot of these children may have been as traumatized by the experience in the hospital with surgeries or interventions compared to the original physical trauma, or is that because of previous traumas that they had?” Dr. Petersen asked. “We don't know.”

He and his associates are in the process of conducting the study in a larger patient population to see whether the findings bear out.

The study was funded by grants from the Penn State Children, Youth, and Families Consortium and the Penn State Children's Miracle Network.

In addition, funding was provided by a grant from the American Academy of Child and Adolescent Psychiatry that was supported by McNeil Consumer and Specialty Pharmaceuticals.

Antihistamines and/or decongestants have no benefit for children who have otitis media with effusion, a Cochrane review of medical literature has concluded.

In fact, children who used them experienced an 11% spike in side effects such as gastrointestinal upset and drowsiness, compared with those who did not use them.

“Because we found no benefit for any of the studied interventions for any of the outcomes measured, and we found harm from the side effects of the interventions, we recommend practitioners not use antihistamines, decongestants, or antihistamine/decongestant combinations to treat otitis media with effusion in children,” wrote the researchers, led by Dr. Glenn Griffin of Quinte West Medical Center in Trenton, Ont. They noted that the findings mirror the current joint guidelines on the management of otitis media with effusion (OME) from the American Academy of Family Physicians, the American Academy of Otolaryngology-Head and Neck Surgery, and the American Academy of Pediatrics (Pediatrics 2004;113:1412–29).

Dr. Griffin and his associates studied 15 randomized, controlled trials of 1,516 children with OME that compared antihistamines, decongestants, or a combination of the two and that appeared in the medical literature through March 2006. Studies that randomized children based on acute otitis media were not included in the analysis (Cochrane Database Syst Rev. 2006;[4]:CD003423). The researchers found no benefit of taking decongestants alone or in combination with antihistamines in terms of being cured within 1 month, lessening hearing loss, risk of OME recurrence, development of otitis media, and the need for tympanostomy.

Six studies in the analysis measured side effects of medications. In these, 17% of children who received decongestants alone or in combination with antihistamines suffered side effects such as gastrointestinal upset and drowsiness, compared with 6% of children who took placebo, a difference of 11%. The researchers estimated that for every nine children treated with the drugs, one would be harmed.

Dr. Griffin and his associates acknowledged that a key limitation of the review was the small number of studies found. “However, we were unlikely to miss studies given our comprehensive search, and we found many more than the previous systematic review on this topic,” they wrote.

Antihistamines and/or decongestants have no benefit for children who have otitis media with effusion, a Cochrane review of medical literature has concluded.

In fact, children who used them experienced an 11% spike in side effects such as gastrointestinal upset and drowsiness, compared with those who did not use them.

“Because we found no benefit for any of the studied interventions for any of the outcomes measured, and we found harm from the side effects of the interventions, we recommend practitioners not use antihistamines, decongestants, or antihistamine/decongestant combinations to treat otitis media with effusion in children,” wrote the researchers, led by Dr. Glenn Griffin of Quinte West Medical Center in Trenton, Ont. They noted that the findings mirror the current joint guidelines on the management of otitis media with effusion (OME) from the American Academy of Family Physicians, the American Academy of Otolaryngology-Head and Neck Surgery, and the American Academy of Pediatrics (Pediatrics 2004;113:1412–29).

Dr. Griffin and his associates studied 15 randomized, controlled trials of 1,516 children with OME that compared antihistamines, decongestants, or a combination of the two and that appeared in the medical literature through March 2006. Studies that randomized children based on acute otitis media were not included in the analysis (Cochrane Database Syst Rev. 2006;[4]:CD003423). The researchers found no benefit of taking decongestants alone or in combination with antihistamines in terms of being cured within 1 month, lessening hearing loss, risk of OME recurrence, development of otitis media, and the need for tympanostomy.

Six studies in the analysis measured side effects of medications. In these, 17% of children who received decongestants alone or in combination with antihistamines suffered side effects such as gastrointestinal upset and drowsiness, compared with 6% of children who took placebo, a difference of 11%. The researchers estimated that for every nine children treated with the drugs, one would be harmed.

Dr. Griffin and his associates acknowledged that a key limitation of the review was the small number of studies found. “However, we were unlikely to miss studies given our comprehensive search, and we found many more than the previous systematic review on this topic,” they wrote.

Antihistamines and/or decongestants have no benefit for children who have otitis media with effusion, a Cochrane review of medical literature has concluded.

In fact, children who used them experienced an 11% spike in side effects such as gastrointestinal upset and drowsiness, compared with those who did not use them.

“Because we found no benefit for any of the studied interventions for any of the outcomes measured, and we found harm from the side effects of the interventions, we recommend practitioners not use antihistamines, decongestants, or antihistamine/decongestant combinations to treat otitis media with effusion in children,” wrote the researchers, led by Dr. Glenn Griffin of Quinte West Medical Center in Trenton, Ont. They noted that the findings mirror the current joint guidelines on the management of otitis media with effusion (OME) from the American Academy of Family Physicians, the American Academy of Otolaryngology-Head and Neck Surgery, and the American Academy of Pediatrics (Pediatrics 2004;113:1412–29).

Dr. Griffin and his associates studied 15 randomized, controlled trials of 1,516 children with OME that compared antihistamines, decongestants, or a combination of the two and that appeared in the medical literature through March 2006. Studies that randomized children based on acute otitis media were not included in the analysis (Cochrane Database Syst Rev. 2006;[4]:CD003423). The researchers found no benefit of taking decongestants alone or in combination with antihistamines in terms of being cured within 1 month, lessening hearing loss, risk of OME recurrence, development of otitis media, and the need for tympanostomy.

Six studies in the analysis measured side effects of medications. In these, 17% of children who received decongestants alone or in combination with antihistamines suffered side effects such as gastrointestinal upset and drowsiness, compared with 6% of children who took placebo, a difference of 11%. The researchers estimated that for every nine children treated with the drugs, one would be harmed.

Dr. Griffin and his associates acknowledged that a key limitation of the review was the small number of studies found. “However, we were unlikely to miss studies given our comprehensive search, and we found many more than the previous systematic review on this topic,” they wrote.

SAN FRANCISCO — Methicillin resistance was noted in 69% of community-acquired soft tissue infections due to Staphylococcus aureus in a single-center study of hospitalized adults in Detroit.

Additionally, more than half of the community-acquired methicillin-resistant Staphylococcus aureus [MRSA] infections were associated with abscesses, Dr. Houssein Jahamy reported in a poster presented at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

MRSA was the etiologic agent in 136 (69%) of the 198 patients hospitalized with a soft tissue infection caused by S. aureus between Nov. 1, 2005 and June 1, 2006 at St. John Hospital and Medical Center in Detroit, reported Dr. Jahamy, a second-year infectious diseases fellow at the hospital. Abscesses were noted in 57% in the MRSA group and in 28% of those with methicillin-sensitive S. aureus infections.

“Right now we are seeing plenty of patients with community-acquired MRSA,” Dr. Jahamy said in an interview. “Some show up at the hospital or clinic complaining of a spider bite.” In most cases, the “spider bite” is a furuncle. “That's a big tip-off that they probably have community-acquired MRSA.”

He and his associates reviewed the microbiology findings for all patients hospitalized with community-acquired soft tissue infections. They also collected information on demographics, comorbid conditions, type and location of initial lesion, and evidence of bloodstream invasion or other complications.

Compared with methicillin-susceptible S. aureus infections, those caused by MRSA were more likely to occur in women (77%) than in men (62%), in patients who did not have diabetes (73%) than in those with diabetes (60%), and in those who did not have a comorbidity (75%) than in those with comorbidities (65%). In line with findings that MRSA infections are more likely to be seen in patients with few comorbidities, MRSA-infected patients had shorter average hospital stays—6 days, compared with 8 days in those with methicillin-susceptible infections.

Dr. Jahamy and his coinvestigators observed no significant differences between the MRSA and methicillin-susceptible S. aureus groups in terms of history of spider bite (7% vs. 4%, respectively), infections that started as a furuncle (23% vs. 18%, respectively), or incidence of bloodstream invasion (6 vs. 9%, respectively).

Dr. Jahamy reported that he had no financial disclosures associated with the study.

SAN FRANCISCO — Methicillin resistance was noted in 69% of community-acquired soft tissue infections due to Staphylococcus aureus in a single-center study of hospitalized adults in Detroit.

Additionally, more than half of the community-acquired methicillin-resistant Staphylococcus aureus [MRSA] infections were associated with abscesses, Dr. Houssein Jahamy reported in a poster presented at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

MRSA was the etiologic agent in 136 (69%) of the 198 patients hospitalized with a soft tissue infection caused by S. aureus between Nov. 1, 2005 and June 1, 2006 at St. John Hospital and Medical Center in Detroit, reported Dr. Jahamy, a second-year infectious diseases fellow at the hospital. Abscesses were noted in 57% in the MRSA group and in 28% of those with methicillin-sensitive S. aureus infections.

“Right now we are seeing plenty of patients with community-acquired MRSA,” Dr. Jahamy said in an interview. “Some show up at the hospital or clinic complaining of a spider bite.” In most cases, the “spider bite” is a furuncle. “That's a big tip-off that they probably have community-acquired MRSA.”

He and his associates reviewed the microbiology findings for all patients hospitalized with community-acquired soft tissue infections. They also collected information on demographics, comorbid conditions, type and location of initial lesion, and evidence of bloodstream invasion or other complications.

Compared with methicillin-susceptible S. aureus infections, those caused by MRSA were more likely to occur in women (77%) than in men (62%), in patients who did not have diabetes (73%) than in those with diabetes (60%), and in those who did not have a comorbidity (75%) than in those with comorbidities (65%). In line with findings that MRSA infections are more likely to be seen in patients with few comorbidities, MRSA-infected patients had shorter average hospital stays—6 days, compared with 8 days in those with methicillin-susceptible infections.

Dr. Jahamy and his coinvestigators observed no significant differences between the MRSA and methicillin-susceptible S. aureus groups in terms of history of spider bite (7% vs. 4%, respectively), infections that started as a furuncle (23% vs. 18%, respectively), or incidence of bloodstream invasion (6 vs. 9%, respectively).

Dr. Jahamy reported that he had no financial disclosures associated with the study.

SAN FRANCISCO — Methicillin resistance was noted in 69% of community-acquired soft tissue infections due to Staphylococcus aureus in a single-center study of hospitalized adults in Detroit.

Additionally, more than half of the community-acquired methicillin-resistant Staphylococcus aureus [MRSA] infections were associated with abscesses, Dr. Houssein Jahamy reported in a poster presented at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

MRSA was the etiologic agent in 136 (69%) of the 198 patients hospitalized with a soft tissue infection caused by S. aureus between Nov. 1, 2005 and June 1, 2006 at St. John Hospital and Medical Center in Detroit, reported Dr. Jahamy, a second-year infectious diseases fellow at the hospital. Abscesses were noted in 57% in the MRSA group and in 28% of those with methicillin-sensitive S. aureus infections.

“Right now we are seeing plenty of patients with community-acquired MRSA,” Dr. Jahamy said in an interview. “Some show up at the hospital or clinic complaining of a spider bite.” In most cases, the “spider bite” is a furuncle. “That's a big tip-off that they probably have community-acquired MRSA.”

He and his associates reviewed the microbiology findings for all patients hospitalized with community-acquired soft tissue infections. They also collected information on demographics, comorbid conditions, type and location of initial lesion, and evidence of bloodstream invasion or other complications.

Compared with methicillin-susceptible S. aureus infections, those caused by MRSA were more likely to occur in women (77%) than in men (62%), in patients who did not have diabetes (73%) than in those with diabetes (60%), and in those who did not have a comorbidity (75%) than in those with comorbidities (65%). In line with findings that MRSA infections are more likely to be seen in patients with few comorbidities, MRSA-infected patients had shorter average hospital stays—6 days, compared with 8 days in those with methicillin-susceptible infections.

Dr. Jahamy and his coinvestigators observed no significant differences between the MRSA and methicillin-susceptible S. aureus groups in terms of history of spider bite (7% vs. 4%, respectively), infections that started as a furuncle (23% vs. 18%, respectively), or incidence of bloodstream invasion (6 vs. 9%, respectively).

Dr. Jahamy reported that he had no financial disclosures associated with the study.

SAN FRANCISCO — A quarter of adult patients who completed the recommended initial therapy for methicillin-resistant Staphylococcus aureus infection experienced clinical failure, results from an urban hospital study showed.

In addition, among a subset of patients who had osteomyelitis, 46% relapsed.

“We have a high rate of failure of treating MRSA infections in this urban population, especially among people with bone infections,” Dr. Julie Dombrowski said in an interview during a poster session at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy. “Even with appropriate standard-of-care treatment at this time, which is IV vancomycin for bone infection, we still are having failures. We need better antibiotics or different antibiotics.”

The researchers reviewed the clinical data from 215 patients at San Francisco General Hospital who completed the recommended therapy for MRSA infections between 1998 and 2004.

Of the 215 patients, 54 (25%) had infections at more than one site. There were 81 cases of osteomyelitis (38%); 60 cases of bloodstream infections without endocarditis (28%); 45 cases of pneumonia (21%); 32 cases of endocarditis (15%); 23 joint infections (11%); 18 epidural abscesses (8%); 15 surgical wound infections (7%); and 1 case of meningitis (0.5%).

The most common comorbidities were diabetes (19%) and HIV (14%). About a third of patients (34%) were homeless, 46% reported they used injection drugs, and 26% reported they abused alcohol, said Dr. Dombrowski, of the department of medicine at the University of California, San Francisco.

She also reported that 53 patients (25%) failed initial antibiotic therapy. Vancomycin monotherapy was used in 159 of the patients (74%), whereas rifampin and gentamicin were the antibiotics used most commonly in combination with vancomycin (in 12% and 8% of cases, respectively.) Of the 81 patients who had osteomyelitis, 37 (46%) relapsed.

Bivariate analysis revealed that the following factors were associated with treatment failure: male gender, diabetes, injection drug use, ICU admission, admission to orthopedics, and pneumonia, endocarditis, or osteomyelitis.

Multivariate analysis of the data revealed that osteomyelitis was the only factor independently associated with treatment failure.

The degree of treatment failure seen in patients with osteomyelitis surprised Dr. Dombrowski. “I expected that we would have more failures among bone infections than other kinds of infections like endocarditis or pneumonia, but we were surprised that we weren't able to cure almost half of the bone infections,” she said at the conference, which was sponsored by the American Society for Microbiology.

SAN FRANCISCO — A quarter of adult patients who completed the recommended initial therapy for methicillin-resistant Staphylococcus aureus infection experienced clinical failure, results from an urban hospital study showed.

In addition, among a subset of patients who had osteomyelitis, 46% relapsed.

“We have a high rate of failure of treating MRSA infections in this urban population, especially among people with bone infections,” Dr. Julie Dombrowski said in an interview during a poster session at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy. “Even with appropriate standard-of-care treatment at this time, which is IV vancomycin for bone infection, we still are having failures. We need better antibiotics or different antibiotics.”

The researchers reviewed the clinical data from 215 patients at San Francisco General Hospital who completed the recommended therapy for MRSA infections between 1998 and 2004.

Of the 215 patients, 54 (25%) had infections at more than one site. There were 81 cases of osteomyelitis (38%); 60 cases of bloodstream infections without endocarditis (28%); 45 cases of pneumonia (21%); 32 cases of endocarditis (15%); 23 joint infections (11%); 18 epidural abscesses (8%); 15 surgical wound infections (7%); and 1 case of meningitis (0.5%).

The most common comorbidities were diabetes (19%) and HIV (14%). About a third of patients (34%) were homeless, 46% reported they used injection drugs, and 26% reported they abused alcohol, said Dr. Dombrowski, of the department of medicine at the University of California, San Francisco.

She also reported that 53 patients (25%) failed initial antibiotic therapy. Vancomycin monotherapy was used in 159 of the patients (74%), whereas rifampin and gentamicin were the antibiotics used most commonly in combination with vancomycin (in 12% and 8% of cases, respectively.) Of the 81 patients who had osteomyelitis, 37 (46%) relapsed.

Bivariate analysis revealed that the following factors were associated with treatment failure: male gender, diabetes, injection drug use, ICU admission, admission to orthopedics, and pneumonia, endocarditis, or osteomyelitis.

Multivariate analysis of the data revealed that osteomyelitis was the only factor independently associated with treatment failure.

The degree of treatment failure seen in patients with osteomyelitis surprised Dr. Dombrowski. “I expected that we would have more failures among bone infections than other kinds of infections like endocarditis or pneumonia, but we were surprised that we weren't able to cure almost half of the bone infections,” she said at the conference, which was sponsored by the American Society for Microbiology.

SAN FRANCISCO — A quarter of adult patients who completed the recommended initial therapy for methicillin-resistant Staphylococcus aureus infection experienced clinical failure, results from an urban hospital study showed.

In addition, among a subset of patients who had osteomyelitis, 46% relapsed.

“We have a high rate of failure of treating MRSA infections in this urban population, especially among people with bone infections,” Dr. Julie Dombrowski said in an interview during a poster session at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy. “Even with appropriate standard-of-care treatment at this time, which is IV vancomycin for bone infection, we still are having failures. We need better antibiotics or different antibiotics.”

The researchers reviewed the clinical data from 215 patients at San Francisco General Hospital who completed the recommended therapy for MRSA infections between 1998 and 2004.

Of the 215 patients, 54 (25%) had infections at more than one site. There were 81 cases of osteomyelitis (38%); 60 cases of bloodstream infections without endocarditis (28%); 45 cases of pneumonia (21%); 32 cases of endocarditis (15%); 23 joint infections (11%); 18 epidural abscesses (8%); 15 surgical wound infections (7%); and 1 case of meningitis (0.5%).

The most common comorbidities were diabetes (19%) and HIV (14%). About a third of patients (34%) were homeless, 46% reported they used injection drugs, and 26% reported they abused alcohol, said Dr. Dombrowski, of the department of medicine at the University of California, San Francisco.

She also reported that 53 patients (25%) failed initial antibiotic therapy. Vancomycin monotherapy was used in 159 of the patients (74%), whereas rifampin and gentamicin were the antibiotics used most commonly in combination with vancomycin (in 12% and 8% of cases, respectively.) Of the 81 patients who had osteomyelitis, 37 (46%) relapsed.

Bivariate analysis revealed that the following factors were associated with treatment failure: male gender, diabetes, injection drug use, ICU admission, admission to orthopedics, and pneumonia, endocarditis, or osteomyelitis.

Multivariate analysis of the data revealed that osteomyelitis was the only factor independently associated with treatment failure.

The degree of treatment failure seen in patients with osteomyelitis surprised Dr. Dombrowski. “I expected that we would have more failures among bone infections than other kinds of infections like endocarditis or pneumonia, but we were surprised that we weren't able to cure almost half of the bone infections,” she said at the conference, which was sponsored by the American Society for Microbiology.

SAN FRANCISCO — The isolation of methicillin-resistant Staphylococcus aureus, either alone or as part of a polymicrobial infection, was associated with treatment failure in 35% of patients with a diabetic foot infection, Dr. Matthew E. Falagas reported during a poster session at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

The finding comes from an analysis of 15 randomized, controlled trials that compared the use of different antibiotics for treating diabetic foot infections.

The analysis showed that “a considerable proportion of patients with diabetes who have infection in [the] foot would not be treated effectively with current [antimicrobial] management,” Dr. Falagas of the Alfa Institute of Biomedical Sciences in Athens, Greece, said in an interview. “As a matter of fact, about one-fourth of all patients fail to be cured with the current antimicrobial regimens and treatment.”

He and his associates found that different regimens of appropriate antibiotics—including penicillins, carbapenems, cephalosporins, and fluoroquinolones—were associated with similar treatment failures. However, in the 68 patients whose infections were caused by methicillin-resistant Staphylococcus aureus (MRSA) alone or as part of a polymicrobial infection, treatment failure was 35%, compared with 23% in the 1,522 patients whose infections were caused by different bacteria.

In patients with infections caused by MRSA, the use of linezolid was not associated with a significantly lower failure rate, compared with other antibiotics (32% vs. 37%, respectively).

The researchers also observed no significant differences in overall treatment failure when they compared patients who had osteomyelitis with those who did not (27% vs. 23%, respectively).

The treatment failures were not a matter of patient compliance “because most of these patients were treated in the hospital with [intravenous] antimicrobial agents,” Dr. Falagas said at the conference, sponsored by the American Society for Microbiology.

Dr. Falagas added that the patients who took carbapenems had fewer treatment failures, a finding he did not expect.

Treatment failure occurred in 35% of foot infection patients such as this patient, who has an infection caused by MRSA, vs. 23% of patients with other types of foot infections. Courtesy Dr. Matthew Falagas

SAN FRANCISCO — The isolation of methicillin-resistant Staphylococcus aureus, either alone or as part of a polymicrobial infection, was associated with treatment failure in 35% of patients with a diabetic foot infection, Dr. Matthew E. Falagas reported during a poster session at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

The finding comes from an analysis of 15 randomized, controlled trials that compared the use of different antibiotics for treating diabetic foot infections.

The analysis showed that “a considerable proportion of patients with diabetes who have infection in [the] foot would not be treated effectively with current [antimicrobial] management,” Dr. Falagas of the Alfa Institute of Biomedical Sciences in Athens, Greece, said in an interview. “As a matter of fact, about one-fourth of all patients fail to be cured with the current antimicrobial regimens and treatment.”

He and his associates found that different regimens of appropriate antibiotics—including penicillins, carbapenems, cephalosporins, and fluoroquinolones—were associated with similar treatment failures. However, in the 68 patients whose infections were caused by methicillin-resistant Staphylococcus aureus (MRSA) alone or as part of a polymicrobial infection, treatment failure was 35%, compared with 23% in the 1,522 patients whose infections were caused by different bacteria.

In patients with infections caused by MRSA, the use of linezolid was not associated with a significantly lower failure rate, compared with other antibiotics (32% vs. 37%, respectively).

The researchers also observed no significant differences in overall treatment failure when they compared patients who had osteomyelitis with those who did not (27% vs. 23%, respectively).

The treatment failures were not a matter of patient compliance “because most of these patients were treated in the hospital with [intravenous] antimicrobial agents,” Dr. Falagas said at the conference, sponsored by the American Society for Microbiology.

Dr. Falagas added that the patients who took carbapenems had fewer treatment failures, a finding he did not expect.

Treatment failure occurred in 35% of foot infection patients such as this patient, who has an infection caused by MRSA, vs. 23% of patients with other types of foot infections. Courtesy Dr. Matthew Falagas

SAN FRANCISCO — The isolation of methicillin-resistant Staphylococcus aureus, either alone or as part of a polymicrobial infection, was associated with treatment failure in 35% of patients with a diabetic foot infection, Dr. Matthew E. Falagas reported during a poster session at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

The finding comes from an analysis of 15 randomized, controlled trials that compared the use of different antibiotics for treating diabetic foot infections.

The analysis showed that “a considerable proportion of patients with diabetes who have infection in [the] foot would not be treated effectively with current [antimicrobial] management,” Dr. Falagas of the Alfa Institute of Biomedical Sciences in Athens, Greece, said in an interview. “As a matter of fact, about one-fourth of all patients fail to be cured with the current antimicrobial regimens and treatment.”

He and his associates found that different regimens of appropriate antibiotics—including penicillins, carbapenems, cephalosporins, and fluoroquinolones—were associated with similar treatment failures. However, in the 68 patients whose infections were caused by methicillin-resistant Staphylococcus aureus (MRSA) alone or as part of a polymicrobial infection, treatment failure was 35%, compared with 23% in the 1,522 patients whose infections were caused by different bacteria.

In patients with infections caused by MRSA, the use of linezolid was not associated with a significantly lower failure rate, compared with other antibiotics (32% vs. 37%, respectively).

The researchers also observed no significant differences in overall treatment failure when they compared patients who had osteomyelitis with those who did not (27% vs. 23%, respectively).

The treatment failures were not a matter of patient compliance “because most of these patients were treated in the hospital with [intravenous] antimicrobial agents,” Dr. Falagas said at the conference, sponsored by the American Society for Microbiology.

Dr. Falagas added that the patients who took carbapenems had fewer treatment failures, a finding he did not expect.

Treatment failure occurred in 35% of foot infection patients such as this patient, who has an infection caused by MRSA, vs. 23% of patients with other types of foot infections. Courtesy Dr. Matthew Falagas