Pneumococcal vaccine: Which, when, and why?

The pneumococcal vaccine was developed to reduce the disease burden of streptococcus pneumoniae, a gram-postive bacteria that has more than 90 serotypes that can cause diseases in humans.  Some of these infections include pneumonia, meningitis, bacteremia, otitis media, and sinusitis.  There are currently two vaccines on the market to raise immunity against pneumococcal infections - PCV13 (Prevnar 13 - which covers 13 serotypes) and PPSV23 (Pneumovax 23 - which covers 23 serotypes).  The 23-valent vaccine covers all of the serotypes in the

"How it works" series: Daptomycin

Daptomycin (Cubicin) is the first antibiotic in a class known as lipopeptides and has a unique mechanism of action.  Daptomycin is a large molecule with a high molecular weight and has two distinct sections.  One section is a 10 member amino acid ring (illustrated as the big red circle) and the other is the attached lipophilic tail (illustrated as the curvy red line).  The lipophilic tail is capable of direct insertion through the

Linezolid-induced thrombocytopenia

Thrombocytopenia is a notable adverse effect of linezolid.  Some of the evidence behind the onset, duration, and the extent of platelet decrease will briefly be described here and summarized in bullets at the bottom of the discussion.  For a discussion of linezolid's mechanism of action and some other notable features, see a prior post here.

Diabetes discharge checklist

A 55 year old business executive is being discharged from the hospital after a brief admission for cellulitis.  His only PMH is HTN and obesity.  During his stay, his casual serum glucoses were found to be in the high 200s mg/dL and a hemoglobin A1C resulted at 11.6%.  What should be done at the inpatient to outpatient transition to address his diabetes?

Essentials from the 2016 American Diabetes Association guidelines

The 2016 American Diabetes Association diabetes guidelines is a lengthy document outlining many aspects of diabetes care including evaluation, diagnosis, prevention, management of glycemia, and management of nonglycemic issues.  Here are some of the more common elements that come up in the internal medicine setting regarding glycemic control.

Empagliflozin (Jardiance) new indication - reduces mortality in type 2 diabetes mellitus

A middle-aged patient with diabetes mellitus type 2, CAD, HTN, and obesity is in clinic for a followup appointment 1 year after his diagnosis with diabetes.  His medications include lisinopril, atorvastatin, aspirin, and metformin (started 1 year ago and titrated to maximum tolerated dose).  Today in clinic, his BP = 148/88 mm Hg, HR = 78 bpm, and HbA1c = 7.6%.  In addition to metformin, are there any other antihyperglycemic medications that we can use to reduce his risk of cardiovascular events?

For many years, metformin was the only antihyperglycemic medication proven to reduce mortality in patients with diabetes mellitus type 2 (as per the UKPDS trial).  Other classes of medications such as the sulfonylureas, thiazolidinediones, and DPP-4 inhibitors have only been shown to reduce HbA1c and/or microvascular events.  This month, the FDA approved