廖東慶 作品 / 228大屠殺！

228這是一個讓台灣人永遠永遠都無法忘得掉的3個數字的組合，這也是一件有計劃和有預謀的「大屠殺」，更是一件讓「神人共憤」的世紀大慘案！「228」屠殺事件的歷史檔案，到現在還未全部能予以開放，這是所有台灣人的「恥辱」，也是「中國國民黨」鐵了心，吃定了台灣人民不說，更把台灣人吃得死死的！不公開「大溪檔案」，不道歉、更不賠償，也不想追查原兇。「中國國民黨」一付老神在在的「問心無愧」的人模人樣，似乎在對台灣人說，你還想怎麼樣？你還能怎麼樣嘛？人都殺了，你就認了吧！弱者，你的名字就叫做「台灣人」！
    「中國國民黨」至今仍然不敢公開「228大屠殺」的真正檔案資料，能賴就賴，並一再粉飾太平，尤其是馬英九把「228大屠殺」定為「官逼民反」，這種行徑更是不能饒恕及放過，他們就只會對台灣人說，要用愛及寬恕來看待228，就是不肯公開228事件的檔案資料，並追查元兇及道歉賠償，這些中國人從來就把台灣人看成是「二等國民」，一直以來都把台灣人踩在腳底下，還把台灣人的善良當作是「懦弱」可欺！
    無論是從那一方面的資料，都可以再再顯示出，蔣介石是「228大屠殺」的元兇，也是屠殺台灣人的大魔頭，在1947年發生228事件的同一個時間，蔣介石人並不是在中國大陸的任何一個地方，而實際情況是蔣介石當時是「躲」在台灣高雄的西子灣，陳誠則是因為沒地方可以住，所以就躲在北投的陸軍醫院裡，當時美國還沒有允許蔣介石等人，可以進入台灣地區，所以蔣介石和陳誠等人，不敢公開出現在台灣，只能用「躲藏」的方式待在台灣。
    由於在中國大陸所發生的「國共內戰」，由蔣介石所率領的國民黨軍隊，一直在節節敗退，蔣介石更是被毛澤東所領導的「紅星軍」打得無處可逃，灰頭土臉，這時候的蔣介石就像一隻垂頭喪氣的公雞一般，在「228大屠殺」還沒發生之前，蔣介石請他的夫人蔣宋美齢和美國陸軍陳納德將軍，偕同飛到美國首都華盛頓，到白宮晉見當時的美國總統杜魯門，蔣宋美齢向杜魯門苦苦哀求，逼得杜魯門總統不能不首肯允許，蔣介石一行人能流亡並進入台灣逃命。
    「228大屠殺」事件並不是偶然或者是突發事件，第二次大戰結束之後，蔣介石己經先請求過麥克阿瑟將軍，希望能讓他的流亡政府進入台灣，但是被麥克阿瑟將軍給嚴厲拒絕，因為在第二次大戰結束之後，台灣和澎湖是己經屬於美國海外的領土，麥克阿瑟將軍是負責整個亞洲區域，而台灣和澎湖也是他的管轄範圍。蔣介石只好請他的夫人前往美國，而蔣介石和陳誠等人就「躲藏」在台灣，一直等到杜魯門總統點頭答應為止！除了接收及遺送日本軍民回日本之外，另外還有維持台灣和澎湖當地治安及秩序，一旦任務完成之後，中國部隊及中國派來的接收人員必須全數離開台灣和澎湖，這是麥克阿瑟將軍的命令。雖然中國的蔣介石和美國的麥克阿瑟將軍，兩人都是貴為5星上將，但是以職權來區分，蔣介石的職權範圍只有在中國戰區裡，而麥克阿瑟將軍則是負責整個亞洲區域，也包括中國在內，所以蔣介石還是要聽命於麥克阿瑟將軍的指揮。
    蔣介石派了陳儀將軍代表美國來接收台灣和澎湖，但是上自陳儀下自每一位接收人員，乘著這個大好時機，貪污腐敗並且又壓榨勒索恐嚇取財，讓台灣人積壓怨恨，一忍再忍，到了1947年的2月28日，這一天就像火山爆發，一發不可收拾。在台北市的煙酒公賣局，緝查私煙小組在這一天，又如往常慣例，開車出去沒收走私的香煙，然後又準備在中午過後拿出來拍賣，還是原來那批私賣香煙的小販，拿出金錢來贖回在早上被沒收的香煙，這些緝查小組人員把錢放入自己的口袋裡，但是在2月28日這一天，有一個賣私煙的女子，苦苦哀求緝私小組能放過一次，這幾個中國人不但對這名婦女，拳打腳踢，而且還拔出手鎗，並用鎗柄來擊打婦女，這時看不過去的台灣人越聚集越多，並挺身打抱不平，這時侯中國人竟然當場開鎗射殺台灣人、、、、、、、、。
    「228大屠殺」就由此開始，由一件「無法無天」的緝私人員他們的「不當」勒索敲詐，引爆出整個台灣示威行動，蔣介石這時侯人正在高雄西子灣「躲藏」著，彭孟緝當時官拜上校，是高雄要塞司令，當時他是負責保護蔣介石的人身安全。陳儀在那個時侯是反對蔣介石的，而且蔣介石人在高雄，再三下令陳儀必須大開殺戒，陳儀當時是不願意向台灣人動手，所以蔣介石只好下手諭，並請專人從台灣搭飛機帶到中國大陸，從中國大陸調動三個師的部隊，緊急開拔遠赴台灣鎮壓殺人，等到支援部隊到了台灣之後，兵分兩路，一支從北部基隆港一上岸之後，就立卽見人就射殺，不管男女老幼，也不管是台灣人還是中國人，一律全部格殺勿論！然後再把屍體拋入基隆港外海，紅色鮮血染滿了整片海面，因為水面上漂浮了無數的台灣人屍體，不分男女老幼，眞是慘不目睹！
    另一支部隊就從高雄港登陸，在蔣介石的「格殺命令」之下，彭孟緝率領援軍部隊，從高雄一路殺進台南和嘉義，並一直殺到台中再往北部殺戮下去。這群中國軍隊從來沒有打過勝戰，和日本打了8年的連戰連敗的「逃亡」戰，幸虧有美軍參戰才打敗了日軍。二次大戰結束之後，又碰上中國共產黨的部隊，又是重複的一場「逃亡兼逃命」的戰爭，好不容昜登陸台灣，這些中國軍隊把台灣人當作日本人來大開殺戒，中國軍隊也只有面對手無寸鐵的台灣民眾，才打贏了第一次勝戰。
也有相當多的中國平民，也被中國軍隊所射殺，中國軍隊在殺了自已的中國平民之後，反而誣陷說是被台灣人所殺，其實如果真的是被台灣人殺的話，那為什麼有那麼多，不計其數的台灣人，甘願冒著生命危險來出面保護及收容，這些素昧平生也不相識的中國平民呢？
    中國軍隊為了殺更多的台灣人，設下陷阱列出有名望的知識份子及紳士的「死亡名單」，也包括許多的教授，誘騙他們出來談判，然後立卽當場槍殺。更有計劃有預謀的列出一份名單出來，並一一捕抓再鎗殺。彭孟緝因殺台灣人有功，蔣介石特別破格讓他晉身兩級到中將，特升他為警備總司令。可以確定的是，陳誠和「228大屠殺」沒有任何關係。在這場「228大屠殺」事件之中，蔣介石到底殺了多少台灣人？按照「中國國民黨」的公開資料，顯示有一千多人被殺，他們另外又強辯說外省人被殺也有一千四百多人，「中國國民黨」簡直是黑心黑到底了！是同樣的一批人嗎？還是只有「中國人」被殺而己，而台灣人一個都沒被殺嗎？。他們所說的話能相信嗎？
    根據美國國會的檔案資料，記戴著有四萬八千多人被屠殺！相信這數字是較保守的，但還不是最確實的。日本在統治台灣51年期間，制定了戶口名簿制度，有人遷進遷出或者有嬰兒誕生或有人病死，都要去有關單位確實改正落實，否則會被日本大人（警察）查到要罰款的。在這方面日本做得十分進步及有效率。這樣反而讓228大屠殺之後，要追查「中國軍隊」鎗殺了多少台灣人而留下了一個正確較無誤的被「屠殺」的人數，經過全台灣和澎湖的戶口調查，總共有十二萬多個台灣人失蹤。而「中國國民黨」說有一千四百多名的「中國平民」被殺，這個數據是怎麼換算來的？以什麼方式做為根據嗎？真是妖言惑眾！滿嘴的胡言亂語！真正的情況是「中國人」不但槍殺了台灣人，更槍殺了中國平民。
    「中國國民黨」連一點點、一絲絲的悔意道歉都沒有，馬英九更是「理直氣壯」的要求台灣人心中要包容，要有寬恕，並嚴厲警告台灣人不要操作族群對決及破壞族群和諧。尤其是在2007年「228大屠殺」60週年前夕，蔣介石的兒媳婦蔣方智怡，手拿一張影印的蔣介石的日記，要為她的公公強辯說，228事件發生之際，她的公公蔣介石人在中國大陸，因不知道台灣真正的情況，所以誤聽陳儀的說詞，才派軍隊來台灣。228事件發生當時，蔣介石人在高雄西子灣直接下令調動3個師的部隊，緊急赴台鎮壓根據美國國會的檔案資料，記戴著有四萬八千多人被屠殺！相信這數字是較保守的，但還不是最確實的。我們可以看看像馬英九和蔣方智怡女士，的說詞及神態，完全顯示出「中國人殺台灣人」一點都沒錯！而且絕大部份的在台灣的中國人也都抱有這種「心態」，從來沒有看到中國人在為「228大屠殺」在道歉，一個都沒有！只看到前兩位的台灣總統，代表政府向台灣人民道歉，很奇怪的場面，「台灣人向台灣人」道歉！台灣人不應該這麼「懦弱」！難怪會讓在台灣的中國人騎到頭上去！
「228大屠殺」是件國際大慘案！「中國國民黨」至今仍然不道歉，也不願公開真相，更不想追查元兇及賠償！台灣人應該團結起來，結合民間的力量，向國際法庭投訴「228大屠殺」事件的始末真相，這是種族屠殺事件，沒有年數限制，被告人就是「中國國民黨」，把所有的文件及照片証據全都呈上國際法庭，在美國的台僑人士，也要透過美國會議員的力量，要求美國政府公開1945年至1948年之間的台灣檔案資料，「中國國民黨」不敢公開「大溪檔案」，那就請美國國會公開這三年的台灣檔案資料，其中更包括了「228大屠殺」事件的秘辛在內！誠如前總統陳水扁先生所說的「沒有真相，就沒有和解」！
         (廖東慶/北美政治評論家)

衛生署長要控告電視評論名嘴，適當嗎?

衛生署長因為電視名嘴批評新流感疫苗，以為疫苗施打率很低是因為他們的批評，要上法院控告名嘴影響民眾施打疫苗的意願，是對錯了矛頭。看看下面一篇文章提到的藍綠各方人士，都在批評。 署長應該反省為什麼這次疫苗會受到那麼多的各方責罵。   他用上法院控告這些名顯然是要「修理」這些人，讓敢批評我的人多跑跑法院、花掉雇用律師的錢。這是司法的誤用, abuse。民主社會中，官員是為民眾服務的。被批評，就不甘願，就要控告，署長的民主修養還不夠，他應該撤回控訴。   署長偏差的(控訴)行為，地檢署立即接受下手調查，當然是上承高階心意，用司法壓制民意、敢說話的人。這又對台灣司法、言論自由，是一大打擊。 這就要靠民眾用選票拔掉這種意欲台灣民主倒退的政黨。否則台灣二十年來民主化的道路，是白走的了!!   台灣的民主、自由、主權、公平的法治，要民眾用選票修整。不過執政者不能感受民意，又無能，不到三年，多次顯現不公平的法治，用司法打擊民主，我們只看到無能的總統、只會被利用來打擊民意的司法院、擺好看拿薪水的監察院。要等四年才能除掉這種政府，是太久了。以後再一年多的時間內，可能台灣輝煌的民主化紀錄，就被破壞殆盡!!! 民眾是需要更積極的表示不滿!!!    民主社會中，會說話，表示意見的人，才是好公民。       醫界再談楊志良告名嘴 這八人請一起告 ◎ 楊斯棓 如果楊某標準不分藍綠，那以下八人也請一併提告。 一告李慶華，李慶華曾公開表示「在全體助理的反對下，他也沒有接種疫苗」，李慶華是六萬票當選的立委，公開表示他的助理反對他打疫苗，所以他不打，對他的選民有沒有示範作用？ 再告楊瓊瓔、林鴻池以及徐少萍，此三者亦為立委，前二為七萬票選上，徐少萍夫婿曾任八年基隆市長，影響層面廣大，發言內容雨港鄉親動見觀瞻，三人曾召開記者會，林鴻池也將相關內容放在個人部落格，記者會上林表示，「探討新流感疫苗的安全性，希望為國人健康把關，將目前對新流感疫苗的疑慮解釋清楚」，他們三位的提問，不就是大話新聞的質疑？ 三告邱毅、李鴻鈞、江玲君，此三者被記者訪問同一天見諸聯合報的內容，邱毅表示，「我的小孩接種新流感疫苗後，出現四肢無力、惡心等類似『暈針』症狀兩週」，也表示，「我對政府的疫苗怎麼可能有信心？」李鴻鈞表示他「有許多朋友都不敢打國內疫苗」，他自己「也是其中一個。」江玲君則說台中市七歲小弟弟的父（醫師劉錦成）母出面控訴衛生署，讓她也「對疫苗的安全起疑慮」。 如果說發言內容讓人不敢打疫苗就要提告，楊志良最該告的就是他本人，因為楊曾在正式場合說「有人一打疫苗可能就往生」，請問百姓聽到衛生署長如是說，會不會引發緩打潮？ （作者為部落客醫師，完整版請見http://ybonbon.blogspot.com/）

Aspergillus spp. (麴菌類) 引起的疾病

 

先瞭解真菌(fungus)的分類﹕

n  真菌(fungus)依hypha(菌絲)是否分節﹑無性孢子產生的方式﹑及有性孢子的型式而可分類如下四綱(class)﹕

1）  Phycomycetes （藻菌綱。菌絲不分節﹔有oospore=卵孢子及zygospore=接合孢子等有性孢子﹔有sporangiospore=孢子囊孢子）﹐是較低等原始的﹐如Rhizopus nigrans。

2）  Ascomycetes (子囊菌綱。菌絲分節﹔能產生ascospore=子囊孢子﹔有外生性無性孢子）﹐如表皮絲狀真菌=dermatophyte﹐Trichophyton (Arthroderma)﹑Microsporum (Nannizzia)﹑Blastomyces (Ajellomyces)。（括弧內為有性生殖期時之名稱。）

3）  Basidiomycetes （擔子菌綱。菌絲分節﹔有外生性無性孢子﹔有擔子柄=basidia可產生擔孢子=basidiospore）﹐如較進化的食用菇類（mushroom）﹑Cryptococcus neoformans (Filobasidiella neoformans)。

4）  Deuteromycetes （Fungi imperfecti=不完全菌綱。僅有無性生殖者）﹐大部分致病性真菌屬此。如Epidermophyton﹑Sporothrix﹑Candida spp.。

n  但從臨床觀點﹐致病性真菌平常粗略地分類如下﹕

1)    可引起superficial mycoses之表皮黴菌﹐如Malassezia furfur會致pityriasis versicolor（斑點糠疹）。

2)    可引起疥癬類cutaneous mycoses之皮膚黴菌﹐包括Trichophyton﹑Epidermophyton﹑Microsporum﹑Candida albicans（也會成全身性伺機性感染）。

3)    可引起subcutaneous mycoses之皮下黴菌﹐如Sporothrix schenkii。

4)    可引起深部（全身性）感染者﹐如Blastomyces dermatides﹑Coccidioides immitis﹑Histoplasma capsulatum﹑Paracoccidioides brasiliensis。

5)    可引起伺機性深部（全身性）感染者﹐如 Aspergillus spp.﹑Candida spp.﹑Cryptococcus neoformans （正常人也可致病）﹑Mucor﹑Rhizopus類。

 

l  Aspergillus spp.遍佈全世界，會引起過敏（allergy）、免疫不全病人的侵入性疾病、肺、及鼻、副鼻腔的感染，統稱aspergillosis。最常見的為Aspergillus fumigatus、Aspergillus flavus,其他還有A. niger(引起otomycosis=外耳黴菌症)、A. sydowi、A. terreus、A. ustus、A. versicolor等十餘種都曾感染人類。

l  可分泌毒素：aflatoxin、ochratoxin、kojic acid、clavacin、gliotoxin、Asp fl等。

l  Aspergillus flavus分泌之毒素aflatoxin (黃麴黴毒素)可致癌。有12種以上，其中B1之毒性及致癌性最強。在英國Aspergillus flavus污染之火雞飼料曾使大量火雞昏迷、厭食、痙攣、死亡。

l  Aspergillus fumigatus可在45°C以上溫度生長，因此在堆肥中最多。遍佈世界各地。

l  感染途徑：孢子(conidia；spore。2.5-3.0 mm大小，可進入肺氣泡=alveolus中)飛到空中，經空氣呼吸道感染。不會人對人感染。

l  潛伏期：數日到數週。

l  引起感染的重要因素不是孢子的數目，而是宿主的免疫力。肺巨嗜細胞、嗜中性白血球(neutrophils)是最重要的。Neutropenia (嗜中性白血球缺少)、器官移植(1.5-5.6%感染率)、高劑量類固醇治療、或其他免疫抑制治療之病人、或小孩有慢性肉芽腫性疾病(chronic granulomatous disease)者都是感染對象。

病變：

l  侵入組織後菌絲(hyphae；mycelia)延血管生長。在肺部感染時在上葉形成菌絲球(fungus ball，aspergilloma)，會導致咳血(hemoptysis)、氣胸(pneumothorax)，可致命。此等病患常原本患有肺結核(pulmonary tuberculosis)、支氣管擴張(bronchiectasis)、anthracosilicosis、histoplasmosis、肺膿瘍(lung abscess)等。可用CT scan、MRI等診斷。

l  原本有氣喘(asthma)之病患可能因為此黴菌感染而有血清IgE增加、黴菌阻塞支氣管(bronchial plugging)、anti-aspergillus antibody增加，可使氣喘惡化，成慢性阻塞性肺疾病(COPD)，稱為allergic bronchopulmonary aspergillosis (ABPA)。對aspergillus antigen有immediate type skin test reaction。

l  正常小孩吸入大量孢子後可能24小時後有燒、呼吸困難、胸部X光有糜粒狀侵潤(miliary infiltrate)，2-4週內會自癒。

l  被感染之免疫不全病患可能因黴菌阻塞而有腦血管梗塞(cerebral infarction)。

l  可感染正常或人工心瓣膜，但血液培養不一定可長出黴菌。

l  消化道潰瘍、穿孔、四肢皮膚潰瘍、肋骨脊椎骨感染、腎及前列腺感染都會發生。

l  Aflatoxin是各種生物產生的毒素中最毒的，長期經口吸取，會引起肝硬化、肝癌。

診斷：

l  組織之鏡檢、或黴菌培養最可靠。血液、腦脊髓液(CSF)、骨髓黴菌培養極少陽性。

治療：

l  ABPA要用類固醇治療。Itraconazole 200 mg, po, bid(可先用loading dose 300 mg, po, bid三天)可能有幫助。

l  Aspergilloma可試itraconazole，如上。也可考慮外科剔除以免合併症之發生。

l  侵入性疾病需用amphotericin B急增至1.0-1.5mg/kg/day, iv drip，總量為2.0-2.5 gm，反應佳者可檢量。Liposomal amphotericin B較少腎毒性。同時設法減少免疫不全現象。

 

（採自2002年許清曉著『傳染病防治手冊』，最有用的中英文索引Index佔全書三分之一，可在藝軒圖書公司購得。以上是有關此病原的基本常識。最新資料還是要從網路或圖書館醫學雜誌取得。）

 

IDSA Issues First Guidelines for Treatment of MRSA

January 5, 2011 — The Infectious Diseases Society of America (IDSA) has issued its first clinical practice guidelines for the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections in children and adults.

The guidelines, released today, will be published in the February 1 issue of Clinical Infectious Diseases.

The 13-member MRSA guidelines panel was convened by the IDSA Standards and Practice Guidelines Committee in 2007 to develop evidence-based, consensus guidelines for clinicians managing patients with MRSA infections.

The guidelines have been endorsed by the Pediatric Infectious Diseases Society, the American College of Emergency Physicians, and the American Academy of Pediatrics.

"These guidelines for MRSA have been eagerly anticipated," Paul Auwaerter, MD, MBA, who was not involved in their development, noted in an interview with Medscape Medical News.

"The guidelines synthesize current information in one comprehensive piece, even though they aren't all as evidenced-based as we'd like; a couple are way down in the C-III world," said Dr. Auwaerter, clinical director of the Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland.

"A lot of this is only expert opinion," he added, "but that's the best we have right now."

A "Living Document"

"MRSA is a major cause of both healthcare associated and community-associated infections," Catherine Liu, MD, lead author of the guidelines and assistant clinical professor in the Division of Infectious Diseases, University of California–San Francisco, told Medscape Medical News.

"It is the predominant cause of skin infections among patients presenting to the emergency room, and can also cause more serious, invasive infections that account for about 18,000 deaths in the United States per year," she noted.

"MRSA clearly has an enormous clinical and economic impact, and clinicians often struggle with the management of these infections," Dr. Liu added. The guidelines provide a "framework" to help clinicians determine how best to evaluate and treat patients with both uncomplicated and invasive infections caused by MRSA.

"It's designed to be a living document, meaning the recommendations will evolve as new information and antibiotics become available," Dr. Liu emphasized.

The guidelines address the management of a variety of clinical syndromes associated with MRSA disease, including skin and soft tissue infections (SSTIs), bacteremia and endocarditis, pneumonia, bone and joint infections, and central nervous system infections.

Some of the key recommendations, according to Dr. Liu, include the following:

• The management of all MRSA infections should include identification, elimination, and/or debridement of the primary source and other sites of infection when possible (eg, drainage of abscesses, removal of central venous catheters, debridement of osteomyelitis, etc).


• Education on personal hygiene and appropriate wound care is recommended for all patients with SSTIs. Patients should be instructed to keep draining wounds covered with clean, dry bandages; maintain good personal hygiene with regular bathing and cleaning of hands with soap and water or an alcohol-based hand gel, particularly after touching infected skin; and avoid reusing or sharing personal items that have contacted infected skin.


• For most simple abscesses or boils, incision and drainage alone is likely adequate, and antibiotic therapy is not needed. Antibiotic therapy is recommended for abscesses associated with the following conditions: severe or extensive disease or rapid progression in presence of associated cellulitis, signs and symptoms of systemic illness, associated comorbidities or immunosuppression (diabetes, HIV), extremes of age, abscess in area difficult to drain completely (eg, face, hand, genitalia), associated septic phlebitis), and lack of response to incision and drainage alone.


• In patients with MRSA bacteremia, follow-up blood cultures 2 to 4 days after initial positive cultures and as needed thereafter are recommended to document clearance of bacteremia.


• To optimize serum trough concentrations in adult patients, vancomycin should be dosed according to actual body weight (15 - 20 mg/kg/dose every 8 - 12 hours), not to exceed 2 g/dose. Trough monitoring is recommended to achieve target concentrations of 15 to 20 µg/mL in patients with serious MRSA infections and to ensure target concentrations in those who are morbidly obese, have renal dysfunction, or have fluctuating volumes of distribution. The efficacy and safety of targeting higher trough concentrations in children requires further study but should be considered in those with severe sepsis or persistent bacteremia.


• When an alternative to vancomycin is being considered for use, in vitro susceptibility should be confirmed and documented in the medical record.


• For methicillin-sensitive S aureus infections, a beta-lactam antibiotic is the drug of choice in the absence of allergy.

 

ACIP Guidelines for Use of Antiviral Agents for Influenza

 

Most cases of influenza resolve spontaneously, with only a few days of physical distress and loss of productivity as the most significant consequences of illness. However, complications of influenza such as pneumonia and otitis media are common, and the current recommendations focus attention on patients at the highest risk for these complications. Such patients include children younger than 5 years (and, especially, < 2 years), adults 65 years or older, persons with severe chronic illness or immunosuppression, pregnant women, persons with morbid obesity, residents of chronic care facilities, and American Indians/Alaskan Natives.

The Advisory Committee on Immunization Practices provides guidelines for the treatment of these high-risk groups, along with normal-risk individuals, in its current recommendations. It also offers a review of the epidemiology, symptoms, and diagnosis of influenza

Study Highlights

• The main method of transmission of influenza is most likely through person-to-person transmission of large-particle respiratory droplets, which generally travel less than 6 feet in a cough or sneeze.


• Uncomplicated influenza illness usually lasts 3 to 7 days, although cough and malaise may persist for more than 2 weeks.


• Children younger than 5 years with influenza are more likely to demonstrate nonspecific symptoms, such as poor oral intake and irritability, vs older children.


• Influenza is difficult to diagnose on clinical grounds alone. Rapid influenza diagnostic tests offer a high specificity but a low sensitivity. Therefore, a positive rapid test result is usually a reliable indicator of infection with influenza, particularly when influenza activity is high in the community.


• Patients in the high-risk categories described in the Clinical Context section should be treated with antiviral medications. If possible, treatment should be initiated within the first 48 hours of illness.


• Antiviral treatment should also be offered immediately to hospitalized patients as well as to individuals with suspected influenza and severe, complicated, or progressive illness.


• Patients at normal risk for complications may be offered antiviral treatment for known or suspected influenza, provided that treatment is initiated within 48 hours. Antiviral therapy has been demonstrated to reduce influenza symptom duration by approximately 1 day among normal-risk adults.


• Oseltamivir and zanamivir are the preferred antiviral agents for influenza, based on evidence that more than 99% of circulating influenza strains are sensitive to these medications. Amantadine and rimantadine should not be used because of a lack of efficacy against influenza B and high levels of treatment resistance among strains of influenza A.


• Oseltamivir may be used for the treatment of children younger than 1 year.


• Oseltamivir and zanamivir may be used as postexposure chemoprophylaxis for unvaccinated household contacts of patients with influenza. Chemoprophylaxis should only be initiated within 48 hours of the most recent exposure.


• Annual influenza vaccination remains the most effective means to prevent influenza infection and its complications.

Clinical Implications

• The clinical diagnosis of influenza is difficult, and rapid influenza diagnostic tests offer high specificity but low sensitivity. Uncomplicated influenza illness usually lasts 3 to 7 days, although cough and malaise may persist for more than 2 weeks.


• Patients at high risk for complications of influenza should receive treatment with oseltamivir or zanamivir within 48 hours of symptom onset. Treatment with these antivirals is more elective among normal-risk adults, and neither amantadine nor rimantadine should be used to treat influenza.

January 28, 2011 — The US Centers for Disease Control and Prevention Advisory Committee on Immunization Practices has issued updated guidelines regarding the use of antiviral agents for the treatment and chemoprophylaxis of influenza, according to a report in the January 21 issue of the Morbidity and Mortality Weekly Report. The new recommendations, which include a summary of the effectiveness and safety of antiviral treatment medications, update those issued by the committee in 2008.

"Antiviral medications are effective for the prevention of influenza, and, when used for treatment, can reduce the duration and severity of illness," write Anthony E. Fiore, MD, from the Influenza Division, National Center for Immunization and Respiratory Diseases, and colleagues.

"However, the emergence of resistance to one or more of the four licensed antiviral agents (oseltamivir, zanamivir, amantadine, and rimantadine) among some circulating influenza virus strains during the past 5 years has complicated antiviral treatment and chemoprophylaxis recommendations. The selection of antiviral medications should be considered in the context of any available information about surveillance data on influenza antiviral resistance patterns among circulating influenza viruses, local, state, and national influenza surveillance information on influenza virus type or influenza A virus subtype, the characteristics of the person who is ill, and results of influenza testing if testing is done."

Principal changes or updates from the 2008 guidelines for use of antiviral agents for the prevention and control of influenza include the following:

• Antiviral treatment should be started as soon as possible in patients with confirmed or suspected influenza that is severe, complicated, or progressive, or that necessitates hospitalization. Rapid influenza diagnostic test, immunofluorescence, reverse transcription-polymerase chain reaction, or viral culture can be used to confirm influenza virus infection.


• Antiviral treatment should be started in outpatients with confirmed or suspected influenza who are at greater risk for complications of influenza based on age (<5 years, and especially <2 years, or ≥65 years) or underlying medical conditions. These include chronic pulmonary disease (including asthma); cardiovascular disease (except hypertension alone); renal, hepatic, hematologic (including sickle cell disease), and metabolic disorders (including diabetes mellitus); neurologic and neurodevelopmental conditions (including disorders of the brain, spinal cord, peripheral nerve, and muscle such as cerebral palsy, epilepsy, stroke, intellectual disability, moderate to severe developmental delay, muscular dystrophy, or spinal cord injury); immunosuppression; pregnancy or being up to 2 weeks postpartum; and morbid obesity. Other high-risk groups are persons 18 years of age or younger treated with long-term aspirin, American Indians/Alaska Natives, and residents of nursing homes and other chronic-care facilities. The guidelines authors note that clinical judgment should be an important component of outpatient treatment decisions.


• Oseltamivir and zanamivir are the recommended antiviral medications because recent viral surveillance and resistance data show that more than 99% of currently circulating influenza virus strains are sensitive to these drugs. The recommended duration of treatment is 5 days, but longer treatment regimens may be needed in severely ill hospitalized patients or in immunosuppressed persons. Choice of antiviral drug, dosage, and duration of therapy should be based on the patient's age, weight, and renal function; presence of other medical conditions; indications for use (ie, chemoprophylaxis or therapy); and potential for interaction with other medications.

Either oseltamivir or zanamivir can be used to treat persons with influenza caused by 2009 H1N1 virus, influenza A (H3N2) virus, or influenza B virus, or when the influenza virus type or influenza A virus subtype is unknown. High levels of resistance to amantadine and rimantadine among circulating influenza A viruses suggests that these drugs should not be used at present. However, the guidelines include information about these drugs in case current recommendations change because adamantane-susceptible strains emerge again:

• For treatment or chemoprophylaxis of influenza among infants younger than 1 year, oseltamivir may be used when indicated.


• Based on clinical judgment, antiviral treatment may also be considered for any outpatient with confirmed or suspected influenza without known risk factors for severe illness, as long as treatment can be started within 48 hours of symptom onset.


• Clinicians should monitor local antiviral resistance surveillance data because antiviral resistance patterns can change over time.

"If an emerging public health threat is identified for which no licensed or approved product exists, the Project BioShield Act of 2004 authorizes the [US Food and Drug Administration] Commissioner to issue an [emergency use authorization (EUA)] so appropriate countermeasures (e.g., distribution of unlicensed antiviral medications) can be taken quickly to protect the safety of the U.S. population," the guidelines authors conclude.

"Specifically, these countermeasures can facilitate the diagnosis, treatment, or prevention of serious or life-threatening diseases, or for conditions caused by chemical, biologic, or radiologic agents for which no adequate, approved, or available alternatives exist. [The Centers for Disease Control and Prevention,] in conjunction with [the National Institutes of Health] provides expert consultation to the [US Food and Drug Administration] Commissioner regarding the appropriateness of EUA requests and supports the distribution of products stored in the Strategic National Stockpile...formulary. EUAs in effect during the 2009 H1N1 pandemic have expired because there is no longer a declared emergency."

Morb Mortal Wkly Rep. 2011;60:1-24.  

使用Calcium Channel blocker者同時用macrolides容易休克

使用 verapamil, diltiazem, nifedipine, amlodipine, or felodipine 等降血壓劑者，再使用 erythromycin 或 clarithromycin 治療感染時很容易休克，住院!!

 

January 27, 2011 — Physicians need to be careful when prescribing macrolide antibiotics to patients on calcium-channel blockers (CCBs) because of an underappreciated drug-drug interaction that can lead to hypotension and shock, new research shows [1]. The findings are important because millions of people take CCBs and many are prescribed antibiotics every year, say Dr Alissa J Wright (University of Toronto, ON) and colleagues in a study published online January 17, 2011 in CMAJ.

This paper attaches a risk estimate to how dangerous this drug combination is.

Although the interaction "is perfectly predictable based upon the pharmacology of the drugs, it has been previously documented in only about five case reports," senior author Dr David Juurlink (University of Toronto, ON) explained to heartwire . He says that this study is the first rigorous attempt to describe the clinical consequences of this interaction: "In a sense, this paper attaches a risk estimate to how dangerous this drug combination is."

It's not wrong to use a macrolide, but it's probably more sensible if you are going to use one to use azithromycin.

The research also shows that there is a safe choice if doctors do need to use a macrolidelike antibiotic, he adds. The study found that macrolides such as erythromycin or clarithromycin increase the risk of hypotension if used in combination with a CCB, but a related antibiotic, azithromycin, does not.

Juurlink observes that "it's not wrong to use a macrolide [in a patient taking a CCB], but it's probably more sensible if you are going to use one to use azithromycin. If, for some reason, you had to use clarithromycin or erythromycin, it might be reasonable just to edge back a little bit on the dose of the CCB."

Biggest Risk With Erythromycin

In their population-based, nested, case-crossover study, Wright and colleagues analyzed the healthcare records of around a million individuals over the age of 65 who were receiving a single CCB between 1994 and 2009. Of these patients, 7100 were admitted to hospital for hypotension or shock, and 176 had received a macrolide antibiotic (36 received erythromycin, 100 received clarithromycin, and 40 received azithromycin) in a seven-day interval immediately before admission to the hospital or in a seven-day control interval one month earlier. For each antibiotic, the researchers estimated the risk of hypotension or shock associated with the use of a CCB.

They found a strong association between erythromycin use and hospital admission for hypotension, with an almost sixfold increased risk

of low BP (odds ratio 5.8), and a lower but still significant risk associated with the use of clarithromycin (OR 3.7). In contrast, there was no such link with azithromycin use (OR 1.5).

Juurlink explains that, pharmacologically, macrolide antibiotics inhibit a cytochrome P450 enzyme, which metabolizes all CCBs, so their use can lead to the accumulation of the CCB and potential toxicity. But azithromycin does not inhibit this cytochrome P450 enzyme. The use of combination CCBs and macrolide antibiotics "isn't exactly uncommon, but no one has actually ever attached a measure of how dangerous the combination is, and that's what this study does," he notes.

The findings, says Juurlink, apply to all CCBs, because they are all metabolized by the same pathway, although it may be a bigger problem with some than others, he says, adding that his team could not examine the risks for separate CCBs because of a lack of statistical power.

Nevertheless, the results "have considerable clinical relevance, highlighting the consequences of an underappreciated yet avoidable drug interaction involving medications used by millions of people every year. Clinicians should be aware of the potential interaction between these drugs," he and his colleagues state.

Juurlink adds that although the use of erythromycin is declining, clarithromycin is still used frequently. "But I don't think clarithromycin and azithromycin are that different in price, quite frankly, so the latter represents a good choice if macrolide antibiotic therapy is required."

Juurlink declares no conflicts. Disclosures for the coauthors are listed in the paper.

References

1.    Wright AJ, Gomes T, Mamdani MM, et al. The risk of hypotension following co-prescription of macrolide antibiotics and calcium-channel blockers. CMAJ 2011; DOI:10.1503/cmaj.100702. Available at www.cmaj.ca.

Clinical Context

Macrolides are the most commonly prescribed antibiotics, according to IMS Health. In the October 2000 issue of the British Journal of Clinical Pharmacology, Westphal reported that cytochrome P450 isoenzyme 3A4 is inhibited by clarithromycin and erythromycin, but not azithromycin. CCBs are substrates for cytochrome P450 3A4, as noted by Dorne and colleagues in the February 2003 issue of Food and Chemical Toxicology, and, therefore, might be potentiated by the use of macrolide antibiotics.

This population-based, nested, case-crossover study assesses the risk for hospitalization because of hypotension or shock in older patients who use CCBs and macrolide antibiotics.

Study Highlights

• 999,234 adults 66 years or older (median age, 71 years) taking a single CCB during a 5-year period were identified.


• Exclusion criteria were first year of eligibility for coverage of prescription medication and prescriptions for more than 1 macrolide in the 30 days before hospitalization.


• 7100 patients were admitted to the hospital for treatment of hypotension.


• Hospitalized patients had a median age of 77 years, and 47.2% were men.


• Types of CCBs used were diltiazem in 40%, amlodipine in 29.6%, nifedipine in 19.4%, verapamil in 8%, and felodipine in 3%.


• Prescription drug data were obtained from the Ontario Drug Benefit Claims Database.


• Demographic records were obtained from the Registered Persons Database.


• CCBs included verapamil, diltiazem, nifedipine, amlodipine, or felodipine.


• Continuous use of CCBs was defined as refill within 180 days of the date of the previous prescription.


• The endpoint was admission to the hospital for treatment of hypotension or shock, death, discontinuation of treatment, or switch to a different CCB.


• Exposure to each macrolide in a 7-day risk period immediately before hospitalization was compared vs a 7-day control period 1 month prior.


• 176 patients received a macrolide during the risk or control periods.


• Erythromycin use had the strongest association with an increased risk for hospitalization for hypotension (OR, 5.8; 95% confidence interval [CI], 2.3 - 15.0; P < .001).


• Clarithromycin use was also associated with an increased risk for hospitalization (OR, 3.7; 95% CI, 2.3 - 6.1; P < .001).


• However, azithromycin use was not associated with an increased risk for hospitalization (OR, 1.5; 95% CI, 0.8 - 2.8; P = .21).


• Results were similar for patients taking a dihydropyridine CCB (nifedipine, amlodipine, or felodipine).


• Study limitations were inability to quantify medication adherence, type and severity of infection, and accuracy of diagnostic codes for hypotension; insufficient power to assess bradycardia; and inability to assess the magnitude of interaction for each CCB.

Clinical Implications

• In adults taking CCBs, erythromycin, followed by clarithromycin, is related to an increased risk for hospitalization for hypotension or shock.


• In adults taking CCBs, azithromycin use is not related to an increased risk for hospitalization for hypotension or shock

 

維基揭秘 扯下中南海驚天黑幕

作者﹕陳破空【大紀元2010年12月08日訊】由澳大利亞人朱利安‧阿桑奇（JulianAssange）所創辦的維基揭秘（Wikileaks），接連和大量披露源自美國政府的機密檔。暫且不論這一重大洩密事件所涉及的司法紛爭或維基揭秘創辦人個人的訴訟官司。面對這一轟動世界的爆破式資訊解密，迄今，包括美國在內，沒有任何一國政府出面否認遭洩密檔的真實性。

事實上，這些動輒以數十萬計的秘密檔，不僅具有爆炸性，而且具有真實性和權威性。因為檔案來源，既不是那種只能記錄表面現象、至多達到背景分析的新聞報導，更不是那種道聼途説、人云亦云的小道消息，而是來自美國政府的機密檔案。

鑑於美國情報機構遙居世界榜首的收集手段、滲透能力和覆蓋面積，其機密檔案的客觀性、真實性和權威性，無人可以低估。

當維基揭秘披露涉及阿富汗和伊拉克戰爭的美國軍事機密時，幾個月來，中共官方媒體大肆報導，幸災樂禍之情，溢於言表。

然而，當11月底，維基揭秘披露美國政府外交機密後，中共神色陡變，態度一百八十度轉彎，全面遮罩和封殺維基揭秘。

原來，這些外交機密，涉及中國部分，曝光中共高層大量秘聞。比如，瑞士銀行鉅額存款。

從前，中國人熟知的，都是國際上臭名昭著的獨裁與腐敗頭子，才在瑞士銀行暗存鉅款，諸如菲律賓的馬科斯、巴拿馬的諾列加、伊拉克的薩達姆，等等。如今，維基揭秘曝光：中共高層和高官，在瑞士銀行擁有多達5,000個帳戶，其中，三分之二屬於中央級大員，幾乎所有中央委員、政治局委員、政治局常委，人人有份。

吃驚之餘，又覺得不該吃驚，國際上，還有什麼樣的獨裁與腐敗頭子，其貪婪，其糜爛，其膽大包天，能夠超得過盤踞北京的獨裁與腐敗頭子？

也是通過維基揭秘，人們發現：幾乎所有中國政府對外投資和對外採購，都附帶回扣條件。為什麼中國政府在加拿大英屬哥倫比亞省大舉投資？

因為中共與該國自由黨關係密切，方便中共高官吃回扣。而當加國自由黨下臺、保守黨上臺後，中國政府就將投資轉向澳大利亞，採購澳洲礦砂，首要動因，同樣基於吃回扣。到2010年，澳大利亞政府換屆後，中共當局又將投資轉向印尼，繼續吃回扣。鉅額回扣，直接流入中共要人或其家屬帳戶，包括江澤民、胡錦濤這等級別。

於是，人們可以明白，去年曝光的胡錦濤兒子胡海峰捲入納米比亞行賄案（中方承攬該國機場港口掃瞄設備專案），不過是中共要人涉入的無數對外行賄案之一。

透過維基揭秘，人們也才恍然大悟：為什麼中國政府購下美國巨大國債、並不斷增購？原因之一，也在於，鉅額美國債券所伴隨的鉅額回扣。中方收購美國債券，由中國證券公司出面；與美方交割，多半經由高盛投資銀行。高盛公司將這些回扣源源不斷地匯入中共高層開設在紐約的幾百個帳戶，包括中共副總理王歧山和中國人民銀行行長周小川家屬的帳戶。

原來，中共中央的所有行為，背後都是一個「貪」字！這些行為，往往以「政策」為幌子，具有超級欺騙性。

中共中、下層官員貪污，著眼國內項目；中共高層領導人貪污，瞄準國際項目。這才叫「神不知鬼不覺」，這才是大手筆。「鯨吞」二字，只有在中南海大貪官那裡，才神傳其內涵；「腐敗」二字，也只有在中南海大貪官那裡，才達到「規模經營」，實現「規模效應」。厚黑深處，舉世無雙。

維基揭秘洩露，曾出任中共外交部長10年、後轉任國務委員、副總理的錢其琛，竟然是美國政府線人！

起因是，法國軍售臺灣，臺灣政府（時任總統為李登輝）為削減中共壓力，默許法國軍售回扣經香港流向北京，其中，部分回扣從香港匯往美國，直接進入錢其琛兒子強尼開設在芝加哥的帳戶。這一鉅額不明財產來源，遭到美國國稅局調查。「鳥為食亡，人為財死。」為保下兒子強尼，錢其琛不惜放下老臉，親自出面，承諾與美國政府合作，向美方提供中共高級機密。

鑑於任職中共外交系統的，多為錢其琛舊部或學生，凡事向錢請教。於是，不論錢在任、半退休或退休，都能牢牢掌握中共外交命脈。從2001年起，錢經常差遣手下心腹，向美國駐北京大使館密報中共內情。

正是經由錢其琛手下線人密報，美方掌握到：北朝鮮根本就沒有核武器，都是中共在那裡部署的。驚天秘聞！這名錢記線人透露：中共在北朝鮮秘密部署核武器，目的是要美國放棄臺灣；如不然，借由永遠議而不決、決而不行的「六方會談」，中朝唱雙簧，牢牢拖住美國。甚至於，可讓金正日政權充當中共「核代理」，發動戰爭，北京則坐收漁利。

其實，深知中共者都明白，這不過是中共厚黑慣技。就像當年與國民黨內戰時期，中共軍頭往往下令其佯攻部隊，「打得越兇猛越好」，以便有效掩護其主力部隊從另一方向發起真正的總攻擊。

當年朝鮮戰爭，中共於戰前就向北朝鮮輸送中國朝鮮族軍人，冒充朝鮮「人民軍」，並充當其主力。首批輸送6.9萬，開戰後又輸送10萬，眼看還不夠，才直接派出「中國人民志願軍」百萬大軍，與美國和聯合國軍死搏。

或許，正是因為美國已經明瞭平壤跳高、由北京主使這一嚴峻現實，在相繼發生北韓炸沉南韓天安艦、炮擊南韓延坪島事件之後，美、日、韓三國才不再理會中共「恢復六方會談」的假意「呼籲」，而徑直舉行三國磋商，強化美、日、韓三國同盟。

維基揭秘還證實：中共在加拿大校園建立共青團組織。這符合之前外界的推測。事實上，中共在美國、加拿大、歐洲、日本以及世界各地的中國留學生中，都出資營建其黨團組織，讓這類組織以「愛國」為名，行「擁共」之實，隨時在海外滋事。

2008年，曾有部分「中國留學生和華人」在加拿大示威，支持北京紅色奧運。至於這類鬧劇的經費，維基揭秘披露，來自中共政治局常委、政法委書記周永康設在加拿大的帳戶，具體執行人是號稱「中國巴菲特」的唐煒臻。在周永康的加拿大關係帳戶上，顯示共有兩千萬美元存款。

維基揭秘涉及中國部分，相信還有更多的未爆彈，有待引爆，震撼可期。中共發言人前後三次表態，將中共高層的複雜心理暴露無遺。

第一次表態，要求「美國政府管好自己的機密」，證明中南海也承認遭洩露文件的真實性；第二次表態，是在中國部分曝光後，中共發言人斥維基解密「內容荒謬」，但「希望不影響中美關係」，表明中南海心態的難堪與無奈；第三次表態，中共發言人乾脆說，檔案洩露，是「顛覆中國（中共）的陰謀」。反映中共領導人內心深處的驚慌與恐懼。

——轉自《自由亞洲電台》

本文網址: http://www.epochtimes.com/b5/10/12/8/n3107377.htm

治療頭蝨的外用新藥--spinosad (Natroba)

FDA Approves New Topical Drug for Head Lice

January 28, 2011 — The US Food and Drug Administration (FDA) has approved spinosad (Natroba Topical Suspension 0.9%, ParaPRO) for the treatment of head lice infestation in people aged 4 years and older.

Head lice (Pediculus capitis) are spread most often by close person-to-person contact. They are very common among schoolchildren in the United States — second only to the common cold among communicable diseases affecting schoolchildren, according to the Mayo Clinic.

A variety of topical over-the-counter medications and prescription medications are currently available to treat head lice.

"Natroba provides another option for the topical treatment of head lice infestations, which are especially prevalent in the pediatric population," said Julie Beitz, MD, director of the Office of Drug Evaluation III in the FDA's Center for Drug Evaluation and Research, in an FDA statement.

Unlike other medications for head lice, spinosad does not require combing through the hair, according to the manufacturer. A fine-tooth comb may be used to remove dead lice and nits from the hair and scalp, but is not required, according to the company's Web site. The pediculicide spinosad should be used as part of an overall lice management program, with other adjunctive measures including hot-water washing or dry-cleaning of all recently worn clothing, hats, used bedding, and towels; and hot-water washing of personal care items such as combs, brushes, and hair clips.

Spinosad is for topical use only and is not recommended for oral, ophthalmic, or intravaginal use. After shaking the bottle well, the patient or caregiver should apply the product to dry scalp and hair, using the minimal amount needed to cover both. After waiting 10 minutes, the patient or caregiver should thoroughly rinse the head and hair with warm water, being careful to avoid contact with the eyes. If live lice are seen 7 days after the first treatment, topical application of spinosad should be repeated.

Clinical Studies

The FDA's approval was based on the safety and effectiveness of spinosad established in 2 multicenter, randomized, active-controlled studies. The active control was permethrin 1%.

A total of 552 patients received a 10-minute treatment with spinosad. If live lice were seen a week later, a second treatment was applied. The proportion of participants who were lice-free 14 days after the final treatment of spinosad was approximately 86% compared with 44% of the active control group.

In testing, the most common adverse events were application site redness (3%), redness and irritation to the eyes (2%), or application site irritation (1%). These events compared favorably with those seen with permethrin 1%, which was associated with erythema at the application site in 7%, ocular erythema in 3%, and irritation at the application site in 2% of participants.

Use in Special Populations

The safety of spinosad in children younger than 4 years old has not been established, the FDA notes.

The agency adds that it is particularly important not to use the product in infants because it contains benzyl alcohol, which has been associated with serious adverse reactions, including death, when applied topically to the skin of children younger than 6 months.

Although clinical studies did not enroll sufficient numbers of participants 65 years and older to examine whether they respond differently than younger participants, other reported clinical experience has not detected differences in responses between elderly and younger patients.

Spinosad is a pregnancy category B medication, with no adequate and well-controlled studies of spinosad topical suspension in pregnant women. Furthermore, human studies did not determine the absorption of benzyl alcohol contained in spinosad topical suspension. Although reproduction studies in rats and rabbits demonstrated no teratogenic effects, animal reproduction studies do not always predict human response, and this drug should be used during pregnancy only if clearly needed.

Regarding nursing mothers, spinosad is not systemically absorbed and therefore is not present in human milk, but benzyl alcohol contained in the topical suspension may be systemically absorbed through the skin. Because the amount of benzyl alcohol excreted in human milk with use of spinosad topical suspension is unknown, caution should be used when a lactating woman is treated. To avoid infant ingestion of benzyl alcohol, a lactating woman may wish to pump and discard breast milk for 8 hours after use of spinosad topical suspension, which represents 5 half-lives of benzyl alcohol.

More information on this drug approval is available on the FDA Web site.

Laurie Barclay, MD, contributed to this news article.

Clinical Implications

• Unlike other medications for head lice, spinosad does not require combing through the hair, but the 10-minute, topical treatment should be used as part of an overall lice management program. If live lice are seen 7 days after the first treatment, the treatment should be repeated.


• The most commonly reported adverse events were application site redness in 3% of patients, eye redness and irritation in 2%, and application site irritation in 1%.


• The safety of spinosad in children younger than 4 years has not been established, and it should especially not be used in infants. Spinosad is a pregnancy category B medication and should be used during pregnancy only if clearly needed. Caution should be used in nursing mothers.