ABSTRACT
The primary purpose of this six-week survey study of women currently taking compounded bioidentical hormone replacement therapy was to determine if compounded bioidentical hormone replacement therapy relieves symptoms of menopause and is well tolerated. The secondary purpose of this study was to compare the symptom relief and tolerability of compounded bioidentical hormone replacement therapy to previously used commercially available products. All strengths and dosage forms of bi-estrogen and tri-estrogen were included, whether used alone or in combination with progesterone, dehydroepiandrosterone or testosterone. The survey instrument consisted of nineteen questions and evaluated the outcomes and side effects for commercially available versus compounded bioidentical hormones. A total of 160 surveys was distributed and 78 were completed. Overall, 57.7% of the women surveyed reported fewer side effects and 71.8% of the women had better relief of menopausal symptoms when using bioidentical hormone replacement therapy. The occurrence and severity of menopausal symptoms decreased significantly after beginning bioidentical hormone replacement therapy. Before treatment, moderate-to-severe symptoms of hot flashes, night sweats, sleep problems, dry skin/hair, vaginal dryness, foggy thinking, mood swings and decrease in sex drive were reported in 52 % to 70% of the women. After initiating treatment the moderate-to-severe range of symptoms dropped to between 4% and 20%. The most commonly reported side effects with bioidentical hormone replacement therapy were weight gain (37.2%), breast tenderness (19.2%) and bloating (23.1%). Weight gain (56.2%), breast tenderness (54.5%), bloating (40%) and mood swings (36.4%) were most commonly seen with commercially available products. Bioidentical hormone replacement relieved the symptoms of menopause and was well tolerated.
ABSTRACT
OBJECTIVE: To present a case of cellulitis/myositis due to Stenotrophomonas maltophilia in the absence of trauma and to discuss a potentially novel treatment option. CASE SUMMARY: A 57-year-old white man, having undergone an allogeneic bone marrow transplant, developed myositis with S. maltophilia of the left soleus muscle; there had been no trauma. Risk factors for infection included neutropenia, prolonged hospitalization and intensive care unit stay, and broad-spectrum antibiotic exposure. The affected area of muscle was resected and the patient successfully treated with trimethoprim/sulfamethoxazole (TMP/SMX), ticarcillin/clavulanate, and aztreonam. DISCUSSION: In severe myositis/cellulitis caused by S. maltophilia, TMP/SMX is considered the drug of choice. However, bacteriostatic agents such as TMP/SMX are less than ideal in neutropenic patients. The combination of ticarcillin/clavulanate plus aztreonam has been shown to improve activity in vitro against this organism compared with TMP/SMX. This is likely due to inhibition of the 2 beta-lactamases this organism produces by clavulanate and aztreonam. In our study of clinical isolates of S. maltophilia, this combination reduced the minimum inhibitory concentration at 90% by 128-fold and was synergistic against 10 of 12 isolates tested in time-kill analysis. CONCLUSIONS: S. maltophilia is emerging as an important pathogen in patients with compromised immunity, leading to severe infections that are difficult to treat. Based on in vitro synergy studied, we recommend considering ticarcillin/clavulanate plus aztreonam as a potential treatment option in immunocompromised patients with S. maltophilia infection.
