Citywide pharmaceutical preparation for bioterrorism.

One community's efforts to become pharmaceutically prepared for an attack with biological agents is described. In response to recent bioterrorist activities, including a local scare in 1999 involving anthrax, the pharmacy department at Deaconess Medical Center in Spokane, Washington, was asked to develop a plan for bioterrorism preparedness. A literature search was conducted, and resources, such as the Centers for Disease Control and Prevention, were contacted. For each biological agent, information was compiled about symptom onset, treatment, postexposure prophylaxis, patient isolation precautions, and the availability of antidotes at local hospitals. A procedure was developed for obtaining antidotes that might not be available or stocked in sufficient quantities. After being reviewed by appropriate authorities, the information was presented to area hospitals and trauma centers, drug wholesalers, hospital risk-management personnel, and emergency management personnel. In May 2000 dozens of emergency and medical personnel attended a day-long program on domestic preparedness. Citywide cooperation was obtained on how to respond to a mass exposure to a bioterrorism agent. The job of a pharmacist during a bioterrorism strike is to rapidly disseminate antidotes and information, provide dosage and vaccination schedules for both treatment and prophylaxis, and counsel patients. Medical facilities in Spokane have cooperated to make the community more prepared for a bioterrorist attack.

Antiretroviral therapy for pediatric and adolescent HIV.

As the number of children infected in the HIV epidemic increases, the school nurse can play an important role in ensuring that these children receive comprehensive health care. Compliance with following an immunization program for HIV-infected children is a potential problem for various reasons. Many of these children come from homes where the mother also has HIV/AIDS. She is likely to be involved in keeping her family together, caring for her own health needs, and meeting financial and social needs of her family. Access to health care may be limited. The majority of vaccines administered within the first few months of life are parenteral and consist of inactivated antigens. Children or infants who are immunosuppressed may be unable to respond to the immunogen, thus rendering them susceptible to many infectious diseases. Heterosexual transmission and pregnancy compound the problems of HIV/AIDS (Flynn, 1994). Compliance following an immunization schedule becomes a greater challenge when working with the adolescent population. Parents may not understand that the risk of receiving vaccine, MMR for example, is less than the risk of severe complications associated with the diseases themselves. Coordination of care between the child, parent, and school district personnel is imperative to minimize the risk of further health-related problems of the HIV-infected child. Encouraging regular immunizations can decrease the child's susceptibility to infection, and administering medications properly can enhance the benefits of the drug therapy. An excellent resource for answering questions of school nurses related to HIV/AIDS is the National Pediatric and Family HIV Resource Center; contact Elaine Gross, R.N., M.S. at 1-800-362-0071.

Protease inhibitors: a therapeutic breakthrough for the treatment of patients with human immunodeficiency virus.

As one of the largest growing classes of antiretroviral drugs, protease inhibitors are promising agents for the management of patients infected with the human immunodeficiency virus (HIV). We reviewed the literature and compared efficacy, dosing, side effects, and drug-interaction profiles of the protease inhibitors saquinavir, ritonavir, indinavir, and nelfinavir. We addressed the use of these antiprotease agents as monotherapy versus use in combination therapy with other antiretroviral medications, and the potential for HIV to develop resistance to this drug class. We also discussed therapy with dual protease inhibitors and the use of protease inhibitors in pregnant or lactating women and in pediatric patients. Finally, we examined case reports of the addition of protease inhibitors to an antiretroviral regimen that ultimately decreases or reverses opportunistic infections.