Update in Endocarditis Prophylaxis

Jason Andrade, MD, Division of Cardiology, University of British Columbia, Department of Medicine, Vancouver, BC.
Aneez Mohamed, MD, Division of Cardiology, University of British Columbia, Department of Medicine, Vancouver, BC.
Chris Rauscher, MD, Division of Geriatric Medicine, University of British Columbia, Department of Medicine, Vancouver, BC.

Infective endocarditis (IE) is a rare but potentially devastating clinical entity with a well-delineated pathogenesis. While previously thought to be a disorder of younger individuals, older adults now represent one of the highest risk groups for the acquisition of and adverse outcomes related to IE. Prior to focusing on the updated recommendations for IE prophylaxis and the rationale behind them, we briefly review the clinical aspects of IE in the general population, as well as special considerations for older adults.
Key words: endocarditis, prophylaxis, older adults, cardiovascular disease, antibiotics.

Optimizing the Prevention and Management of Influenza in Older Adults

Janet E. McElhaney, MD, FRCPC, FACP, Geriatrician, Center for Immunotherapy of Cancer and Infectious Diseases and UConn Center on Aging, University of Connecticut School of Medicine, Farmington, CT, USA.

Influenza is a serious illness and is probably the single cause of excess mortality during the winter months in the portion of the population that is aged 65 and over. In spite of its limited efficacy in older adults, influenza vaccination is a cost-saving medical intervention that can help to prevent pneumonias, exacerbations of heart failure, and, surprisingly, heart attacks and strokes. As hospitalization rates for acute respiratory illnesses continue to rise in spite of widespread vaccination programs, antiviral drugs need to be incorporated into prophylaxis and early treatment strategies for influenza. Particularly in the institutional setting, seasonal prophylaxis or influenza outbreak control that involves the staff is essential.

Key words: influenza, antiviral drugs, vaccination, prophylaxis, drug resistance.

Antithrombotic Drugs for Secondary Stroke Prophylaxis

A Review of Efficacy, Toxicity and Safety Considerations

Charles L Bennett, MD, PhD
The Chicago VA Healthcare
System/Lakeside Division, the Robert H Lurie Comprehensive Cancer Center and
the Division of Hematology/Oncology of the Department of Medicine,
Northwestern University,
Chicago, IL, USA.

Richard H Bennett, MD
Department of Neurology,
Albert Einstein Northern Hospital and
the Medical School of the University of Pennsylvania,
Philadelphia, PA, USA.

Introduction
Stroke is a common cause of morbidity and mortality in older adults in the United States and Canada. Fortunately, in both countries, the age-adjusted national death rate for stroke has declined, reflecting increasingly widespread use of primary and secondary prophylaxis efforts. The mainstay of stroke prevention is the use of antiplatelet agents which interfere with thrombus formation by platelets in diseased or damaged blood vessels (see Figure 1). While aspirin has been the primary antiplatelet agent, over the past ten years, ticlopidine (Ticlid), clopidogrel (Plavix) and extended release dipyridamole plus aspirin (Aggrenox) have been approved for use in this setting.