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"I'm Throwing you (ID) Pearls Here" by Steven P. LaRosa, M.D.

Prior to me employed by a non-academic teaching hospital I spent 11 years teaching Infectious Disease to medical students, Internal Medicine residents and ID fellows at 3 different academic teaching hospitals. I had a vast array of clinical pearls that I would share on teaching rounds. In my last 5 years in a non-teaching setting I am often amazed that no one ever taught physicians who are Board Certified in Internal Medicine these important teaching points. I thought it might be useful to share some of my favorite ID teaching points or "pearls" in this blog. 1) oral Beta lactam agents are not adequate treatment of bacteremia 2) Beta-lactam- beta lactamase drugs (Unasyn, Zosyn) and Carbapenems (Ertapenem and Meropenem) have perfectly adequate anaerobic coverage and do not require the addition of Metronidazole 3) Oral vancomycin has no bioavailability 4) Vancomycin is inferior to Beta lactam drugs for the treatment of serious MSSA infections 5) When awaiting sensiti
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"The Viral Hypothesis of Alzheimer's Disease: Time to put it to the test!" by Steven P. LaRosa, M.D.

Alzheimer’s disease (AD) was estimated to affect 35.5 million people worldwide in 2010 and is expected to affect 115.4 million people by 2050. Approximately 10% of people over 65 are affected and 50% of population > 85 are affected. The currently approved drugs provide minimal benefit. The benefit of experimental drugs observed in Phase II clinical trials has been followed by resounding failures in adequately powered Phase III clinical trials. Even the results of the highly publicized Biogen study have significant questions associated with it. It is quite clear that a new strategy must be entertained and tested. Four members of the Human Herpes Virus family have been associated with development of Alzheimer’s disease; HSV-1, VZV, HHV-6A, and HHV-7. HSV-1 is capable in vitro leading to the production the Beta amyloid protein found in senile plaques and phosphorylating tau protein seen in neurofibrillary tangles seen in Alzheimer’s, a   phenomenon that can be blocked by co-incub
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Opening One’s Mind to Lyme Disease Treatment (at least to need for more clinical trials)

Recently I was contacted and interviewed by a party to get my feelings about the state of treatment of Lyme disease. On the phone we lamented about the sizable number of poor souls who continue to suffer symptoms after what is considered standard of care treatment. I made it clear to the interviewer that I practice only evidence-based medicine and that I treat patients based upon the IDSA guidelines. I also railed against physicians who treat patients with months of parenteral antibiotic therapy for “Chronic Limes’ Disease” (ha ha). I stated fairly aggressive and believe that such practices opens the patient to life threatening infections including catheter-related bacteremia and Clostridium difficile colitis. After I got off the phone I started to do some soul searching. I have gotten so used to saying the same lines over and over again, but when was the last time that I actually had looked at the literature? The answer obviously was way too long ago. I was able to
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