Human bite wounds

1
OraSure Technologies, Inc.

• OraSure HIV-1 (FDA 12/94)
• Collection pad between lower cheek and gum for
  2-5 minutes collecting oral mucosal transudate
  (OMT)
• Requires no blood or needles
• 99 accurate using ELISA (tests for antibodies)
• OraSure HIV-1 Western Blot (FDA 6/96)
• Confirmatory for ELISA
• OraQuick HIV (FDA 11/7/02)
• Rapid HIV-1 antibody test

2
OraQuick Rapid HIV-1 Antibody Test

• Uses finger-stick whole blood samples (loop)
• Point-of-care test portable
• Approximately 20 minutes
• Sensitivity 99.6 and specificity of 100
• Co-distribution with Abbott Laboratories
• 40,000 CLIA-approved sites conduct 17 million HIV
  tests in USA annually
• 8,000 tested never return for results
• One-third in public health settings
• 20 of all pregnant women unaware of status at
  time of delivery
• 600,000 1,000,000 needle stick injuries each
  year
• Subject information pamphlet

3
OraQuick - Indications

• HIV counseling and testing sites
• STD clinics
• Community health centers
• Drug treatment centers
• Hospitals
• Physician offices
• Managed care organizations
• Prisons

4
Voriconazole

• Indications
• IA (halo or air cresent sign GM antigen)
• Refractory Scedosporium apiospermum or Fusarium
  spp. infections
• Activity
• Inhibits cell wall synthesis
• Fluconazole with side chains
• Fungistatic/cidal

5
Voriconazole

• Dosing
• 200 mg and 50 mg tablets with 96
  bioavailability 200 mg vials for IV
• LOAD (steady state 1 vs 5 days)
• Oral one hour pre or post meal
• No gastric acid affect
• Genetic polymorphism
• Increase dose by 50 for refractory disease
• Oral with CrCl lt 50 SBECD (lt2 urine)
• Pregnancy class D

6
Voriconazole

• Visual disturbances (30)
• Photopsia, blurred vision, chromatopsia,
  photophobia
• Dose-related within 30 mnutes and generally
  short-lived
• ? Monitor with prolonged use
• Visual hallucinations
• Transaminitis (13.3)
• Rash (6)

7
Voriconazole

• Drug interactions (CYP2C19, CYP2C9, CYP3A4)
• Effect on voriconazole
• Avoid rifampin, carbamazepine, long-acting
  barbiturates
• Effect of voriconazole
• Avoid sirolimus, rifabutin, cisapride, quinidine,
  terfenadine, astemizole, ergot alkaloids
• Monitor cyclosporine, tacrolimus, warfarin,
  statins, benzos, calcium channel blockers, etc.