Duloxetine (Cymbalta - Lilly) is the second drug to be approved by the FDA for treatment of fibromyalgia. Pregabalin (Lyrica), which is also approved for treatment of neuropathic pain and epilepsy, was the first. Duloxetine is a selective serotonin and norepinephrine reuptake inhibitor (SNRI) that is already marketed for treatment of depression and diabetic neuropathy.

The most common cause of travelers' diarrhea, usually a self-limited illness without fever lasting several days, is infection with noninvasive enterotoxigenic (ETEC) or enteroaggregative (EAEC) strains of Escherichia coli. Campylobacter, Shigella, Salmonella, Aeromonas, viruses and parasites are less common.

The American Heart Association (AHA) recently published a statement saying that it would be reasonable to obtain an electrocardiogram (ECG) in children being evaluated for stimulant drug therapy for attention deficit hyperactivity disorder (ADHD). A subsequent news release in conjunction with the American Academy of Pediatrics provided a clarification, saying that it would be reasonable to consider obtaining an ECG in such children.

The U.S. Advisory Committee on Immunization Practices has recommended administration of the quadrivalent conjugated polysaccharide meningococcal vaccine (Menactra – Sanofi Pasteur) to all persons 11 to 18 years old, particularly those entering high school and college freshmen living in dormitories.1,2 The peak incidence of meningococcal disease, after early childhood, occurs in the 15-19 year-old age group. The conjugate vaccine is more immunogenic than the meningococcal capsular polysaccharide vaccine (Menommune – Sanofi Pasteur).

ADVERSE EFFECTS — The most common adverse reactions with the conjugate vaccine have been headache, fatigue and malaise, in addition to pain, redness and induration at the injection site. Guillain-Barré syndrome has occurred rarely.3

CONCLUSION — Previously unvaccinated children starting high school or going away to college this fall should receive a single dose of meningococcal conjugate vaccine (Menactra).

1. Centers for Disease Control and Prevention (CDC). Advisory Committee on Immunization Practices. Revised recommendations of the Advisory Committee on Immunization Practices to vaccinate all persons aged 11-18 years with meningococcal conjugate vaccine. MMWR Morb Mortal Wkly Rep 2007; 56:794.
2. Menactra: a meningococcal conjugate vaccine. Med Lett Drugs Ther 2005; 47:29.
3. Centers for Disease Control and Prevention (CDC). Update: Guillain-Barre syndrome among recipients of Menactra meningococcal conjugate vaccine — United States, October 2005-February 2006. MMWR Morb Mortal Wkly Rep 2006; 55:364.

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