Schizophrenia after prenatal exposure to Toxoplasma gondii?

cline; however, results from another large surveillance study of 1531 isolates of Streptococcus pneumoniae, collected in the United States during the winter of 1999–2000, found that 25.9% of isolates were resistant to macrolides and 16.4% were resistant to tetracycline [6]. In another US study, resistance to tetracycline and to macrolides was 20% and 34%, respectively [7]. Since doxycycline is, in general, more active in vitro against S. pneumoniae than tetracycline, doxycycline is at least as active as the macrolides. Although there is an abundance of recently published results from controlled clinical trials for the newer macrolides (as reviewed by Lynch and Martinez [8]), the new fluoroquinolones, and a combination of b-lactams with or without macrolides, reports of recent data on doxycycline are very limited. A recent review that included a MEDLINE search for the evaluation of doxycycline in the treatment of CAP revealed only 2 studies published since 1990, only 1 of which was performed after 1995, when the prevalence of penicillin-resistant S. pneumoniae (PRSP) was relatively high (110%) [9]. In this latter study, only 43 patients were treated with doxycycline; of these, only 8 patients had documented infection due to S. pneumoniae (none with PRSP) [10]. We agree with Dr. Johnson [1] that doxycycline represents a potentially inexpensive, fluoroquinolone-sparing alternative for the treatment of CAP and that effective options for therapy that take the pressure off use of fluoroquinolones is important. Although doxycycline is included as an option in the recent practice guidelines, it is rarely used. In a review of antimicrobial use by 12000 patients with CAP who were treated as outpatients, Gilbert et al. [11] found that, although 73.4% of outpatients received a macrolide agent, only 3.5% received doxycycline. Since doxycycline is generic, there is no corporate advantage for promotion of the drug or for sponsoring a clinical trial. We agree with Dr. Johnson that a well-controlled clinical trial is indicated, and we echo his call for alternative sources for sponsoring such a study. Use of doxycycline should prove to be a cost-effective therapy for the treatment of CAP and is an important therapy option that deserves more use and study.