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Leaders
Prophylactic use of antibiotics and immunisations in patients with SLE
  1. W R Gilliland,
  2. G C Tsokos
  1. Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
  1. Correspondence to
    Dr W R Gilliland;
    wgilliland{at}usuhs.mil and
    gtsokos{at}usuhs.mil

https://doi.org/10.1136/ard.61.3.191

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    Early diagnosis and treatment of infections in SLE is a challenge

    Over the past several decades, medical research has improved our knowledge about the cause, recognition, and treatment of a variety of infectious diseases. Despite these advances, infections remain a major cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE) throughout the world.1–,3 Almost two decades ago, the Lupus Survival Study Group examined the causes of death of 1103 patients with SLE. Infections accounted for 33% of the deaths, whereas active disease for 31%.4 Table 1⇓ summarises more recent studies, demonstrating the discouraging fact that the percentage of deaths due to infection has changed little since the earlier reports.

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    Table 1

    Infection as a cause of death in patients with SLE

    Doctors caring for patients with SLE are left to answer the vexing question: how do we control the inflammation related to disease activity without increasing the infection rate? Considering that corticosteroids and other immunosuppressive agents used to control the underlying disease also increase the susceptibility to infections, this is indeed a difficult question.

    POSSIBLE STRATEGIES

    Several strategies may be helpful in decreasing the morbidity and mortality related to infections.

    Simple hygiene

    Perhaps the simplest strategy is to educate patients and their healthcare providers about the importance of simple hygienic measures such as hand washing in order to …

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