Contingency management (CM) based interventions that reinforce adherence to prescribed medications have shown promise in a variety of disadvantaged populations. Fifty-six participants with histories of illicit substance use who were prescribed antiretroviral medication but evidenced suboptimal adherence during a baseline assessment were randomly assigned to 16 weeks of weekly CM-based counseling or supportive counseling, followed by 16 additional weeks of data collection and adherence feedback to providers. The CM intervention involved review of data generated by electronic pill-bottle caps that record bottle opening (MEMS) and brief substance abuse counseling. CM participants were reinforced for MEMS-measured adherence with drawings from a bowl for prizes and bonus drawings for consecutive weeks of perfect adherence. Potential total earnings averaged $800. Mean MEMS-measured adherence to the reinforced medication increased from 61% at baseline to 76% during the 16-week treatment phase and was significantly increased relative to the supportive counseling group (p = 0.01). Furthermore, mean log-transformed viral load was significantly lower in the CM group. However, by the end of the 16-week follow-up phase, differences between groups in adherence and viral load were no longer significantly different. Proportions of positive urine toxicology tests did not differ significantly between the two groups at any phase. A brief CM-based intervention was associated with significantly higher adherence and lower viral loads. Future studies should evaluate methods to extend effects for longer term benefits.

Vaginal microbicides may improve prevention outcomes for high-risk inner-city women.

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method is presented for the synthesis of cefpodoxime proxetil (XII), a third-generation cephalosporin for oral administration. Compared to previously reported methods the new procedure affords better yields and no purification step by column chromatography is necessary. -(RODRIGUEZ, J. C.; HERNANDEZ, R.; GONZALEZ, M.; RODRIGUEZ, Z.; TOLON, B.; VELEZ, H.; VALDES, B.; LOPEZ, M. A.; FINI*, A.; Farmaco 58 (2003) 5, 363-369; Ist. Sci. Chim., Univ. Bologna, I-40127 Bologna, Italy; Eng.) -M. Bohle 36-177

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Antibiotics Antibiotics U 1200An Alternative Procedure for Preparation of Cefdinir. -This alternative procedure allows to overcome the drawback of the use of diketene during the synthesis of cefdinir by the best current synthetic method. The first part of the synthesis of cefdinir (XV), consists of the preparation of (VIII), carrier of the vinyl modified cephem nucleus. Phenylacetylation of (II), the most critical step in this part, is effected by activating phenylacetic acid (III) with Vilsmeier reagent. The second part of this synthesis of (XV) consists of the preparation of protected (XIII) carrying the antibiotic moiety. The key step in this part is the formation of the aminothiazole ring, effected by N,N-dimethylacetamide as a solvent without using any catalyst. Finally, coupling of the intermediates (VIII) and (XIII) followed by deprotection furnish title compound (XV) in 14.3% overall yield from (I). -(GONZALEZ, M.; RODRIGUEZ, Z.; TOLON, B.; RODRIGUEZ, J. C.; VELEZ, H.; VALDES, B.; LOPEZ, M. A.; FINI*, A.; Farmaco 58 (2003) 6, 409-418; Ist. Sci. Chim., Univ. Bologna, I-40127 Bologna, Italy; Eng.) -H. Hoennerscheid 35-183 2003 Antibiotics