摘要:

Emerging evidence suggests an association between some asthma and pulmonary infection by the atypical organismsChlamydia pneumoniaeandMycoplasma pneumoniae, but a causal role for infection remains unproven and controversial. Most acute exacerbations of asthma are triggered by acute infections that are due to viral respiratory pathogens, not to bacteria or atypical organisms. Administration of antibiotics for acute exacerbations of asthma has been shown to be ineffective. Most evidence linking atypical infections to asthma is consistent with a promoting role for chronic infection in producing persistent asthma symptoms. Preliminary studies suggest that prolonged (≥6 weeks) administration of doxycycline or macrolides may eradicateC. pneumoniaefrom respiratory secretions and improve long term, not acute, asthma symptoms. Randomised, controlled trials are currently under way to investigate the effectiveness of these prolonged courses of macrolides and azalides (roxithromycin, clarithromycin and azithromycin) in adults with stable persistent asthma. Traditional courses (7 to 10 days) of any antibiotic are incapable of eradicating chronicC. pneumoniaeorM. pneumoniaeinfection; furthermore, β-lactam and sulphonamide-based antibiotics that are commonly prescribed in acute respiratory syndromes are ineffective against these atypical organisms. Unless the goal is to treat documented sinusitis associated with asthma, it is inappropriate to prescribe traditional courses of any antibiotic for acute asthma exacerbations; whether longer courses of antibiotics should be prescribed to eradicate chronic atypical infections and decrease persistent asthma severity remains to be established.

ISSN:1173-8804    

出版商:ADIS    

年代:2000

数据来源: ADIS

摘要:

Several new immunosuppressive agents have recently been approved for use in solid organ transplantation. Many of these agents have narrow therapeutic ranges, which necessitates drug concentration monitoring in order to optimise efficacy, minimise toxicity and individualise dosages. Some of the lessons learned with the clinical use of the revolutionary agent cyclosporin have been applied to the newer agents tacrolimus and sirolimus. The agent mycophenolate mofetil has been in clinical use without widespread drug concentration monitoring; however, recent data suggest that therapeutic monitoring may improve clinical outcomes, especially in certain high risk subsets of patients. This review focuses on the literature published to date on drug concentration monitoring of the newer immunosuppressive agents − tacrolimus, mycophenolate mofetil and sirolimus. In addition, pertinent aspects of the clinical pharmacokinetics and metabolism of each agent are reviewed.

ISSN:1173-8804    

出版商:ADIS    

年代:2000

数据来源: ADIS

摘要:

Allergic rhinitis can affect up to one-fifth of the population and the economic impact is increasing. H1receptor antagonists were the first major pharmacologic treatment, but the associated sedation limited their use. The 2 initial second generation less sedating antihistamines, astemizole and terfenadine, were found to prolong the cardiac QTcinterval, especially when administered with other medications metabolised by the same cytochrome (CYP) P450 isoenzyme, CYP3A4. Other second generation antihistamines, fexofenadine, loratadine and cetirizine, do not cause clinically significant cardiac QTcinterval prolongation. Two newer agents, ebastine and mizolastine, are also effective in the treatment of allergic rhinitis. Ebastine, however, prolongs the cardiac QTcinterval in laboratory animals and humans, the clinical significance of which is unknown. Desloratadine and norastemizole, metabolites of loratadine and astemizole, respectively, are 2 other second generation antihistamines found to be effective treatments for seasonal allergic rhinitis. Unlike their parent compounds, they do not prolong the cardiac QTcinterval.All clinically available intranasal corticosteroids are effective in the treatment of allergic rhinitis, but studies to evaluate possible long term systemic adverse effects are limited. Mometasone furoate and fluticasone propionate have lower oral bioavailability compared with other corticosteroids that are given intranasally. This may be important, since it is likely that some of the intranasal corticosteroid is ingested. Two 1-year growth studies in children indicated that intranasal beclomethasone dipropionate given twice daily reduces growth velocity, whereas intranasal mometasone furoate given once daily in the morning does not. Other studies are needed.Most but not all studies have shown that leukotriene antagonists are effective in the treatment of allergic rhinitis. H1receptor antagonists are not very effective in reducing nasal congestion, but leukotriene antagonists do attenuate this symptom. Furthermore, one study demonstrates an additive benefit in treating allergic rhinitis with the combination of a H1receptor and leukotriene antagonist.Clinical trials have demonstrated that anti-immunoglobulin (Ig) E is effective in the treatment of seasonal allergic rhinitis when free IgE is reduced to <25 µg/L. The reduction of total IgE is dose dependent and subcutaneous and intravenous administration are both effective.Immunotherapy is also an effective treatment for allergic rhinitis. CpG oligonucleotides is a novel adjuvant for allergen immunotherapy. This adjuvant used in a murine model shifts the immune response away from the allergic or TH2 phenotype. Studies in humans have not been performed.

ISSN:1173-8804    

出版商:ADIS    

年代:2000

数据来源: ADIS

摘要:

ObjectiveTo perform a meta-analysis using data from all clinical trials and studies of a ribosomal vaccine (Ribomunyl®) in order to estimate its overall effect on the number of infections and antibacterial courses used per person.Design and settingMeta-analysis of studies performed between 1985 and 1999 in 7 European countries and also in Kazakhstan, Tunisia, Morocco and Argentina.Patients and participantsInformation from 14 213 adults and children.ResultsThere were 9 randomised, double-blind, placebo-controlled studies, 3 randomised nonblind studies and 16 nonblind studies with no placebo arm in which the response to ribosomal vaccine was compared with historical information. The mean number of infections per person in a study period of 3 months using placebo was found to be 2.39 (standard error ± 0.50), and in a study period of 6 months was 3.35 (±0.41) infections. In both study periods, ribosomal vaccine use was associated with a reduction in the number of infections per person of 1.43 (±0.26). In the study period, patients on placebo reported 3.02 (±0.44) antibacterial courses, whereas ribosomal vaccine was associated with a reduction of 1.32 (±0.42) antibacterial courses.ConclusionsIn spite of variability in data quality, and the small sample size in some of the studies, we conclude that in patients with recurrent respiratory infections ribosomal vaccine significantly reduces both the number of infections and the number of antibacterial courses compared with placebo. This study is a strong and objective demonstration of the efficacy of ribosomal vaccine in limiting the number of otorhinolaryngological infections in children and adults.

ISSN:1173-8804    

出版商:ADIS    

年代:2000

数据来源: ADIS

摘要:

▴ SDZ ASM 981 is an anti-inflammatory macrolactam which binds with high affinity to macrophilin-12. The resulting complex inhibits calcineurin, thus blocking the synthesis of inflammatory cytokines.Table.Features and properties of SDZ ASM 981 (ASM 981, pimecrolimus)▴ Twice daily application of topical SDZ ASM 981 1% cream was effective in the treatment of atopic dermatitis in adults and children in clinical trials.▴ Summarised results from 260 patients with atopic dermatitis indicate that the efficacy of SDZ ASM 981 is dose dependent. The highest concentration evaluated (1% cream) was not as effective as betamethasone valerate 1% cream in this 3-week trial.▴ The efficacy of SDZ ASM 981 and clobetasol ointments, used under occlusion, did not differ significantly in 10 patients with chronic psoriasis. Likewise, SDZ ASM 981 0.6% and betamethasone valerate 1% creams were similarly effective in 66 patients with allergic contact dermatitis.▴ Concentrations of SDZ ASM 981 in the blood during topical treatment were invariably below 2.1 µg/L.▴ Oral SDZ ASM 981 20mg or 30mg twice daily were effective in a dose dependent manner in the reduction of psoriasis in adults with no evidence of adverse effects.▴ SDZ ASM 981 was well tolerated in the available trials, exhibiting no potential for systemic adverse reactions and no atrophogenic potential, a problem commonly associated with corticosteroid treatment.

ISSN:1173-8804    

出版商:ADIS    

年代:2000

数据来源: ADIS

ISSN:1173-8804    

出版商:ADIS    

年代:2000

数据来源: ADIS