摘要:

Biotechnology products have had a substantial impact on the health care system, including cost and patient care. In some hospitals, agents produced by biotechnology account for 10% or more of the pharmacy budget. As of May 1996, 29 biological products had been approved for use in the United States, including, in many instances, agents for diseases or conditions for which no drugs were previously available. These compounds are different molecules, often with very different types of properties from synthetic chemicals. They are relatively expensive compared with traditionally manufactured synthetic drugs. The increasing availability, individual characteristics, and relative expense of these products mandate a systematic method of evaluating them for use in various health care systems. Thirteen essential points must be considered when evaluating them for clinical use: availability of alternative agents; indications (both labeled and unlabeled); glycosylation; adverse events; administration and pharmacokinetics; monitoring needs; shipping, handling, and storage; stability; pharmacoeconomic studies; concomitant drug costs; special pharmacy procedures; reimbursement; and manufacturer's support.

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1996.tb03635.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

The Internet is an excellent source of drug and poison information. Despite the relative ease and minimal costs associated with accessing the Internet, many pharmacists and other health care professionals have been slow to adopt this new technology.

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1996.tb03636.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

The optimum therapy for cryptococcal meningitis in patients with the acquired immunodeficiency syndrome (AIDS) remains unresolved. Traditional therapy consists of amphotericin B with or without flucytosine. Obstacles exist in administering these agents to patients with AIDS. Mortality rates during initial therapy are relatively high. Given the lack of proved benefit, we do not recommend adding flucytosine to amphotericin B routinely. The search for more efficacious and less toxic agents continues. The oral triazoles, especially fluconazole, have increased the options for treatment of this disease. New strategies and novel approaches in managing cryptococcal meningitis in patients with AIDS continue to be developed.

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1996.tb03637.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

The long‐term kidney allograft survival rate is still far from optimum. Conventional immunosuppressive drugs used to prevent allograft rejection are associated with significant side effects. Moreover, withdrawal of these agents is often associated with graft loss due to rejection. No treatment is available for chronic rejection. Graft tolerance is difficult to achieve in humans, and therefore a continued goal in organ transplantation is to develop immunosuppressive regimens that are associated with fewer side effects and decreased rates of rejection, and that promote graft tolerance. The advent of newer pharmacologic agents and bioreagents is expected to improve patient and graft survival rate

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1996.tb03638.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

A comprehensive search of the published literature was undertaken to identify reports providing patient‐specific data relating to adverse neurologic events with cyclosporine. References cited in the articles identified by the search were manually reviewed to ensure that articles were pertinent. Studies and case reports on cyclosporine neurotoxicity in which individualized patient data were provided were included for review and analysis. Information pertaining to all aspects of cyclosporine neurotoxicity, including epidemiology, clinical manifestations, postulated mechanisms, and management implications, was evaluated. Estimates from case series suggest a 0.5–35% frequency of the disorder. Risk factors include supratherapeutic blood concentrations of cyclosporine, and pharmacokinetic and pharmacodynamic drug interactions, hypocholesterolemia, and other metabolic abnormalities. Postulated mechanisms include a vasculopathy based on cyclosporine's effect on endothelial cell synthesis of prostaglandin, and release and uptake of endothelin as well as inhibition of mitochondrial steroid 26‐hydroxylase. Reported adverse events involved all levels of the neuraxis. Associated abnormalities include elevated cerebrospinal fluid protein and pleocytosis, various electroencephalogram abnormalities, and characteristic neuroimaging findings. In most patients these events were reversible with dosage reduction or withdrawal of therapy. Many reports described positive rechallenge, and in rare instances the events regressed despite continuing or reintroducing the

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1996.tb03639.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Enterococci are the second most common cause of hospital‐acquired infections, and drug resistance among these organisms is a growing problem. Vancomycin‐resistant enterococci (VRE) now account for 7.9% of the nosocomial enterococcal infections. There is no standard therapy for VRE. Although some agents have shown in vitro activity alone or in combination, including ciprofloxacin, doxycycline, novobiocin, teicoplanin, chloramphenicol, and rifampin, treatment options are limited to combinations of drugs with marginal efficacy against the pathogens. Quinupristin‐dalfopristin is a new investigational agent with activity against gram‐positive cocci, includ

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1996.tb03640.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Granulocyte‐macrophage colony‐stimulating factor (GM‐CSF) and granulocyte colony‐stimulating factor (G‐CSF) have an important yet controversial role in the care of patients undergoing bone marrow transplantation (BMT). Numerous studies have documented acceleration of neutrophil recovery by the agents. Because of the differences and lack of published clinical outcomes and of direct comparisons of the two CSFs, coupled with limited data from phase III trials, it is difficult to draw conclusions from the literature on the use of the agents after BMT. Issues that must be critically evaluated are toxicity profile, dose, initiation and duration of administration, route of administration,

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1996.tb03641.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

The severity of chronic hepatitis D infection and its unfavorable progress necessitate research into drugs and protocols capable of changing the natural history of the disease. Over the last few years interferon (IFN)‐α has been the drug of choice in the management of this infection. We assessed its long‐term efficacy by analyzing 5 controlled and 10 uncontrolled trials conducted between 1987 and 1994. The Mantel‐Haenszel‐Peto method was used in the former to perform statistical analysis. The odds ratio (0.16, confidence interval 0.058‐0.476) confirmed the efficacy of IFN‐α, even if the coefficient was not significant because of the limited number of spontaneous remissions in the trials. Although IFN treatment is fully beneficial in only a small number of patients with chronic hepatitis D infection, at present it is the only av

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1996.tb03642.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Coronary artery bypass surgery is an accepted treatment for patients with coronary artery disease. Perioperative morbidity includes development of supraventricular arrhythmias. To prevent this, prophylactic administration of drugs such as calcium channel blockers, digoxin, and β‐blockers have been advis

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1996.tb03643.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Secondary hyperparathyroidism (HPT) is characterized by persistent hypersecretion of parathyroid hormone (PTH), and produces characteristics of hyperparathyroid bone disease and a variety of biochemical and hormonal derangements. Management of uremic secondary HPT involves both prevention and treatment. Among preventive measures are attempts to control serum phosphate and serum calcium concentrations through dietary restriction, administration of phosphate binders, and calcium supplementation. Treatment with a vitamin D analog such as calcitriol returns plasma calcium concentrations toward normal and suppresses PTH secretion. The availability of a parenteral formulation of calcitriol, and new information regarding alternative routes of administration and regimens employing oral pulse dosing have renewed interest in calcitriol for the management of uremic secondary HPT.

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1996.tb03644.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY