ISSN:1075-2765    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a group of agents with similar action but diverse chemical structures and mechanism of action. There is considerable interpatient variability in the pain relief obtained from NSAIDs even when these agents belong to the same chemical family. The reasons for this interpatient variability include pharmacodynamic actions, pharmaco-kinetic parameters, or a combination of both. Furthermore, two distinct forms of the key enzyme cyclo-oxygenase (COX) have been identified. The constitutive enzyme COX-1 is found in most tissues and is believed to confer gastric mucosal protective action, and COX-2, the inducible enzyme, is implicated in pain and inflammation. Selective inhibition of COX-1 and COX-2 may allow prediction of drugs' major effects. By definition, NSAIDs are expected to modulate synovial inflammation present in the arthritic joints. Whether NSAIDs can positively influence the progression of arthritic disorders by modifying the underlying pathology remains to be answered. This review provides guidelines on how to choose NSAIDs rationally keeping in view the mechanism of tissue injury, the mode of action of NSAIDs, and their adverse effects.

ISSN:1075-2765    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Serious skin and skin-structure infections may require parenteral antibiotic therapy. Such infections are generally polymicrobial, and they often involve both gram-positive and gram-negative aerobes as well as anaerobic bacteria. Effective treatment thus requires the use of a broad-spectrum antibiotic or combination therapy. The development of antibiotic resistance by clinically important pathogens has significantly increased the difficulty of treating skin and skin-structure infections. One of the major mechanisms of resistance observed in organisms likely to be associated with such infections is the development of β-lactamases that inactivate β-lactam antibiotics. Two approaches have been taken to combat this problem: the use of β-lactam/β-lactamase inhibitor combinations and the development of β-lactamase-stable drugs. Both strategies have resulted in treatments that are clinically and bacteriologically effective in patients with skin and skin-structure infections. The use of one β-lactam/β-lactamase inhibitor combination, ampicillin/sulbactam, has been demonstrated to be more cost-effective than treatment with β-lactamase-stable antibiotics, such as cefoxitin and imipenem/cilastatin, for this indication.

ISSN:1075-2765    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The objective of this study was to assess the efficacy and tolerability of transdermal clonidine in inner-city African-American and Hispanic-American patients with essential hypertension. A multiclinic open-label, prospective trial for 12 weeks was used. Dose titration was based on office blood pressure (BP) measurements of > 140/90 mm Hg. Clinical sites were community-based primary care centers. Untreated and treated hypertensive patients whose diastolic BP exceeded 90 mm Hg were administered transdermal clonidine at 0.1 mg or 0.2 mg delivery daily. The drug was titrated after 1 month if diastolic BP was greater than 90 mm Hg. At 12 weeks of treatment, change in blood pressure from baseline as well as adverse effects and patient satisfaction were assessed. A total of 357 patients entered the treatment phase of the study, and 315 patients (244 African-Americans, 67 Hispanic-Americans) had evaluable data. Transdermal clonidine significantly (P< .001) lowered BP in all patients by 15.7/12.8 ± 18.1/9.6 mm Hg, and heart rate was reduced by 3 ± 9 beats/min (P< .001). There were no differences in BP reduction according to race and ethnicity, gender, or age. The most common adverse effects were pruritus or discomfort at the patch site, dizziness, dry mouth, and fatigue. Eleven percent of the patients discontinued treatment because of one of these adverse effects. A large proportion of patients (67%) reported that transdermal clonidine was more convenient to use than oral therapy. Transdermal clonidine, alone or in combination with other antihypertensive therapies, significantly lowered BP and heart rate in inner-city hypertensive patients. The drug was generally well tolerated, with 89% of the patients remaining in the trial. Patient acceptability was high with the once-weekly treatment, which is an important feature for this particular hypertensive population.

ISSN:1075-2765    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

This article presents a meta-regression analysis of published studies of omeprazole plus antibiotics (amoxicillin, clarithromycin, or an imidazole derivative) in the treatment ofHelicobacter pylori. Eligible studies were all randomized, controlled trials published through April 1996 with 10 or more patients receiving omeprazole plus antibiotics for 5 or more days and testing forH. pylorieradication 4 weeks or more after treatment. Probability of eradication was calculated for each treatment arm, and logistic regression was performed using study characteristics as covariates. Seventy-four studies involving 117 treatment arms with 4,769 patients were identified. The eradication rate was 76% for omeprazole plus clarithromycin and 65% for omeprazole plus amoxicillin dual regimens (P< .0001). Eradication rates for triple regimens were 82%, omeprazole plus amoxicillin plus clarithromycin; 83%, omeprazole plus amoxicillin plus imidazole; and 89%, omeprazole plus clarithromycin plus imidazole. In a multiple logistic regression analysis, significant factors were antibiotic, disease, omeprazole dose, and whether treatment was followed by maintenance omeprazole. A systematic overview of the best available evidence suggests that dual therapy with omeprazole plus clarithromycin is superior to omeprazole plus amoxicillin. Triple therapy is better than dual therapy. Treatment works better on ulcers than on nonulcer dyspepsia. Higher doses of omeprazole give better results. Additional trials exploring higher omeprazole doses for varying durations as well as cost, side effects, and compliance trade-offs with efficacy are recommended.

ISSN:1075-2765    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Iscador is being used by many patients as unconventional anticancer and immunomodulating therapy. To determine the toxicity profile and biochemical effects of Iscador Qu Spezial (Weleda AG Schwäbisch Gmünd, Germany) in human immunodeficiency virus (HIV)-positive patients and healthy controls, we performed a phase I/II study. Escalating doses of Iscador Qu Spezial, standardized for its lectin and viscotoxin content, were administered to 16 HIV-positive patients and 8 healthy subjects during a period of 6 to 8 months. Iscador Qu Spezial preparations were administered twice per week subcutaneously in increasing doses (ie, 0.01 mg, 0.1 mg, 1.0 mg, 2.0 mg, 5.0 mg, and 0.1 mg/kg for 2–6 weeks per dose). Drug-related adverse effects were flulike symptoms, gingivitis, fever, local erythema, and eosinophilia. These side effects were never severe. The incidence of systemic adverse events was highest in HIV-positive patients. Furthermore, increased urea levels and slightly decreased total protein caused by a minor decrease in albumin were observed. None of the HIV-positive patients progressed in disease stage. Iscador Qu Spezial can be administered safely to immunocompromised patients.

ISSN:1075-2765    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The purpose of this study was to compare the efficacy of three dosages of potassium-magnesium citrate in overcoming thiazide-induced hypokalemia and magnesium loss and increasing urinary pH and citrate. Sixty-one normal subjects first took hydrochlorothiazide at 50 mg/d. After 3 weeks of thiazide treatment or earlier if hypokalemia developed, the subjects were randomized to take one of three dosages of potassium-magnesium citrate (K4MgCit2) for 3 weeks while continuing on the thiazide: 4 tablets per day (24 mEq potassium, 12 mEq magnesium, and 36 mEq citrate per day), 7 tablets per day (49 mEq potassium, 24.5 mEq magnesium, and 73.5 mEq citrate per day), or 10 tablets per day (70 mEq potassium, 35 mEq magnesium, and 105 mEq citrate per day). Outcome measures were changes in serum potassium and magnesium and urinary potassium, magnesium, pH, and citrate. All three dosages of potassium-magnesium citrate significantly increased serum potassium concentration, with >80% of subjects regaining normal values despite continued thiazide therapy. The two higher dosages, but not the lowest dosage, caused a small but significant increase in serum magnesium concentration, while substantially increasing urinary magnesium. All three dosages significantly increased urinary pH and citrate in a dose-dependent manner. The lowest dosage produced increases sufficient to prevent stone recurrence. Side effects of thiazide therapy were ameliorated by the highest dosage but not by the two lower dosages. Potassium-magnesium citrate at a dosage of 4 tablets per day is adequate to correct thiazide-induced hypokalemia and to increase urinary pH and citrate sufficiently for stone prevention. Higher dosages are probably required for the prevention of magnesium loss and adverse symptoms of thiazide therapy.

ISSN:1075-2765    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Tardive dyskinesia (TD) is a source of great concern in psychiatric practice because of the iatrogenic nature of the disorder. It is a serious adverse reaction associated with neuroleptic drug therapy and is characterized by abnormal, involuntary, irregular, repetitive movements of the face and limbs that are purposeless in nature. It develops during exposure to or withdrawal from neuroleptics in patients with a history of neuroleptic use for at least 3 months, or 1 month in patients 60 years or older. To date, the structural or chemical pathology, etiology, and pathophysiology are not well understood, and no consistently effective pharmacological treatment is available. Numerous agents have been used in the management of TD; however, at the present time there are no safe and effective treatments for TD. A review of various agents used in managing TD is presented. Improvements in research design and methodology have been applied to clinical trials, and as a result, the stage has been set for advancement in this area of clinical psychiatry.

ISSN:1075-2765    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

We present a case report of a woman for whom a topical mucosal ulcer drug was prescribed and the pharmacist erroneously dispensed a calcium channel blocker (CCB), resulting in toxicities from the drug and withdrawal symptoms when attempts were made to stop the CCB. The pharmacolocy and toxicology of CCBs are discussed, particularly in relation to the adverse experiences of the case.

ISSN:1075-2765    

出版商:OVID    

年代:1999

数据来源: OVID