RESUMEN
AIM: To compare the pharmacokinetics/pharmacodynamics, antibiotic resistance and clinical efficacy of continuous (CA) vs. intermittent administration (IA) of cefotaxime in patients with obstructive pulmonary disease and respiratory infections. METHODS: A randomized controlled prospective nonblinded study was performed in 93 consecutive hospitalized patients requiring antibiotics for acute exacerbations of chronic obstructive pulmonary disease. Forty-seven patients received 2 g of cefotaxime intravenously over 24 h plus a loading dose of 1 g, and 46 patients were given the drug intermittently (1 g three times daily). RESULTS: Similar pathogens were identified in both groups, being mostly Haemophilus influenzae (51%), Streptococcus pneumoniae (21%) and Moraxella catharralis (18%). Mean minimal inhibitory concentration (MIC) values were also similar before and after treatment in both groups. Clinical cure was achieved in 37/40 (93%) (CA) vs. 40/43 (93%) (IA) of patients (P = 0.93). In microbiologically evaluable patients, criteria such as 70% of treatment time with antibiotic concentrations > or = MIC (CA 100%vs. IA 60% of patients) and/or > or = 5 x MIC (CA 100%vs. IA 55% of patients) were significantly better following continuous administration (P < 0.01). Samples with suboptimal antibiotic concentrations were found in 0% of CA vs. 65% of IA patients (P < 0.01). CONCLUSIONS: Although clinical cure rates were comparable, continuous cefotaxime administration led to significantly greater proportions of concentrations > MIC and > 5 x MIC compared with intermittent dosing. Continuous administration of cefotaxime at a lower dose [2 g (CA) vs. 3 g (CI)] is equally effective pharmacodynamically and microbiologically, may be more cost-effective and offers at least the same clinical efficacy. Based on these observations, we recommend continuous administration of cefotaxime as the preferred mode of administration.
Asunto(s)
Antibacterianos/administración & dosificación , Antibacterianos/farmacocinética , Cefotaxima/farmacocinética , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Adulto , Anciano , Antibacterianos/farmacología , Cefotaxima/administración & dosificación , Cefotaxima/farmacología , Susceptibilidad a Enfermedades/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
A 74-year-old woman with insulin-dependent diabetes mellitus type 2 developed severe, reversible renal failure due probably to the administration of high doses of intravenous immunoglobulins (IVIG) for Guillain-Barré syndrome. The preparation administered did not contain sucrose or mannitol as adjuvants. The risk factors for the development of acute renal failure include pre-existent diabetes mellitus, reduced renal function and advanced age. In approximately 150 case reports in the literature, acute renal failure developed mainly after the use of sucrose-containing IVIG preparations. The course of both the onset of and the recovery from the renal failure and the histopathological findings in the described patient were in accordance with these findings. Since other causes were unlikely and in view of the supportive finding of elevated colloid osmotic pressure, it was concluded that the renal failure in this case was probably mediated by the oncotic effect of the macromolecular immunoglobulin itself.
Asunto(s)
Lesión Renal Aguda/inducido químicamente , Inmunoglobulinas Intravenosas/efectos adversos , Factores de Edad , Anciano , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/metabolismo , Femenino , Síndrome de Guillain-Barré/tratamiento farmacológico , Humanos , Inmunoglobulinas Intravenosas/uso terapéutico , Factores de Riesgo , Sacarosa/efectos adversosRESUMEN
OBJECTIVE: The purpose of this study was to compare health-related quality of life of delayed sleep phase syndrome (DSPS) patients with a random Dutch sample and four samples of patients with other chronic conditions. We also investigated the effectiveness of treatment with 5 mg of melatonin on the quality of life of DSPS patients. METHODS: Forty-three DSPS patients completed a quality-of-life questionnaire (Medical Outcome Study Short Form-36 [MOS SF-36] health survey) just before and 2-9 months after participation in a clinical trial involving the administration of melatonin. Scores were compared with responses to the same survey by a random Dutch sample and by patients with sleep apnea, clinical depression, migraine, and osteoarthritis. RESULTS: MOS SF-36 scales scores were significantly lower in DSPS patients relative to age- and gender-adjusted norms for the Dutch sample. Some health dimensions were more affected, and others less affected, by DSPS compared with the other chronic conditions. Melatonin treatment improved all scales except the scale "role due to emotional problems." CONCLUSION: DSPS has a unique significant quality-of-life burden that seems to be improved by treatment with melatonin.
Asunto(s)
Hipnóticos y Sedantes/uso terapéutico , Melatonina/uso terapéutico , Calidad de Vida/psicología , Trastornos del Sueño del Ritmo Circadiano/tratamiento farmacológico , Trastornos del Sueño del Ritmo Circadiano/psicología , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores , Estudios de Casos y Controles , Enfermedad Crónica , Femenino , Estudios de Seguimiento , Humanos , Hipnóticos y Sedantes/metabolismo , Masculino , Melatonina/metabolismo , Persona de Mediana Edad , Saliva/metabolismo , Encuestas y CuestionariosRESUMEN
In a double-blind placebo-controlled cross-over study, 30 patients with Delayed Sleep Phase Syndrome (DSPS) were included, of whom 25 finished the study. Melatonin 5 mg was administered during two weeks in a double-blind setting and two weeks in an open setting successively or interrupted by two week of placebo. The study's impact was assessed by measurements of the 24-h curves of endogenous melatonin production and rectal temperature (n = 14), polysomnography (n = 22), actigraphy (n = 13), sleep log (n = 22), and subjective sleep quality (n = 25). Mean dim light melatonin onset (DLMO) (+/- SD), before treatment, occurred at 23.17 hours (+/- 138 min). Melatonin was administered five hours before the individual DLMO. After treatment, the onset of the nocturnal melatonin profile was significantly advanced by approximately 1.5 hour. Body temperature trough did not advance significantly. During melatonin use, actigraphy showed a significant advance of sleep onset and polysomnography, a significant decreased sleep latency. Sleep architecture was not influenced. During melatonin treatment patients felt significantly more refreshed in the morning. These results show that analysis of DLMO of patients suffering from DSPS is important both for diagnosis and therapy. These results are discussed in terms of the biochemistry of the pineal.
Asunto(s)
Antioxidantes/uso terapéutico , Luz , Melatonina/uso terapéutico , Trastornos del Sueño-Vigilia/tratamiento farmacológico , Adulto , Temperatura Corporal , Estudios Cruzados , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastornos del Sueño-Vigilia/diagnóstico , Sueño REM , Síndrome , Factores de TiempoRESUMEN
The occurrence of headache and its change after treatment with melatonin 5 mg were studied in 30 patients with delayed sleep phase syndrome. The medication was taken 5 hours before the endogenous nocturnal plasma melatonin concentration had reached 10 pg/mL. Three women (aged 14, 14, and 23 years) suffered from chronic tension-type headache. Their headache disappeared within 2 weeks after the start of treatment with melatonin. One 54-year-old man suffered from disabling migraine attacks without aura, twice a week. After starting melatonin treatment, only three migraine attacks were reported in 12 months. Ever since his 40s, a 60-year-old man complained of cluster headache episodes lasting about 2 months, twice a year. In the year since starting melatonin treatment, only one 5-day cluster episode occurred. Nocturnal melatonin secretion in the patients with delayed sleep phase syndrome and headache did not differ significantly from that in the patients with the sleep disorder but without headache. Melatonin may be helpful in patients with headache who are suffering from delayed sleep phase syndrome. Its effectiveness may be due to modification of vascular and nociceptive systems or to its chronobiological action which adjusts the patient's biological clock to his/her life-style.
Asunto(s)
Relojes Biológicos , Cefalea/tratamiento farmacológico , Cefalea/fisiopatología , Melatonina/uso terapéutico , Trastornos del Sueño-Vigilia/tratamiento farmacológico , Trastornos del Sueño-Vigilia/fisiopatología , Adolescente , Método Doble Ciego , Femenino , Cefalea/sangre , Cefalea/complicaciones , Humanos , Masculino , Melatonina/farmacología , Persona de Mediana Edad , Sueño/efectos de los fármacos , Trastornos del Sueño-Vigilia/complicaciones , SíndromeRESUMEN
A 15-year-old girl developed a prominent delayed sleep phase syndrome (DSPS) following traumatic brain injury. Several physiological markers of the sleep-wake rhythm: plasma melatonin, body temperature, wrist activity and sleep architecture (EEG) were delayed almost half a day, returning to normal after treatment with 5 mg melatonin. This report suggests an association between traumatic brain injury and DSPS. Awareness of this phenomenon may result in better possibilities for treatment of patients with brain injury.
Asunto(s)
Lesiones Encefálicas/complicaciones , Fases del Sueño/fisiología , Trastornos del Sueño-Vigilia/etiología , Trastornos del Sueño-Vigilia/fisiopatología , Adolescente , Temperatura Corporal/fisiología , Ritmo Circadiano/fisiología , Femenino , Humanos , Melatonina/sangre , Melatonina/uso terapéutico , Monitoreo Fisiológico , Recto/fisiopatología , Trastornos del Sueño-Vigilia/tratamiento farmacológico , Síndrome , Factores de TiempoRESUMEN
In 20 patients with pure menstrual migraine either Estraderm TTS 50 patches (E) or placebo (P) patches were applied during three successive menstrual cycles, randomly allocated to the treatment sequences E-P-E or P-E-P. Clinical neurophysiological tests, contingent negative variation (CNV) and exteroceptive temporalis muscle suppression test (ETST) were performed before treatment. The predictive value of these tests regarding the efficacy of Estraderm TTS was studied. Neither the number, duration and severity of the migraine attacks, nor the consumption of analgesics and ergotamine differed significantly during Estraderm TTS and placebo treatment. The ETST was consistent with migraine in 35% (95% confidence interval 15.4 to 59.2) of the patients. The CNV in 55% (31.5 to 76.9), and both tests in 25% (8.7 to 49.1%). Regarding the prediction of the Estraderm TTS effect on the migraine attacks, the specificity of the ETST, CNV and the combination of ETST with CNV, calculated for the first two cycles, was respectively 81.8% (48.2 to 97.7), 45.5% (16.8 to 76.6) and 80% (28.4 to 99.5). For the last two cycles these values were respectively 75% (42.8 to 94.5), 50.0% (21.1 to 87.9) and 71.4% (29.0 to 96.3). The sensitivity of the tests was respectively 62.5% (24.5 to 91.5), 62.5% (24.5 to 91.5) and 66.7% (22.3 to 95.7) in the first 2 cycles. In the last 2 cycles 50.0% (15.1 to 84.3), 62.5% (24.5 to 91.5) and 60% (14.7 to 94.7). This study did not demonstrate an effectiveness of Estraderm TTS in perimenstrual migraine, except for the subgroup of perimenstrual migraine patients in whom the ETST test results were consistent with migraine.
Asunto(s)
Variación Contingente Negativa , Estradiol/administración & dosificación , Trastornos de la Menstruación/tratamiento farmacológico , Trastornos Migrañosos/tratamiento farmacológico , Trastornos Migrañosos/fisiopatología , Músculo Temporal/fisiopatología , Administración Cutánea , Adulto , Estimulación Eléctrica , Estradiol/uso terapéutico , Femenino , Humanos , Persona de Mediana Edad , Valor Predictivo de las PruebasRESUMEN
A patient is described with proven delayed type allergy for heparin and a low molecular heparin. A literature survey shows that the dermatological picture varies. Occurrence of erythematous plaques without a superficial dermatitis is possible. Epicutaneous tests are often not sufficient, and intracutaneous or even subcutaneous tests are necessary to demonstrate the allergy.
Asunto(s)
Eccema/inducido químicamente , Heparina de Bajo-Peso-Molecular/efectos adversos , Heparina/efectos adversos , Hipersensibilidad Tardía/inducido químicamente , Femenino , Humanos , Hipersensibilidad Tardía/diagnóstico , Persona de Mediana Edad , Pruebas CutáneasRESUMEN
In an in vitro model, the release and penetration through a silicon membrane of different cream formulations and ointments containing 0.5% dithranol were studied. The results indicated that the method is not suitable for predicting in vivo release and penetration. Experiments with rabbits showed that the degree of skin irritation produced by a hospital-prepared product containing 0.5% dithranol was comparable to that of of a commercial product. Clinical efficacy and side-effects of these two products were investigated in a double-blind left-right comparative study in 35 patients with chronic plaque psoriasis. The two creams proved to be equally effective and showed the same incidence of side-effects.
Asunto(s)
Antralina/administración & dosificación , Animales , Antralina/efectos adversos , Antralina/química , Método Doble Ciego , Femenino , Humanos , Irritantes , Masculino , Pomadas , Psoriasis/tratamiento farmacológico , Conejos , SolubilidadRESUMEN
The case is reported of a 23-year-old man, working in agriculture, who was exposed to the silage additive ammonium tetraformiate, a strong acid. While pumping the fluid some of the substance entered his mouth and was swallowed. He vomited and developed transient dyspnoea. On admission he appeared acidotic, with haemolysis and haemoglobinuria. Lesions on the soft palate and in the oesophagus were observed, and a pulmonary infiltrate developed. Information on the substance was initially not available. Labeling appeared incomplete and misleading. Optimal treatment was delayed.
Asunto(s)
Enfermedades de los Trabajadores Agrícolas/inducido químicamente , Formiatos/envenenamiento , Neumonía por Aspiración/inducido químicamente , Compuestos de Amonio Cuaternario/envenenamiento , Acidosis/inducido químicamente , Adulto , Hemoglobinuria/inducido químicamente , Hemólisis/efectos de los fármacos , Humanos , MasculinoRESUMEN
Twenty-one patients, suffering from bronchial asthma, with a moderate and clearly reversible airway obstruction, completed a double-blind cross-over trial of two theophylline sustained-release preparations, Theolair Retard (= Theolair S.R. = Nuelin S.R.) and Theolin Retard (= Theo-Dur). The serum theophylline concentration curves of Theolin Retard were significantly flatter than the curves of Theolair Retard, with less peak-trough variation. Pulmonary function in both treatment groups appeared to be the same. There were no differences in side effects, nor in asthma symptoms. However, patients complained significantly more of coughing during treatment with Theolin Retard. In two patients using antacids, the peak-trough variation with Theolair Retard was considerably larger than average. The favourable theophylline concentration profile of Theolin Retard is not reflected in pulmonary function, side effects or asthma symptoms. For this group of asthmatic hospitalized inpatients the practical differences between the two preparations are not distinctive.
Asunto(s)
Obstrucción de las Vías Aéreas/etiología , Asma/tratamiento farmacológico , Teofilina/administración & dosificación , Adolescente , Adulto , Anciano , Asma/sangre , Asma/fisiopatología , Ensayos Clínicos como Asunto , Preparaciones de Acción Retardada , Método Doble Ciego , Femenino , Humanos , Pulmón/fisiopatología , Masculino , Persona de Mediana Edad , Teofilina/sangreRESUMEN
Rectal administration of progesterone in relatively high doses is sometimes advocated for a few gynaecological disorders. Two different kinds of suppositories, containing 200 mg of active substance in a fatty base, were administered to six volunteers. The progesterone plasma concentrations, measured at I, 2 and 6 hours after administration, showed large interindividual differences. However, the average concentrations did not differ significantly between the two kinds of suppositories. The concentrations reached are in the order of magnitude of the normal top levels in the second half of the menstrual cycle.