The alarming increase of bacterial resistance has had a serious impact on treatment practices for patients with meningitis and has prompted investigation of other possibly effective antibiotic regimens with agents, su...
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The alarming increase of bacterial resistance has had a serious impact on treatment practices for patients with meningitis and has prompted investigation of other possibly effective antibiotic regimens with agents, such as gatifloxacin and trovafloxacin, that have excellent activity against Streptococcus pneumoniae. The use of fluoroquinolones in children has been limited by studies that report chondrotoxicity in young animals. Gatifloxacin, a new fluoroquinolone, was recently tested in a rabbit model of cephalosporin-resistant pneumococcal meningitis. In these studies, animals were infected with a ceftriaxone-resistant (minimal inhibitory concentration [MIC], 4 mu g/mL;minimal bactericidal concentration [MBC], 4 mu g/mL) and gatifloxacin-susceptible (MIC, 0.125 mu g/mL;MBC, 0.25 mu g/mL) strain of S. pneumoniae and were treated with either a single or divided-dose regimen of gatifloxacin. Results from these studies are reviewed and compared with data from other studies that used a similar rabbit model of pneumococcal meningitis. Overall, it was found that the bacteriologic efficacy of gatifloxacin against S. pneumoniae was as effective as that of conventional regimens. Bactericidal activity of gatifloxacin was correlated with the area under the time-concentration curve-to-MBC ratio;maximal activity was achieved when gatifloxacin concentrations exceeded the MBC for the entire dosing interval.
Treatment of HIV infection is rapidly changing from a hit-or-miss hodgepodge of unknowns, in which nearly anything beneficial was acceptable, to a true science based on reproducible principles. With this growth in com...
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Treatment of HIV infection is rapidly changing from a hit-or-miss hodgepodge of unknowns, in which nearly anything beneficial was acceptable, to a true science based on reproducible principles. With this growth in complexity HIV therapy has become a valid field of medicine, The potency of available agents, their success in suppressing the destructive nature of HIV infection, and the increasingly rapid pace of technology development in this area require that HIV-seropositive patients he treated by physicians specializing in the field. The growing but finite number of antiretroviral therapeutic agents demands that a thoughtful, strategic, long-term approach be formulated. The evolving science of antiretroviral resistance testing offers great promise for better shaping this approach, which is still less than straightforward, Potential interactions, some good and some bad, between mutations within HIV genes will profoundly affect therapy and are still to be defined. Declaring that a regimen has failed and choosing a new one to replace it is a complex task, particularly when all the factors involved are considered (eg, risking viral load, declining CD4 count, patient adherence, patient preferences, drug interactions, adverse. effects), Care of HIV-positive patients has always been an art, and now at last: it is becoming a science.
Diabetes mellitus is the fourth leading cause of death by disease in the United States. Metformin hydrochloride was developed for the treatment of type 2 diabetes during the late 1950s (1) and was first marketed world...
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Diabetes mellitus is the fourth leading cause of death by disease in the United States. Metformin hydrochloride was developed for the treatment of type 2 diabetes during the late 1950s (1) and was first marketed worldwide in 1959 (2). The Food and Drug Administration approved its use in the United States in 1995 (3,4). Its mechanism of action is not known, but it is believed to cause inhibition of gluconeogenesis, thus eliminating glucotoxicity and reversing insulin resistance (1,4). It has no effect on insulin release.
In this double-blind, placebo-controlled, crossover, parallel study, we treated 20 adults who had seasonal allergic rhinitis with once-daily fixed-combination loratadine/pseudoephedrine sulfate to observe its effect o...
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In this double-blind, placebo-controlled, crossover, parallel study, we treated 20 adults who had seasonal allergic rhinitis with once-daily fixed-combination loratadine/pseudoephedrine sulfate to observe its effect on relieving symptoms, primarily nasal congestion. Acoustic rhinometry detected a trend toward improvement in nasal patency, although the difference between pre- and post-treatment measures was not statistically significant. Endoscopic inferior turbinate photography documented that treatment led to statistically significant reductions in the amount of nasal edema and nasal secretions. The results of a quality-of-life questionnaire suggested that treatment alleviated nasal and ocular symptoms of rhinoconjunctivitis. An analysis of subjective visual analog scale scores showed a trend toward improvement in most but not all nasal symptoms. We conclude that once-a-day fixed-combination loratadine/pseudoephedrine is effective in relieving nasal congestion in patients with seasonal allergic rhinitis.
Objective: To determine the separate and combined effects of the estrogen and progestin components of a modern triphasic oral contraceptive (OC) formulation on extent of coronary artery atherosclerosis. Methods: Femal...
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Objective: To determine the separate and combined effects of the estrogen and progestin components of a modern triphasic oral contraceptive (OC) formulation on extent of coronary artery atherosclerosis. Methods: Female cynomolgus monkeys (n = 81) were fed atherogenic diets for 32 months. After the first 7 months, they were randomized to four groups and treated triphasically for 21 of each 28 days with ethinyl estradiol (E2) (monkey equivalent of 30-40 pg), levonorgestrel (monkey equivalent of 50-125 mu g), a combination of the two steroids, or placebo. Results: Treatment with estrogen alone reduced coronary artery atherosclerosis extent 67% compared with untreated controls (P < .05). Treatment with progestin alone had no effect (P > .20). While atherosclerosis extent in monkeys treated with the combined OC was reduced 28%, this did not differ statistically from the other groups (P > .20). Conclusion: In doses used for oral contraception, E2, like all other estrogens studied to date, has a marked inhibitory effect on atherosclerosis progression. Levonorgestrel, at doses used in modern OC formulations, antagonizes this effect. When considered with other experimental evidence, these findings support the concept that progestins used in OCs and hormone replacement therapy can antagonize estrogen's atheroinhibitory effects. Whether this occurs seems to depend on a relative balance between estrogen and progestin with respect to dose, potency, route, and pattern of administration. However, when considered with evidence from previous studies, the findings also indicate a modest atheroinhibitory influence of combination (estrogen-progestin) OCs. ((C) 2000 by The American College of Obstetricians and Gynecologists.).
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