Pharmatherapeutica最新文献

A drug monitoring study was carried out co-operatively by industry, a university department of clinical pharmacology and a randomly selected sample of general practitioners throughout Italy to collect case history and clinical data on over 10,000 patients with anaemia treated for 2 to 4 months with a preparation containing ferritin plus vitamin B12 co-enzyme and folinic acid. Analysis of the data generated, whilst confirming the effectiveness and tolerability of the study medication, highlighted the usefulness of the research methodology for describing the pattern of use of a drug widely prescribed in general medicine.

An open, multi-centre study was carried out to assess the efficacy and acceptability of an ointment formulation of 2% miconazole and 1% hydrocortisone ('Daktacort') in 73 patients with eczematous lesions, with or without bacterial superinfection. Patients were instructed to apply the ointment to the lesions morning and evening for 14 days; those with residual lesions were asked to continue treatment for a further 14 days. Assessments of the severity of the patients' symptoms were made by investigators before and after 7 and 14 days of treatment, and a global evaluation of response was made at the end of the treatment period. Patients kept a daily diary for 14 days in which they recorded the severity of their symptoms, acceptability of the ointment and details of any problems associated with treatment. Investigator rating of pruritus, weeping/bleeding, scaling, crusting, erythema, excoriation and burning/pain showed a significant improvement in these symptoms after 7 days and global assessment showed 85% of patients had responded after 14 days of treatment. Patient assessment using a diary card confirmed this improvement, and 96% found the ointment to be an acceptable form of treatment.

A total of 37 patients with skin and soft tissue infections was evaluated after oral treatment with the narrow-spectrum antibiotic flucloxacillin (62.5 mg to 1 g twice daily). Only 3 patients failed to respond to therapy, with the remainder being cured or demonstrating a satisfactory response after 1 or 2-weeks' treatment. Five patients suffered from side-effects, which were minor and did not necessitate the withdrawal of treatment.

There is a high incidence of wound dehiscence, ranging from 6.9% to 22%, after surgery for severe obesity. Different surgical techniques to minimize this drawback of the operation have been proposed, but none have seemed to be really effective. A different approach to this problem has been tried using topical treatment with hyaluronic acid through the drains of the laparotomy suture. Twenty patients subjected to jejuno-ileal by-pass for severe obesity were randomized into two treatment groups: hyaluronic acid (80 mg/daily) or placebo (saline), for 5 days, starting at the operation. Granulation tissue was withdrawn from the wound through polyvinyl catheters 1, 3 and 5 days after the operation. It was processed for light, scanning and transmission electron microscopy. Ten days after the operation, the wounds were examined for dehiscence. Hyaluronic acid treatment reduced the incidence and degree of dehiscence macroscopically, increased the maturation of granulation tissue during the first post-operation days and stimulated fibroblasts to synthesize procollagen shortly after the operation.

A case report is given of a patient with a 3-year history of recurrent attacks of dry cough and dyspnoea associated with cyanosis but with no demonstrable organic cause. The patient's condition responded favourably to a combined regimen of antidepressant chemotherapy and supportive psychotherapy. The authors emphasise the importance of the recognition and proper treatment of psychological disorders associated with such forms of respiratory distress.

A double-blind study was carried out in 53 elderly patients in 6 geriatric nursing homes to assess the effectiveness of the neuroleptics, zuclopenthixol and melperon (flubuperone), in the relief of restlessness, aggressiveness and other such symptoms. The initial daily dose was 4 mg zuclopenthixol or 75 mg melperon, increased if necessary over the treatment period of 4 weeks. Assessments were made on entry and after 1, 2 and 4 weeks of treatment of the overall severity of illness and of individual symptoms. The results showed that there was significant improvement in the condition of patients in both treatment groups and a significant reduction in mean total as well as in the main single symptom scores. These changes were already apparent after 1 week of treatment. Although there was a tendency for faster improvement in the zuclopenthixol group, there were no significant differences between the groups in any of the parameters assessed. Side-effects were few and generally mild and transient.

An open, randomized trial was carried out in 50 patients with severe respiratory tract infections due to various pathogens to compare the effectiveness and tolerability of co-trimoxazole and cephalexin. Patients were divided into two groups, each of 25, and treated for 15 days with either 1 tablet of co-trimoxazole (160 mg trimethoprim plus 800 mg sulphamethoxazole) every 12 hours or 1 capsule of cephalexin (500 mg) every 6 hours. The results of bacteriological and radiological investigations before and after 10 and 15 days of treatment showed that, although response to cephalexin was somewhat faster, both drugs were equally effective and well-tolerated over the full treatment period and there was good correlation between the laboratory findings as well as clinical improvement in symptoms. Taking the cost-benefit ratio into consideration, it is suggested that co-trimoxazole should be used for first-line therapy in respiratory tract infections and cephalexin only as a reserve drug for infections which do not respond to the routine use of co-trimoxazole.

A controlled study was carried out in 12 healthy male volunteers to evaluate the effects of fructose-1,6-diphosphate (FDP) on cardiac and respiratory parameters and work capacity during maximal muscular exercise on a cycloergometer. Each subject was studied in 3 sessions, separated by at least 36 hours. Workload started at 50 watts with stepwise increases, consisting of 25 watts every 3 minutes, up to muscular exhaustion or until the predicted maximum heart rate was attained. The first session, with no treatment, served as the control test; in the other two sessions, each subject received, prior to exercising, a single intravenous dose of either 7.5 g dextrose or 15 g FDP, according to a within-subject comparative study design. In resting conditions and during the exercise, heart rate, ventilation (VE), and oxygen consumption (VO2) were monitored. At the end of each session, the total work (TW) performed and the maximum oxygen consumption (VO2 max) were computed. No difference was found between the values obtained in the control and dextrose treatment sessions. The increments in heart rate, VE and VO2 at each workload observed after FDP treatment were lower (p less than 0.01) than those in control and dextrose sessions. A 25% increase in TW associated with a 12% increase in VO2 max was observed after FDP (p less than 0.01). The data indicate that FDP is potentially capable of improving muscular performance, and several possible mechanisms of action for the observed effects are discussed.

Ninety-two patients undergoing vascular surgery took part in a controlled clinical trial to study the effectiveness of a new low molecular weight (LMW) heparin for prevention of post-operative deep vein thrombosis. Forty-six patients were treated daily, for 7 days after operation, with a single subcutaneous injection of 15,000 Anti X-activated Factor Units of the new LMW heparin; the remaining 46 patients were treated, for the same period, with 2 daily subcutaneous injections of 5,000 International Units of calcium heparin. Deep vein thrombosis detection was by the radioactive fibrinogen uptake test, performed each day during therapy in all patients. A very low incidence of sub-clinical deep vein thrombosis was observed; in 3 (6.5%) patients in the LMW heparin group and in 4 (8.6%) patients of the calcium heparin group. The results of laboratory investigation showed that the antithrombotic activity (inhibition of Factor Xa) of the LMW preparation was significantly greater than that of calcium heparin, while activated partial thromboplastin time was greater in the calcium heparin group. The new preparation also showed better local tolerance, with less pain on subcutaneous injections.

Thirty-seven patients with advanced cancer requiring oral administration of strong narcotics for pain control have been treated with one or other of two commercially-available, sustained-release morphine preparations. Patients were followed up primarily at home, supervised by a local hospice care team, and received daily dosage ranging from 60 mg to 420 mg morphine administered as 30 mg sustained-release tablets delivered at intervals from 6 to 10 hours for 'Roxanol SR' and from 8 to 14 hours for 'MS Contin'. Duration of treatment ranged from 2 to 80 days, and 17 of 19 patients who received sustained-release morphine for 20 or more days achieved a stable dosage schedule. Thirty-five of the 37 patients obtained good to excellent analgesia and only 2 of them required intermittent 'rescue' doses of standard morphine between doses of the sustained-release preparation. From experience with the use of the two preparations it was considered that 'MS Contin' was preferable because of the smaller size of the tablets and because of the longer duration of analgesia provided. It is concluded that sustained-release morphine preparations offer a safe and efficacious alternative to immediate-release analgesics and can help to improve the quality of life for the patient and care-givers.