bluuebunny/crossref_metadata_2025_split huggingface dataset:
Antimicrobial Liquid Formulations: A Blind Taste Comparison of Three Brands of Penicillin VK and Three Brands of Amoxicillin
Authors: Chan Debora Schotik , Demers Denise M , Bass James W 
Published: January 2017

OBJECTIVE: To rate the perception of taste, texture, smell and aftertaste of various brands of penicillin VK and amoxicillin. DESIGN: Oral, liquid formulations of three brands of penicillin VK (PenVee K, V-Cillin-K, VeeTids) and three brands of amoxicillin (Amoxil, Trimox, Wymox) were evaluated for smell, texture, taste, and aftertaste by 30 volunteers in a blind study. Each category was scored on a scale of 1 to 5. The order in which the drugs were sampled was randomized for the first three groups of five participants. The order then was reversed for the remaining three groups of participants. SETTING: A 537-bed US Army teaching hospital. PARTICIPANTS: Participants included 30 healthy adult volunteers from the Departments of Pediatrics, Nursing, and Pharmacy. MAIN OUTCOME MEASURES: Drugs received cumulative scores in each category, as well as an overall total score ranking. The data were analyzed using one-way ANOVA for repeated measures with a post hoc Duncan's multiple range test to determine significant differences between individual means. RESULTS: Overall, Trimox and Amoxil scored significantly higher than the remaining drugs. Although V-Cillin-K scored highest in the smell category, its score was significantly below those of Trimox and Amoxil in the texture, taste, aftertaste, and overall categories. Overall, the three penicillin VK solutions scored lower than the three amoxicillin suspensions, with PenVee K ranking the lowest. Among the penicillin VK solutions, V-Cillin-K scored significantly higher overall than the other two penicillin VK solutions. CONCLUSIONS: Overall, all three amoxicillin oral, liquid suspensions that were studied scored significantly better than the three penicillin VK solutions.
Severe Hyperphosphatemia Induced by a Phosphate-Containing Oral Laxative
Authors: Filho Aldo J Peixoto , Lassman M Nathan 
Published: January 2017

OBJECTIVE: To describe a case of severe hyperphosphatemia following unintentional overdosage with an oral phosphate laxative, and raise attention to the risks of using such medications in the elderly. CASE SUMMARY: An 84-year-old white woman was admitted with confusion 8 hours after inadvertently ingesting 12 fluid ounces of Fleet Phospho-Soda (instead of the prescribed 1½ fluid ounces) prior to a colonoscopy. Her serum phosphate and ionized calcium concentrations were 10.3 mmol/L and 0.56 mmol/L, respectively. She was treated conservatively with oral phosphate binders and made an uneventful recovery. DISCUSSION: Several previous reports have described hyperphosphatemia in association with phosphate laxatives, especially in patients with renal or colonic disease. Our case again presents two important issues in the use of phosphate laxatives by the elderly: (1) the frequently overlooked underlying renal insufficiency in which, despite “normal” serum creatinine values, renal phosphate handling may be impaired; and (2) the potential for drug misuse and poor compliance in the elderly. CONCLUSIONS: Caution should be taken with the use of phosphate laxatives in the elderly in the face of potentially serious metabolic abnormalities that may be generated.
Technical and Interpretive Problems of Peripheral Nerve Stimulation in Monitoring Neuromuscular Blockade in the Intensive Care Unit
Authors: Rudis Maria I , Guslits Benjamin G , Zarowitz Barbara J 
Published: January 2017

OBJECTIVE: To review the literature and provide an overview of the technical and interpretive problems associated with peripheral nerve stimulation in monitoring neuromuscular blockade in the intensive care unit. DATA SOURCES: A computerized search on MEDLINE from 1985 through 1994 was performed to identify English-language comparative studies, abstracts, and review articles pertaining to peripheral nerve stimulation, train-of-four monitoring, and neuromuscular blockade in the critical care setting. STUDY SELECTION AND DATA EXTRACTION: Relevant studies in humans were selected and information was extracted on the use of peripheral nerve monitoring in the critically ill. DATA SYNTHESIS: Use of peripheral nerve stimulation is complicated in the intensive care unit. Problems may occur with the patient, the device, as well as operator technique, all of which may lead to errors in interpretation of the depth of paralysis. The critically ill patient has changing comorbid disease states and total body water composition, which may impair the accuracy or reproducibility of measurements. Technical problems relate to the operation of the device, electrode placement, and suboptimal delivery of the desired current. Difficulties in performing peripheral nerve stimulation and interassessor variability contribute to errors of interpretation. CONCLUSIONS: These difficulties compromise the precision, accuracy, and reliability of the peripheral nerve stimulator as a tool for monitoring neuromuscular blockade in the critically ill. Peripheral nerve stimulation should be used in conjunction with clinical parameters to make decisions regarding dose adjustments. Doses should be reduced as much as possible to provide the minimum depth of paralysis that is clinically appropriate. Technical directions and training programs for peripheral nerve stimulation should be developed, and designated individuals should be trained in its application. Large, prospective, controlled studies are necessary to evaluate the incidence of prolonged paralysis or motor neuropathy with administration of neuromuscular blocking agents in patients whose dose is adjusted on the basis of peripheral nerve stimulation.
Evaluation of Symptom Distress in a Bone Marrow Transplant Outpatient Environment
Authors: Lawrence Carol C , Gilbert Colleen J , Peters William P 
Published: January 2017

OBJECTIVE: To measure patient perceptions of autologous bone marrow transplantation (ABMT)-associated symptoms in the outpatient setting, assess the efficacy of the established antiemetic protocol, evaluate patient satisfaction, and report patient medication compliance. DESIGN: A prospective, descriptive study of patients with breast cancer who were enrolled in an outpatient ABMT program. SETTING: Duke University Autologous Bone Marrow Transplantation Program. METHODS: Patient perceptions of 12 symptoms were measured by the Symptom Distress Scale (SDS) on the day of admission to the hospital, the day of discharge to the outpatient clinic, after bone marrow reinfusion, and before patient release from the clinic. The number of retching and vomiting episodes was recorded by each patient daily. Patient satisfaction was determined by a standardized personal interview conducted prior to discharge. Patient compliance was assessed by a review of patient medication documentation. RESULTS: Twenty-eight patients were enrolled over 5 months. The median SDS scores for each symptom evaluated revealed that anorexia, nausea, fatigue, insomnia, and bowel problems were the most distressing symptoms patients experienced in the outpatient ABMT program. Scores for pain, negative outlook, cough, diminished concentration, and change in appearance indicated only mild distress associated with these variables. The total number of vomiting episodes ranged from 1 to 33 total episodes per patient per outpatient stay. The percentage of patients experiencing a complete antiemetic response ranged from 24% to 48% over the 4 days after chemotherapy but steadily improved thereafter to a peak of 90% 1 week later. Patient satisfaction results showed that patients preferred being out of the hospital and reported their anxiety controlled, although most had some problems with the outpatient clinic or medications required. CONCLUSIONS: Loss of appetite, fatigue, and insomnia have been identified as symptoms that are frequently present during the course of the outpatient ABMT program. Mild, intermittent nausea persists in the outpatient setting for up to 9 days after bone marrow transplant despite continuous combination antiemetic therapy. Patient interviews confirmed the belief that patients enjoy being out of the hospital. Medication compliance is more than 90% in this structured outpatient setting.
Polypharmacy among Nursing Home Geriatric Medicaid Recipients
Authors: Gupta Sanjay , Rappaport Harvey M , Bennett Lonnie T 
Published: January 2017

OBJECTIVE: To determine the factors that influence the number of different drugs prescribed to geriatric Medicaid recipients residing in Louisiana's intermediate care facilities I (ICFs I). DESIGN: Observational and cross-sectional with descriptive and analytic components. PARTICIPANTS: All geriatric Medicaid recipients in Louisiana ICFs I during 1994 (n= 19 932). METHODS: Relevant data on sex, age, race, geographic region of a recipient, number of prescribing physicians, number of pharmacies used, and the number of drugs prescribed to a recipient were extracted from the state Medicaid files. Frequencies for the seven study variables were calculated. Regression analysis was used to evaluate the influence of the six predictor variables on the number of drugs prescribed. RESULTS: The study population was 73.63% women, 60.07% 81 years of age and older, 70.65% white, 23.21% African-American, 6.14% other races, and 29.83% from predominantly rural north Louisiana. A total of 44.60% of the residents received prescriptions from one physician, 8.41% of the residents were single pharmacy users, and 45.65% were prescribed more than 10 drugs during the year. The regression model accounted for 20.53% of the total variation in the number of drugs prescribed to a recipient. Race, geographic region, number of prescribing physicians, and number of pharmacies used by a recipient influenced the number of drugs prescribed. CONCLUSIONS: To reduce the number of drugs prescribed and polypharmacy among geriatric Medicaid recipients, Louisiana's ICFs I should minimize the number of physicians and pharmacies used in this population.
Famciclovir for Treatment of Herpesvirus Infections
Authors: Luber Andrew D , Flaherty John F 
Published: January 2017

OBJECTIVE: To discuss the antiviral activity, pharmacokinetics, clinical efficacy, and adverse effect profile of famciclovir, the oral prodrug of penciclovir (PCV), and to compare these features of famciclovir with those of acyclovir in the treatment of herpesvirus infections. DATA SOURCES: Literature was identified by MEDLINE search, and abstracts from recent meetings were included where relevant. Data provided by the manufacturer were also used. STUDY SELECTION: Data regarding antiviral activity were included if accepted and widely used methods were followed. Clinical trials in which a comparison with acyclovir or placebo was performed were given the highest priority. DATA SYNTHESIS: In comparison with acyclovir, PCV has similar antiviral activity although its mode of action is not identical. When administered orally, famciclovir, the oral prodrug of PCV, is better absorbed than acyclovir, yielding an absolute bioavailability of PCV of 77%. The predominant route of PCV elimination is via the kidneys, with a half-life of approximately 2.5 hours. In trials comparing famciclovir with acyclovir for the treatment of herpes zoster in immunocompetent individuals, comparable results were obtained. Famciclovir is also effective as therapy for recurrent episodes of genital herpes and may prove useful for chronic suppressive therapy. The most common adverse effects of famciclovir are headache and gastrointestinal upset. The dosage of famciclovir for herpes zoster in immunocompetent individuals is 500 mg po tid for 7 days; for recurrent genital herpes a dosage of 125 mg po bid for 5 days is recommended. Dosage adjustments are necessary in patients with renal dysfunction. CONCLUSIONS: Given its comparable efficacy, similar adverse effect profile, and less frequent dosing schedule than acyclovir, famciclovir represents a viable alternative for treatment of herpes zoster and for episodic therapy of recurrent genital herpes in immunocompetent adults. Specific recommendations for other uses of famciclovir await the publication of recent clinical trial results.
What is the Role of Angiotensin-Converting Enzyme Inhibitors in Congestive Heart Failure and after Myocardial Infarction?
Authors: Nelson Kent M , Yeager Bryan F 
Published: January 2017

OBJECTTVE: To discuss the controversies surrounding the choice of angiotensin-converting enzyme (ACE) inhibitor, and the timing, dosage, and duration of ACE inhibitor therapy for congestive heart failure (CHF) and after myocardial infarction (MI). The beneficial effects of ACE inhibition in patients with CHF and after MI are reviewed. Human clinical trials are reviewed and their clinical implications are discussed. DATA SOURCES: MEDLINE searches (1985–1995) identified human clinical trials and review articles. DATA EXTRACTION: Landmark human clinical trials with morbidity and mortality end points were included. The validity of the study data were assessed on the basis of study methods, population characteristics, and statistical power. DATA SYNTHESIS: ACE inhibitors exert beneficial effects in patients with CHF by hemodynamic and neurohormonal mechanisms. The attenuation of ventricular remodeling that occurs with ACE inhibition does not fully explain the results of clinical trials in patients after MI. Routine determination of ejection fraction to guide ACE inhibitor therapy is not as important as the patient's clinical status. Clinicians should titrate the chosen ACE inhibitor on the basis of hemodynamic response to target doses used in major clinical trials. Because the beneficial effects of ACE inhibitors appear to be a class effect, choice of an agent should include cost considerations and the results of clinical trials. CONCLUSIONS: ACE inhibitors reduce morbidity and mortality in selected CHF and post-MI patients. Patients with symptomatic CHF benefit most from ACE inhibitor therapy, and it should be continued indefinitely. Treatment effects in asymptomatic patients are delayed. The role of ACE inhibitor therapy in preventing morbidity and mortality in asymptomatic patients with preserved ventricular function requires further study.
Nefazodone: Its Place among Antidepressants
Authors: Cyr Monica , Brown Candace S 
Published: January 2017

OBJECTIVE: To review the pharmacology, pharmacokinetics, efficacy, adverse effects, and drug interactions of nefazodone, as well as to determine its place among currently available antidepressants. DATA SOURCES: A search of European and American literature using EMBASE and MEDLINE was completed. Nefazodone was the search term. DATA SYNTHESIS: Nefazodone is an antidepressant that blocks serotonin type 2 (5-HT2) receptors in addition to inhibiting the reuptake of serotonin and norepinephrine. In double-blind, placebo-controlled studies, nefazodone demonstrates antidepressant activity at dosages ranging from 400 to 600 mg/d. Sedation, dry mouth, nausea, and dizziness are the more common adverse effects of nefazodone. Nefazodone, an analog of trazodone, has not been associated with priapism at this time, and may have fewer sexual adverse effects than other antidepressants. More studies are needed to determine the potential role of nefazodone in treating anxiety, pain, and premenstrual syndrome. STUDY SELECTION: Only double-blind, placebo-controlled studies designed to establish the efficacy of nefazodone as an antidepressant were reviewed. CONCLUSIONS: Based on placebo-controlled, double-blind, comparative trials, nefazodone demonstrates greater efficacy than placebo, and equivalent efficacy to imipramine. Somnolence, dry mouth, nausea, dizziness, and constipation are the most common adverse effects. Nefazodone appears to have a milder adverse effect profile than the tricyclic antidepressants, causes fewer sexual dysfunctions than the serotonin selective reuptake inhibitors, and may cause less dizziness than trazodone. Nefazodone at dosages of at least 300 mg/d provides another option for the treatment of depression.
AUIC — A General Target for the Optimization of Dosing Regimens of Antibiotics?
Authors: Costa Teresa Dalla , Derendorf Hartmut 
Published: January 2017

OBJECTIVE: To present a systematic evaluation of the area under the inhibitory curve (AUIC) approach for the optimization of antibiotic dosing schedules for three major antibiotic classes (beta-lactams, quinolones, aminoglycosides). It has been proposed that an AUIC over 24 hours of at least 125 may be an applicable target parameter for the optimization of antibiotic dosing schedules across these antibiotic classes. Some limitations of this approach are presented and discussed. METHODS: A precise equation for the calculation of AUIC is derived. Moreover, a specific equation is derived for the situation that results in a trough concentration at the end of the dosing interval equal to the minimum inhibitory concentration (MIC). With the same three drags used for deriving the target AUIC value (tobramycin, cefmenoxime, ciprofloxacin), different dosing regimens are simulated to obtain the target AUIC of 125. RESULTS: Very different serum concentration profiles can result in the same AUIC. In an example for cefmenoxime, dosing regimens of 1 g q6h and 4.2 g q24h resulted in equal AUIC values of 125, whereas the respective time above MIC differed dramatically (99% of the dosing interval for q6h vs. 36% for q24h). CONCLUSIONS: It does not seem valid to accept the proposed breakpoint AUIC target of at least 125 as an applicable value for determining the appropriate dosing schedule of these classes of antibiotics. Based on the limitations discussed about the AUIC approach, the same conclusion also holds for any other fixed AUIC breakpoint target value.
Disposition of Foscarnet during Peritoneal Dialysis
Authors: Alexander Alicia CM , Akers Adam , Matzke Gary R. , Aweeka Francesca T. , Fraley Donald S. 
Published: January 2017

OBJECTIVE: To report the disposition of foscarnet in a patient undergoing peritoneal dialysis. CASE SUMMARY: A 34-year-old man with AIDS received foscarnet for the treatment of esophageal cytomegalovirus. We characterized the clearance of foscarnet in this patient during continuous cyclic peritoneal dialysis (CCPD) and continuous ambulatory peritoneal dialysis (CAPD). DISCUSSION: The foscarnet half-lives during CCPD and CAPD were 41.4 and 45.8 hours, respectively. These values are significantly greater than the half-life of 4.5 hours observed in patients with normal renal function and about half that reported in anuric patients undergoing hemodialysis during the interdialytic period. The CCPD and CAPD clearances of foscarnet were 5.8 and 4.5 mL/min, respectively; the CAPD clearances of creatinine and urea nitrogen were 4.1 and 6.0 mL/min, respectively. The patient's estimated total body clearance values of foscarnet during CCPD and CAPD were 9.8 and 8.8 mL/min, respectively. Thus, CCPD and CAPD augmented the patient's residual clearance of foscarnet by 145% and 105%, respectively. CONCLUSIONS: Since incremental increases in residual clearance of 30% or more generally will result in clinically significant changes in a drug's serum concentration, foscarnet dosage needs to be individualized for patients receiving peritoneal dialysis.
Fatal Myocardial Infarction Potentially Induced by Paclitaxel
Authors: Hekmat Elham 
Published: January 2017

OBJECTIVE: To report a case of a fatal myocardial infarction (MI) possibly induced by paclitaxel in a patient with metastatic breast cancer. CASE SUMMARY: A 67-year-old African-American woman with metastatic breast cancer was treated with a paclitaxel infusion. Fifteen hours into the 24-hour continuous infusion, the patient developed tachypnea, respiratory distress, and chest pain. Paciltaxel infusion was discontinued. Electrocardiogram findings revealed ST elevation in leads 2, 3, and aVF acutely. The cardiac enzymes were abnormal and the echocardiogram changes showed severe global left ventricular dysfunction consistent with acute MI. The patient died 13 hours after stopping the paclitaxel infusion. DISCUSSION: Cardiac adverse effects of paclitaxel have been described in preliminary studies. Paclitaxel-induced cardiac abnormalities are usually described as asymptomatic and transient. MI secondary to paclitaxel infusion has rarely been reported. The mechanism by which paclitaxel causes cardiac abnormalities, especially myocardial damage, is not well understood. CONCLUSIONS: Myocardial damage secondary to paclitaxel infusion is a serious and life-threatening adverse effect. Caution should be exercised in all patients treated with paclitaxel until more information regarding risk factors is available.
A Practical Look at the Clinical Usefulness of the Beta-Lactam/Beta-Lactamase Inhibitor Combinations
Authors: Hart Susan M. , Bailey Elaine M. 
Published: January 2017

OBJECTIVE: To aid clinicians in developing an approach to the use of intravenous beta-lactam/beta-lactamase inhibitors on a patient-specific basis. To achieve this, the pharmacology, in vitro activity, and clinical use of the intravenous beta-lactam/beta-lactamase inhibitor combinations in the treatment of selected infections seen in hospitalized patients are discussed. DATA IDENTIFICATION: An English-language literature search using MEDLINE (1987–1995); Index Medicus (1987–1995); program and abstracts of the 32nd (1992), 33rd (1993), 34th (1994), and 35th (1995) Interscience Conference on Antimicrobial Agents and Chemotherapy; bibliographic reviews of review articles; and package inserts. STUDY SELECTION: In vitro and in vivo studies on the pharmacokinetics, microbiology, pharmacology, and clinical effectiveness of ampicillin/sulbactam, ticarcillin/clavulanate, and piperacillin/tazobactam were evaluated. DATA SYNTHESIS: Many properties of the beta-lactam/beta-lactamase inhibitor combinations are similar. Differences in dosing, susceptibilities, and clinical applications are important considerations for clinicians. Potential roles for these agents in the clinical setting include pneumonia, intraabdominal infections, and soft tissue infections. A short discussion on susceptibility data interpretation is also presented. CONCLUSIONS: There are important differences among the available beta-lactam/beta-lactamase inhibitor combinations, such as spectra of activity, which need to be considered in choosing an agent for a patient-specific case. These products can be useful alternatives to conventional two- to three-drug regimens in mixed infections such as foot infections in patients with diabetes and hospital-acquired intraabdominal infections.