bluuebunny/crossref_metadata_2025_split huggingface dataset:
Selective Decontamination of the Digestive Tract in Intensive Care Patients: Review and Commentary
Authors: Gomez Eleanor C. , Markowsky Susan J. , Rotschafer John C. 
Published: January 2017

OBJECTIVE: To evaluate the benefits, risks, and costs of antimicrobial regimens used for selective decontamination of the digestive tract (SDD) in intensive care unit (ICU) patients. DATA SOURCES: Information was obtained from clinical trials, review articles, abstracts, and textbooks. Key indexing terms included antibiotics, selective decontamination, and infections. STUDY SELECTION: Research articles describing controlled clinical trials of SDD in medical or surgical ICU patients were reviewed. Trials that investigated transplant, cirrhotic, leukemic, or oncology patient populations were excluded. DATA EXTRACTION: The details of studies that evaluated nosocomial infection or nosocomial pneumonia rates were extracted. These included study design, demographics, SDD regimens, severity of illness scores, and colonization, infection, and mortality rates. DATA SYNTHESIS: The use of SDD in mechanically ventilated surgical or trauma ICU patients reduces the incidence of colonization, nosocomial pneumonia, and overall infection rates, but does not change the overall mortality rate. Administration of antibiotic and antifungal agents in a nasogastric suspension is required for SDD. The addition of systemic prophylactic antibiotics or oropharyngeal paste was not required to decrease nosocomial infections. The most frequently studied SDD regimen (colistin/amphotericin B/tobramycin) is not feasible for use in the US because of exorbitant drug costs. Less expensive alternatives include norfloxacin/nystatin, or colistin/nystatin/gentamicin. CONCLUSIONS: Additional research is required before SDD regimens can be routinely recommended in surgical and trauma ICU patients. A multicenter study is warranted to determine the long-range benefits, potential for resistance, and cost-effectiveness of SDD.
Hepatic and Renal Dysfunction following Nafcillin Administration
Authors: Lestico Mitchell R. , Vick Karen E. , Hetsko Cyril M. 
Published: January 2017

OBJECTIVE: To review four cases of combined hepatic and renal toxicity that may be associated with the administration of nafcillin in adults. This type of adverse event with the use of nafcillin has not been previously documented in the literature. DATA SOURCES: References from pertinent articles are identified throughout the text. DATA SYNTHESIS: Nafcillin is a widely used penicillinase-resistant penicillin. In four patients receiving nafcillin doses greater than 9 g/24 hours, changes in renal and hepatic function markers were noted within 72 hours of the initiation of nafcillin therapy. Laboratory values returned toward baseline when nafcillin therapy was discontinued. Elevations in blood urea nitrogen, creatinine, total bilirubin, and lactate dehydrogenase have been previously described in the literature for penicillin-like agents other than nafcillin. The exact mechanism for such toxicities as well as patient risk factors have not been clearly established. CONCLUSIONS: Caution should be taken when initiating nafcillin therapy. Evaluation of renal and liver function tests prior to initiating nafcillin therapy and within the first 72 hours appears warranted. If hepatic and/or renal toxicity is observed, discontinuation of nafcillin should be considered.
Contribution to the Issue of Essential Drugs in Czechoslovakia
Authors: Kolář Josef V. , Foltán Viliam J. 
Published: January 2017

OBJECTIVE: To determine the ratio represented by essential drugs (EDs) in the total consumption of drugs in Czechoslovakia in 1989. DESIGN: Retrospective analysis of the assortment and consumption of EDs in 1989. SETTING: Department of the Organization and Management of Pharmacy, Faculty of Pharmacy, Bratislava. MAIN OUTCOME MEASURES: Consumption of drugs and/or pharmacotherapeutic groups, expressed by the number of formulations, number of units, and in financial terms. RESULTS: EDs constitute approximately one-third of the total consumption of drugs in Czechoslovakia (both in terms of volume and finances); almost 60 percent of EDs have dosage forms and concentrations identical to those shown in the World Health Organization Model List of Essential Drugs (Sixth List). CONCLUSIONS: The results obtained indicate that there is need for a regular updating of the drug policy within the public health branch of the government to more effectively regulate the production and import of drugs.
Comparative Trial in Volunteers to Investigate Possible Ethanol-Ranitidine Interaction
Authors: Kleine Michael-W. , Ertl Doris 
Published: January 2017

OBJECTIVE: To assess the effect of ranitidine on ethanol absorption after ethanol 0.5 g/kg is given in three single doses of 0.167 g/kg to simulate normal social drinking. DESIGN: A double-blind, placebo-controlled, crossover trial was performed in 16 healthy men. Ethanol serum concentrations were measured on day 6 of each of the three treatment periods (placebo, ranitidine 150 mg bid, or ranitidine 300 mg bid). METHODS: Ethanol 0.167 g/kg was administered followed by a standard meal at 1700. The last tablet of the test medication was given 15 minutes later. Thirty and 60 minutes after the first intake, the same amount of ethanol was given again. Serum ethanol concentrations were measured multiple times during the four-hour period following oral ingestion of the first dose. RESULTS: Comparison of median serum ethanol concentrations, the areas under the curve, peak and time to peak serum ethanol concentrations showed no significant differences during medication with placebo, ranitidine 150 mg bid, or ranitidine 300 mg bid. Peak ethanol concentrations (median values) were 153, 140, and 155 mg/L, respectively. CONCLUSIONS: This study shows that treatment with ranitidine, in a dose up to 300 mg bid, has no significant effect on serum ethanol concentrations, even when ethanol was given in divided doses to simulate normal patterns of social drinking. This implies that concomitant dosing with ranitidine will not increase the adverse effects of moderate doses of ethanol on concentration and psychomotor function.
Baclofen-Induced Bronchoconstriction
Authors: Dicpinigaitis Peter V. , Nierman David M. , Miller Albert 
Published: January 2017

OBJECTIVE: To report the occurrence of acute bronchospasm in one asthmatic patient and increased bronchial reactivity in another following the administration of a single dose of oral baclofen. CASE SUMMARY: On two separate occasions, a 46-year-old asymptomatic asthmatic man developed dyspnea and chest tightness one hour after the ingestion of baclofen 40 mg. Pulmonary function studies revealed a significant decrease in airflow relative to baseline. A 33-year-old asymptomatic woman with a history of exercise-induced dyspnea and wheezing displayed bronchial hyperresponsiveness to inhaled methacholine 2 hours after ingesting 40 mg of baclofen. The patient had had a negative methacholine challenge test 72 hours earlier. DISCUSSION: The gamma-aminobutyric acid-agonist baclofen has been shown to reduce airway responsiveness to various bronchoconstricting agents in animal studies. The etiology of this seemingly paradoxical response in two patients is unclear, but may offer insight into the neurally mediated airway constriction that occurs in asthma. CONCLUSIONS: Clinicians should be aware of the possibility of baclofen-induced bronchospasm, especially in asthmatic patients.
Vancomycin Administration into the Cerebrospinal Fluid: A Review
Authors: Luer Mark S. , Hatton Jimmi 
Published: January 2017

OBJECTIVE: To discuss administering vancomycin directly into the cerebrospinal fluid (CSF) to treat serious central nervous system (CNS) infections. DATA SOURCES: References were obtained through an online search of MEDLINE, limited to material published in English. In addition, information was extracted from clinical trials, review articles, abstracts, and textbooks. STUDY SELECTION: Systematic evaluation of this topic in humans has not been done in a prospective manner. Related research articles describing the pathophysiology of CNS infections, intrathecal drug administration, and case reports of CSF vancomycin administration were reviewed. DATA EXTRACTION: Case reports regarding CSF vancomycin dosing were evaluated and included: Drug dosing, infecting organism, infectious disease state, infectious outcome, CSF dynamics/flow abnormalities, methods of drug administration, drug monitoring, and toxicities. DATA SYNTHESIS: The results of this review are based on qualitative evaluations of anecdotal case reports and a basic understanding of intrathecal and intraventricular drug dosing principles. CSF administration of vancomycin is an effective means of bypassing the blood-brain barrier to achieve greater drug concentrations within the CSF. Current limitations to the CSF administration of vancomycin include a lack of data describing its safety, efficacy, and pharmacokinetics. CONCLUSIONS: CNS infections may require the CSF administration of vancomycin for successful eradication. Recommendations for dosing in the literature vary. Because of the potential toxicities associated with elevated CSF concentrations of vancomycin, dosing should be conservative.
Ceftazidime Dosing in the Elderly: Economic Implications
Authors: Vlasses Peter H. , Bastion Wynette A. , Behal Raj , Sirgo Mark A. 
Published: January 2017

OBJECTIVE: This study evaluated the prevalence and resulting costs of ceftazidime dosing in excess of product labeling recommendations in elderly hospitalized patients. Ceftazidime is a beta-lactam antibiotic excreted via glomerular filtration. According to product labeling, ceftazidime dosing can frequently be decreased in the elderly because glomerular filtration declines with age. METHODOLOGY: A multicenter, retrospective utilization audit involving 11 US academic medical centers examined 221 medical records of patients 65 years of age or older receiving ceftazidime (any brand, any indication). The creatinine clearance of each patient was estimated using the Cockcroft-Gault formula. RESULTS: Renal insufficiency, defined as an estimated creatinine clearance of less than 50 mL/min, was present in 111 of the patients (50 percent). Ceftazidime dosing in excess of product labeling recommendations was noted in 75 of those 111 (68 percent). The cost of excess ceftazidime dosing for those 75 patients (i.e., extra drug acquisition, preparation, administration) was $13 822.50. CONCLUSIONS: Although the dosage of ceftazidime required in a specific patient is based on many factors, ceftazidime is frequently overdosed in the elderly because renal function is not considered. Ceftazidime dose-adjustment in the elderly, based on the estimated creatinine clearance, can lead to cost savings. In the US, where hospital reimbursement by Medicare is based on diagnosis, institutions can realize direct cost savings.
Prescription of Antimicrobial Drugs to Hospitalized Children
Authors: Kolář Josef V. , Kadáková Eva 
Published: January 2017

OBJECTIVE: To analyze with regard to age, gender, and diagnosis, the profile, frequency of prescribing, and cost of antimicrobial drugs (AMDs) in hospitalized children. DESIGN: Retrospective study of medical records of children hospitalized during 1987 and 1988. SETTING: First Pediatric Clinic, Children's Teaching Hospital, Bratislava, Czechoslovakia (now Slovakia). PATIENTS: One thousand randomly selected hospitalized children. MAIN OUTCOME MEASURES: Patterns of AMD prescribing. Consumption is expressed by the number of drugs and cost per child. RESULTS: AMDs were prescribed to 69.9 percent of the patients (average 1.91 per patient). Ampicillin was the drug most frequently prescribed (20.0 percent), followed by oxacillin (12.8 percent). The mean length of stay was 15.9 days. An average of 3.61 drugs from other pharmacotherapeutic categories were prescribed per patient. Most children who received AMD treatment were in the 1-year group (patients between six months and 1.5 years of age [88.6 percent]). CONCLUSIONS: This study provides an overview of the prescribing of AMDs and other drugs in hospitalized children in Bratislava.
Serum Aldosterone Concentrations and Urine Output in Oliguric Intensive Care Unit Patients Receiving Low-Dose Dopamine
Authors: Dick Michael , Dasta Joseph F. , Choban Patricia S. , Sinha Renu , Flancbaum Louis 
Published: January 2017

OBJECTIVE: To determine whether the diuretic and natriuretic effects of low-dose dopamine (2.5 μ/kg/min) are associated with changes in serum aldosterone concentration. DESIGN: Prospective clinical study. SETTING: Surgical intensive care unit (SICU) of a university hospital. PARTICIPANTS: Oliguric (urine output <0.5 mL/kg/h) SICU patients. All patients were resuscitated to pulmonary artery occlusion pressure > 10 mm Hg, mean arterial pressure >65 mm Hg, and cardiac index >2.5 L/min/m2. Patients with a serum creatinine concentration > 176.8 μmol/L (2.0 mg/dL.), those who received diuretics within 12 hours prior to entry into the study, and renal transplant recipients were excluded. MAIN OUTCOME MEASURES: Hourly urine output (mean ± SD) was recorded 2 hours before and for 6 hours after the initiation of lowdose dopamine. Urine sodium and serum aldosterone concentrations were obtained prior to and 6 hours after the start of low-dose dopamine. RESULTS: Fifteen patients were enrolled in the study. Urine output (mean ±SD) increased from 0.31 ± 0.11 mL/kg/h before to 0.80 ± 0.34 mL/kg/h following low-dose dopamine (p<0.01). Urine sodium concentrations increased from 46 ± 32 mmol/L baseline to 72 ± 53 mmol/L following low-dose dopamine (p<0.05), and serum aldosterone concentrations decreased from 415.82 ± 341.48 pmol/L prior to low-dose dopamine infusion to 256.04 ± 204.17 pmol/L (p<0.05). Cardiac output, pulmonary artery occlusion pressure, mean arterial pressure, and heart rate did not change. CONCLUSIONS: Low-dose dopamine significantly increases urine output and urine sodium excretion in oliguric, critically ill, surgical patients, and is associated with a decrease in serum aldosterone concentration. The diuretic and natriuretic effects of low-dose dopamine may be, in part, related to a dopamine-mediated inhibition of aldosterone secretion.
Assessment of 24-Hour Gastric pH Measurements in Trauma Patients Receiving Intravenous Famotidine by Intermittent Bolus versus Continuous Infusion Administration
Authors: Jones Lori A. , Gonzalez Edgar R. , Reines H. David , Venitz Jurgen 
Published: January 2017

OBJECTIVE: To compare the effects of intermittent bolus versus continuous infusion intravenous famotidine on gastric pH in critically ill trauma patients. DESIGN: Twenty patients were randomized to receive famotidine by intermittent bolus or continuous infusion for 24 hours. Patients fasted during the study period. Hourly gastric pH measurements were made using an indwelling sensor/sump tube. SETIING: The study was conducted in a university teaching hospital. PARTICIPANTS: Adult patients admitted to the neurosurgical or surgical/trauma intensive care unit within 72 hours of traumatic injury were enrolled in the study if they had two consecutive hourly gastric pH readings of <4 without receiving antacids, sucralfate, or histamine2-antagonists. MAIN OUTCOME MEASURES: Groups were compared with regard to (1) total dose of famotidine received/24 hours, and (2) number of dosage changes required to maintain a gastric pH value of ≥4. RESULTS: The median dose of famotidine required to maintain a gastric pH ≥4 was 50 mg/24 h (25th–75th percentiles = 40–55 mg) in the intermittent bolus group compared with 42 mg/24 h (25th–75th percentiles = 42–52 mg) in the continuous infusion group (p=0.9577). A dosage increase was required by 5 of 8 patients (62 percent) receiving intermittent bolus therapy, whereas only 2 of 8 patients (25 percent) in the continuous infusion group required a dosage adjustment (p=0.315, power=0.318). CONCLUSIONS: Intravenous famotidine (40–50 mg/d) effectively controlled gastric pH in critically ill trauma patients. Patients treated with intermittent bolus therapy required slightly more drug and more frequent dosage adjustments to achieve a gastric pH ≥4. These differences did not reach statistical significance.
Close Clinical Observation Minimizes the Complications of Beta-Blocker Withdrawal
Authors: Eisele George , Gilmore Linda L. , Blanchard Edward B. 
Published: January 2017

OBJECTIVE: To determine whether beta-blocker withdrawal under close medical supervision poses undue risks. DESIGN: Retrospective case review. Data extracted from previous study. SUBJECTS: 114 hypertensive subjects tapered from beta-blocker therapy. Subjects were a subset of patients originally studied for blood pressure medication withdrawal and biofeedback training. MAIN OUTCOME MEASURES: Frequency of symptoms and adverse effects reported by subjects during medication taper to the study nurse. RESULTS: Symptoms were no more likely to occur with beta-blocker withdrawal than with withdrawal of other types of antihypertensive medications. Most adverse effects were classified as minor. Two subjects experienced major symptoms. One subject required reinstitution of beta-blockers for palpitations, and another exhibited angina upon beta-blocker withdrawal. CONCLUSIONS: In well-screened patients under careful monitoring, withdrawal from beta-blockers appears to present a small, manageable risk.
Implementation and Evaluation of a Standardized Herpes Simplex Virus Prophylaxis Protocol on a Leukemia/Bone Marrow Transplant Unit
Authors: Rayani Shelina A. , Nimmo Cindy J. Reesor , Frighetto Luciana , Martinusen Shelagh M. , Nickoloff Donna M. , Reece Donna E. , Jewesson Peter J. 
Published: January 2017

OBJECTIVE: To assess the impact of a standardized acyclovir prophylaxis protocol for the prevention of herpes simplex virus (HSV) infection and disease in bone marrow transplant and leukemic patients. DESIGN: Two-phase, open sequential study involving prospective patient monitoring and retrospective health record review. SETIING: Tertiary care teaching hospital. PATIENTS: Fifty-seven patients (35 preprotocol, 22 postprotocol) who received acyclovir for HSV prophylaxis during an 18-month study period. INTERVENTIONS: An acyclovir HSV prophylaxis protocol was developed and implemented. Under this protocol, all HSV immunoglobulin G-seropositive hematology patients received an acyclovir regimen of 125 mg/m2 iv q6h or 600 mg po q6h (if tolerated) from day −5 to day 30. Regimens not matching protocol were modified by pharmacists in conjunction with the prescriber. All treatment courses were followed daily by pharmacists to modify dosage according to renal function and assess appropriateness of the iv route. Tablets, capsules, or suspensions were promoted if the patient was considered tolerant of the oral route. MAIN OUTCOME PARAMETERS: Outcome parameters included (1) incidence of parenteral, oral, or combined therapy; (2) total prophylactic acyclovir dose per patient; (3) mean prophylactic acyclovir daily dose; (4) mean duration of acyclovir prophylaxis; and (5) HSV reactivation rate. RESULTS: Following implementation of the protocol, the mean total iv acyclovir dose per patient decreased from 20.1 g (range 3.6–109.5) to 11.7g (range 1.0–43.0; p=0.1162). The mean cumulative oral dose increased from 12.1 g (range 0.4–70.0) to 33.1g (range 2.4–93.6; p=0.00(7). Mean duration of therapy increased from 27.6 to 33.5 days (p=0.23). The mean duration of oral therapy increased from 10.5 days (±SD 10.9) to 17.2 days (±SD 12.1) (p=0.034). The appropriateness of use of the iv dosage form increased from 53 to 88 percent of treatment days (p=0.013). No difference in HSV reactivation rate was observed when comparing patients prior to and following protocol implementation. A drug acquisition savings of $1112.00 (CON) per patient was realized. CONCLUSIONS: The implementation of a standardized HSV acyclovir prophylaxis protocol has resulted in significant drug acquisition cost savings without an apparent negative impact on patient outcome.
Gastric Retention of Enteric-Coated Magnesium Chloride Tablets
Authors: Chapron Dennis J. , Korman Lisa B. , Barry William L. 
Published: January 2017

OBJECTIVE: To describe a patient with gastric retention of enteric-coated magnesium chloride tablets. Potential drug and disease etiologies accounting for failure to empty this dosage form are discussed. DESIGN: Single case report. CASE SUMMARY: A seriously ill patient with metastatic small-cell lung cancer accumulated 21 enteric-coated magnesium chloride tablets in his stomach during a four-day administration period. The patient had gastroscopic evidence of mild pylorospasm and suspected gastric motor dysfunction. The latter may have been the result of several factors including concurrent use of oxycodone, vagal dysfunction from chronic alcoholism and cisplatin-based chemotherapy, and possibly a paraneoplastic neuromuscular syndrome involving the gastrointestinal tract. CONCLUSIONS: Enteric-coated tablets are indigestible solids, often of considerable size. Strong antral contractions, associated with phase 3 of the interdigestive migrating myoelectric complex, are usually required to carry such dosage forms through a normal pyloric channel and into the duodenum. Seriously ill patients who may have gastric hypomotility or pyloric channel narrowing are probably not good candidates for therapy with large enteric-coated dosage forms.
Adverse Interaction between Clonidine and Verapamil
Authors: Jaffe Ronen , Livshits Tatyana , Bursztyn Michael 
Published: January 2017

OBJECTIVE: To report two cases of a possible adverse interaction between clonidine and verapamil resulting in atrioventricular (AV) block in both patients and severe hypotension in one patient. CASE SUMMARIES: A 54-year-old woman with hyperaldosteronism was treated with verapamil 480 mg/d and spironolactone 100 mg/d. After the addition of a minimal dose of clonidine (0.15 mg bid), she developed complete AV block and severe hypotension, which resolved upon cessation of all medications. A 65-year-old woman was treated with extended-release verapamil 240 mg/d. After the addition of clonidine 0.15 mg bid she developed complete AV block, which resolved after all therapy was stopped. DISCUSSION: An adverse interaction between clonidine and verapamil has not been reported previously. We describe two such cases and discuss the various mechanisms that might cause such an interaction. Clinicians should be acquainted with this possibly fatal interaction between two commonly used antihypertensive drugs. CONCLUSIONS: Caution is recommended in combining clonidine and verapamil therapy, even in patients who do not have sinus or AV node dysfunction. The two drugs may act synergistically on both the AV node and the peripheral circulation.