bluuebunny/crossref_metadata_2025_split huggingface dataset:
Digoxin Toxicity Secondary to Clarithromycin Therapy
Authors: Nawarskas James J. , McCarthy David M. , Spinier Sarah A. 
Published: January 2017

OBJECTIVE: To report a case of digoxin toxicity thought to be secondary to clarithromycin therapy. CASE SUMMARY: A 78-year-old white woman with congestive heart failure taking digoxin 0.25 mg po qd presented to our hospital with nausea, vomiting, and diarrhea. She had taken clarithromycin 500 mg po bid for 3 days, and a serum digoxin concentration obtained the day of admission was 4.4 μg/L. An electrocardiogram (ECG) done on admission revealed ST segment changes consistent with digoxin effect and later asymptomatic, nonsustained ventricular tachycardia (NSVT). Clarithromycin was discontinued and digoxin was withheld at admission, resulting in the resolution of symptoms, ECG abnormalities, and NSVT on day 3 of hospitalization. On day 5 her serum digoxin concentration was 1.5 μg/L and digoxin therapy was reinstituted at a dose of 0.125 mg/d po. DISCUSSION: This is the fourth published case implicating clarithromycin as the cause of digoxin toxicity. This interaction is most likely due to clarithromycin eradication of digoxinmetabolizing gut flora, thereby increasing digoxin bioavailability. CONCLUSIONS: Approximately 10% of patients are thought to be extensive presystemic metabolizers of digoxin and may therefore be most susceptible to a drug interaction with clarithromycin. Serum digoxin concentrations in such patients should be monitored closely during clarithromycin therapy.
Delayed Chronic Diarrhea and Weight Loss Possibly Due to Ticlopidine Therapy
Authors: Mansoor George A. , Aziz Khalid 
Published: January 2017

OBJECTIVE: To report a case of delayed-onset chronic diarrhea, anorexia, and weight loss possibly complicating the use of ticlopidine. CASE SUMMARY: A 48-year-old white man presented with unremitting diarrhea associated with anorexia and marked weight loss. His history was significant for transient ischemic attack, resistant hypertension, homocystinemia, and chronic renal insufficiency. The patient had tolerated ticlopidine therapy for 2 years without problems, and there had been no changes in his drug regimen for several months. No abnormality was found on detailed digestive system evaluation and all symptoms and signs promptly resolved after ticlopidine therapy was discontinued. DISCUSSION: The occurrence of diarrhea early during ticlopidine therapy should make the clinician consider the drug as the most likely cause. However, the appearance of chronic diarrhea, anorexia, and weight loss years after a patient had tolerated the drug is less typical for ticlopidine. In such situations, if no other cause can be identified, cautious withdrawal of the drug should be considered. We believe that all the patient's symptoms reported here were likely due to ticlopidine. CONCLUSIONS: Clinicians should be aware that the gastrointestinal adverse effects of ticlopidine may surface years after therapy is begun. The cause of ticlopidine-induced diarrhea remains unknown.
Prevention of Group B Streptococcus Infection in Neonates
Authors: Logsdon Beth A. , Casto Daniel T. 
Published: January 2017

OBJECTIVE: To review the epidemiology of group B Streptococcus (GBS) infection, risk factors for infection, and clinical manifestations of disease in the neonate, as well as the role of chemoprophylaxis and immunoprophylaxis in prevention of GBS disease and current recommendations for prevention. DATA SOURCES AND STUDY SELECTION: MEDLINE searches (1976–1997) of the English-language literature. DATA SYNTHESIS: Despite clinical advances in health care in the past two decades, GBS remains a leading cause of serious neonatal infection. Most early-onset GBS infections can be prevented through the use of intrapartum antimicrobial chemoprophylaxis. Preventing GBS infection in neonates is more cost-effective than treating GBS infections, and implementing prevention programs can reduce morbidity and mortality resulting from GBS disease. Many proposals have been made regarding prevention strategies; however, they have not been implemented widely and consistently in the US. To coordinate both pediatric and obstetric supported strategies, the Centers for Disease Control and Prevention (CDC) recently published recommendations for prevention of neonatal GBS disease through two possible strategies. In the first strategy, intrapartum antibiotic chemoprophylaxis should be offered to all women identified by prenatal culture as colonized and those who develop premature membrane rupture or onset of labor at less than 37 weeks gestation. The second strategy involves administration of intrapartum antibiotics to all women who develop one or more risk factors at the time of membrane rupture or onset of labor. CONCLUSIONS: GBS is difficult to eradicate, causing many women to be colonized with the organism during pregnancy and labor, thereby infecting their infant. Prevention strategies have been published for more than 10 years without successful implementation. Although optimal prevention management has not been defined, following one of two strategies recommended by the CDC can prevent the majority of GBS infections in neonates.