Introduction: Revolutionary changes in the macrolide and azalide antibiotics
Article Abstract:
This introduction to a symposium concerning azithromycin reviews the pharmacokinetic basis for antimicrobial therapy, with particular emphasis on the actions, effectiveness, and limitations of treatment with macrolide antibiotics (such as erythromycin) and azalides (such as azithromycin). An ideal antimicrobial drug should: be effective against a range of bacteria; have selective toxicity for microbes; not induce drug resistance; have no or minimal side effects; be available in both oral, injectable, and infusible form; and require infrequent dosing. Erythromycin, while widely used and effective in many instances, is associated with gastrointestinal side effects, has a rather narrow range of activity, and has certain other limitations. The use of many macrolides is limited by the fact that they are not stable under acidic conditions, such as those in the stomach, and are poorly absorbed when given orally. However, newer agents are more resistant to acid: some of these are roxithromycin, clarithromycin, and dirithromycin. Azithromycin is active against many Gram-positive and some Gram-negative bacteria (a classification system based on the microorganism's response to the Gram stain). It penetrates well into tissues and transported by certain white blood cells, which deliver the drug to the infected site. This means that the standard way of estimating antimicrobial effectiveness, the measurement of blood levels of the drug, is not meaningful for such a drug. Most organisms that are resistant to erythromycin are also resistant to other macrolides and to azalides. Macrolides can be inactivated by enzymes present in bacteria. Azithromycin seems to be the first antibiotic that is effective against genital chlamydial infections with just one dose, and also appears effective against group A streptococcal pharyngitis after only a five-day course. Several problems remain to be solved concerning this drug, including its effects in patients with bacteremia (bacteria in the bloodstream), its activity in sites with low pH (such as abscesses), and its potential to induce resistance. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
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Improving the conduct of epidemiological studies: an introduction to quality principles
Article Abstract:
The Environmental Protection Agency (EPA) mandated in 1989 that epidemiologic studies should be conducted with good laboratory practices. A recent conference was convened to address the issues raised by the EPA legislation. The conference produced a roster of guidelines for good epidemiologic practices. These guidelines included quality issues, but did not deal with them as a separate item. The quality of epidemiologic studies has not hitherto been the subject of academic pursuit, textbooks, or conferences. The distinctions between quality, quality assurance and quality control are discussed in this report. Quality refers to the inherent excellence of the study, its conduct and its outcomes. Quality assurance refers to mechanisms to provide for conformance with the protocol requirements. Quality control provides the means of assessing error and providing corrections. The inclusion of the quality process in industrial and occupational epidemiologic studies, developed at the outset, contributes to assuring a successful investigation. Implicit in the quality process is also the empowerment of participant team members to recommend and implement changes. These principles, when added to the aforementioned guidelines for good epidemiologic practices, will contribute substantially to the quality of studies dealing with the epidemiologic concerns of industry. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Journal of Occupational Medicine
Subject: Health care industry
ISSN: 0096-1736
Year: 1991
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Age-related changes in renal function
Article Abstract:
Aging produces a variety of functional changes in the kidneys, such as glomerular filtration. Some chronic conditions, such as hypertension and diabetes, alter the filtration process, thus increasing the risk of kidney failure. Kidneys shrink with age as overall blood flow decreases, while acid-base balances are off. Analyzing both serum creatinine and creatinine clearance provides an accurate reading of renal function. Since drugs are often processed through the kidneys, doses should be adjusted accordingly.
Publication Name: Critical Care Nursing Quarterly
Subject: Health care industry
ISSN: 0887-9303
Year: 1996
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