Ceftazidime monotherapy for empiric treatment of febrile neutropenic patients: a metaanalysis
Patients with cancer or low numbers of white blood cells (neutropenia) are susceptible to infection, which is the leading cause of death in these patients. It is estimated that 85 to 90 percent of all fevers in such patients are caused by bacterial infections. Escherichia coli and different species of Pseudomonas and Klebsiella are a significant cause of death in patients with suppressed immune systems (the body's natural defense system for fighting infection). Studies have shown that beginning treatment with antibiotic drugs as soon as fever develops, instead of waiting for clinical laboratory results, can improve survival rates. Two different types of antibiotic treatments, monotherapy and combination therapy, have been developed and used for treating infections in patients who have neutropenia and fever. Monotherapy relies upon ceftazidime alone, while combination therapy uses several different antibiotics at the same time. Combination therapy may improve survival, but it can be toxic to the patient, can be difficult to administer, can cause patient discomfort, and is expensive. Ceftazidime treatment is less toxic, easier to administer and is less expensive than combination therapy. However, it is not clear whether ceftazidime is as effective as combination therapy. Therefore, a statistical analysis of all clinical trials using combination or monotherapy for treating infections in patients with neutropenia was performed. The results of the analysis indicate that there is no significant advantage of using combination therapy over ceftazidime for treating most patients. However, there may be a subgroup of patients who will derive more benefit from treatment with combination therapy. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Journal of Infectious Diseases
Disulfiram treatment of alcoholism
Disulfiram is a drug used in the treatment of alcoholism. When alcohol is consumed while taking 250 mg to 500 mg of disulfiram daily, the patient has an adverse reaction; heart and breathing rates increase, followed by nausea, vomiting, pallor and a drop in blood pressure. This alcohol-use deterrent has been prescribed for 40 years. However, there is a fine line between the therapeutic and toxic effects of disulfiram even at therapeutic doses. Some patients may experience convulsions, abnormal heart rhythms, heart attack and liver disorder. When disulfiram is used short-term it can reduce the frequency of alcohol consumption, especially in patients who fear adverse reactions. There is no evidence that disulfiram affects the long-term reduction of alcoholism. Disulfiram should be used in combination with supportive therapy, education, supervision and rehabilitation. Alcoholics who are compliant with therapeutic regimes and live in a stable living environment are the best candidates for disulfiram therapy. The drug is not likely to stop patients from drinking completely, but it is able to reduce the number of days of alcohol ingestion for a three to six month period. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Annals of Internal Medicine
Understanding the clinical and economic outcomes of HIV therapy: the Johns Hopkins HIV Clinical Practice Cohort
The Johns Hopkins Health System AIDS Service in Baltimore, MD, maintains an extensive database on 3,000 HIV-infected patients. Established in 1990, the database tracks inpatient and outpatient care for most HIV patients in Maryland, many of whom are poor and black. Sixty percent of patients treated by the AIDS Service are insured by Medicaid, and 75% make less than $10,000 per year. The Johns Hopkins AIDS Service was among the first facilities to identify the failure of AZT (zidovudine) in long-term single-drug therapy, and to study the effect of poor patient compliance on treatment failure.
Publication Name: Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology
- Abstracts: Chemotherapy use in the last 6 months of life among Medicare patients with cancer. How willing are doctors to give patients with terminal cancer accurate information about their chances of survival?
- Abstracts: Hepatitis A vaccine. Argatroban for treatment of heparin-induced thrombocytopenia. Twinrix: a combination hepatitis A and B vaccine
- Abstracts: Assessing the efficacy of three dentifrices in the treatment of dentinal hypersensitivity. The effects of toothpastes on the residual microbial contamination of toothbrushes
- Abstracts: Outcome among surviving very low birthweight infants: a meta-analysis. Deafness in children of very low birth weight
- Abstracts: Biosynthesis and physiologic effects of estrogen and pathophysiologic effects of estrogen deficiency: a review