American family physician
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American family physician · Aug 1997
ReviewCommunity-acquired pneumonia in adults: initial antibiotic therapy.
Community-acquired pneumonia is a common infection encountered in clinical practice and is the leading cause of death due to infectious disease in the United States. To choose initial antimicrobial therapy appropriately, physicians must keep informed of recent developments in the epidemiology and clinical manifestations of atypical pathogens, antibiotic resistance and new antibiotics. Differentiating between "typical" and "atypical" pneumonia based on the initial clinical presentation is difficult. ⋯ Older adults or those with comorbidities should be treated with erythromycin plus trimethoprim-sulfamethoxazole, a second- or third-generation cephalosporin, or a new macrolide. Empiric therapy for moderately or severely III hospitalized patients usually begins with erythromycin plus a second- or third-generation cephalosporin. Physicians should use initial antibiotic therapy for coverage of both typical and atypical pathogens.
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Antidepressants can cause a variety of withdrawal reactions, starting within a few days to a few weeks of ceasing the drug and persisting for days to weeks. Both tricyclic antidepressants and selective serotonin reuptake inhibitors cause similar syndromes, most commonly characterized by gastrointestinal or somatic distress, sleep disturbances, mood fluctuations and movement disorders. ⋯ Alternatively, tricyclic antidepressant withdrawal symptoms often respond to anticholinergics, such as atropine or benztropine mesylate. Three case reports of antidepressant withdrawal are presented, including one featuring akathisia (motor restlessness) related to withdrawal of venlafaxine.
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Intrathecal narcotics are a relatively recent addition to the list of analgesic options that are available for the management of labor pain. Pain during the first stage of labor is related to repetitive uterine contractions and resultant cervical dilatation, while pain during the second stage is due to stretching of the perineum. ⋯ The drugs most often used for intrathecal administration include sufentanil, fentanyl, meperidine and morphine. Use of intrathecal narcotics does not significantly affect the natural progression of labor, and no adverse fetal outcomes have been reported.