Clinical therapeutics
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Clinical therapeutics · Jan 2008
Clinical TrialColistin serum concentrations after intravenous administration in critically ill patients with serious multidrug-resistant, gram-negative bacilli infections: a prospective, open-label, uncontrolled study.
The emergence of multidrug-resistant nosocomial pathogens, such as Pseudomonas aeruginosa and Acinetobacter baumannii, has led to the revival of the systemic use of antimicrobial agent colistin in critically ill patients, but only limited data are available to define its pharmacokinetic profile in these patients. ⋯ CMS dosage regimens administered to these critically ill adult patients were associated with suboptimal Cmax/MIC ratios for many strains of gram-negative bacilli currently reported as sensitive (MIC, < or = 2 microg/mL).
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Clinical therapeutics · Jan 2008
LetterHow Connecticut primary care physicians view treatments for streptococcal and nonstreptococcal pharyngitis.
Inappropriate antibiotic treatment of respiratory infections has been reported to be common; however, the specifics of this inappropriate treatment are not completely defined. ⋯ This pilot survey found that 61% of Connecticut PCPs might treat GABHS with penicillin according to existing guidelines although the penicillin might be prescribed QID instead of the recommended BID or TID. Thirty-two percent of these PCPs reported they would use antibiotics to treat non-GABH pharyngitis.
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Clinical therapeutics · Jan 2008
Randomized Controlled Trial Multicenter Study Comparative StudyComparison of levalbuterol and racemic albuterol in hospitalized patients with acute asthma or COPD: a 2-week, multicenter, randomized, open-label study.
The National Heart, Lung, and Blood Institute guideline recommends that dosing racemic albuterol be administered every 1 to 4 hours for treating patients with asthma or chronic obstructive pulmonary disease (COPD) in the hospital. Previously published preliminary and retrospective studies suggested that levalbuterol can be administered every 8 hours for the treatment of bronchoconstriction in hospitalized patients. However, it is unclear how the different dosing regimens affect the total number of nebulizations (scheduled plus as-needed treatments) and the costs of treatment of bronchoconstriction in a hospital setting. Moreover, it is not clear how the different dosing regimens affect symptom outcomes and health status in hospitalized patients with asthma or COPD. ⋯ In these hospitalized patients with acute asthma or COPD treated with levalbuterol every 6 to 8 hours or racemic albuterol every 1 to 4 hours, significantly fewer total nebulizations were required with levalbuterol, without an increased need for rescue nebulizations during 14 days of hospitalization. Both treatments were associated with improvements from baseline in symptoms and health status. The costs of treating bronchoconstriction in hospitalized patients were similar between the levalbuterol and racemic albuterol groups.
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Clinical therapeutics · Jan 2008
Randomized Controlled TrialTopical amethocaine gel 4% for intramuscular injection in term neonates: a double-blind, placebo-controlled, randomized trial.
Topical local anesthetic agents such as amethocaine penetrate intact skin and block pain signals originating from the dermis during medical procedures. They have been found to attenuate pain from various procedures, including intramuscular (i.m.) injection of vaccines. Published data on their effectiveness for i.m. injection of vitamin K in neonates were not identified. ⋯ Topical amethocaine gel 4% was ineffective in reducing pain on i.m. injection of vitamin K in these full-term neonates. Treatment was generally well tolerated and nurses concluded that, given the choice, they would use a topical anesthetic.
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Clinical therapeutics · Jan 2008
Randomized Controlled TrialOpen-label, prospective, randomized comparison of propofol and sevoflurane for laryngeal mask anesthesia for magnetic resonance imaging in pediatric patients.
Magnetic resonance imaging (MRI) for pediatric patients often requires deep sedation or anesthesia because they must remain completely immobile for a relatively long period to obtain high-quality images. ⋯ This small study found that sevoflurane, at the doses used in this study, provided shorter induction and faster recovery times than i.v. propofol for LMA anesthesia in these selected children undergoing MRI. The percentage of MRI interruption in the propofol group was significantly higher than that in the sevoflurane group. Sevoflurane was associated with a significantly higher score on the PAED scale, indicating greater emergence delirium.