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
Economic assessment of early initiation of inhaled corticosteroids in chronic obstructive pulmonary disease using propensity score matching.
Chronic obstructive pulmonary disease (COPD), characterized by airway obstruction and inflammation leading to chronic bronchitis and emphysema, is an important cause of morbidity, mortality, and increased health care utilization and expenditures. ⋯ ICS treatment initiated along with bronchodilators reduced COPD exacerbation events and expenditures in these managed care plans. Further research is needed to address potential selection bias due to unobserved factors.
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Clinical therapeutics · Jan 2008
Cardiovascular outcomes among patients newly initiating atorvastatin or simvastatin therapy: a large database analysis of managed care plans in the United States.
While the results of randomized clinical trials have indicated that statins improve outcomes in patients without cardiovascular disease (CVD), it remains uncertain whether there are differences in efficacy between statins, particularly in clinical practice, where the public health implications could be substantial. ⋯ In these patients without CVD, atorvastatin 10 or 20 mg was associated with a significantly lower risk of CV events compared with simvastatin 20 or 40 mg. Further studies are required to determine whether differences in persistence, achieved low-density lipoprotein cholesterol levels, or other factors contribute to these differences in outcomes.
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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.