Pharmacotherapy
-
Comparative Study
Comparison of bivalirudin and argatroban for the management of heparin-induced thrombocytopenia.
To compare the effectiveness of bivalirudin and argatroban in achieving anticoagulation goals and to compare clinical outcomes assessing the safety and efficacy in patients with known or suspected heparin-induced thrombocytopenia (HIT). ⋯ Bivalirudin and argatroban were similar in achieving and maintaining therapeutic anticoagulation goals, clinical outcomes, and safety. This study suggests that bivalirudin represents an alternative in the management of HIT, but prospective studies are needed.
-
To estimate the effectiveness of influenza vaccination in people in the United Kingdom at low risk for influenza during an 11-year period from July 1996-June 2007. ⋯ Seasonal influenza vaccination provided substantial protection against clinically diagnosed influenza when given within 4 months of annual seasonal outbreaks in people at low risk. A review of the incidence of influenza over the 11-year period provides compelling indirect evidence that influenza vaccines were similarly effective in those who were at high risk. These results provide a useful background to current and future influenza outbreaks whose course is uncertain.
-
Colistin is a polymyxin antibiotic that was discovered in the late 1940s for the treatment of gram-negative infections. After several years of clinical use, its popularity diminished because of reports of significant nephrotoxicity and neurotoxicity. Recently, the antibiotic has resurfaced as a last-line treatment option for multidrug-resistant organisms such as Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae. ⋯ Therefore, dosage alterations in this patient population are imperative to achieve maximal efficacy and minimal toxicity. With regard to colistin toxicity, most studies show that nephrotoxicity is reversible and less frequent than once thought, and neurotoxicity is rare. Further research is needed to fully understand the impact that the two regulatory systems have on resistance, as well as the dosages of colistin needed to inhibit and overcome these developing patterns.