The Annals of pharmacotherapy
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To discuss the pathogenesis, incidence, and clinical presentation of postdural puncture headaches (PDPHs) and to provide a comprehensive evaluation on the pharmacologic management of PDPH. ⋯ Intravenous and oral caffeine are effective and noninvasive treatments for PDPH. Epidural NaCl 0.9% or dextran are alternatives when the EBP is unsuccessful or contraindicated. Several methods of pharmacologic management have been cited in the literature, but all require further evaluation.
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Randomized Controlled Trial Clinical Trial
Sequential parenteral and oral ciprofloxacin regimen versus parenteral therapy for bacteremia: a pharmacoeconomic analysis.
To compare, in patients with gram-negative bacteremia, a course of parenteral antibiotic therapy alone with initial parenteral therapy followed by oral ciprofloxacin in terms of the length of hospitalization, clinical effectiveness, toxicity, and cost. ⋯ Parenteral therapy for 72 hours followed by oral ciprofloxacin significantly shortened both the number of hospital days taking antibiotics and the length of stay compared with parenteral therapy alone. Both regimens were equally effective and safe in the therapy of gram-negative bacteremia, and initial parenteral therapy followed by oral ciprofloxacin was cost-effective.
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To report a life-threatening anaphylactoid reaction to oral pefloxacin in a patient with AIDS and to review the pertinent literature. ⋯ There is a need for continued vigilance in the reporting of adverse drug reactions in patients with AIDS, especially with new drug. Also, care must be taken in introducing drugs, including fluoroquinolones, to this patient population.
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Comparative Study
Combining event rates from clinical trials: comparison of Bayesian and classical methods.
To compare an empirical Bayesian, a fully Bayesian, and a classical fixed-effect (Peto) method for pooling event rates from separate epidemiologic studies or clinical trials. ⋯ For the data sets considered, Bayesian methods, which are computer intensive but intuitively appealing, provided results that were consistent with the classic fixed-effect Peto method. Introduction of the more extreme data points did not alter this conclusion.
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To longitudinally evaluate unbound and total serum phenytoin concentrations during intravenous phenytoin maintenance dosage and to determine the relationship among phenytoin protein binding, serum albumin, and unbound fatty acid concentrations in patients with head injuries during intensive care unit (ICU) and convalescent care. ⋯ Phenytoin protein binding was significantly correlated with albumin and was more variable in ICU and convalescent patients with brain injuries than in healthy volunteers. The high dosage requirements and subtherapeutic unbound phenytoin concentrations observed during acute care are best explained by increased metabolism. Phenytoin dosage requirements decreased during convalescence.