Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2001
ReviewSingle versus combination intravenous antibiotic therapy for people with cystic fibrosis.
Choice of antibiotic, and the use of single or combined therapy are controversial areas in the treatment of respiratory infection in Cystic Fibrosis (CF). Advantages of combination therapy include wider range of modes of action, possible synergy and reduction of resistant organisms; advantages of monotherapy include lower cost, ease of administration and reduction of drug related toxicity. Current evidence does not provide a clear answer and therefore the use of intravenous antibiotic therapy in CF requires further evaluation. ⋯ The results of this systematic review of monotherapy versus combination therapy for pulmonary exacerbations in CF are inconclusive. The review raises important methodological issues. There is a need for a randomised controlled trial which needs to be well designed in terms of adequate randomisation allocation, blinding, power and long-term follow up. Results need to be standardised to a consistent method of reporting, in order to validate the pooling of results from multiple studies.
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Retrospective survival data have suggested poor effectiveness of oxygen therapy in patients with interstitial lung disease (ILD). ⋯ The assumption that home oxygen therapy has a beneficial survival effect in patients with ILD has not been demonstrated in the single RCT identified.
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Inhaled budesonide is a widely used inhaled corticosteroid for asthma. ⋯ This review strongly supports use of budesonide in chronic asthma. Consensus guidelines for chronic asthma suggest titrating inhaled steroid dose to individual requirements. Evidence from this review of trials does not present a case for routine dose titration above 800 mcg/d.
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Inhaled budesonide (BUD) is available in a range of doses for treating chronic asthma. ⋯ Budesonide exhibits a clinically significant dose response effect for improvement in FEV1 in severe asthma and reduction of exacerbations in moderate to severe asthma. No significant dose dependent improvements in FEV1, PEFR or symptoms are evident in non-oral steroid treated asthmatics with mild to moderate disease. Dose dependent alterations in sensitive measures of hypothalamic-pituitary-adrenal function were evident but the clinical significance of these changes is unclear.
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Cochrane Db Syst Rev · Jan 2001
ReviewD-Penicillamine for preventing retinopathy of prematurity in preterm infants.
Retinopathy of prematurity remains a common problem. A low rate of this disorder was unexpectedly observed among infants treated with intravenous d-penicillamine to prevent hyperbilirubinemia. This observation led to the investigation of its use to prevent retinopathy of prematurity. ⋯ D-penicillamine is unlikely to affect survival, and may reduce the incidence of acute ROP among survivors. Studies to date justify further investigation of this drug in a broader population; careful attention to possible side effects is needed.