DICP : the annals of pharmacotherapy
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Comparative Study
Three-point versus two-point method for early individualization of aminoglycoside doses.
An approach using two serum concentrations following the initial dose of an aminoglycoside was retrospectively evaluated using the first and third samples from all three-point studies conducted by the pharmacokinetic consult service in 1988. The same Sawchuk and Zaske method was used for the three-point and two-point studies. Although the predicted peaks and troughs from the two-point study were statistically different from those of the three-point study, it is the authors' opinion that the root mean squared error of 0.38 mg/L (95% confidence interval [CI] 0.31-0.45) for the peaks and 0.09 mg/L (95% CI 0.06-0.11) for troughs is well within the limits of acceptable clinical error for gentamicin and tobramycin. Eliminating one-third of initial aminoglycoside concentrations could result in significant time and cost savings.
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Topical capsaicin has been introduced in the U. S. and Canada as a cream indicated for temporary relief of neuralgia following episodes of herpes zoster infections and in the treatment of diabetic neuropathy. Although capsaicin is clinically used as an external analgesic for temporary relief of neuralgia, it has also been widely used as a research tool to study peripheral pain. ⋯ Further clinical studies are warranted in several of these conditions to establish the efficacy of topical capsaicin. Serious or unexpected adverse reactions from clinical use have not been reported to date. Considering the paucity of safe and effective treatments for the conditions mentioned above, capsaicin cream appears to warrant further clinical investigations to establish its efficacy in a variety of chronic pain syndromes.
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Sulfasalazine has been used for many years in the management of ulcerative colitis. As many as 20 percent of patients treated with it experience intolerable adverse effects usually attributed to its sulfapyridine component. ⋯ In clinical trials, mesalamine has proved efficacious in treating refractory cases of distal ulcerative colitis, proctitis, and proctosigmoiditis. Because of its high cost compared with more conventional treatment modalities, it should be reserved for cases that are either refractory or intolerant to conventional treatment.
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Misoprostol has been associated with adverse reactions, including gastrointestinal symptoms, gynecologic problems, and headache. Changes in mental status, however, have not been reported. ⋯ Her delirium significantly improved after misoprostol was discontinued and her mental status returned to normal within a week. Because no other factors related to this patient changed significantly, the delirium experienced by this patient possibly resulted from misoprostol therapy.