Expert opinion on pharmacotherapy
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Trachoma, a recurrent follicular conjunctivitis caused by Chlamydia trachomatis, is the leading cause of preventable blindness worldwide. Efforts to control this disease have met with limited success. This failure is due in part to the limitations of conventional antibiotic treatment, a prolonged course of topical tetracycline. ⋯ The frequency and target population of mass distribution campaigns need to be defined. A few countries are beneficiaries of a philanthropic donation by the manufacturer of azithromycin, Pfizer Inc. However, in the absence of a drug donation programme the cost-effectiveness of this measure is unclear.
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Reviparin sodium (Clivarine), Knoll AG) is a low molecular weight heparin (LMWH) with a mean peak molecular weight of 3900 Da. It is characterised by a narrow molecular weight distribution profile, with an anti-factor Xa (anti-Xa):anti-factor IIa (anti-IIa) ratio of >or=3.6. In healthy human volunteers, plasma anti-Xa activity was up to five times higher and lasted three times longer with reviparin compared with unfractionated heparin (UFH). ⋯ At a daily dose of 4200 IU anti-Xa reviparin was as effective as UFH or enoxaparin in preventing DVT in high risk orthopaedic surgery and as effective as UFH in prevention of DVT and/or pulmonary embolism (PE) and/or mortality in high risk orthopaedic surgery. In patients with acute venous thromboembolism (VTE), reviparin was more effective than UFH in thrombus reduction and at least as effective as UFH in the prevention of clinical recurrence of DVT and/or PE. The use of reviparin is associated with a similar or lower incidence of bleeding complications than UFH.
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The paper presents the most recent recommendations for the treatment and prevention of infective endocarditis (IE). The treatment of IE is complex and requires close collaboration among specialists in infectious diseases, cardiology, cardiac surgery and microbiology. The mainstay of medical treatment is antibiotic therapy. ⋯ The decision to intervene and the optimal timing of the intervention requires careful consideration of multiple potential risks: the haemodynamic risk, the infectious risk, the risk due to cardiac lesions, the risk due to extracardiac complications and the risk due to the location of infective endocarditis. Even though the efficacy of antibiotic prophylaxis of IE is not completely proven, it is recommended for selected patients who undergo an at-risk procedure. Lists of cardiac conditions and of medical procedures at risk are presented; specific antibiotic prophylactic regimens for dental and upper respiratory tract procedures in out-patients, procedures under general anaesthesia and urological and GI procedures are outlined.