Expert opinion on pharmacotherapy
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Expert Opin Pharmacother · Feb 2008
Review Comparative StudyClinical trials with thiazolidinediones in subjects with Type 2 diabetes--is pioglitazone any different from rosiglitazone?
The thiazolidinediones, rosiglitazone and pioglitazone are used in the treatment of Type 2 diabetes (T2DM). Both have been shown to decrease glycated haemoglobin levels, fasting plasma glucose, insulin, and free fatty acids levels in subjects with T2DM. However, these agents have markedly different effects on lipids. ⋯ Despite the improvements in surrogate end points, there is little clear evidence that either rosiglitazone or pioglitazone cause major improvements in cardiovascular outcomes. Thus, rosiglitazone has no effect or may even increase cardiovascular outcomes, whereas, in high-risk subjects, pioglitazone has a marginal ability to decrease cardiovascular outcomes. Unless the thiazolidinediones are shown to improve cardiovascular or other outcomes (e.g., renal) in the next few years, their continued use in T2DM should be questioned.
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Expert Opin Pharmacother · Feb 2008
ReviewInhaled beclometasone dipropionate/formoterol extra-fine fixed combination in the treatment of asthma: evidence and future perspectives.
Combinations of a long-acting beta(2)-agonist (LABA) and an inhaled corticosteroid (ICS) are effective and safe options in asthma management. ⋯ In the treatment of asthma, BDP/F was shown to be at least as effective and well-tolerated as other available combinations of ICS and LABA with the advantage of a better cost effectiveness, and more effective in improving asthma control than BDP and formoterol given via separate inhalers. The extra-fine BDP/F combination appears to be a valuable therapeutic option in the management of asthma.
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Expert Opin Pharmacother · Feb 2008
ReviewManagement of Candida infections in the adult intensive care unit.
The epidemiology of Candida infection in intensive care units (ICUs) and the management strategies for such infections in non-neutropenic intensive care patients are discussed in this review. Candida species are one of the leading causes of nosocomial bloodstream infections and a significant cause of morbidity in patients admitted to the ICU. ⋯ Treatment of fungal infections is now possible with newer antifungal agents, including newer azoles (e.g., voriconazole, posaconazole) and echinocandins (e.g., micafungin, anidulafungin). However, there is a critical need for improvement in diagnosis of invasive Candida infection in order to provide clinicians the opportunity to intervene earlier in the diseases course.
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Expert Opin Pharmacother · Feb 2008
ReviewPneumococcal antimicrobial resistance: therapeutic strategy and management in community-acquired pneumonia.
Streptococcus pneumoniae has been consistently shown to represent the most frequent causative agent of community-acquired pneumonia (CAP) and pneumococcal antibiotic resistance towards different families of antibiotics continues to be a much-debated issue. Microbial resistance causes a great deal of confusion in choosing an empirical treatment for pneumonia and this makes it necessary to know which factors actually determine the real impact of antimicrobial resistance on the outcome of pneumococcal infections. Several different aspects have to be taken into account when analyzing this matter, such as the study design, the condition of the patient at the time of diagnosis, the choice of the initial antimicrobial regimen (combination or monotherapy) and the pharmacokinetic/pharmacodynamic variables of the chosen antibiotic. ⋯ In areas of high prevalence of high-level macrolide resistance, empirical monotherapy with a macrolide is not optimal for the treatment of hospitalised patients with moderate or moderately-severe CAP. Fluoroquinolones are considered to be excellent antibiotics in the treatment of pneumococcal CAP in adults, but their general recommendation has been withheld due to fears of a widespread development of resistance. Most international guidelines recommend combination therapy (beta-lactam plus a macrolide) for the treatment of hospitalised patients with CAP.