Expert opinion on pharmacotherapy
-
Expert Opin Pharmacother · Sep 2003
Review Comparative StudyCost-effectiveness of different postoperative analgesic treatments.
Pain may produce metabolic changes after surgery, which may contribute to further morbidity. A variety of medicines and techniques can be used to successfully treat pain. ⋯ This article reviews the literature evaluating the cost-effectiveness of providing different types of postoperative analgesics and finds that most studies are so poorly conducted that they prevent definitive conclusions being made. The author suggests that further studies be done using analgesics as just one part of a multimodal rehabilitation approach with careful attention to defining outcome, costs and achieving sufficient power to find or exclude meaningful differences.
-
Expert Opin Pharmacother · Sep 2003
Review Comparative StudyReview of bemiparin sodium--a new second-generation low molecular weight heparin and its applications in venous thromboembolism.
Bemiparin sodium (Hibor, Ivor, Zivor, Badyket, Laboratorios Farmaceuticos Rovi SA) is a new second-generation low molecular weight heparin (LMWH). Bemiparin has the lowest mean molecular weight (3600 Da), the longest half-life (5.3 h) and the largest antifactor Xa:antifactor IIa ratio (8:1) of all LMWHs. Bemiparin promotes a greater release of tissue factor pathway inhibitor than unfractionated heparin (UFH) or dalteparin. ⋯ Bemiparin was as effective as UFH for clot prevention during haemodialysis. The use of bemiparin was associated with a lower incidence of major and minor bleeding as compared to UFH in abdominal surgery. When compared with enoxaparin in orthopaedic surgery, a lower rate of complications at injection site was observed.
-
Expert Opin Pharmacother · Sep 2003
Review Comparative StudyCost-benefit analysis of ivermectin, permethrin and benzyl benzoate in the management of infantile and childhood scabies.
In the US, 6% sulfur in petrolatum has been the most frequently administered treatment for infantile scabies. It appears to be safe but there is no literature containing a large series of patients on which to base that determination. In the UK, benzyl benzoate is the approved product. ⋯ It remains present on the skin for several days, therefore protecting against reinfestation. Ivermectin is a systemic drug which is assumed to be safe in infants, although it requires repeated doses and does not protect against reinfestation. In the opinion of the author, 5% permethrin is the best treatment for scabies in infants and young children.
-
Bacterial meningitis is still a major cause of death and disability in children worldwide. With the advent of conjugate vaccines against the three major pathogens, the burden of disease is increasingly concentrated in developing countries that cannot afford the vaccines. Antibiotic resistance is an increasing problem; in developed countries, high-level resistance to beta-lactams among Streptococcus pneumoniae necessitates the addition of vancomycin to third-generation cephalosporins. ⋯ Avoidance of secondary brain injury from hypoxia, hypotension, hypo-osmolarity and cerebral oedema, hypoglycaemia or convulsions is essential for a good outcome. The problem of bacterial meningitis will only be solved if protein-conjugate vaccines (or other effective vaccine strategies) against S. pneumonia, H. influenzae and epidemic strains of Neisseria meningitidis are available to all the world's children. Making third-generation cephalosporins affordable in the developing world is also a necessary intervention, but better antibiotics will not overcome the problems of poor access to hospitals and late presentation with established brain injury, and will inevitably bring further pressure for antimicrobial resistance.
-
Expert Opin Pharmacother · Aug 2003
ReviewAntibiotic prophylaxis strategies in the prevention of ventilator-associated pneumonia.
Ventilator-associated pneumonia (VAP) is defined as a nosocomial pneumonia occurring > 48 h after endotracheal intubation. VAP may occur very early after intubation and it is usually defined as early-onset pneumonia, which occurs during the first 4 days. The occurrence of VAP is associated with an increase in morbidity and mortality. ⋯ Antibiotic prophylaxis strategies to prevent VAP can be administered over an extended period to cover all microorganisms using selective digestive decontamination regimens, or in a short-term course of no more than 24 h. Probably, the second strategy is the most useful in the prevention of VAP because it has a lower impact on the emergence of bacterial resistance. This manuscript aims to review current opinions regarding antibiotic prophylaxis strategies in the prevention of VAP.