Drug and therapeutics bulletin
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Sepsis, the systemic inflammatory response to infection, is common among severely ill patients and can be life-threatening. Over a quarter of patients in UK intensive care units (ICUs) have severe sepsis in the first 24 hours after admission. ⋯ Drotrecogin alfa (activated) (Xigris - Eli Lilly), a recombinant human activated protein C, is licensed for treating adults who have severe sepsis with multiple organ failure. Here we assess its efficacy and safety.
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Use of statin therapy is a key first-line approach in preventing coronary heart disease events and stroke in people at increased risk of developing such complications. Ezetimibe (Ezetrol - MSD-Schering-Plough), the first licensed azetidinone drug, is being promoted as an adjunct to statin therapy to achieve greater reductions in blood cholesterol concentrations than occur with a statin alone. Here we review ezetimibe and consider its place in clinical practice.
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Each year, around 1 in 1,000 adults in the UK has an acute upper gastrointestinal bleed. Acute treatment often includes the use of a proton pump inhibitor, although none is licensed in the UK for this indication. Here we consider whether such treatment helps and, if so, how it should be used.
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At any one time, most 16-18-years-old and up to half of adults have acne. In 60% of all teenagers, the condition will be sufficiently severe for them to self-treat or seek medical advice. ⋯ However, there have been suggestions that the drug itself might cause depression and suicide. Here we consider these concerns, and the implications for the use of isotretinoin when managing patients of all ages.
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Six years ago, we reviewed the selective aromatase inhibitors, anastrozole and letrozole, for the treatment of women with breast cancer. We concluded that anastrozole was at least as effective as megestrol (the standard treatment at that time for women with advanced postmenopausal breast cancer in whom tamoxifen had failed), but that there was insufficient published evidence to decide the place of letrozole in therapy. Since then, these drugs have become standard second-line treatment options for postmenopausal women with locally advanced or metastatic, hormone-receptor-positive breast cancer, and a third selective aromatase inhibitor, [symbol: see text] exemestane (pronounced eks-ee-mes-tane), has been added to the market. Here we consider whether the aromatase inhibitors should replace tamoxifen as first-line therapy.