1/81. nitrofurantoin-associated Sweet's syndrome.A 53-year-old woman was seen for arthralgias, fever, and a painful rash developing at the end of a 7-day course of nitrofurantoin for a urinary tract infection. Her only other medication was naproxen, which was started after the onset of symptoms. Initial biopsy showed microscopic changes suggestive of a toxic eruption, but within 3 days the clinical signs and symptoms typical of Sweet's syndrome evolved. A repeat biopsy showed microscopic features characteristic of that diagnosis. The patient subsequently cleared with prednisone therapy. We report this patient as a case consistent with drug-induced Sweet's syndrome induced by nitrofurantoin.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
2/81. nitrofurantoin-induced lung disease: two cases demonstrating resolution of apparently irreversible CT abnormalities.A reticular pattern on high resolution CT (HRCT) invariably represents significant lung pathology and is the dominant feature of irreversible fibrosis. We present two cases of nitrofurantoin-induced pulmonary toxicity in which the initial HRCT showed a widespread reticular pattern and associated distortion of the lung parenchyma, thought to represent established fibrosis. Follow-up HRCT scans after withdrawal of the drug showed resolution of this supposedly irreversible pattern.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
3/81. Improvement of c-reactive protein levels and body temperature of an elderly patient infected with pseudomonas aeruginosa on treatment with Mao-bushi-saishin-to.OBJECTIVE: To examine the effectiveness of Mao-bushi-saishin-to (Ma-Huang-Fu-Zi-Xi-Xin-Tang in Chinese medicine) (Tochimototenkaido Co. Ltd., Osaka, japan), one of the traditional herbal medicines, against resistant bacterial infection. SETTING: The nursing Center Himawari, Izumo, japan DESIGN, PATIENT, AND PREPARATION: Half of the standard dose of Mao-bushi-saishin-to was prescribed for 7 days to one elderly patient with fever and positive c-reactive protein (CRP) levels suffering from drug resistant pseudomonas aeruginosa. The daily standard dose of Mao-bushi-saishin-to is prepared from 1200 mg of dried extract obtained from three crude drugs, Ephedrae Herba (4 g), Asiasari Radix (3 g), and Aconiti Tuber (1 g). It is certified by the Japanese Ministry of health and Welfare. RESULTS: The patient's fever and CRP level returned to normal levels. CONCLUSIONS: In cases in which the fever does not fall in response to antibiotics for at least 3 days, half of the standard dose of Mao-bushi-saishin-to for 7 days might be worth trying to induce remission, especially for elder patients.- - - - - - - - - - ranking = 2keywords = drug (Clic here for more details about this article) |
4/81. pharmacokinetics of gemcitabine and 2',2'-difluorodeoxyuridine in a patient with ascites.Gemcitabine (dFdC) is a prodrug that undergoes metabolism by cytidine deaminase to form an inactive metabolite, 2',2'-difluorodeoxyuridine (dFdU). The pharmacokinetics of dFdC and dFdU have been studied; however, their disposition has never been evaluated in a patient with ascites. A patient with pancreatic cancer and malignant ascites was treated with dFdC 1,500 mg/m2 over 150 minutes weekly for 3 weeks, repeated every 4 weeks. Serial plasma and ascites samples were obtained on weeks 1 and 2 of cycle 2. High-pressure liquid chromatography was used to quantify dFdC and dFdU in plasma and ascites. The systemic dispositions of dFdC and dFdU were similar to those reported in patients without ascites. The concentration of dFdC in ascites approached 1 mg/ml. ascitic fluid did not serve as a depot for dFdC, and the agent's concentration in ascites approached that at which its phosphorylation is saturated.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
5/81. levofloxacin induced polymorphic ventricular tachycardia with normal QT interval.Polymorphic ventricular tachycardia (PVT) is a form of ventricular tachycardia characterized by QRS complexes that seem to change direction during the tachycardia. If associated with a prolonged QT interval, it is called torsades de pointes. In the absence of a congenital long qt syndrome, torsades is seen with certain drugs such as antiarrhythmic agents (Class IA, IC, III), psychotropic medications, antidepressants, antihistamines, and electrolyte disturbances. We report the first case of polymorphic ventricular tachycardia with normal QT interval associated with the oral use of levofloxacin in the absence of other etiologies known to cause these arrhythmias.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
6/81. In vivo selection of pseudomonas aeruginosa with decreased susceptibilities to fluoroquinolones during fluoroquinolone treatment of urinary tract infection.OBJECTIVES: To present a case of fluoroquinolone treatment failure in urinary tract infection caused by pseudomonas aeruginosa, accompanied by in vivo selection of the post-treatment isolate that showed decreased susceptibilities to fluoroquinolones, and to report fluoroquinolone resistance mechanisms in the post-treatment isolate. methods: A patient with urinary tract infection was treated with a suboptimal dose of a fluorinated quinolone, gatifloxacin. P. aeruginosa strains were isolated before and after fluoroquinolone treatment. The pretreatment and post-treatment isolates were examined for relatedness by arbitrarily primed polymerase chain reaction. For these isolates, the minimum inhibitory concentration of antimicrobial agents was determined and mutations in the target genes (gyrA and parC) and regulatory genes (mexR and nfxB) for drug efflux pumps were analyzed. RESULTS: Failure of fluoroquinolone treatment of urinary tract infection was observed. The post-treatment isolate, which was assumed to be isogenic to the pretreatment isolate, exhibited fourfold to 16-fold increases in the MIC of fluoroquinolones. In this isolate, a new mutation, not observed in the pretreatment isolate, was found only in the gyrA gene, resulting in an amino acid change of aspartic acid to asparagine in codon 87 of GyrA. CONCLUSIONS: The P. aeruginosa isolate that was initially susceptible to fluoroquinolones showed decreased susceptibility to fluoroquinolones after treatment with a suboptimal dose of one fluoroquinolone. In the post-treatment isolate, the alteration of GyrA would be responsible for the decreased susceptibility to fluoroquinolones. We should be aware that inappropriate use of fluoroquinolones could select such a strain harboring a quinolone resistance-associated alteration of dna gyrase.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
7/81. The application of cost effectiveness analysis to derive a formulary for urinary tract infections.According to economic principles an inappropriate prescription is the choice of an antimicrobial with higher/equivalent cost and lower effectiveness (or higher cost and equivalent/lower efficacy) than an alternative (in this case, the former is specified as a "dominated" drug). To identify cost-effective antibiotics we applied the principles of incremental cost-effectiveness analysis (ICEA) to microbiological data of San Bortolo Hospital. Its 27 wards were grouped in 9 functional areas. The resistance patterns of 8 urinary pathogens in the 1997 microbiology data base were assessed. The measure of antibiotic effectiveness was expressed as the percentage of isolates susceptible to each antibiotic tested. The difference in cost (i.e. the incremental change) between each antibiotic and the next more expensive alternative was calculated, and compared with the incremental change in effectiveness. Calculations were made for each pathogen. The antibiotics remaining after exclusion of all "dominated" antibiotics were pooled on a list defined as "Specific Area Formulary". The implications of the use of economic principles within a general antimicrobial policy are discussed.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
8/81. A case of pemphigus vulgaris possibly triggered by quinolones.pemphigus vulgaris is an autoimmune blistering disorder in which both genetic and environmental factors, mainly drugs, are thought to play a part in its aetiopathogenesis. Although some drugs that contain thiol groups, such as D-penicillamine and captopril, and non-thiol drugs, such as cephalosporin, have been reported to trigger or induce pemphigus, there are no previous reports regarding the influence of quinolones in triggering this disease. Here we present a case of pemphigus possibly triggered by quinolones.- - - - - - - - - - ranking = 3keywords = drug (Clic here for more details about this article) |
9/81. Current implications of drug resistance in spinal cord injury.A 54-yr-old man with C6 quadriplegia and a neurogenic bowel and bladder was evaluated for clearance of a urinary tract infection after treatment for organisms susceptible to the antibiotics used, and an organism resistant to all antibiotics on the panel grew on the initial follow-up urine culture. Multidrug-resistant organisms present increasing challenges and risks in the management of the neurogenic bladder in patients with spinal cord injury. In an effort to control and reduce the impact and risk associated with these organisms, management methods of the neurogenic bladder and infection control policies should be adjusted according to guidelines from the Centers for disease Control and related research; such policies could include surveillance for multidrug-resistant organisms and isolation of patients who test positive for these organisms.- - - - - - - - - - ranking = 6keywords = drug (Clic here for more details about this article) |
10/81. levofloxacin-induced granulomatous interstitial nephritis.The authors report the case of a 47-year-old woman in whom a systemic illness developed characterized by fever, malaise, abnormal liver function results, and acute renal failure after treatment for presumed urinary tract infection with levofloxacin. Because of suspicion of an allergic drug reaction, all medications were discontinued, but the patient remained febrile with renal failure for 18 days. Complete workup for presumed vasculitis, autoimmune illness, or infectious etiologies was negative, and the patient underwent both renal and liver biopsy. liver biopsy results showed nonspecific changes. Renal biopsy disclosed extensive granulomatous interstitial nephritis with associated granulomatous vasculitis. The patient was begun on oral steroids with rapid defervescence of fever and progressive normalization of renal function. The authors discuss the association of granulomatous nephritis with drugs and review the known nephrotoxicity of fluoroquinolones.- - - - - - - - - - ranking = 2keywords = drug (Clic here for more details about this article) |
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