Search PubMed⌕ Search

Biomedical subjects

A Del Favero

Publications and source records attributed to A Del Favero.

At least 55 records · Page 3Linked to original sources
PubMed1993

The new fluorinated quinolones for antimicrobial prophylaxis in neutropenic cancer patients.

Fluoroquinolones are the most attractive agents for prophylactic use in neutropenic cancer patients, due to their broad antimicrobial spectrum, high concentration in the faeces, systemic bactericidal activity, uncommon emergence of resistant strains and good tolerability. They have proved to be more effective than placebo, oral non-absorbable antibiotics or cotrimoxazole in the prevention of Gram-negative infections. In a prospective, randomised multicentre study performed by the GIMEMA infection program, ciprofloxacin was demonstrated to be more effective than norfloxacin for the reduction of febrile episodes, use of systemic antibiotics, and Gram-negative infections in neutropenic patients with haematological malignancies. The greater efficacy may be related to its better systemic or greater antibacterial activity. The potential problems related to the prophylactic use of fluoroquinolones are the increasing prevalence of Gram-positive infections caused by streptococci and coagulase-negative staphylococci; the reported emergence and nosocomial spread of resistant strains, especially among coagulase-negative staphylococci; the lack of their usefulness as empirical therapy in febrile neutropenic patients. Fluoroquinolones are today the better choice for preventing Gram-negative infections in neutropenic patients and ciprofloxacin should probably be preferred. More information on their efficacy and their relationship to the overall susceptibility of micro-organisms in patients with cancer would be valuable, and careful monitoring of patients treated with these drugs is therefore warranted.

Anti-Bacterial Agents↗
PubMed1993

Ondansetron.

Ondansetron is the first selective antagonist of the 5-hydroxytryptamine receptors (type 3) marketed for the prevention of emesis induced by antineoplastic agents. Ondansetron has been shown to be more active and less toxic than high-dose metoclopramide in patients submitted to cisplatin chemotherapy. Furthermore, when dexamethasone was added to ondansetron, its antiemetic efficacy increased significantly. In the prevention of emesis induced by a high single dose of cisplatin or by repeated low doses, ondansetron combined with dexamethasone has been shown to be the more efficacious and less toxic antiemetic treatment. However, in the prevention of delayed emesis from cisplatin, its role is still to be defined. In patients submitted to moderately emetogenic chemotherapeutic agents, ondansetron has shown an efficacy superior or equal to standard doses of metoclopramide, but is less toxic. Moreover, when compared with dexamethasone, its antiemetic efficacy and tolerability is similar; in this group of patients ondansetron should be used only when steroids fail. Ondansetron toxicity is generally mild; in particular, it does not induce extrapyramidal reactions. The most frequent side-effects are headache and constipation.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1993

Reliability and validity of a quality of life questionnaire in cancer patients.

Two studies were sequentially conducted to validate a new questionnaire which takes into consideration the most important variables which could influence quality of life evaluation. Particular attention was given to the methodology employed to collect data and to the patients' characteristics. In the first study 80 consecutive cancer patients were randomised to twice fill in one of four different types of questionnaire, each one characterised by a different polarisation of semantic and syntactic extreme values of the visual linear analogue (for instance, "very much" always on the right, regardless of the semantic value of the answer; positive semantic value always on the right, regardless of whether it was "very much" or "not at all"; and so on). The second study, conducted on 60 lung cancer patients, consisted in testing the reliability (by measuring the reproducibility in different ways) and the validity (by performing a factor analysis) of the type of questionnaire indicated by the first study as the most reliable. The internal coherence was also evaluated by measuring the effects of physical and psychological conditions on the responses.

Adult↗
PubMed1993

Reducing chemotherapy-induced nausea and vomiting. Current perspectives and future possibilities.

Nausea and vomiting are among the most distressing adverse effects of cancer chemotherapy. In the last 10 years considerable advances in the prevention of chemotherapy-induced emesis have been made. From an analysis of the results obtained in patients receiving moderately- to severely-emetogenic drugs the following guidelines in choosing the best antiemetic treatment can be given: 1. For the prevention of acute emesis induced by a high single dose of cisplatin (> or = 50 mg/m2) or by low doses (20 to 40 mg/m2) repeated for 4 to 5 days, the combination of ondansetron plus dexamethasone is the most efficacious and least toxic antiemetic therapy. 2. For the prevention of delayed emesis the combination of oral dexamethasone plus metoclopramide seems to offer the best protection, although over 40% of patients still experience delayed nausea and vomiting. 3. For the prevention of acute emesis induced by moderately emetogenic drugs, corticosteroids (dexamethasone or methylprednisolone) are efficacious and safe antiemetic agents. Although equally efficacious, the serotonin (5-HT)3 receptor antagonists, due to their higher acquisition costs, are indicated only in patients refractory to corticosteroids or in those who cannot use them. Unresolved problems in antiemetic research include: (i) identification of the best antiemetic treatment for those areas of cancer chemotherapy where adequate data are lacking, such as high dose regimens for bone marrow transplantation; (ii) optimisation of treatment for the most widely used chemotherapy regimens; and (iii) identification of the best rescue treatment for patients who fail to respond to antiemetic prophylaxis. Although many new 5-HT3 antagonists are currently being studied, the possible improvement in efficacy and tolerability brought about by these agents will probably only be marginal.

Antiemetics↗
PubMed1992

Antiemetic activity of two different high doses and schedules of metoclopramide in dacarbazine-treated cancer patients.

The antiemetic activity of two different high doses and schedules of metoclopramide in dacarbazine-treated cancer patients was compared in a double-blind crossover study. Regimen A consisted of metoclopramide [2 mg/kg x 4 intravenously (i.v.)] plus methylprednisolone (250 mg x 2 i.v.) plus diphenhydramine (50 mg x 2 i.v.). Regimen B consisted of metoclopramide (3 mg/kg x 2 i.v.) plus dexamethasone (20 mg i.v.) and diphenhydramine (50 mg i.v.). Both treatments were administered for the first 2 days of 5-day dacarbazine chemotherapy. Thirty-two patients (13 men and 19 women) affected by melanoma and sarcoma were entered in the study. Complete protection against nausea and vomiting for the first 2 days of chemotherapy in both antiemetic regimens was not significantly different. Patient preference and tolerance of the two antiemetic treatments were similar. Regimen B, employing a lower dosage of metoclopramide and steroids and using a more simple schedule of administration should be the preferred treatment.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1992

Issues in the measurement of nausea.

Measurement of nausea is essential for the evaluation of efficacy of antiemetic treatment. Frequency, duration and intensity of nausea should be assessed in all trials. Three different methods: a discrete scale (DS), a visual analogue scale (VAS) and a continuous chromatic analogue scale (ACCS) of measuring nausea and four different dimensions maximal intensity, (MI); entity, (E); duration, (D) and quantity, (Q) were evaluated in 849 cancer patients undergoing chemotherapy. A substantial agreement between the different scales was found and no advantage was shown for using an analogue (VAS) rather than a discrete (DS) scale. There was a trend towards increasing sensitivity in detecting differences as the dimension of nausea used encompassed wider aspects of this symptom (Q more sensitive than E more sensitive than MI).

Antiemetics↗
PubMed1991

Effects of parenteral diclofenac sodium on upper gastrointestinal motility after food in man.

In experimental animal models nonsteroidal anti-inflammatory drugs may influence gastrointestinal motility, but as evidence is lacking in man. The effect of diclofenac sodium 75 mg i.m. on the motor response of the upper gastrointestinal tract to food has been studied by manometry in 9 healthy volunteers. Diclofenac had no effect on the motor activity of the stomach, duodenum, or jejunum after a 605 kcal meal.

Adult↗
PubMed1991

Double-blind crossover trial of single vs. divided dose of metoclopramide in a combined regimen for treatment of cisplatin-induced emesis.

In a double-blind crossover antiemetic study in cisplatin-treated cancer patients, metoclopramide 4 mg/kg as a single intravenous dose (regimen A) was compared with 3 mg/kg in two doses (regimen B). In both regimens, metoclopramide was combined with dexamethasone and diphenhydramine. 65 consecutive, chemotherapy-naïve inpatients (45 males and 20 females) treated with high doses (at least 50 mg/m2) of cisplatin entered the study and 54 completed both treatments. Complete protection from vomiting and nausea, mean number of emetic episodes, mean maximum intensity of nausea and mean duration of emesis or nausea were similar with the two antiemetic regimens. 23 patients (43%) did not express a treatment preference, while 16 (30%) preferred regimen B and 15 (28%) preferred regimen A. Side-effects were similar with the two metoclopramide schedules. A combined antiemetic regimen of a single high dose of metoclopramide (4 mg/kg) can preserve efficacy and tolerability and thus should be preferred.

Cisplatin↗
PubMed1991

In-vitro effects of teicoplanin, teicoplanin derivative MDL 62211 and vancomycin on human polymorphonuclear cell function.

The in-vitro effects on human neutrophil (PMN) functions of three structurally related glycopeptide antibiotics, vancomycin, teicoplanin and the teicoplanin derivative MDL 62211 were investigated. Teicoplanin and MDL 62211 significantly inhibited adherence, chemotaxis, phagocytosis and killing of Candida albicans by PMN's at a concentration of 500 mg/l, whereas PMN viability was only affected at drug concentrations of 2000 mg/l. Vancomycin interfered with PMN adherence and phagocytosis only at a concentration of 2000 mg/l without affecting PMN viability. Chemotaxis and killing of C. albicans were also not affected by this concentration. Teicoplanin and the teicoplanin-derivative MDL 62211 was found to have adverse effects on selected indices of PMN function in vitro only at concentrations higher than those employed in therapy, while vancomycin interfered only at very high concentrations.

Anti-Bacterial Agents↗
PubMed1991

The role of gram-positive therapy in the neutropenic patient.

The increasing prevalence of Gram-positive infections in neutropenic cancer patients seems to be related to the use of central venous catheters, chemotherapy-induced oral and gastrointestinal mucositis, and the prophylactic use of fluoroquinolones. The need for anti-Gram-positive therapy in the neutropenic patient is supported by the increasing prevalence and the changing resistance of Gram-positive pathogens, as well as by the poor response of Gram-positive bacteraemia to aminoglycoside plus beta-lactam regimens. Combined therapy with either vancomycin or teicoplanin and other empirical antibiotics, has proved efficacious in adults and children with neutropenia, fever and Gram-positive infection. Vancomycin exerts greater antibacterial activity against strains of coagulase-negative staphylococci than teicoplanin and there is more data on its routine clinical use. In its favour, teicoplanin is less toxic and easier to administer. The time when a glycopeptide antibiotic should be introduced is still a matter of debate; support for both initial therapy and subsequent rescue therapy is found in the current literature. Large clinical trials are warranted to clarify further the role of anti-Gram-positive therapy in the neutropenic patient.

Aminoglycosides↗
PubMed1991

Methodology of antiemetic trials: a review.

Chemotherapy-related nausea and vomiting can be controlled with available antiemetics in a high percentage of patients, while emesis remains a critical problem in some subgroups and with certain drugs. In the ceaseless attempt to find newer drugs and better treatment modalities, a sound methodology in antiemetic research is essential. Several factors should always be considered when planning an antiemetic trial: first, the different emetic power of various chemotherapy agents, their dosages and route and schedule of administration and second, the type of antiemetic used, its dosage and timing, and its possible combination with other antiemetics. Important factors which influence outcome but which are often under-evaluated are those related to patient population such as age, gender, and previous experience with chemotherapy. Considering the relevance of subjective phenomena in nausea and vomiting, it is essential that any study be randomized and double blinded. The parallel type of study design is preferable to the cross-over and a large number of patients is usually required to achieve meaningful results. Efficacy and toxicity should be properly evaluated by trained personnel in a standardized way, using a validated, relatively simple methodology.

Adult↗
PubMed1991

Pharmacokinetics and tolerability of teicoplanin in healthy volunteers after single increasing doses.

In this double-blind, randomized study, five healthy subjects per group received doses of 15, 20, or 25 mg of teicoplanin per kg of body weight, and one subject per group received a 0.9% NaCl placebo as single intravenous infusion over 30 min. Serial blood samples and urine were collected for 13 days postadministration, and concentrations of teicoplanin were determined by microbiological assay. The pharmacokinetic data were analyzed by noncompartmental and compartmental analyses. Laboratory safety tests, audiometry, and serum creatinine clearance measurements were done prior to day 1 and on days 2 and 14. In the three groups, peak levels at the end of the infusion averaged 194, 197, and 253 mg/liter, respectively. Mean concentrations in plasma 24 h after the administration were 10.5, 13.6, and 19.8 mg/liter, respectively. Mean values of volume of distribution at steady state were 0.80, 0.87, and 0.87 liters/kg, respectively. Terminal half-lives averaged 88, 83, and 92 h. Mean total clearance values were 10.9, 11.0, and 11.3 mg/h/kg, respectively, with renal clearance accounting for 75, 81, and 78%, respectively, of the total. The 13-day cumulative mean urinary recovery ranged from 71 to 78% of the dose within the groups. The pharmacokinetics of teicoplanin appears to be linear in the range of administered doses. Teicoplanin was generally well tolerated. Side effects, appearing in five subjects, were represented by fevers, chills, and skin reactions; these adverse reactions were mild, but one episode of rash necessitated the interruption of infusion, and one episode of chills necessitated treatment with corticosteroids. There was no indication of drug-related modifications of laboratory test results.

Adult↗