Biomedical subjects
C R Philpot
Publications and source records attributed to C R Philpot.
Drug treatment of sexually transmittable diseases.
Sexually transmittable diseases are an important group of conditions which frequently confront the Australian family practitioner. Primary-care health workers need especially to know how to deal with acute urethritis, persistent vaginitis and recurrent genital herpes, and should be aware of the rapidly spreading world-wide epidemic of drug-resistant gonorrhoea. The drug treatment aspects of managing sexually transmitted diseases in Australia are summarised.
Plesiomonas shigelloides septic arthritis complicating rheumatoid arthritis.
A patient with severe seropositive rheumatoid arthritis and hepatic cirrhosis developed septic arthritis of his knees. Plesiomonas shigelloides was isolated from joint fluid, blood, and also from the gut. The patient's joint symptoms responded to treatment with oral trimethoprim-sulphamethoxazole, but he died of uncontrolled gastrointestinal bleeding five days later.
A survey of sexually transmitted disease centres in Australia.
In a nationwide survey carried out in 1981 centres offering free treatment for sexually transmitted diseases (STD) were located and the facilities available to the public were assessed. At least one special centre was located in each of the eight states and territories of Australia, but not in all cases did the clinics meet the basic requirements recommended by the Australian National Health and Medical Research Council. The STD clinics were almost exclusively found in capital cities, leaving large populations with no locally available specialist advice. The major centres, with one or two notable exceptions, were open only during routine office hours. In several centres staffing levels were barely adequate to cope with patient loads let alone deal with other important work required of reference centres--the training of health care workers, education of high risk groups, and institution of STD control programmes. In several respects the sexually transmitted diseases services in Australia were found to be inadequate to meet the needs of the population.
Absorption and bioavailability of oral erythromycin.
1 Extent and rate of absorption of erythromycin were studied in 24 healthy volunteers whose disposition kinetics after i.v. injections had been previously documented. 2 Two clinically attractive oral dosage regimens were administered: erythromycin stearate tablets 1 h before meals (Regimen A), and erythromycin base capsules 30 min after start of meals (Regimen B), each equivalent to erythromycin 250 mg, 6 h apart for 9 doses. 3 Serum concentrations of erythromycin measured during the 1st and 9th (steady-state) dosing intervals resulted in higher maximum serum concentrations for Regimen A (median 1.1, range 0-3.3 and 2.7, 0.6-7.3 mg/l for Doses 1 and 9, respectively) compared with Regimen B (0.4, 0-2.2 and 1.4, 0.2-4.9 mg/l). 4 Absorption occurred earlier with Regimen A with times to maximum concentrations (median, range) being 128, 60-greater than 360 and 118, 75-210 min for doses 1 and 9 respectively, (lag times 75, 15- greater than 360 and 73, 10-110 min) compared with 303, 130-greater than 360 and 173, 45-greater than 360 min (lag times 183, 70-greater than 360 and 190, 20-330 min) for Regimen B. 5 Where it could be assessed, absolute bioavailability for Regimen A was approximately 30% (Dose 1) and 65% (Dose 9) and 40% for both doses of Regimen B. 6 Whereas individual serum concentration-time curves were accurately predicted by the mean for Regimen A, predictability for Regimen B was impossible due to prolonged and variable lag time. 7 The large intersubject variability in erythromycin serum concentration after oral administration, has been shown conclusively to be related to variability in absorption kinetics and absolute bioavailability rather than to variability in disposition kinetics.
Relapse of antibiotic-associated colitis after vancomycin therapy.
Antibiotic-associated colitis, although occasionally fatal, is a disease which is considered to be self-limiting and non-recurring. Recently, specific treatment with oral vancomycin directed at the trigger organism, Clostridium difficile, has been shown to be effective. A case in which antibiotic-associated colitis was treated with vancomycin and subsequently recurred is described. The fact that such relapse can occur indicates that further evaluation of the efficacy of vancomycin is required.
Significance of enteric gram-negative bacilli in the throat.
Pharyngeal micro-organisms of 131 Australian and Malaysian children and adults were compared by analysis of aerobic culture of throat swab specimens. Enteric Gram-negative bacilli were commonly isolated in small numbers from Malaysian adults whether they had sore throats (28%) or not (36%), but were detected in only 9% of Australian adults without sore throats and in only 12% and 4% of Malaysian children with and without sore throats respectively. In other respects microbiological findings were similar in the different groups of subjects studied. It is concluded that the pharyngeal carriage rate of enteric Gram-negative bacilli may differ substantially between different groups of normal individuals. Our findings also suggest that these micro-organisms do not have a pathogenic role in pharyngitis.
Intersubject and dose-related variability after intravenous administration of erythromycin.
1 It is well-known that considerable variability and unpredictability in serum concentrations results from orally administered erythromycin. 2 Disposition kinetics and their variability were studies in 24 healthy subjects after a single dose of erythromycin lactobionate and four doses were studied to evaluate dose-related variability in five other subjects. 3 Erythromycin kinetics were adequately described by a classical two compartment open model with little intersubject variability. 4 Dose-related variability occurred. Clearance was independent of dose but T1/2 beta and Vdss increased with dose. 5 Data are presented to show that non-invasive sampling of urine and saliva are of limited value in studying erythromycin pharmacokinetics.
Cryptococcal meningitis in pregnancy.
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