[Apropos of 5 cases of listeriosis. Review of the Belgian and foreign literature].
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Adult↗
Biomedical subjects
J Sternon
Publications and source records attributed to J Sternon.
[Multiple and recurring gastroduodenal ulcers, initial signs of Brill-Symmers disease].
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Aged↗
Open randomized study comparing doxycycline and co-amoxiclav in the treatment of acute suppurative tracheobronchitis in adults. The Collaborative Group of the Centre Universitaire de Medécine Générale de L'Université Libre de Bruxelles (CUMG-ULB) Investigators.
Doxycycline and co-amoxiclav were compared in a randomized clinical trial involving adult patients with acute suppurative tracheobronchitis. Patients were treated for 5 to 10 days with either antibiotic following three schemes: co-amoxiclav 500 mg three times daily, or doxycycline 200 mg on day 1 followed by 100 mg daily, or 200 mg daily. Assessment after 5-9 days was based only on clinical parameters. Patients with inadequate response to the initial treatment were crossed over to the alternative antibiotic. Of the 210 patients enrolled, 206 were available for evaluation of efficacy. Both antibiotic regimens proved equally efficacious, with rates of clinical response (cure or improvement) of 89% and 91% for doxycycline and coamoxiclav, respectively. Patients who were crossed over to the alternative antibiotic had a significantly lower cure rate after their second course of antibiotics (22% compared with 70%). Adverse effects, most often of gastro-intestinal origin, were more common in the co-amoxiclav group than in the doxycycline-treated group, but rarely caused cessation of treatment.
Acute Disease↗
Azithromycin compared with clarithromycin in the treatment of adult patients with acute purulent tracheobronchitis: a cost of illness study.
Adult, professionally active patients with acute purulent tracheobronchitis were treated with azithromycin (3 or 5 days; n = 62) or clarithromycin (7 to 10 days; n = 69) in an open, randomized study. Bronchitis-related costs and treatment efficacy were assessed at day 5-6 and day 14-21. Both antibiotics were of equal clinical efficacy, although the median time to improvement of symptoms was significantly shorter for azithromycin patients than for clarithromycin patients. Some 77% of azithromycin patients and 78% of clarithromycin patients were unable to work for at least 1 day. The total time when patients were unable to work was shorter for azithromycin patients than for clarithromycin patients, but this difference did not remain significant when weekends and holidays were taken into account. Further studies are needed to assess the impact of azithromycin on time to clinical improvement, on lost working days, and on the associated costs.
Absenteeism↗
[Multiple bacterial resistance in daily practice].
Present and future solutions to the problem of bacterial multiple resistance involve physicians, patients and veterinarians. Their behaviour should evolve to take into account the medical and economical issues of antibiotic prescription. The clinical diagnosis requires a more rigorous assessment, based on bacteriological and rapid antigenic tests. Vaccination in both young people and the elderly, is an essential prophylactic tool, which is too often neglected. When a bacterial infection is suspected or proven, priority should be given to a targeted antimicrobial therapy with a bactericidal activity, in order to quickly eradicate pathogens. Therapies should be shorter and questionable antibioprophylaxis should also be avoided. A watch laboratory network should provide physicians with an adequate information on local bacterial resistance patterns on a regular basis, in order to allow them adjusting their prescription.
Bacterial Infections↗
[The coxibs, third generation of non-steroidal anti-inflammatory agents].
The coxibs, specific anti-Cox-2, represent an interesting evolution for the treatment of patients suffering from rheumatic conditions and presenting gastrointestinal ulcer risk. Anti-inflammatory effectiveness is comparable with the other NSAIDs, but the toxicity for the gastrointestinal mucosa is slightly lower. Contra-indications, extradigestive adverse effects and interactions are the same as for any other NSAIDs. Their risks and cost must be taken into account as such as the rheumatic condition of the patient. They may be prescribed to patients presenting a gastrointestinal risk and the relevant cost is reasonable. Pharmacovigilance survey at mid to long term is necessary.
Animals↗
[Cholinesterase inhibitors in Alzheimer's disease].
During the last years, treatment of Alzheimer's disease has improved following a better detection of this disease and, more importantly, following a better knowledge of its physio-pathogeny. After years of aspecific symptomatic treatments, acetylcholinesterase inhibitors have been recently released and can be considered as a specific symptomatic treatment. In this pharmacologic class, more practical and less toxic drugs are nowadays available. Treatments of behavioral disturbances have also been recently improved. Nowadays we have to find treatments able to modify the clinical evolution and eventually prognosis of this disease, and even to prevent it for the patients at risk. Nevertheless a simplification of the prescriptions is justified, to the detriment of drugs without any proven activity.
Alzheimer Disease↗
[New molecules].
Presentation of six drugs: clopidogrel, raloxifene, mecillinam, natiglinide and repaglinide, pneumococcal conjugate vaccine. For each, positive and negative arguments, questions on hold and rating.
Amdinocillin↗
[Flouroquinolones of the third and fourth generations].
Levofloxacin, levorotatory isomer of ofloxacine, is the only FQ3G on the belgian market since the middle of 2000 and is a little more efficient than the FQ2G against S. pneumoniae. The FQ4G are in vitro active against the common and atypic respiratory pathogenes and significantly more efficient against the Gram positive cocci, principally against S. pneumoniae. Their long duration of action allows one oral administration a day sufficient to obtain bactericidal levels in the serum. Their secondary effects are located principally at the level of digestive tract, neurologic system or cutaneous area. In the U.S.A., several FQ4G (clina-, grepa-, spar-, trova-floxacin) were withdrawn from use after observance of severe toxicity, while there were being administrated on a large scale. Furthermore, two of these "respiratory" FQ4G (gemi- and moxifloxacin) should reinforced our therapeutic armoury, moxifloxacin as of 2002 and gemifloxacin as of 2004. The position of FQ3G and 4G are in discussion. In the case of pneumonia acquired in the community and confirmed by X-Ray, our recommendation is to administer a new FQ at the first choice if the patient is allergic to penicillin, debilitated or if a penicillin resistant S. pneumoniae is suspected (epidemiology, recent antibiotherapy) and at the second choice if it is resistance to penicilline or to macrolide, in case of atypic pneumonia. Today, the majority of the pneumonia acquired outside the hospital is empirically treated with a betalactam (oral or intravenous), with or without macrolide. The new FQ are important drugs. One must avoid overprescription which leads to bacterial resistance (especially S. pneumoniae).
Anti-Infective Agents↗
[Generics: similarities, bioequivalence but no conformity].
The using of generic forms (GF) is presented as a potential source of budgetary "saving of money" in the field of pharmaceutical expenses. Not frequently prescribed in Belgium, they win a new interest thanks to the recent making use of the "reference repayment". Sale's authorization of GF is controlled by european rules, but some questions about their identity to original medications remain. Do similarities based only upon qualitative and quantitative composition in active molecules, pharmaceutical forms and biodisponibility give us all requested guaranties? Several cases of discordances can appear; the major elements of non conformity are the nature of excipients, notice's contents and the value of biodisponibility studies. However, in term of economy, in the drug market, development of GF appears to constitute an unavoidable phenomenon.
Belgium↗
[Conjugate vaccines].
Conjugate vaccines extend the vaccinal prevention for children to more diseases. Conjugating the capsular polysaccharide to a carrier protein transforms a T-independent antigen in a T-dependent, allowing protection of the children (before 2 years of age) against Haemophilus influenzae type b, meningococcal C and pneumococcal infections. This article reviews the 3 conjugate vaccines and their results with focus on some questions: antigens interference in the immunological response, serological subrogate for protection, herd immunity and replacement of circulating serotypes.
Haemophilus Infections↗
[Dutasteride (Avodart): a novel 5-alpha reductase inhibitor for treatment of benign prostate hypertrophy].
Dutasteride (Avodart), a novel dual 5-alpha reductase inhibitor is effective for the treatment of benign prostate hypertrophy, of more than 30 cc because the reduction of the level of dihydrotestosterone. By reducing prostatic volume, dutasteride improves moderate to severe symptoms and flow rate. It allows a reduction of disease progression by reducing the rate of acute urinary retention and need for surgery.
Azasteroids↗
[Rimonabant (Acomplia), specific inhibitor of the endocannabinoid system].
The endocannabinoid system plays a major role in the regulation of body energy by stimulation of the appetite in the hypothalamus and increase of fat accumulation in adipocytes. The blockade of the cannabinoid system (CB1) by the specific inhibitor (rimonabant) decreases food intake and adiposity in animals and in humans. Moreover rimonabant lowers tobacco addiction. Clinical studies (RIO-LIPIDS and RIO-EUROPE) have recently confirmed that rimonabant combined with a hypocaloric diet over 1 year, promoted significant decrease of body weight, waist circumference and improvement of dyslipidemia. Rimonabant was well tolerated with mild and transient side effects. The future place of rimonabant in the strategy of obesity is still to be clarified.
Animals↗
[Treatment of Paget's disease of bone with zoledronic acid].
Bone pain and bone deformities are the most common manifestations of Paget's disease of bone, even if the diagnosis is nowadays most often made by chance following a routine measurement of serum alkaline phosphatase. Woven bone is formed following a marked increase in bone resorption due to a stimulation of osteoclast activity. Biphosphonates constitute the modern treatment of Paget's disease of bone. Tiludronate (Skelid), or better risedronate (Actonel), are administered orally every day during at least 2 months. Zoledronic acid (Aclasta), as a single 15-min 5 mg infusion, has been recently compared to risedronate, 30 mg/d orally for 2 months, in two randomized studies including 357 patients. Zoledronic acid had a superior therapeutic efficacy, as judged by its rapidity of action, the duration of the biochemical response and the percentage of responders. Thus, at 6 months, alkaline phosphatase levels were normalized in 89% of the patients in the zoledronic acid group as compared to 58% in the risedronate group. The most frequent side effect was a flu-like syndrome, observed in 10% of the patients. An adequate intake of calcium and vitamin D is recommended to avoid posttreatment hypocalcemia. The introduction of Aclasta should simplify and improve the therapeutic management of Paget's disease of bone.
Bone Density Conservation Agents↗
[Omega-3 fatty acids and cardiovascular diseases].
Most--but not all--epidemiological studies have demonstrated that omega-3 intake, either from nutrition or supplementation, reduces cardiovascular risk. A few intervention studies have shown a reduction of studden death in patients followed after a myocardial infarction. However EBM studies from the Cochrane Library do not confirm the real advantage of omega-3 in any group of subjects. Probably, the most interesting prescription of omega-3 supplementations would benefit to the patients after myocardial infarction, in addition to drugs that have proved their efficacy (aspirine, beta-blocker statin and ACE inhibitor).
Cardiovascular Diseases↗
[Insulin analogues: place of detemir (levemir)].
Insulin detemir (Levemir) is a soluble long-acting human insulin analogue acylated with a 14-carbon fatty acid. Insulin detemir is 98-99% albumin bound in plasma. It has a more predictable glucose-lowering effect than NPH insulin or insulin glargin. There is a dose-response relationship, but at the dose of 0.4 units/ kg (an average normal dose), the duration of action reaches nearly 24 h. Therefore, detemir, most often injected once per day at bedtime, seems to be the ideal basal insulin in the basal-prandial therapy for type 1 diabetic patients. The boli of insulin, in order to cover the meals, may be done with a rapid acting human insulin and/or a fast acting analogue. In comparison with NPH insulin, detemir has been shown to reduce the risk of (severe) hypoglycaemias, particularly nocturnal (up to 50%). Fasting hyperglycaemia is often lower, but it is not necessarily true for glycated haemoglobin. In addition, detemir has been associated with less weight gain than NPH insulin. Detemir is well tolerated and no specific safety concerns have been raised.
Diabetes Mellitus, Type 1↗
[Omalizumab, an anti-IgE monoclonal antibody to treat severe asthma].
Omalizumab (Xolair) is the first representative of a new therapeutical class, which will be soon available in severe allergic asthma. By neutralizing Ac IgE, omalizumab fulfils an anti-inflammatory action of which the effect has been shown beneficial in the treatment of severe allergic asthma and particularly in severe asthma for which the therapeutical arsenal is for the time being disappointing and associated to frequent side effects there where omalizumab is well tolerated.
Anti-Inflammatory Agents, Non-Steroidal↗
[Pregabalin (Lyrica) and neuropathic pain syndromes].
Pregabalin is a novel central nervous system (CNS) drug with no interaction at benzodiazepine or GABA receptor. Its mechanism of action is correlated with its high affinity for the alpha/delta submit of the voltage-dependant CNS calcium channel. Pregabalin is rapidly absorbed with at least 90% bioavailable irrespective of dose, does not bind to plasma proteins and is excreted virtually unchanged by the kidneys. Pharmacokinetics are linear and predictable across the therapeutic dose range (150-600 mg/ day). Pregabalin is indicated, like gabapentin, in the treatment of neuropathic pain syndromes like post-herpetic neuralgia (PHN) and diabetic polyneuropathy (DPN). Efficacy in other neuropathic pain syndromes need further investigations. This paper emphasizes advantages and disadvantages on a clinical point of view.
Absorption↗