Biomedical subjects
Publications and source records attributed to R A Gleckman.
Diabetic patients are at risk to develop traditional and unique infections. These infections have suggestive symptoms and signs, but often require radiography and/or tissue biopsy for confirmation. Management of these unique infections typically requires a multidisciplinary approach (medical and surgical).
Adverse drug reactions represent a major source of morbidity and mortality and must be considered in the differential diagnosis for patients who are experiencing new medical problems or whose clinical status is worsening. Familiarity with antibiotic-induced adverse effects can improve drug selection and reduce reactions. Before antibiotic therapy is started, the potential benefits and the possible adverse effects should be weighted in light of each patient's situation. Prevention is the best route, but if adverse events do occur, they must be recognized and corrected promptly.
Fever is a common finding in the patient who is infected with the human immunodeficiency virus. As immunocompetence wanes, febrile episodes become more common, although the virus itself is seldom the cause of the fever. A thorough evaluation, based on the history and physical findings and directed by the level of immunosuppression relative to the CD4+ cell count, provides the framework upon which an approach to this complex problem is based. Noninfectious causes of fever, for example, drug reactions or adverse effects or neoplasms, should be considered in the differential diagnosis. Finally, health care workers should discuss the diagnostic evaluation with the patient before starting the process, as some individuals may be reluctant to undergo such an investigation.
Unique antibiotic concerns exist for the management of infections in elderly patients. Issues concerning age-associated physiological alterations, compliance, drug-drug interactions, adverse drug reactions, and guidelines for empiric therapy are reviewed in this article.
Knowledge of the respiratory pathogens that cause pneumonia, combined with data obtained from the initial history, physical examination, and laboratory studies, provides the framework for an empirical approach to the treatment of community-acquired pneumonia. Selection of empirical therapy is based in large part on which of three broad groups the patient belongs to: previously well young adults, adults who are older or have a history of smoking or alcoholism, or HIV-infected adults. Several newer oral agents offer subtle advantages and disadvantages when compared with traditional agents, and these must be carefully weighed when prescribing treatment.
Elderly patients with persistent unexplained fever require a diagnostic evaluation that focuses on specific infections (eg, occult abdominal abscess, bacterial endocarditis, miliary tuberculosis), rheumatic disorders (eg, temporal arteritis, polyarteritis nodosa), and neoplasms (eg, lymphoma, nephroma). Assessment is directed by the subtle clues elicited from meticulous, repeated history taking and physical examination. Therapeutic trials or exploratory laparotomy may be appropriate but should not be attempted out of a sense of frustration.
Urinary tract infections are the most common bacterial infections experienced by elderly patients. These infections are often asymptomatic, although on occasion they produce discomfort for selective older patients (particularly those with obstructive uropathy), and present a risk for bacteremia, septic shock, adult respiratory distress syndrome, and death. The limited available data suggest that there are major differences with regard to pathogenesis, microbiology, clinical features, laboratory abnormalities, and therapy between young and elderly women who develop symptomatic pyelonephritis. There is a need to provide a standard antibiotic prophylaxis program to those elderly patients with specific cardiac conditions who are scheduled to undergo urinary procedures.
Pneumonia is the most common infectious disease necessitating hospitalization of elderly patients. A number of misconceptions exist regarding the clinical and radiological features of pneumonia in elderly patients. Early recognition and appropriate therapy can reduce morbidity and enhance survival. This article explores the manifestations of pneumonia in the elderly, as well as the diagnostic approach and contemporary therapy.
Third-generation cephalosporins are indicated for treatment of sexually transmitted diseases, resistant salmonellosis, and infections in the febrile leukopenic host. The practicing physician must weigh the expanding role of these agents against their limitations. Some potential problems include bleeding (confined to the use of moxalactam [Moxam] or cefoperazone [Cefobid]), a reaction like that to disulfiram (Antabuse) when combined with alcohol (also confined to the use of moxalactam or cefoperazone), and superinfection. A prolonged course of treatment entails significant expense. Further evaluation and clinical experience is necessary before use of third-generation cephalosporins for some of the newer indications (eg, late stages of Lyme disease, neurosyphilis) becomes routine medical practice.
As the elderly segment of our population expands, physicians will be prescribing medications more frequently for this age group. Physiologic changes, drug-drug interactions, and untoward adverse reactions are more common in the elderly. In addition, therapeutic decisions regarding antimicrobial agents for infectious disease in the aged are also complicated by the burgeoning number of compounds available to clinicians. A thorough knowledge of various antibiotic interactions, potential toxicities, and pharmacokinetics is necessary to safely and effectively prescribe these agents for elderly patients.
The elevated serum glucose levels of diabetics affect traditional host defenses, predisposing these individuals to infectious processes. The elderly diabetic patient is also faced with senescence of the immune system which can alter host defense mechanisms and increase the risk of infection. Infections in elderly diabetics can be severe and life-threatening, and only through the prompt recognition and treatment of these disorders can morbidity and mortality be avoided. Broad-spectrum antimicrobial agents, in conjunction with surgical intervention, are often necessary to eradicate these infections. Common sites of involvement include the skin, biliary tract, urinary tract, and the soft tissues and bones of the feet.
There are unique challenges for the physician who prescribes an antibiotic to an elderly patient. Advanced age is associated with physiological alterations and a reduction in the excretion of numerous compounds. Mental and physical illness in aged patients will impair unsupervised drug compliance. Antibiotic-related adverse events and antibiotic-associated drug interactions pose a threat to life and impede the desired therapeutic outcome.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.