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Biomedical subjects

S R Knowles

Publications and source records attributed to S R Knowles.

30 records · Page 2Linked to original sources
PubMed1996

Dapsone in prevention of recurrent neutrophilic eccrine hidradenitis.

Neutrophilic eccrine hidradenitis has been described in patients with acute myelogenous leukemia and other malignant diseases, usually during chemotherapy. We describe a 46-year-old man with Hodgkin's disease in whom neutrophilic eccrine hidradenitis developed after each of the first two treatments with lomustine. Dapsone, 100 mg daily, was initiated 48 hours before the patient's third treatment with lomustine and was continued for 14 days. This regimen was successful in suppressing the reaction during the first course and three subsequent courses of lomustine.

Antineoplastic Agents↗
PubMed1996

Serious adverse reactions induced by minocycline. Report of 13 patients and review of the literature.

BACKGROUND: Minocycline has been reported to cause serious, albeit rare, adverse events, including serum sickness-like reaction, hypersensitivity syndrome reaction, and drug-induced lupus. A retrospective review of patients seen in our Adverse Drug Reaction Clinic as well as information obtained from the Health Protection Branch was done to identify patients with minocycline-induced reactions. In addition, the literature concerning serious reactions to minocycline was reviewed. OBSERVATIONS: Six patients with a hypersensitivity syndrome reaction, 6 patients with a serum sickness-like reaction, and 1 patient who had symptoms consistent with drug-induced lupus were identified. A review of the literature identified 11 cases of hypersensitivity syndrome reaction, 1 case of serum sickness-like reaction, and 24 cases of drug-induced lupus. Serum sickness-like reactions occur sooner than hypersensitivity syndrome reactions (15.6 vs 23.7 days, P = .04). Drug-induced lupus occurs on average 2 years after the start of minocycline therapy. CONCLUSIONS: Dermatologists need to be aware of the serious adverse reactions that can develop after minocycline use. In patients who may require long-term therapy with minocycline ( > 1 year), we suggest that antinuclear antibody and hepatic transaminase levels be determined at baseline. Rechallenge with minocycline or other tetracyclines is currently not recommended for patients who develop these serious reactions.

Adolescent↗
PubMed1995

Lithium therapy associated with hidradenitis suppurativa: case report and a review of the dermatologic side effects of lithium.

Lithium is frequently used in the management of several psychiatric disorders including acute mania, bipolar (manic-depressive) disorder, and recurrent depression. We describe a patient in whom hidradenitis suppurativa developed while the patient was receiving lithium. The cutaneous side effects of lithium are reviewed. The most frequent are psoriasis, acneiform lesions, folliculitis, alopecia, and a maculopapular/macular eruption. Many of these side effects respond less readily to conventional therapy while the patient is receiving lithium.

Acne Vulgaris↗
PubMed1995

Azathioprine hypersensitivity-like reactions--a case report and a review of the literature.

Azathioprine is used in a variety of dermatological conditions. However, because of its side-effect profile, azathioprine is limited for use in patients with severe disease. An unpredictable, rare and potentially fatal side-effect of azathioprine is the development of a hypersensitivity reaction, often consisting of fever, hypotension and oliguria. We describe a 17-year-old patient with leucocytoclastic vasculitis who was placed on azathioprine; within 15 days of start of therapy, she developed a fever. Azathioprine was discontinued and an evaluation for sepsis was undertaken; all cultures were negative and the fever abated. Azathioprine was restarted 5 days later. After a single dose, fever, nausea and vomiting, diarrhoea, hypotension, tachycardia and oliguria developed and the patient was admitted to an intensive care unit. Azathioprine was discontinued and investigations revealed no sign of an infection. All the above signs and symptoms abated within 24 h and the patient was discharged from hospital in 7 days. A review of 28 case reports in the literature of azathioprine-induced hypersensitivity reactions suggest that most commonly a fever and gastrointestinal symptoms occurred on initial presentation. In addition, a maculopapular rash, urticaria, vasculitis, erythema multiforme or erythema nodosum may occur. Hepatotoxicity and nephritis have also been reported. The aetiology of the reaction is unknown but sudden onset of fever and hypotension suggests that this reaction may be due to cytokine or mediator release induced by azathioprine. As azathioprine is metabolized to 6-MP, rechallenges to both should be avoided in patients who experienced an azathioprine hypersensitivity-like reaction.

Adolescent↗
PubMedDate not supplied

A cost-utility analysis of second-line antibiotics in the treatment of acute otitis media in children.

Newer antibiotics have higher acquisition costs than the first-line antibiotics but may offer superior outcomes, including enhanced eradication of resistant organisms, safety, and compliance in the treatment of acute otitis media. A rational choice among differing therapies should systematically address all these factors. We conducted a cost-utility analysis to compare the commonly used second-line antibiotics--cefaclor (CEF), amoxicillin-clavulanate (AMX-CLA), and erythromycin-sulfisoxazole (ERY-SULF). A meta-analysis of comparative clinical trials was performed to derive point estimates with a 95% confidence interval for rates of success and adverse events. Costs for drugs, laboratory tests, and physician visits were obtained from the government formulary and fee schedules. The cost for management of adverse events was estimated from the findings of a survey of pediatricians. Utilities (preferences or ratings of health states) were derived from responses of physicians to a standardized scenario of acute otitis media with combinations of adverse events. These utilities were used to obtain quality-adjusted life-day (QALD) scores over a 30-day horizon as a measure of effectiveness. Overall cost and QALD were calculated using decision analytic modeling. CEF performed significantly better than the two other drug treatments with the lowest expected cost ($108.00) and highest outcome (28.15 QALD); AMX-CLA was second in cost and third in outcome ($119.00, 27.98 QALD); and ERY-SULF was third in cost and second in outcome ($120.00, 28.03 QALD). These rankings were robust to variations in event rates over the 95% confidence interval. In this analysis, CEF was the most cost-effective antibiotic strategy for second-line therapy when differential success rates, adverse-event profiles, and impact on quality-of-life were considered.

Anti-Bacterial Agents↗