ABSTRACT
About 2 per cent of adults have active chronic otitis media, the majority being managed by medical means. Previous controlled studies have been unable to show benefit from any medication, including systemic or topical antibiotics, but the effect of the addition of topical steroids to the latter has never been evaluated. One hundred and sixty three adults with active chronic otitis media were randomly allocated to receive either antibiotic/steroid ear drops or placebo therapy over a 4-6 week period. Fifty-two per cent of ears receiving active therapy, as opposed to 30 per cent on placebo therapy (p less than 0.05), became otoscopically inactive if compliance to medication was greater than 70 per cent. However, when there was an open mastoid cavity, active therapy was no more successful than placebo. Though gentamicin was the antibiotic used, there was no evidence of ototoxic inner ear damage. Surprisingly, correlation between clinical activity and patient report of a discharge was poor. Forty per cent of both treatment groups considered that their ear had become dry following therapy and these were not the same patients whose ears had become otoscopically inactive.
Subject(s)
Gentamicins/therapeutic use , Hydrocortisone/therapeutic use , Otitis Media, Suppurative/drug therapy , Otitis Media/drug therapy , Administration, Oral , Administration, Topical , Adult , Aged , Chronic Disease , Clinical Trials as Topic , Drug Therapy, Combination , Female , Gentamicins/administration & dosage , Gentamicins/adverse effects , Humans , Hydrocortisone/administration & dosage , Male , Middle Aged , Prospective Studies , Random AllocationSubject(s)
Antiemetics/therapeutic use , Dronabinol/analogs & derivatives , Prochlorperazine/therapeutic use , Vomiting/chemically induced , Adult , Aged , Antineoplastic Agents/adverse effects , Clinical Trials as Topic , Double-Blind Method , Dronabinol/therapeutic use , Drug Therapy, Combination , Female , Humans , Male , Middle Aged , Vomiting/drug therapySubject(s)
Chlorpromazine/administration & dosage , Metoclopramide/administration & dosage , Nausea/drug therapy , Vomiting/drug therapy , Cisplatin/adverse effects , Clinical Trials as Topic , Double-Blind Method , Female , Humans , Injections, Intramuscular , Injections, Intravenous , Male , Middle Aged , Nausea/chemically induced , Random Allocation , Vomiting/chemically inducedABSTRACT
Nabilone, a synthetic cannabinoid, and Prochlorperazine were compared in a double-blind crossover study of 34 patients with lung cancer undergoing a 3-day schedule of chemotherapy with Cyclophosphamide, Adriamycin and Etoposide. Symptom scores were significantly better for patients on nabilone for nausea, retching and vomiting (P less than 0.05). Fewer subjects vomited with nabilone (P = 0.05) and the number of vomiting episodes was lower (P less than 0.05); no patients on nabilone required additional parenteral anti-emetic. More patients preferred nabilone for anti-emetic control (P less than 0.005). Adverse effects common with nabilone were drowsiness (57%), postural dizziness (35%) and lightheadedness (18%). Euphoria was seen in 14% and a "high" in 7%. Erect systolic blood pressure was lower in nabilone patients on Day 1 (P = 0.05) but postural hypotension was a major problem in only 7%. Nabilone is an effective oral anti-emetic drug for moderately toxic chemotherapy, but the range and unpredictability of its side-effects warrant caution in its use.
Subject(s)
Antiemetics/therapeutic use , Dronabinol/analogs & derivatives , Lung Neoplasms/drug therapy , Adult , Aged , Antiemetics/adverse effects , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Carcinoma, Small Cell/drug therapy , Clinical Trials as Topic , Dizziness/chemically induced , Double-Blind Method , Dronabinol/adverse effects , Dronabinol/therapeutic use , Female , Humans , Male , Middle Aged , Nausea/prevention & control , Prochlorperazine/therapeutic use , Sleep Stages , Vomiting/prevention & controlABSTRACT
A mixed bacterial flora of aerobic and anaerobic organisms can be isolated from the mucopurulent discharge in nearly 50% of individuals with active chronic otitis media. The role of the anaerobic flora has never been defined. A total of 33 patients with a mixed bacterial flora were treated with metronidazole alone or in combination with systemic antibiotics. The anaerobic flora was eliminated in 15 of 23 compliant individuals but the ears remained clinically active or mucoid in all. Anaerobic organisms would appear unlikely to be the primary pathogen in active chronic otitis media. Metronidazole alone or in combination with systemic antibiotics would also appear to be an ineffective medical treatment of active chronic otitis media as none of the 23 ears became inactive.
