A post-marketing acceptability study in 11,685 patients of the efficacy of timolol/bendrofluazide in the management of hypertension in general practice.

A post-marketing acceptability study was performed in 11,685 patients to assess the efficacy and acceptability of 10 mg timolol/2.5 mg bendrofluazide in patients with mild to moderate hypertension in general practice. The initial dose was 1 tablet/day. This was adjusted at weekly intervals up to a maximum of 4 tablets/day or until blood pressures of less than or equal to 95 mmHg diastolic or, in patients of greater than or equal to 60 years, less than or equal to 100 mmHg plus the patient's age (in years) systolic, were achieved. Stabilized patients were followed-up after 12, 24 and 48 weeks. Of the patients enrolled, 69% (8039) were successfully treated for at least 8 weeks, 26% (3033) were withdrawn and 5% (613) defaulted. One tablet/day was required by 61% of patients and 29% required 2 tablets/day to achieve stabilization. The mean reductions in systolic and diastolic blood pressures and pulse rate were 31 and 19 mmHg, and 11 beats/min, respectively. Over 60% of the patients enrolled were still taking timolol/bendrofluazide after 12 months' continuous therapy. The most frequently reported reason for withdrawal was an 'adverse event' which occurred in 15.4% (1805) of patients. Only 1.9% (217) failed to achieve target blood pressure on 4 tablets/day. This large study has shown timolol/bendrofluazide to be a highly effective and acceptable once daily therapy for mild to moderate hypertension in general practice.

Long-term follow-up of 500 patients with mild to moderate hypertension who had successfully completed a 3-month general practice study of a timolol-bendrofluazide combination ('Prestim').

A sample of 500 patients with mild to moderate hypertension, who had been successfully controlled on once daily timolol/bendrofluazide at the end of a 3-month general practice study, was followed up after approximately 1 year of treatment. Physicians who had participated in the trial were questioned on the current status of these patients. Out of 479 reports received, data showed that 358 (75%) patients were still normotensive 47 weeks after starting treatment with timolol/bendrofluazide and in a further 8 patients other antihypertensive agents had been added to this therapy. Of the 113 patients no longer receiving timolol/bendrofluazide, only 38 (7.9%) had stopped therapy due to adverse effects. It is concluded that the results are a further indication that timolol/bendrofluazide offers an acceptable and balanced long-term form of therapy in hypertension for both the patient and the physician.

A multi-centre general practice clinical evaluation of pivmecillinam plus pivampicillin ('Miraxid') and co-trimoxazole ('Septrin') in respiratory tract infections.

Seven-day courses of either 200 mg pivmecillinam plus 250 mg pivampicillin or co-trimoxazole (800 mg sulphamethoxazole plus 160 mg trimethoprim) given twice daily were compared in a multi-centre general practice study in 318 patients with signs and symptoms of upper or lower respiratory tract infection. Patients were stratified into four diagnostic groups (sinusitis, otitis media, throat infections, and acute bronchitis) and randomly allocated to treatment within these groups. Assessments at Day 7 showed that both treatments were equally effective clinically, 154 (91%) patients in the pivmecillinam plus pivampicillin group showing clinical cure or improvement and 142 (88%) patients in the co-trimoxazole group. Side-effects were reported by 19 (11.9%) patients in the pivmecillinam plus pivampicillin group and by 24 (15.8%) patients in the co-trimoxazole group. Two patients in the pivmecillinam plus pivampicillin group and 4 patients in the co-trimoxazole group stopped treatment.

A clinical comparison of pivmecillinam plus pivampicillin (Miraxid) and a triple tetracycline combination (Deteclo) in respiratory infections treated in general practice.

Seven-day courses of either pivmecillinam 200 mg plus pivampicillin 250 mg (Miraxid) or a combination of tetracycline hydrochloride, chlortetracycline hydrochloride and demeclocycline hydrochloride (Deteclo) 300 mg, both given twice daily, were compared in a multicentre general practice study in 408 patients with symptoms of upper or lower respiratory tract infection. Patients were stratified into four diagnostic groups: sinusitis, otitis media, throat infections, and acute bronchitis and randomly allocated to treatment within these groups. Assessment at 7 days showed no difference in clinical efficacy between the two treatments where 193 of the 208 infections receiving Miraxid (93%) were rated as either cured or improved compared with 181 of the 201 infections treated with Deteclo (90%). At 7 days, the percentage of patients completely free of symptoms was the same for both groups (66%). The mean time for symptoms to clear was 3.9 days in the Miraxid group and 4.0 days in the Deteclo group. Side-effects were reported by significantly fewer patients in the Miraxid group (9.3%) than the Deteclo group (17.5%) (p less than 0.05) and six patients in the latter group failed to complete the course of treatment. Miraxid given twice daily for respiratory tract infections is as effective as Deteclo but causes significantly fewer side-effects.

A multi-centre general practice comparison of a fixed-dose combination of pivmecillinam plus pivampicillin with amoxycillin in respiratory tract infections.

Seven-day courses of either 200 mg pivmecillinam plus 250 mg pivampicillin given twice daily or 250 mg amoxycillin given 3-times daily were compared in a multi-centre general practice study in 350 patients with symptoms of upper or lower respiratory tract infection. Patients were stratified into four diagnostic groups: sinusitis, otitis media, throat infections, and acute bronchitis, and randomly allocated to treatment within these groups. Assessments at 7 days showed no difference in overall clinical efficacy between the two treatments; however, patients with acute bronchitis showed a better response to pivmecillinam plus pivampicillin. After treatment, signs of infection were absent in 139 (79%) patients in the pivmecillinam plus pivampicillin group and in 143 (80%) patients in the amoxycillin group. Both treatments were well tolerated, adverse effects being reported in only 17 (9.8%) patients after pivmecillinam plus pivampicillin and 15 (8.6%) patients after amoxycillin. These were mainly associated with disturbances of the gastro-intestinal tract where reports of diarrhoea were twice as common after amoxycillin.

Housing and health. The role of the environmental health practitioner.

From a health standpoint, the residential environment is both the dwelling and its associated areas. The dwelling and related area are interrelated both in terms of sanitation problems affecting physical health and other problems affecting mental health. The residential environment certainly represents a complicated public health problem. The issue of inadequate shelter has been addressed throughout history, but the relationship of shelter and health brings it to our attention now. It is estimated that one out of every four persons in our nation lives with some kind of shelter deficiency. The Federal Housing Act of 1949 was instrumental in creating an awareness that the quality of shelter and the surrounding environment has a great influence upon the physical and mental health and well-being of each individual. When the Housing Act of 1949 was passed, the American Public Health Association Committee on the Hygiene of Housing acknowledged the role public health agencies would have in eliminating and preventing health hazards associated with substandard dwellings. It also recognized the need for a formal code to establish minimum standards for the condition and maintenance of dwellings.

Preliminary experience with parenteral mecillinam.

Case reports are reviewed of 26 patients, mainly with severe Gram-negative infections, treatment with parenteral mecillinam. Twenty-three patients received other antibiotics in addition to mecillinam. In 19 patients, potentially synergistic antimicrobial therapy was given. Overall, a beneficial clinical effect was recorded in 17 (68%) of the 25 patients assessed. A better response was observed in those patients who had not received other antibiotics before treatment with mecillinam was instituted. It is concluded that parenteral mecillinam may have an important role in the treatment of severe Gram-negative infections.

A novel adaptation of the information game for the development of a new drug.

Medical advisers in the pharmaceutical industry have an important function and place in the development and evaluation of new drugs. Although mainly involved in the human and clinical investigations, it is essential that they have the background knowledge and experience to evaluate the results of pre-clinical studies and to apply these safely and effectively to the clinical situation. It is rare nowadays for a medical adviser to obtain direct experience in all areas of drug research due to its complexity. Simulation exercises are a means of obtaining this experience without suffering the results of a wrong decision. An adaptation of the Information Game proved to be a useful and acceptable means of illustrating the decisions that need to be made in a drug development programme and at the same time provided experience in coping with the various problems that might arise in such a programme. The training objectives of the game should be clearly defined at the outset in order to concentrate on the parts of the game that really matter and cover the maximum number of teaching opportunities.

The organization of a postgraduate training course for medical advisers in the pharmaceutical industry.

A postgraduate training and education course for physicians working in the field of pharmaceutical medicine is described. The course proved welcome and acceptable to the participants and provided valuable experience for the organizers. The scientific content and information gained in organizing the course have been incorporated in the planning of a postgraduate diploma course in pharmaceutical medicine.

Intravenous fusidic acid ('Fucidin') in the management of severe staphylococcal infections: a review of 46 cases.

Case reports are reviewed of 46 patients with severe, life-threatening infections, mainly staphylococcal, who were treated with intravenous fusidic acid. Overall, 22 (48%) patients survived and 24 died, 10 of these within 24 hours of commencing treatment with fusidic acid. Thirty-nine patients received unsuccessful antibiotic therapy prior to the administration of fusidic acid. It was not possible to relate prior antibiotic treatment to outcome, and, in such severe infections, complicating diseases had an adverse effect upon survival. It is concluded that intravenous fusidic acid ('Fucidin') has an important place in the treatment of severe staphylococcal infections.