Symptomatic vaginal candidiasis after pivmecillinam and norfloxacin treatment of acute uncomplicated lower urinary tract infection.

The comparative incidence of symptomatic vaginal candidiasis associated with pivmecillinam and norfloxacin treatment in women with acute symptomatic uncomplicated UTI was determined in two randomised, double-blind, clinical trials. Adverse events reported following general enquiry were reviewed. Presence of Candida vaginitis was based upon the specification as such by investigators, the presence of specific symptoms such as genital pruritus and/or the prescription of specific anti Candida therapy. The incidences of Candida vaginitis were as follows; Study 1 pivmecillinam 200 mg tid for 7 days 13 (4.6%), pivmecillinam 200 mg bid for 7 days 7 (2.4%), pivmecillinam 400 mg bid for 3 days 6 (2.1%) and placebo 6 (2.1%), P=0.19. Study 2 pivmecillinam 400 mg bid for 3 days 7 (1.5%), norfloxacin 400 mg bid for 3 days 20 (4.3%), P=0.016. The incidence of Candida vaginitis in women with acute symptomatic uncomplicated UTI given 3 days treatment with pivmecillinam 400 mg bid is similar to that seen with placebo and is significantly less than the incidence with norfloxacin 400 mg bid for 3 days.

Patient attitudes to topical antipsoriatic treatment with calcipotriol and dithranol.

OBJECTIVE: Assessment of patient preference for antipsoriatic treatment with calcipotriol ointment or short-contact dithranol cream. METHODS: Two hundred and fifty-eight psoriatic patients treated with calcipotriol (n = 138) or dithranol (n = 120) for up to 3 months, assessed the acceptability of treatment, overall satisfaction with treatment, their treatment preference using the 'willingness to pay' principle and selected their treatment of choice. RESULTS: Overall satisfaction with calcipotriol was significantly better (72.7%, dithranol 60.3%; odds ratio 1.75, 95% CI 1.03, 2.99: P = 0.04). Patients considered calcipotriol a more acceptable treatment than dithranol in its appearance, smell, non-irritancy, method and ease of application and lack of staining. Dithranol was considered less sticky than calcipotriol. Patients were 'willing to pay' a mean of pound sterling 12.16 monthly for calcipotriol and pound sterling 10.66 monthly for dithranol. 'Willingness to pay' did not correlate well with overall treatment satisfaction and was not correlated with household income. Calcipotriol was the preferred treatment of choice (calcipotriol 63%, dithranol 24%). CONCLUSION: Patients with psoriasis prefer treatment with calcipotriol ointment over short-contact dithranol cream.

Comparison of pivmecillinam and cephalexin in acute uncomplicated urinary tract infection.

The clinical and bacteriological efficacy of a 3-day course of pivmecillinam, 200 mg three times daily, was compared with that of a 7-day course of cephalexin, 250 mg four times daily, in 216 patients with a bacteriologically confirmed, acute, uncomplicated, urinary tract infection. Both treatments were similarly effective. Clinical cure or improvement was obtained in 95.3% of patients given pivmecillinam and in 93.6% of patients given cephalexin. Bacteriological success was achieved in 89.7 and 81.7% patients taking pivmecillinam or cephalexin, respectively. Eradication rates for Escherichia coli were 90.1% for pivmecillinam and 80.6% for cephalexin. Both treatments were well tolerated. This study has confirmed that a 3-day course of pivmecillinam is effective and well tolerated in uncomplicated cystitis.

A comparison of treatment with dithranol and calcipotriol on the clinical severity and quality of life in patients with psoriasis.

In a multicentre, randomized, open study, 306 patients of either sex, over 18 years of age with stable chronic plaque psoriasis > 100 cm2 in surface area, and who gave informed consent, applied Dovonex (calcipotriol) ointment (50 micrograms/g) twice daily or Dithrocream (short-contact dithranol) 0.1-2% for up to 3 months. The number of patients 'cleared' or with 'marked improvement' at the end of treatment were: investigators' assessment--calcipotriol 92 of 153 (60.1%); dithranol 67 of 131 (51.1%); odds ratio 1.44 [95% confidence interval (CI) 0.90, 2.31; P = 0.128]; patients' assessment--calcipotriol 93 of 153 (60.8%); dithranol 65 of 131 (49.6%); odds ratio 1.57 (95% CI 0.98, 2.52; P = 0.059). Significant improvement in patients' quality of life as assessed by the Psoriasis Disability Index (PDI) and the Sickness Impact Profile (SIP) were seen in both treatment groups. Reduction in the total mean score for PDI was 6.5 in the calcipotriol group (95% CI 4.4, 8.6; P = 0.001) and 3.7 in the dithranol group (95% CI 1.1, 6.3; P = 0.005). The reduction in the total mean score for SIP was 2.8 in the calcipotriol group (95% CI 1.4, 4.3; P < 0.001) and 1.7 in the dithranol group (95% CI 0.2, 3.1; P = 0.024). Calcipotriol treatment tended to have advantages over treatment with dithranol in improving quality of life.

Long-term use of the low molecular weight heparin tinzaparin in haemodialysis.

Fifty-two patients with chronic renal failure undergoing hospital haemodialysis were given a single bolus dose of tinzaparin (Innohep, Leo Laboratories, UK) into the arterial side of the dialyser, for up to 43 consecutive dialyses. The mean tinzaparin dose at the beginning was 2,139 IU anti-Xa and at the end 2,186 IU anti-Xa. Overall, tinzaparin proved a satisfactory anticoagulant for 1,370 (96.0%) out of 1,427 dialyses. Significant clot formation was prevented in 1,326 (92.8%) out of 1,429 dialyses. The clinically effective dose was associated with a mean plasma anti-Xa activity 1 h after dosing of 0.4 IU/ml and suppressed fibrinopeptide A formation for up to 4 h. Bleeding, from the skin or mucous membranes, was recorded at 27 (1.9%) of 1,408 dialyses. Prolonged fistula bleeding on completion of dialysis was recorded on only 20 occasions. Other haemorrhagic events included haematemesis, bruising and subconjunctival haemorrhage (each in 1 patient) and epistaxis (2 patients). Three patients died during the study of causes considered unrelated to tinzaparin therapy, myocardial infarction (2 patients) and multiple myeloma. Other adverse events reported included vomiting (3 patients) and hypotension (3 patients). Three patients ceased treatment due to haematemesis, prolonged bleeding from fistula puncture and thrombosis of the arteriovenous access, respectively. A small, but statistically significant, increase within the normal reference range was recorded in the mean values for aspartate aminotransferase and alanine aminotransferase.

Intravenous treosulfan versus intravenous treosulfan plus cisplatinum in advanced ovarian carcinoma.

In a prospective, multicentre, randomized trial, the efficacy and tolerance of treosulfan alone was compared with that of treosulfan plus cisplatinum in 135 women with advanced ovarian carcinoma. No statistically significant difference was found between the two treatments in terms of median survival. Combined treatment was associated with significantly greater side-effects and haematological toxicity. Optimal survival with minimal toxicity can be achieved by using treosulfan alone in patients (mainly stages Ic or II) with minimal postoperative residual disease. Patients (likely to be stage III or IV) with greater residual disease should receive treosulfan plus cisplatinum.

Isoprinosine does not influence the natural history of herpes zoster or postherpetic neuralgia.

In a double-blind randomised trial, 38 elderly patients with acute herpes zoster received either isoprinosine (IP) or placebo. IP neither shortened the acute phase of herpes zoster nor prevented postherpetic neuralgia. Transient asymptomatic hyperuricaemia affected one third of IP treated patients. Shortcomings in study design and misleading interpretation of results are common in previously published clinical trials of herpes zoster and postherpetic neuralgia. Guidelines for future studies are proposed.

Fusidic acid in orthopaedic infections due to coagulase-negative staphylococci.

Twenty orthopaedic in-patients who developed an acute infection due to coagulase-negative staphylococci, and which was associated with a foreign body in 11 cases, were treated with fusidic acid. All patients were given oral medication, except for 1 child with acute osteomyelitis who was treated intravenously for the first 7 days. The mean daily dose was 21 mg/kg and the mean duration of treatment 20 days. Fusidic acid was given alone in 5 patients and concurrently with another antibiotic in the other 15 patients. All patients responded satisfactorily with resolution of the relevant signs and symptoms, although 1 patient relapsed subsequently. Mild side-effects were observed in 3 patients.

Nasal carriage and antibiotic susceptibility of Staphylococcus aureus in general practice.

The incidence of nasal carriage of Staphylococcus aureus and the in vitro susceptibility of isolates to fusidic acid, penicillin, erythromycin, methicillin and tetracycline was determined in 204 patients who had been treated previously with a short course of a topical preparation of Fucidin for acute skin sepsis, and in an equal number of control subjects. Staphylococcus aureus was isolated from 36 per cent and 34 per cent of patients in the Fucidin and control groups respectively. Only one of the 144 isolates was resistant to fusidic acid. Short, single courses of topical therapy in general practice are unlikely to be epidemiologically hazardous in the long term. Evidence of possible cross-infection in general practice was obtained.

A comparative trial of pivmecillinam/pivampicillin and amoxycillin/clavulanate in the therapy of urinary tract infection in a general practice population.

Fifty-eight patients seen in general practice presenting with symptoms of acute urinary tract infection were entered consecutively into an open randomized trial of 200 mg pivmecillinam plus 250 mg pivampicillin twice daily or 250 mg amoxycillin plus 125 mg clavulanate 3-times daily for 5 days. The results were analyzed in 41 patients with significant bacteriuria (23 on pivmecillinam/pivampicillin and 18 on amoxycillin/clavulanate). Both antibiotic combinations produced good overall bacteriological cure, but there were a considerable number of persisting symptoms despite the absence of significant bacteriuria. Eight patients in the pivmecillinam/pivampicillin group and 5 in the amoxycillin/clavulanate group had side-effects, principally thrush, vomiting and abdominal pain, and 1 patient from each group ceased treatment for this reason. Sensitivity profiles of urinary isolates (41 trial, 135 non-trial) to both combinations and to ampicillin and mecillinam showed that the majority were fully sensitive to amoxycillin/clavulanate and to a lesser extent to pivmecillinam/pivampicillin; resistance was highest to ampicillin.

An evaluation of parenteral mecillinam in a chest hospital.

The efficacy of parenteral mecillinam was evaluated in 105 elderly patients with lower respiratory tract infections or urinary tract infections. Another antibiotic, usually amoxycillin, was given concurrently in cases of respiratory infection. An adequate response was note in 86% of chest infections and in all of the urinary tract infections assessed. Mecillinam proved to have a low toxicity profile and intramuscular injections were very well tolerated.

Carbenicillin plus cefazolin with or without mecillinam as an early treatment of bacteremia caused by gram-negative organisms: randomized double-blind study.

Mecillinam or a placebo was added to a combination of cefazolin and carbenicillin as an early therapy of septicemia caused by gram-negative organisms in patients with serious underlying diseases, none of whom was neutropenic, however. Patients in whom infection was caused by pathogens against which mecillinam and cefazolin or mecillinam and carbenicillin were synergistic might have responded more often than patients treated with nonsynergistic combinations. However, overall results did not show any benefit from combining mecillinam with cefazolin and carbenicillin. This study suggests that in nonneutropenic patients with septicemia caused by gram-negative organisms, there is no need to intensify antimicrobial therapy beyond a certain point of efficacy. The measurement of the bactericidal activity in the serum of treated patients might serve as guide for adequate therapy.

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.

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.