Bismuth salicylate for diarrhea in children.

QUESTION: Recently, I had a visit from a 5-year-old patient who had been given bismuth subsalicylate for a diarrheal illness by a local family physician during a trip to South America. Is this a practice we should encourage? ANSWER: Research from developing countries has found the use of bismuth subsalicylate to be effective in shortening the duration of diarrheal illness. Despite these findings, its limited effectiveness and concerns about it potentially causing Reye syndrome, compliance, and cost are the key reasons it is not routinely recommended for children.

[Trend in platelet antiaggregants utilization in the autonomous community of Valencia, Spain (2000-2005)]. / Tendencia en la utilización de antiagregantes en la comunidad Valenciana (2000-2005).

BACKGROUND: Platelet antiaggregants are basic drugs for preventing ischemic arterial diseases. This study is aimed at ascertaining the trend in their use in Primary Care in the Autonomous Community of Valencia during the 2000-2005 period. METHODS: Descriptive study of the use of platelet antiaggregants (ATC code: B01AC) dispensed charged to the National Health System in the Autonomous Community of Valencia in Primary Care. Data given in defined daily doses (DDD) per 1000 inhabitants per day. RESULTS: In 2005, three drugs totalled 98% of all those prescribed overall (acetyl salicylicacid (ASA) 66%, clopidogrel 23% and triflusal 9%). Oral antiaggregant use rose by 23% within the 2000-2005 period (from 29.6 to 36.5 DDD/1000 inhab./day). Clopidogrel showed a 218% increase, whilst ASA was the most used drug, with quite a stable percentage of use throughout said time period (nearing 70%). The expense generated by this group of drugs doubled, clopidogrel having been the highest-cost drug/DDD (2.14 EUROS), its use having totalled 23% of all antiaggregants yet the expense thereof having totalled 76% of the total expenditure. CONCLUSIONS: The use of antiaggregants increased in the Autonomous Community of Valencia during the time period under study. The utilization of ASA remained stable, whilst clopidogrel increased its market share despite the treatment guide recommendations and the restrictions on its use. The consumption of clopidogrel noticeably contributed to the drug spending for this group.

Management of acne.

Precise classification methods are used to define acne according to type (comedonal, papulopustular, or nodular) and severity. The relative effectiveness of several topical and systemic agents has been established in clinical trials, making possible an algorithm of specific treatment decisions based on acne classification.

Economic evaluation of triflusal and aspirin in the treatment of acute myocardial infarction.

OBJECTIVE: To compare the costs to the Spanish healthcare system of 35 days' treatment with triflusal (600 mg/day) and aspirin (300 mg/day) in patients with confirmed acute myocardial infarction within 24 hours of onset of symptoms. DESIGN: A cost minimisation analysis based on the results of the Triflusal in Acute Myocardial Infarction study (TIM) was conducted. The hypothesis was that despite a higher acquisition cost of triflusal, savings would result because of differences in efficacy and safety outcome (non-fatal cerebrovascular event and haemorrhagic events). Diagnostic Related Groups were used as a proxy for determining hospital costs in Spain and the values were obtained from different sources and refer to year 2000 costs. Only direct medical costs were considered for the economic analysis. RESULTS: Although the acquisition cost of triflusal was more expensive than that of aspirin, the cost of prevented events - non-fatal ischaemic cerebrovascular events and cerebral haemorrhages - entirely compensated for the cost of triflusal. The overall cost of treating patients with triflusal, compared with aspirin, represented a net saving of 28.4% per patient treated. CONCLUSION: Our study showed that triflusal is cost saving compared with aspirin in the treatment of the acute phase of myocardial infarction.

The pharmacoeconomic impact of antimicrobial therapy for peptic ulcer disease in a large urban jail.

PURPOSE: To determine the pharmacoeconomic impact of antimicrobial treatment of peptic ulcer disease (PUD) in a large urban jail. PATIENTS AND METHODS: Retrospective comparison of PUD-related pharmacy and laboratory expenditures over a 2-year period before and after the institution of a PUD treatment protocol with the priority of Helicobacter pylori eradication for inmates in Rikers Island Correctional Facility. RESULTS: After the protocol was adopted, total pharmacy-related and laboratory-related expenses for PUD care decreased by 40.2%, and expenditures for ranitidine declined by 52.2%. There was an increase in spending for antimicrobial agents and H. pylori antibody testing, but this was insignificant compared to the savings generated by decreased ranitidine usage. Annual savings in our facility as a result of this intervention were $123,449. CONCLUSIONS: Modern therapeutic strategies for PUD aimed at eradicating H. pylori can result in significant savings in the institutional setting; these savings are largely attributable to the decreased usage of histamine-2 receptor antagonists.

Pharmacoeconomic comparison of treatments for the eradication of Helicobacter pylori.

BACKGROUND: Patients with Helicobacter pylori-induced duodenal ulcer should have their infection eradicated. The optimal choice of antibiotic therapy, however, is less clear. OBJECTIVE: To evaluate costs and outcomes of treatment with 8 antibiotic regimens with documented activity against H pylori vs maintenance therapy with histamine2-receptor antagonists (H2RA). METHODS: A meta-analysis for 119 studies enrolling 6416 patients to determine aggregate eradication rates. The complexity of each regimen was used to determine the anticipated compliance rate and actual effectiveness. A decision analytic model with Monte Carlo simulation determined annual costs and health outcomes. RESULTS: Average annual total costs of testing for H pylori infection and antibiotic treatment ranged from $223 to $410 and prevented ulcer recurrence in 70% to 86% of patients. The H2RA maintenance therapy cost $425 and prevented recurrence in 72% of patients. The lowest costs and recurrence rates were achieved by 3 regimens: standard triple therapy (a combination of bismuth subsalicylate, metronidazole, and tetracycline hydrochloride) for 14 days ($223, with 18% recurrence); a combination of clarithromycin, metronidazole, and a proton pump inhibitor for 7 days ($235, with 15% recurrence); and standard triple therapy with a proton pump inhibitor for 7 days ($236, with 14% recurrence). CONCLUSION: Treatment with any regimen resulted in lower costs compared with H2RA maintenance therapy. Three antibiotic regimens had consistently lower costs and better outcomes: standard triple therapy for 14 days, metronidazole, clarithromycin, and a proton pump inhibitor for 7 days, and standard triple therapy plus a proton pump inhibitor for 7 days.

Treatment of superficial mycoses in the tropics: Whitfield's ointment versus clotrimazole.

BACKGROUND: In tropical primary health care, essential drugs should be safe, effective, and as inexpensive as possible. To treat the very common dermatophyte infections of the skin, one may use inexpensive Whitfield's preparations, more expensive topical imidazole derivatives, or extremely expensive oral antifungals. Because a cream base is felt to be more appropriate than an ointment in tropical conditions, we wanted to compare the effectiveness of Whitfield's cream and a topical imidazole derivative in field conditions in the tropics. METHODS: A double-blind trial was performed involving 153 patients with a dermatophyte infection of the skin in Karonga District, Northern Malawi, including 25 patients who were HIV-1-seropositive, comparing Whitfield's cream with clotrimazole cream. RESULTS: 75 patients were treated with Whitfield's cream and 78 with clotrimazole cream for a period of 6 weeks. Cure rates ranged from 80% to over 90% depending on the definition of cure. If positive cultures after treatment were used as criterion for treatment failure, six were found in each treatment group. One in each treatment failure group was an HIV-1-seropositive patient. CONCLUSIONS: The great majority of patients in the tropics with a dermatophyte infection of the skin can be cured with a topical antimycotic preparation and do not need expensive oral therapy. This also proved to be valid for HIV-1-seropositive patients. Whitfield's cream and clotrimazole cream are both very effective. The lower cost makes Whitfield's cream the treatment of choice in dermatophyte infections of the skin in tropical primary health care.