Matching articles for "metronidazole"
Lotilaner (Xdemvy) for Demodex Blepharitis
The Medical Letter on Drugs and Therapeutics • June 24, 2024; (Issue 1705)
The FDA has approved a 0.25% ophthalmic solution
of the ectoparasiticide lotilaner (Xdemvy – Tarsus) for
treatment of Demodex blepharitis. Lotilaner is the first
drug to be approved in the US for this...
The FDA has approved a 0.25% ophthalmic solution
of the ectoparasiticide lotilaner (Xdemvy – Tarsus) for
treatment of Demodex blepharitis. Lotilaner is the first
drug to be approved in the US for this indication.
Drugs for Rosacea
The Medical Letter on Drugs and Therapeutics • February 5, 2024; (Issue 1695)
Rosacea is a common, chronic inflammatory facial
eruption of unknown cause. It is more prevalent
in women than in men, and disease onset typically
occurs after age 30. Rosacea is characterized
by erythema,...
Rosacea is a common, chronic inflammatory facial
eruption of unknown cause. It is more prevalent
in women than in men, and disease onset typically
occurs after age 30. Rosacea is characterized
by erythema, telangiectasia, and flushing, and
sometimes by recurrent, progressive crops of
acneiform papules and pustules, usually on the
central part of the face. Some patients develop
granulomas and tissue hypertrophy, which may lead
to rhinophyma (a bulbous nose), particularly in men.
Blepharitis and conjunctivitis are common. Keratitis
and corneal scarring occur rarely.
Drugs for Rosacea
The Medical Letter on Drugs and Therapeutics • February 5, 2024; (Issue 1695)
Rosacea is a common, chronic inflammatory facial
eruption of unknown cause. It is more prevalent
in women than in men, and disease onset typically
occurs after age 30. Rosacea is characterized
by erythema,...
Rosacea is a common, chronic inflammatory facial
eruption of unknown cause. It is more prevalent
in women than in men, and disease onset typically
occurs after age 30. Rosacea is characterized
by erythema, telangiectasia, and flushing, and
sometimes by recurrent, progressive crops of
acneiform papules and pustules, usually on the
central part of the face. Some patients develop
granulomas and tissue hypertrophy, which may lead
to rhinophyma (a bulbous nose), particularly in men.
Blepharitis and conjunctivitis are common. Keratitis
and corneal scarring occur rarely.
Comparison Table: Some Topical Drugs for Rosacea (online only)
The Medical Letter on Drugs and Therapeutics • February 5, 2024; (Issue 1695)
...
View the Comparison Table: Some Topical Drugs for Rosacea
Live Fecal Microbiota (Rebyota) for Prevention of CDI Recurrence
The Medical Letter on Drugs and Therapeutics • March 6, 2023; (Issue 1671)
The FDA has approved Rebyota (Ferring), a rectally-administered,
live fecal microbiota suspension, for
prevention of additional recurrences of Clostridioides
difficile infection (CDI) following antibiotic...
The FDA has approved Rebyota (Ferring), a rectally-administered,
live fecal microbiota suspension, for
prevention of additional recurrences of Clostridioides
difficile infection (CDI) following antibiotic treatment
for a recurrent episode of CDI in adults. Rebyota is
the first microbiome-based treatment to be approved
for this indication. It is not approved for initial
treatment of CDI. Fecal microbiota transplantation
(FMT) has been used in patients with multiple
CDI recurrences.
Epsolay - A Benzoyl Peroxide Cream for Rosacea
The Medical Letter on Drugs and Therapeutics • February 6, 2023; (Issue 1669)
Epsolay (Galderma), a 5% benzoyl peroxide cream,
has been approved by the FDA for treatment of
inflammatory lesions of rosacea in adults. It is the first
product containing benzoyl peroxide to be...
Epsolay (Galderma), a 5% benzoyl peroxide cream,
has been approved by the FDA for treatment of
inflammatory lesions of rosacea in adults. It is the first
product containing benzoyl peroxide to be approved
in the US for treatment of rosacea. Benzoyl peroxide
formulations approved for acne have been used off-label
to treat rosacea for years, but itching and burning
have limited their use.
Two Vonoprazan Combinations (Voquezna) for H. pylori
The Medical Letter on Drugs and Therapeutics • October 31, 2022; (Issue 1662)
The FDA has approved vonoprazan, a potassium-competitive
acid blocker, copackaged with amoxicillin
(Voquezna Dual Pak – Phathom) and with amoxicillin
and clarithromycin (Voquezna Triple Pak) for
treatment...
The FDA has approved vonoprazan, a potassium-competitive
acid blocker, copackaged with amoxicillin
(Voquezna Dual Pak – Phathom) and with amoxicillin
and clarithromycin (Voquezna Triple Pak) for
treatment of Helicobacter pylori infection in adults.
Vonoprazan is the first potassium-competitive acid
blocker to be approved in the US. It has been available
in Japan for treatment of various acid-related
disorders since 2014. Vonoprazan is not available
alone in the US.
Drugs for Sexually Transmitted Infections
The Medical Letter on Drugs and Therapeutics • June 27, 2022; (Issue 1653)
This article includes recommendations for management
of most sexually transmitted infections (STIs)
other than HIV and viral hepatitis. Some of the
indications and dosages recommended here have
not been...
This article includes recommendations for management
of most sexually transmitted infections (STIs)
other than HIV and viral hepatitis. Some of the
indications and dosages recommended here have
not been approved by the FDA (see Table 1).
Drugs for GERD and Peptic Ulcer Disease
The Medical Letter on Drugs and Therapeutics • April 4, 2022; (Issue 1647)
Gastroesophageal reflux disease (GERD) is the most
common GI condition encountered in the outpatient
setting; it affects about 20% of people in the...
Gastroesophageal reflux disease (GERD) is the most
common GI condition encountered in the outpatient
setting; it affects about 20% of people in the US.
Treatment of Clostridioides difficile Infection
The Medical Letter on Drugs and Therapeutics • September 6, 2021; (Issue 1632)
Clostridioides (formerly Clostridium) difficile infection
(CDI) is the most common infectious cause of
healthcare-associated diarrhea in adults. Guidelines
on management of CDI have recently been...
Clostridioides (formerly Clostridium) difficile infection
(CDI) is the most common infectious cause of
healthcare-associated diarrhea in adults. Guidelines
on management of CDI have recently been updated.
Minocycline Foam (Zilxi) for Rosacea
The Medical Letter on Drugs and Therapeutics • November 16, 2020; (Issue 1611)
The FDA has approved a 1.5% topical foam formulation
of minocycline (Zilxi – Foamix) for treatment of
inflammatory lesions of rosacea in adults. It is
the only topical minocycline product approved...
The FDA has approved a 1.5% topical foam formulation
of minocycline (Zilxi – Foamix) for treatment of
inflammatory lesions of rosacea in adults. It is
the only topical minocycline product approved for
this indication. The same manufacturer markets
minocycline foam 4% (Amzeeq) for treatment of acne
in patients ≥9 years old.
Talicia - A 3-Drug Combination for Helicobacter pylori Infection
The Medical Letter on Drugs and Therapeutics • June 1, 2020; (Issue 1599)
The FDA has approved a fixed-dose combination
of omeprazole, amoxicillin, and rifabutin (Talicia –
RedHill) for treatment of Helicobacter pylori infection
in adults. Talicia is the first rifabutin-based...
The FDA has approved a fixed-dose combination
of omeprazole, amoxicillin, and rifabutin (Talicia –
RedHill) for treatment of Helicobacter pylori infection
in adults. Talicia is the first rifabutin-based product to
be approved for this indication.
Table: Drugs for Ulcerative Colitis (online only)
The Medical Letter on Drugs and Therapeutics • July 2, 2018; (Issue 1550)
...
View Table: Drugs for Ulcerative Colitis
Table: Drugs for Crohn's Disease (online only)
The Medical Letter on Drugs and Therapeutics • July 2, 2018; (Issue 1550)
...
View Table: Drugs for Crohn's Disease
Clarithromycin in Patients with Coronary Artery Disease
The Medical Letter on Drugs and Therapeutics • May 21, 2018; (Issue 1547)
The FDA has warned that use of the macrolide
antibiotic clarithromycin (Biaxin, and generics) may
increase the risk of cardiovascular morbidity and
mortality in patients with heart...
The FDA has warned that use of the macrolide
antibiotic clarithromycin (Biaxin, and generics) may
increase the risk of cardiovascular morbidity and
mortality in patients with heart disease.
Secnidazole (Solosec) for Bacterial Vaginosis
The Medical Letter on Drugs and Therapeutics • March 26, 2018; (Issue 1543)
The FDA has approved secnidazole oral granules
(Solosec – Symbiomix/Lupin) for single-dose treatment
of bacterial vaginosis (BV) in adult...
The FDA has approved secnidazole oral granules
(Solosec – Symbiomix/Lupin) for single-dose treatment
of bacterial vaginosis (BV) in adult women.
Drugs for GERD and Peptic Ulcer Disease
The Medical Letter on Drugs and Therapeutics • January 15, 2018; (Issue 1538)
Gastroesophageal reflux disease (GERD) is the most
frequent GI condition encountered in the outpatient
setting; it affects about 20% of the US population.
Heartburn and regurgitation are the classic...
Gastroesophageal reflux disease (GERD) is the most
frequent GI condition encountered in the outpatient
setting; it affects about 20% of the US population.
Heartburn and regurgitation are the classic symptoms
of GERD.
Drugs for Common Bacterial Infections in Adults
The Medical Letter on Drugs and Therapeutics • October 23, 2017; (Issue 1532)
Bacterial infections in adults are generally treated
empirically, with the antibiotic covering most, but not
all, of the potential causative pathogens. For some
infections, culture and sensitivity testing...
Bacterial infections in adults are generally treated
empirically, with the antibiotic covering most, but not
all, of the potential causative pathogens. For some
infections, culture and sensitivity testing can guide
treatment, allowing for use of narrower-spectrum
antibiotics. The recommended dosages and durations
of antibiotic treatment for common respiratory, skin, and
urinary tract infections are listed in Tables 1-3. Infectious
disease experts now recommend shorter treatment
durations for many infections to reduce the development
of antimicrobial resistance and minimize adverse effects.
Drugs for Helicobacter pylori Infection
The Medical Letter on Drugs and Therapeutics • July 17, 2017; (Issue 1525)
About 50% of the world’s population is infected with
Helicobacter pylori. These gastric bacteria can cause
chronic inflammation and have been associated with
development of gastritis, peptic ulcer disease,...
About 50% of the world’s population is infected with
Helicobacter pylori. These gastric bacteria can cause
chronic inflammation and have been associated with
development of gastritis, peptic ulcer disease, gastric
adenocarcinoma, and gastric mucosa-associated
lymphoid tissue (MALT) lymphoma. Eradication of H.
pylori can promote gastric healing, prevent recurrence
of duodenal and gastric ulcers, and reduce the
incidence of gastric cancer. Guidelines for treatment
of H. pylori infection were updated recently.
Drugs for Sexually Transmitted Infections
The Medical Letter on Drugs and Therapeutics • July 3, 2017; (Issue 1524)
The text and tables that follow include recommendations
for management of sexually transmitted
infections (STIs) other than HIV and viral hepatitis.
Some of the indications and dosages recommended
here have...
The text and tables that follow include recommendations
for management of sexually transmitted
infections (STIs) other than HIV and viral hepatitis.
Some of the indications and dosages recommended
here have not been approved by the FDA.
Oxymetazoline Cream (Rhofade) for Rosacea
The Medical Letter on Drugs and Therapeutics • May 22, 2017; (Issue 1521)
The FDA has approved the selective alpha1A-adrenergic
receptor agonist oxymetazoline as a 1% cream (Rhofade
– Allergan) for topical treatment of persistent facial
erythema of rosacea in adults....
The FDA has approved the selective alpha1A-adrenergic
receptor agonist oxymetazoline as a 1% cream (Rhofade
– Allergan) for topical treatment of persistent facial
erythema of rosacea in adults. Brimonidine, a selective
alpha2-adrenergic receptor agonist, was approved in
2013 as a 0.33% gel (Mirvaso) for the same indication.
Like Mirvaso, Rhofade is not indicated for treatment of
inflammatory lesions of rosacea. Oxymetazoline has
been available over the counter for many years as a
nasal decongestant spray (Afrin, and others).
Comparison Table: Some Topical Drugs for Rosacea (online only)
The Medical Letter on Drugs and Therapeutics • May 22, 2017; (Issue 1521)
...
View the Comparison Table: Some Topical Drugs for Rosacea
Bezlotoxumab (Zinplava) for Prevention of Recurrent Clostridium difficile Infection
The Medical Letter on Drugs and Therapeutics • March 27, 2017; (Issue 1517)
The FDA has approved the fully human monoclonal
antibody bezlotoxumab (Zinplava – Merck) for use
with antibacterial drug treatment to reduce recurrence
of Clostridium difficile infection (CDI) in adults...
The FDA has approved the fully human monoclonal
antibody bezlotoxumab (Zinplava – Merck) for use
with antibacterial drug treatment to reduce recurrence
of Clostridium difficile infection (CDI) in adults with
CDI at high risk for recurrence. It is the first drug to be
approved for this indication.
Antimicrobial Prophylaxis for Surgery
The Medical Letter on Drugs and Therapeutics • May 23, 2016; (Issue 1495)
Antimicrobial prophylaxis can decrease the
incidence of postoperative surgical site infection
after some procedures. Since the last Medical Letter
article on this subject, consensus guidelines have
been...
Antimicrobial prophylaxis can decrease the
incidence of postoperative surgical site infection
after some procedures. Since the last Medical Letter
article on this subject, consensus guidelines have
been published. Recommendations for prophylaxis
in specific surgical procedures are listed in Table 1.
Drugs for Rosacea
The Medical Letter on Drugs and Therapeutics • February 1, 2016; (Issue 1487)
This common, chronic inflammatory facial eruption
of unknown cause is more prevalent in women
than in men. Rosacea is characterized by erythema
and telangiectasia, and sometimes by recurrent,
progressive...
This common, chronic inflammatory facial eruption
of unknown cause is more prevalent in women
than in men. Rosacea is characterized by erythema
and telangiectasia, and sometimes by recurrent,
progressive crops of acneiform papules and pustules,
usually on the central part of the face. Some patients
develop granulomas and tissue hypertrophy, which
may lead to rhinophyma (a bulbous nose), particularly
in men. Blepharitis and conjunctivitis are common.
Keratitis and corneal scarring occur rarely.
Ivermectin Cream (Soolantra) for Rosacea
The Medical Letter on Drugs and Therapeutics • April 13, 2015; (Issue 1466)
The FDA has approved a 1% cream formulation
of the antiparasitic drug ivermectin (Soolantra –
Galderma) for topical treatment of inflammatory
lesions of rosacea. Ivermectin is available in the US
in...
The FDA has approved a 1% cream formulation
of the antiparasitic drug ivermectin (Soolantra –
Galderma) for topical treatment of inflammatory
lesions of rosacea. Ivermectin is available in the US
in tablets (Stromectol, and generics) for treatment of
onchocerciasis and other worm infestations and as a
0.5% lotion (Sklice) for treatment of head lice.
Ceftolozane/Tazobactam (Zerbaxa) - A New Intravenous Antibiotic
The Medical Letter on Drugs and Therapeutics • March 2, 2015; (Issue 1463)
The FDA has approved ceftolozane/tazobactam
(Zerbaxa – Cubist), a combination of a new cephalosporin
antibiotic and a beta-lactamase inhibitor, for
intravenous treatment of complicated urinary tract
and...
The FDA has approved ceftolozane/tazobactam
(Zerbaxa – Cubist), a combination of a new cephalosporin
antibiotic and a beta-lactamase inhibitor, for
intravenous treatment of complicated urinary tract
and intra-abdominal infections in adults.
Drugs for Inflammatory Bowel Disease
The Medical Letter on Drugs and Therapeutics • August 4, 2014; (Issue 1448)
Aminosalicylates are effective for induction and maintenance
of remission in mild to moderate ulcerative
colitis. They are not recommended for treatment of
Crohn's disease.
FORMULATIONS — Oral mesalamine...
Aminosalicylates are effective for induction and maintenance
of remission in mild to moderate ulcerative
colitis. They are not recommended for treatment of
Crohn's disease.
FORMULATIONS — Oral mesalamine is rapidly absorbed in the small intestine and most of the drug does not reach the colon. Pentasa releases mesalamine gradually throughout the gastrointestinal tract. Delzicol, Asacol HD, Lialda, and Apriso delay the release of the drug until it reaches the distal ileum and colon. Sulfasalazine (Azulfidine, and generics), balsalazide (Colazal, and others), and olsalazine (Dipentum) are prodrugs; mesalamine is azo-bonded to a second moiety and released in the colon following bacterial cleavage of the bond. Mesalamine is also available as an enema (Rowasa, and generics) and as a rectal suppository (Canasa).
FORMULATIONS — Oral mesalamine is rapidly absorbed in the small intestine and most of the drug does not reach the colon. Pentasa releases mesalamine gradually throughout the gastrointestinal tract. Delzicol, Asacol HD, Lialda, and Apriso delay the release of the drug until it reaches the distal ileum and colon. Sulfasalazine (Azulfidine, and generics), balsalazide (Colazal, and others), and olsalazine (Dipentum) are prodrugs; mesalamine is azo-bonded to a second moiety and released in the colon following bacterial cleavage of the bond. Mesalamine is also available as an enema (Rowasa, and generics) and as a rectal suppository (Canasa).
Treatment of Atrial Fibrillation
The Medical Letter on Drugs and Therapeutics • July 7, 2014; (Issue 1446)
The treatment of atrial fibrillation includes anticoagulation,
rate control, and rhythm control. New US
guidelines for the management of atrial fibrillation
have recently been...
The treatment of atrial fibrillation includes anticoagulation,
rate control, and rhythm control. New US
guidelines for the management of atrial fibrillation
have recently been published.
Drugs for Peptic Ulcer Disease and GERD
The Medical Letter on Drugs and Therapeutics • April 1, 2014; (Issue 140)
H2-RECEPTOR ANTAGONISTS (H2RAs) —
Currently available H2RAs are listed in Table 1.
These drugs inhibit the action of histamine at the H2-receptor of the gastric parietal cell, decreasing basal
acid...
H2-RECEPTOR ANTAGONISTS (H2RAs) —
Currently available H2RAs are listed in Table 1.
These drugs inhibit the action of histamine at the H2-receptor of the gastric parietal cell, decreasing basal
acid secretion and, to a lesser degree, food-stimulated
acid secretion. All H2RAs are about equally effective
for treatment of PUD and GERD. H2RAs are faster
acting than PPIs in relieving symptoms of dyspepsia or
GERD, but they are not as effective as PPIs in relieving
symptoms or in healing erosive esophagitis. Repeated
administration of H2RAs leads to pharmacologic tolerance
and has been associated with the development
of new dyspeptic symptoms. Rebound acid hypersecretion
can occur after stopping H2RAs.
Brimonidine Gel (Mirvaso) for Rosacea
The Medical Letter on Drugs and Therapeutics • October 14, 2013; (Issue 1427)
The FDA has approved the selective alpha2-adrenergic
receptor agonist brimonidine as a 0.33% gel
(Mirvaso – Galderma) for topical treatment of adults
with persistent facial erythema of rosacea....
The FDA has approved the selective alpha2-adrenergic
receptor agonist brimonidine as a 0.33% gel
(Mirvaso – Galderma) for topical treatment of adults
with persistent facial erythema of rosacea. Brimonidine
is also available in ophthalmic formulations for treatment
of glaucoma.
Drugs for Sexually Transmitted Infections
The Medical Letter on Drugs and Therapeutics • September 1, 2013; (Issue 133)
Many infections can be transmitted during sexual contact.
The text and tables that follow include recommendations
for management of sexually transmitted
infections (STIs) other than HIV, viral hepatitis,...
Many infections can be transmitted during sexual contact.
The text and tables that follow include recommendations
for management of sexually transmitted
infections (STIs) other than HIV, viral hepatitis, and
enteric infections. Some of the indications and
dosages recommended here have not been approved
by the FDA.
Drugs for Bacterial Infections
The Medical Letter on Drugs and Therapeutics • July 1, 2013; (Issue 131)
The text that follows reviews some common bacterial
infections and their empiric treatment pending the
results of culture and susceptibility testing. The recommendations
made here are based on the results...
The text that follows reviews some common bacterial
infections and their empiric treatment pending the
results of culture and susceptibility testing. The recommendations
made here are based on the results of
susceptibility studies, clinical trials, and the opinions
of Medical Letter reviewers. Tables 1 and 2 list the usual
dosages of antibacterial drugs.
Drugs for Acne, Rosacea and Psoriasis
The Medical Letter on Drugs and Therapeutics • January 1, 2013; (Issue 125)
The pathogenesis of acne is multifactorial: follicular
hyperkeratinization, bacteria, sebum production,
androgens, and inflammation all play a role. The gram-positive
microaerophilic bacteria...
The pathogenesis of acne is multifactorial: follicular
hyperkeratinization, bacteria, sebum production,
androgens, and inflammation all play a role. The gram-positive
microaerophilic bacteria Propionibacterium
acnes promote development of acne lesions by secreting
chemotactic factors that attract leukocytes to the
follicle, causing inflammation.
Antimicrobial Prophylaxis for Surgery
The Medical Letter on Drugs and Therapeutics • October 1, 2012; (Issue 122)
Antimicrobial prophylaxis can decrease the incidence
of postoperative infection, particularly surgical site
infection, after some procedures. Recommendations
for such prophylaxis are listed in the table that...
Antimicrobial prophylaxis can decrease the incidence
of postoperative infection, particularly surgical site
infection, after some procedures. Recommendations
for such prophylaxis are listed in the table that begins
on page 74. Antimicrobial prophylaxis for dental procedures
to prevent endocarditis was recently discussed
in The Medical Letter.
Drugs for Inflammatory Bowel Disease
The Medical Letter on Drugs and Therapeutics • March 1, 2012; (Issue 115)
Inflammatory bowel disease (IBD) is generally classified
as either Crohn’s disease (CD) or ulcerative
colitis (UC). More detailed guidelines on their treatment
are available from the American College...
Inflammatory bowel disease (IBD) is generally classified
as either Crohn’s disease (CD) or ulcerative
colitis (UC). More detailed guidelines on their treatment
are available from the American College of
Gastroenterology.
Fidaxomicin (Dificid) for Clostridium Difficile Infection
The Medical Letter on Drugs and Therapeutics • September 19, 2011; (Issue 1373)
The FDA has approved fidaxomicin (Dificid – Optimer),
a new oral macrolide antibiotic, for treatment of
Clostridium difficile-associated diarrhea in patients
≥18 years old. The incidence and severity of...
The FDA has approved fidaxomicin (Dificid – Optimer),
a new oral macrolide antibiotic, for treatment of
Clostridium difficile-associated diarrhea in patients
≥18 years old. The incidence and severity of C. difficile
infection (CDI) have increased in recent years with the
emergence of an epidemic hypervirulent strain
(NAP1/B1/027), possibly related to widespread use of
fluoroquinolones.
Drugs for Peptic Ulcer Disease and GERD
The Medical Letter on Drugs and Therapeutics • September 1, 2011; (Issue 109)
Peptic ulcer disease (PUD) is usually caused by nonsteroidal
anti-inflammatory drugs (NSAIDs) or by
infection with Helicobacter pylori. Gastroesophageal
reflux disease (GERD) can be caused by...
Peptic ulcer disease (PUD) is usually caused by nonsteroidal
anti-inflammatory drugs (NSAIDs) or by
infection with Helicobacter pylori. Gastroesophageal
reflux disease (GERD) can be caused by transient
lower esophageal sphincter relaxation, reduced lower
esophageal sphincter tone, hiatal hernia, delayed gastric
emptying or hormonal changes due to pregnancy.
Acid suppressive therapy is the cornerstone of management
for both PUD and GERD.
Treatment of Clostridium Difficile Infection
The Medical Letter on Drugs and Therapeutics • February 21, 2011; (Issue 1358)
Clostridium difficile infection (CDI) is the most common infectious cause of healthcare-associated diarrhea in adults. The incidence and severity of CDI have increased in recent years with the emergence of an...
Clostridium difficile infection (CDI) is the most common infectious cause of healthcare-associated diarrhea in adults. The incidence and severity of CDI have increased in recent years with the emergence of an epidemic virulent strain (NAP1/BI/027). Common risk factors include admission to a healthcare facility, increasing age and severity of underlying illness, gastric acid suppression and exposure to antimicrobials, particularly clindamycin, ampicillin, cephalosporins or fluoroquinolones. Patients who develop CDI while receiving a precipitating antibiotic should have the antibiotic discontinued, if possible, or switched to another appropriate antimicrobial with a lower risk of CDI.
Rifaximin (Xifaxan 550) for Hepatic Encephalopathy
The Medical Letter on Drugs and Therapeutics • November 1, 2010; (Issue 1350)
The FDA has approved a new 550-mg tablet of rifaximin (Xifaxan – Salix), a minimally absorbed oral
antibiotic, to reduce the risk of recurrent hepatic encephalopathy (HE). A 200-mg tablet has been...
The FDA has approved a new 550-mg tablet of rifaximin (Xifaxan – Salix), a minimally absorbed oral
antibiotic, to reduce the risk of recurrent hepatic encephalopathy (HE). A 200-mg tablet has been available
for treatment of travelers’ diarrhea since 2004.
Drugs for Sexually Transmitted Infections
The Medical Letter on Drugs and Therapeutics • July 1, 2010; (Issue 95)
Many infections can be transmitted during sexual contact. The text and tables that follow are limited to management of sexually transmitted infections (STIs) other than HIV, viral hepatitis and enteric...
Many infections can be transmitted during sexual contact. The text and tables that follow are limited to management of sexually transmitted infections (STIs) other than HIV, viral hepatitis and enteric infections. The drugs of choice, their dosages and alternatives are listed in a table that begins on page 54. A table listing the adverse effects of some of these antimicrobials begins on page 58.
Drugs for Bacterial Infections
The Medical Letter on Drugs and Therapeutics • June 1, 2010; (Issue 94)
The text below reviews some common bacterial infections and their treatment. The recommendations made
here are based on the results of susceptibility studies, clinical trials and the opinions of Medical Letter...
The text below reviews some common bacterial infections and their treatment. The recommendations made
here are based on the results of susceptibility studies, clinical trials and the opinions of Medical Letter consultants.
Drugs for Inflammatory Bowel Disease
The Medical Letter on Drugs and Therapeutics • September 1, 2009; (Issue 85)
Inflammatory bowel disease (IBD) is either Crohn's disease or ulcerative colitis. Drug selection is guided by disease type (Crohn's versus ulcerative colitis), severity and location and whether the goal is...
Inflammatory bowel disease (IBD) is either Crohn's disease or ulcerative colitis. Drug selection is guided by disease type (Crohn's versus ulcerative colitis), severity and location and whether the goal is induction or maintenance of remission. Table 1 on page 66 lists the drugs used to treat IBD with their formulations and cost. Table 2 on page 68 lists the drugs of choice and their doses for different indications. Table 3 on page 71 lists the drugs' adverse effects and recommendations for monitoring. More detailed guidelines are available from the American College of Gastroenterology.
Antimicrobial Prophylaxis for Surgery
The Medical Letter on Drugs and Therapeutics • June 1, 2009; (Issue 82)
Antimicrobial prophylaxis can decrease the incidence of infection, particularly surgical site infection, after certain procedures. Recommendations for prevention of surgical site infection are listed in the...
Antimicrobial prophylaxis can decrease the incidence of infection, particularly surgical site infection, after certain procedures. Recommendations for prevention of surgical site infection are listed in the table that begins on page 48. Antimicrobial prophylaxis for dental procedures to prevent endocarditis is discussed in The Medical Letter 2007; 49:99.
Drugs That May Cause Psychiatric Symptoms
The Medical Letter on Drugs and Therapeutics • December 15, 2008; (Issue 1301)
Many drugs can cause psychiatric symptoms, but a causal connection is often difficult to establish. Psychiatric symptoms that emerge during drug treatment could also be due to the underlying illness, previously...
Many drugs can cause psychiatric symptoms, but a causal connection is often difficult to establish. Psychiatric symptoms that emerge during drug treatment could also be due to the underlying illness, previously unrecognized psychopathology, or psychosocial factors. The withdrawal of some drugs can cause symptoms such as anxiety, psychosis, delirium, agitation or depression.
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Drugs for Acne, Rosacea and Psoriasis
The Medical Letter on Drugs and Therapeutics • November 1, 2008; (Issue 75)
The pathogenesis of acne is multifactorial: follicular hyperkeratinization, bacteria, sebum production, androgens and inflammation all play a role. The gram-positive microaerophilic bacteria Propionibacterium...
The pathogenesis of acne is multifactorial: follicular hyperkeratinization, bacteria, sebum production, androgens and inflammation all play a role. The gram-positive microaerophilic bacteria Propionibacterium acnes promote development of acne lesions by secreting chemotactic factors that attract leukocytes to the follicle, causing inflammation.
Treatment of Peptic Ulcers and GERD
The Medical Letter on Drugs and Therapeutics • August 1, 2008; (Issue 72)
Peptic ulcers caused by treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) are mainly gastric ulcers. Most duodenal and other gastric ulcers are caused by the gram-negative bacillus Helicobacter...
Peptic ulcers caused by treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) are mainly gastric ulcers. Most duodenal and other gastric ulcers are caused by the gram-negative bacillus Helicobacter pylori. Gastroesophageal reflux disease (GERD) is caused by gastric acid reflux into the esophagus. Drugs that suppress gastric acid production are the primary treatment for GERD and peptic ulcers.
Addendum: Warfarin-Acetaminophen Interaction
The Medical Letter on Drugs and Therapeutics • June 16, 2008; (Issue 1288)
A reader expressed disappointment that our recent listing of “Some Warfarin Drug Interactions”1 did not include acetaminophen. Perhaps it should have. Acetaminophen can increase the anticoagulant effect of...
A reader expressed disappointment that our recent listing of “Some Warfarin Drug Interactions”1 did not include acetaminophen. Perhaps it should have. Acetaminophen can increase the anticoagulant effect of warfarin, particularly with continued use, but it does so inconsistently. The mechanism of this interaction has not been established, but may be related to an acetaminophen metabolite inhibiting vitamin K-epoxide reductase, the target for warfarin’s anticoagulant effect.2
Patient susceptibility varies, possibly on a genetic basis; occasional use of acetaminophen generally has little or no effect on the international normalized ratio (INR) in patients on chronic warfarin therapy, but in some, even a few grams of the drug may cause a dramatic increase in INR. One study in healthy subjects found no effect of acetaminophen 4 g per day for 2 weeks, while another study in patients with the same acetaminophen dose for the same period of time found a moderate increase in INR.3,4 It might be prudent to monitor INR in patients on chronic warfarin therapy more closely than usual when they take more than 2 g per day of acetaminophen for more than a few days.
1. Pharmacogenetic-based dosing of warfarin. Med Lett Drugs Ther 2008; 50:39.
2. HH Thijssen et al. Paracetamol (acetaminophen) warfarin interaction: NAPQI, the toxic metabolite of paracetamol, is an inhibitor of enzymes in the vitamin K cycle. Thromb Haemost 2004; 92:797.
3. D Kwan et al. The effects of acetaminophen on pharmacokinetics and pharmacodynamics of warfarin. J Clin Pharmacol 1999; 39:68.
4. I Mahe et al. Paracetamol: A haemorrhagic risk factor in patients on warfarin. Br J Clin Pharmacol 2005; 59:371.
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Patient susceptibility varies, possibly on a genetic basis; occasional use of acetaminophen generally has little or no effect on the international normalized ratio (INR) in patients on chronic warfarin therapy, but in some, even a few grams of the drug may cause a dramatic increase in INR. One study in healthy subjects found no effect of acetaminophen 4 g per day for 2 weeks, while another study in patients with the same acetaminophen dose for the same period of time found a moderate increase in INR.3,4 It might be prudent to monitor INR in patients on chronic warfarin therapy more closely than usual when they take more than 2 g per day of acetaminophen for more than a few days.
1. Pharmacogenetic-based dosing of warfarin. Med Lett Drugs Ther 2008; 50:39.
2. HH Thijssen et al. Paracetamol (acetaminophen) warfarin interaction: NAPQI, the toxic metabolite of paracetamol, is an inhibitor of enzymes in the vitamin K cycle. Thromb Haemost 2004; 92:797.
3. D Kwan et al. The effects of acetaminophen on pharmacokinetics and pharmacodynamics of warfarin. J Clin Pharmacol 1999; 39:68.
4. I Mahe et al. Paracetamol: A haemorrhagic risk factor in patients on warfarin. Br J Clin Pharmacol 2005; 59:371.
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Correction: Natalizumab (Tysabri) for Crohn's Disease
The Medical Letter on Drugs and Therapeutics • June 2, 2008; (Issue 1287)
The May 5, 2008 article (Med Lett Drugs Ther 2008; 50:34) on the approval of natalizumab (Tysabri) for treatment of Crohn's disease in the "Adverse Effects" section on page 35 included the statement:...
The May 5, 2008 article (Med Lett Drugs Ther 2008; 50:34) on the approval of natalizumab (Tysabri) for treatment of Crohn's disease in the "Adverse Effects" section on page 35 included the statement: "post-marketing hepatotoxicity, sometimes fatal or requiring liver transplantation, has occurred." Actually, no fatal hepatotoxicity or liver transplantation has been reported to date. The FDA warning about post-marketing hepatotoxicity with Tysabri that was the basis for our statement said: "The combination of transaminase elevations and elevated bilirubin without evidence of obstruction is recognized as an important predictor of severe liver injury that may lead to [emphasis added] death or the need for a liver transplant in some patients." Also, in the last sentence of the Conclusion, we should have said: "Because of the risk of serious hepatic toxicity and the rare but even more serious risk of developing progressive multifocal leukoencephalopathy, it should be used only in patients who have not responded to other drugs, including a TNF inhibitor." The italicized words should be substituted for "it is FDA-approved for use."
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Pharmacogenetic-Based Dosing of Warfarin
The Medical Letter on Drugs and Therapeutics • May 19, 2008; (Issue 1286)
Warfarin sodium (Coumadin, and others) and other coumarin anticoagulants prevent thrombosis, but patient response is highly variable and overanticoagulation can lead to hemorrhage. Genotyping patients for...
Warfarin sodium (Coumadin, and others) and other coumarin anticoagulants prevent thrombosis, but patient response is highly variable and overanticoagulation can lead to hemorrhage. Genotyping patients for single nucleotide polymorphisms (SNPs) that affect coumarin metabolism and sensitivity may help clinicians estimate the therapeutic warfarin dose. The FDA has added a note to warfarin labeling recommending lowrange doses for patients with such genetic variations. Commercial tests for these variants are now available and cost about $500 per test.
Natalizumab (Tysabri) for Crohn's Disease
The Medical Letter on Drugs and Therapeutics • May 5, 2008; (Issue 1285)
Natalizumab (Tysabri - Elan and Biogen) is a monoclonal antibody approved for induction and maintenance treatment of moderate to severe Crohn's disease (CD) refractory to conventional therapies and inhibitors...
Natalizumab (Tysabri - Elan and Biogen) is a monoclonal antibody approved for induction and maintenance treatment of moderate to severe Crohn's disease (CD) refractory to conventional therapies and inhibitors of tumor necrosis factor (TNF). Initially approved in 2004 for the treatment of multiple sclerosis (MS), natalizumab was temporarily withdrawn from the market after 3 patients developed progressive multifocal leukoencephalopathy (PML). It is now available for treatment of both MS and CD through a restricted distribution program.
Doripenem (Doribax) - A New Parenteral Carbapenem
The Medical Letter on Drugs and Therapeutics • January 28, 2008; (Issue 1278)
Doripenem (Doribax - Ortho-McNeil Janssen), an intravenous (IV) carbapenem antibiotic with a spectrum of activity similar to that of imipenem and meropenem, has been approved by the FDA for treatment of...
Doripenem (Doribax - Ortho-McNeil Janssen), an intravenous (IV) carbapenem antibiotic with a spectrum of activity similar to that of imipenem and meropenem, has been approved by the FDA for treatment of complicated intra-abdominal and urinary tract infections. Use of doripenem for treatment of nosocomial pneumonia, including ventilator-associated pneumonia, is still under FDA review.
Tinidazole (Tindamax) - A New Option for Treatment of Bacterial Vaginosis
The Medical Letter on Drugs and Therapeutics • September 10, 2007; (Issue 1269)
Tinidazole (Tindamax - Mission Pharmacal), an oral antiprotozoal drug available in the US since 2004 for treatment of trichomoniasis, giardiasis, amebiasis and amebic liver abscess, was recently approved by the...
Tinidazole (Tindamax - Mission Pharmacal), an oral antiprotozoal drug available in the US since 2004 for treatment of trichomoniasis, giardiasis, amebiasis and amebic liver abscess, was recently approved by the FDA for treatment of bacterial vaginosis.
Drugs for Sexually Transmitted Infections
The Medical Letter on Drugs and Therapeutics • September 1, 2007; (Issue 61)
Many infections can be transmitted during sexual contact. The text and tables that follow are limited to management of sexually transmitted infections (STIs) other than HIV, viral hepatitis and enteric...
Many infections can be transmitted during sexual contact. The text and tables that follow are limited to management of sexually transmitted infections (STIs) other than HIV, viral hepatitis and enteric infections. Guidelines are available from the US Centers for Disease Control and Prevention (CDC) with detailed recommendations for treatment of these diseases.
Choice of Antibacterial Drugs
The Medical Letter on Drugs and Therapeutics • May 1, 2007; (Issue 57)
Information about empirical treatment of bacterial infections, emerging trends in antimicrobial resistance, new drugs and new data about older drugs continue to become available. Usual pathogens and empiric...
Information about empirical treatment of bacterial infections, emerging trends in antimicrobial resistance, new drugs and new data about older drugs continue to become available. Usual pathogens and empiric treatment for some common types of infections are summarized in the text and a table listing the drugs of choice and alternatives for each pathogen begins on page 40. The recommendations made here are based on the results of susceptibility studies, clinical trials and the opinions of Medical Letter consultants.
Antimicrobial Prophylaxis for Surgery
The Medical Letter on Drugs and Therapeutics • December 1, 2006; (Issue 52)
Antimicrobial prophylaxis can decrease the incidence of infection, particularly surgical site infection, after certain procedures. Recommendations for prevention of surgical site infection are listed in this...
Antimicrobial prophylaxis can decrease the incidence of infection, particularly surgical site infection, after certain procedures. Recommendations for prevention of surgical site infection are listed in this article.
Treatment of Clostridium difficile-Associated Disease (CDAD)
The Medical Letter on Drugs and Therapeutics • November 6, 2006; (Issue 1247)
The gram-positive anaerobic bacillus Clostridium difficile is the most common identifiable cause of antibiotic-associated diarrhea. The antibiotics most often implicated have been ampicillin, second and third...
The gram-positive anaerobic bacillus Clostridium difficile is the most common identifiable cause of antibiotic-associated diarrhea. The antibiotics most often implicated have been ampicillin, second and third generation cephalosporins, clindamycin and fluoroquinolones. The emergence in recent years of a new, more toxic epidemic strain (BI/NAP1), possibly related to widespread use of fluoroquinolones, has caused a marked increase in the incidence and severity of C. difficile-associated disease (CDAD).
Drugs for Acne, Rosacea and Psoriasis
The Medical Letter on Drugs and Therapeutics • July 1, 2005; (Issue 35)
The pathogenesis of acne is multifactorial: follicular hyperkeratinization, Propionibacterium acnes bacteria, sebum production, androgens and inflammation have all been implicated. P. acnes, a gram-positive...
The pathogenesis of acne is multifactorial: follicular hyperkeratinization, Propionibacterium acnes bacteria, sebum production, androgens and inflammation have all been implicated. P. acnes, a gram-positive microaerophilic bacterium, plays an important role in the development of acne lesions by secreting chemotactic factors that attract leukocytes to the follicle, causing inflammation.
Drugs for Sexually Transmitted Infections
The Medical Letter on Drugs and Therapeutics • October 1, 2004; (Issue 26)
Many infections can be transmitted during sexual contact. The text and tables that follow are limited to management of sexually transmitted infections (STIs) other than HIV, viral hepatitis and enteric...
Many infections can be transmitted during sexual contact. The text and tables that follow are limited to management of sexually transmitted infections (STIs) other than HIV, viral hepatitis and enteric infections. Guidelines are available from the US Centers for Disease Control and Prevention (CDC) with detailed recommendations for treatment of these diseases (MMWR Recomm Rep 2002; 51, RR-6:1). New guidelines are expected soon.
Tinidazole (Tindamax) - A New Anti-Protozoal Drug
The Medical Letter on Drugs and Therapeutics • August 30, 2004; (Issue 1190)
Tinidazole (Tindamax - Presutti Labs), an oral antiprotozoal drug similar to metronidazole (Flagyl, and others), has been approved by the FDA for treatment of trichomoniasis in adults and for treatment of...
Tinidazole (Tindamax - Presutti Labs), an oral antiprotozoal drug similar to metronidazole (Flagyl, and others), has been approved by the FDA for treatment of trichomoniasis in adults and for treatment of giardiasis, intestinal amebiasis and amebic liver abcess in adults and children more than 3 years old. Tinidazole has been widely used outside of the US for decades under the trade name Fasigyn (Pfizer).
Drugs for Parasitic Infections
The Medical Letter on Drugs and Therapeutics • August 16, 2004; (Issue 1189)
Parasitic infections are found throughout the world. With increasing travel, immigration, use of immunosuppressive drugs and the spread of AIDS, physicians anywhere may see infections caused by previously...
Parasitic infections are found throughout the world. With increasing travel, immigration, use of immunosuppressive drugs and the spread of AIDS, physicians anywhere may see infections caused by previously unfamiliar parasites. The table below lists first-choice and alternative drugs for most parasitic infections. The brand names and manufacturers of the drugs are listed in this article.
Antimicrobial Prophylaxis for Surgery
The Medical Letter on Drugs and Therapeutics • April 1, 2004; (Issue 20)
Antimicrobial prophylaxis can decrease the incidence of infection, particularly surgical site infection, after certain operations, but this benefit must be weighed against the risks of toxic and allergic...
Antimicrobial prophylaxis can decrease the incidence of infection, particularly surgical site infection, after certain operations, but this benefit must be weighed against the risks of toxic and allergic reactions, emergence of resistant bacteria, adverse drug interactions, superinfection and cost. Medical Letter consultants generally recommend antimicrobial prophylaxis only for procedures with high infection rates, those involving implantation of prosthetic material, and those in which the consequences of infection are likely to be especially serious.
Choice of Antibacterial Drugs
The Medical Letter on Drugs and Therapeutics • March 1, 2004; (Issue 19)
New drugs for bacterial infections and new information about older drugs continue to become available. Empirical treatment of some common bacterial infections is discussed in this article. A table listing the...
New drugs for bacterial infections and new information about older drugs continue to become available. Empirical treatment of some common bacterial infections is discussed in this article. A table listing the drugs of choice and alternatives for each pathogen begins on page 18. These recommendations are based on results of susceptibility studies, clinical trials and the opinions of Medical Letter consultants. Local resistance patterns should be taken into account. Trade names are listed on page 24.
Drugs for Peptic Ulcers
The Medical Letter on Drugs and Therapeutics • February 1, 2004; (Issue 18)
Most peptic ulcers not caused by nonsteroidal anti-inflammatory drugs (NSAIDs) are associated with infection of the gastric mucosa by the gram-negative bacilli Helicobacter pylori. The majority of NSAID-related...
Most peptic ulcers not caused by nonsteroidal anti-inflammatory drugs (NSAIDs) are associated with infection of the gastric mucosa by the gram-negative bacilli Helicobacter pylori. The majority of NSAID-related ulcers are gastric. H. pylori infection causes both duodenal and gastric ulcers. Eradication of H. pylori promotes healing and markedly decreases recurrence of both duodenal and gastric ulcers (A Shiotamni and DY Graham, Med Clin North Am 2002; 86:1447; FKL Chan and WK Leung, Lancet 2002; 360:933). The first step in the management of peptic ulcers is the diagnosis and treatment of H. pylori.
Azelaic Acid (Finacea) for Rosacea
The Medical Letter on Drugs and Therapeutics • September 15, 2003; (Issue 1165)
Azelaic acid 15% gel (Finacea Berlex) is now available in the US for treatment of mild to moderate rosacea. A 20% cream formulation of the drug (Azelex Allergan; Medical Letter 1996; 38:52) has been marketed...
Azelaic acid 15% gel (Finacea Berlex) is now available in the US for treatment of mild to moderate rosacea. A 20% cream formulation of the drug (Azelex Allergan; Medical Letter 1996; 38:52) has been marketed here since 1996 for treatment of acne. The effectiveness of Finacea compared to its own vehicle and to metronidazole gel is discussed. Information on the drug's mechanism of action, adverse effects, dosage and cost are also included.
Drugs for Pneumonia
The Medical Letter on Drugs and Therapeutics • September 1, 2003; (Issue 13)
The choice of drugs for treatment of pneumonia depends on the most likely pathogens causing the infection and local antimicrobial resistance patterns. Factors such as severity of illness, presence of co-morbid...
The choice of drugs for treatment of pneumonia depends on the most likely pathogens causing the infection and local antimicrobial resistance patterns. Factors such as severity of illness, presence of co-morbid conditions and whether the infection is community or hospital-acquired also need to be considered.
Nitazoxanide (Alinia) -- a New Anti-protozoal Agent
The Medical Letter on Drugs and Therapeutics • April 14, 2003; (Issue 1154)
Nitazoxanide (Alinia - Romark Labs), a new antiparasitic drug, has been approved by the FDA in a liquid formulation for treatment of diarrhea caused by Cryptosporidium parvum and Giardia lamblia in children 1...
Nitazoxanide (Alinia - Romark Labs), a new antiparasitic drug, has been approved by the FDA in a liquid formulation for treatment of diarrhea caused by Cryptosporidium parvum and Giardia lamblia in children 1 to 11 years old. It is the first drug approved for treatment of cryptosporidiosis and the first to become available as a liquid for treatment of giardiasis. The FDA is reviewing a tablet formulation of nitazoxanide for use in adults.
Drugs That May Cause Psychiatric Symptoms
The Medical Letter on Drugs and Therapeutics • July 8, 2002; (Issue 1134)
Many drugs can cause psychiatric symptoms, but a causal connection is often difficult to establish. Psychiatric symptoms that emerge during drug treatment may also be due to the underlying illness, previously...
Many drugs can cause psychiatric symptoms, but a causal connection is often difficult to establish. Psychiatric symptoms that emerge during drug treatment may also be due to the underlying illness, previously unrecognized psychopathology, or psychosocial factors. The withdrawal of some drugs can cause symptoms such as anxiety, psychosis, delirium, agitation or depression.
Drugs for Parasitic Infections
The Medical Letter on Drugs and Therapeutics • April 1, 2002; (Issue 1127)
Superseded--purchase updated Parasitic Infections articleParasitic infections are found throughout the world. With increasing travel, immigration, use of immunosuppressive drugs and the spread of AIDS,...
Superseded--purchase updated Parasitic Infections article
Parasitic infections are found throughout the world. With increasing travel, immigration, use of immunosuppressive drugs and the spread of AIDS, physicians anywhere may see infections caused by previously unfamiliar parasites.
Note: Drugs for Parasitic Infections, revised and updated, is now available to both subscribers and nonsubscribers on our web site. This article, a bi-annual feature of The Medical Letter for many years, will not be published as a printed issue in 2002, but is included in the 16th edition of The Medical Letter Handbook of Antimicrobial Therapy. The handbook is now available and can be ordered by calling customer service at 1-800-211-2769.
Parasitic infections are found throughout the world. With increasing travel, immigration, use of immunosuppressive drugs and the spread of AIDS, physicians anywhere may see infections caused by previously unfamiliar parasites.
Note: Drugs for Parasitic Infections, revised and updated, is now available to both subscribers and nonsubscribers on our web site. This article, a bi-annual feature of The Medical Letter for many years, will not be published as a printed issue in 2002, but is included in the 16th edition of The Medical Letter Handbook of Antimicrobial Therapy. The handbook is now available and can be ordered by calling customer service at 1-800-211-2769.
Budesonide (Entocort EC) For Crohn's Disease
The Medical Letter on Drugs and Therapeutics • January 21, 2002; (Issue 1122)
Budesonide (Entocort EC — AstraZeneca), a locally active glucocorticosteriod widely used for inhalation treatment of allergic rhinitis and asthma (Medical Letter 2000; 42:19), has been approved for oral...
Budesonide (Entocort EC — AstraZeneca), a locally active glucocorticosteriod widely used for inhalation treatment of allergic rhinitis and asthma (Medical Letter 2000; 42:19), has been approved for oral treatment of mild to moderate active Crohn's disease involving the ileum and/or ascending colon. Both oral budesonide and budesonide enemas have been available for years in Europe and Canada for treatment of inflammatory bowel disease.
Drugs that may cause Cognitive Disorders in the Elderly
The Medical Letter on Drugs and Therapeutics • November 27, 2000; (Issue 1093)
Older patients are especially susceptible to drug-induced cognitive impairment. They are more likely to be taking multiple drugs, to have higher blood levels of those drugs because of renal or hepatic...
Older patients are especially susceptible to drug-induced cognitive impairment. They are more likely to be taking multiple drugs, to have higher blood levels of those drugs because of renal or hepatic dysfunction, and to have pre-existing cognitive problems that make it difficult to detect the role of drugs causing new symptoms or making old ones worse.
Oral Contraceptives
The Medical Letter on Drugs and Therapeutics • May 15, 2000; (Issue 1078)
Two types of oral contraceptives are available in the USA: combination oral contraceptives that contain both an estrogen and a progestin, and progestin-only contraceptives, or "mini-pills."Used as directed, all...
Two types of oral contraceptives are available in the USA: combination oral contraceptives that contain both an estrogen and a progestin, and progestin-only contraceptives, or "mini-pills."Used as directed, all oral contraceptives marketed in the USA are similarly effective in preventing pregnancy.
Drugs for Sexually Transmitted Infections
The Medical Letter on Drugs and Therapeutics • September 24, 1999; (Issue 1062)
Many infections can be transmitted during sexual contact. The text and tables [in this article] are limited to treatment of non-HIV infections associated primarily with sexual...
Many infections can be transmitted during sexual contact. The text and tables [in this article] are limited to treatment of non-HIV infections associated primarily with sexual transmission.
Drugs for Parasitic Infections
The Medical Letter on Drugs and Therapeutics • January 2, 1998; (Issue 1017)
(Superseded by the 2013 version. Click here to purchase.)Parasitic infections are found throughout the world. With increasing travel, immigration, use of immunosuppressive drugs and the spread of AIDS,...
(Superseded by the 2013 version. Click here to purchase.)
Parasitic infections are found throughout the world. With increasing travel, immigration, use of immunosuppressive drugs and the spread of AIDS, physicians anywhere may see infections caused by previously unfamiliar parasites. The table lists first-choice and alternative drugs for most parasitic infections.
Parasitic infections are found throughout the world. With increasing travel, immigration, use of immunosuppressive drugs and the spread of AIDS, physicians anywhere may see infections caused by previously unfamiliar parasites. The table lists first-choice and alternative drugs for most parasitic infections.
Drugs for Treatment of Peptic Ulcers
The Medical Letter on Drugs and Therapeutics • January 3, 1997; (Issue 991)
Most peptic ulcers not caused by nonsteroidal anti-inflammatory drugs (NSAIDs) are now thought to be associated with infection of the gastric mucosa by the gram-negative bacilli Helicobacter pylori. The...
Most peptic ulcers not caused by nonsteroidal anti-inflammatory drugs (NSAIDs) are now thought to be associated with infection of the gastric mucosa by the gram-negative bacilli Helicobacter pylori. The majority of NSAID-related ulcers are gastric. H. pylori have been associated with both duodenal and gastric ulcers. Eradication of H. pylori promotes healing and markedly decreases recurrence of both duodenal and gastric ulcers (AH Soll, JAMA, 275:622, 1996).
Meropenem - A New Parenteral Broad-Spectrum Antibiotic
The Medical Letter on Drugs and Therapeutics • September 27, 1996; (Issue 984)
Meropenem (Merrem - Zeneca), a carbapenem similar to imipenem-cilastatin (Primaxin), has been approved by the US Food and Drug Administration for intravenous (IV) treatment of complicated intra-abdominal...
Meropenem (Merrem - Zeneca), a carbapenem similar to imipenem-cilastatin (Primaxin), has been approved by the US Food and Drug Administration for intravenous (IV) treatment of complicated intra-abdominal infections in adults and children and bacterial meningitis in children more than three months old. Imipenem (Medical Letter, 28:29, 1986) has been useful for treatment of serious infections in which broad coverage of nosocomial organisms, including anaerobes, is needed. Other drugs for these indications were reviewed in the Medical Letter article on 'The Choice of Antibacterial Drugs' (volume 38, page 25, March 29, 1996).
Clarithromycin and Omeprazole for Helicobacter Pylori
The Medical Letter on Drugs and Therapeutics • June 7, 1996; (Issue 976)
The US Food and Drug Administration (FDA) recently approved the marketing of clarithromycin (Biaxin - Abbott), a macrolide antibiotic, and omeprazole (Prilosec - Astra Merck), a proton pump inhibitor, for...
The US Food and Drug Administration (FDA) recently approved the marketing of clarithromycin (Biaxin - Abbott), a macrolide antibiotic, and omeprazole (Prilosec - Astra Merck), a proton pump inhibitor, for concurrent use in treatment of duodenal ulcers associated with Helicobacter pylori.
Drugs for Treatment of Peptic Ulcers
The Medical Letter on Drugs and Therapeutics • July 22, 1994; (Issue 927)
Most peptic ulcers not caused by nonsteroidal anti-inflammatory drugs (NSAIDs) are now thought to be associated with infection of the gastric mucosa by the gram-negative bacilli Helicobacter pylori (NIH...
Most peptic ulcers not caused by nonsteroidal anti-inflammatory drugs (NSAIDs) are now thought to be associated with infection of the gastric mucosa by the gram-negative bacilli Helicobacter pylori (NIH Consensus Development Panel, JAMA, 272:65, July 6, 1994). NSAID-related ulcers are usually gastric. H. pylori have been associated with both duodenal and gastric ulcers.
Piperacillin/Tazobactam
The Medical Letter on Drugs and Therapeutics • January 21, 1994; (Issue 914)
Piperacillin/tazobactam (Zosyn - Lederle), an antibiotic combination product, has been approved by the US Food and Drug Administration for intravenous treatment of intra-abdominal, pelvic, skin, and...
Piperacillin/tazobactam (Zosyn - Lederle), an antibiotic combination product, has been approved by the US Food and Drug Administration for intravenous treatment of intra-abdominal, pelvic, skin, and skin-structure infections and for community-acquired pneumonia of moderate severity.
Drugs For Treatment of Peptic Ulcers
The Medical Letter on Drugs and Therapeutics • November 29, 1991; (Issue 858)
Drugs that accelerate healing and prevent relapse or reurrence of peptic ulcers act either by decreasing gastric acidity or by enhancing mucosal defense mechanisms. Risk factors that may cause breakdown of...
Drugs that accelerate healing and prevent relapse or reurrence of peptic ulcers act either by decreasing gastric acidity or by enhancing mucosal defense mechanisms. Risk factors that may cause breakdown of mucosal defenses include the use of aspirinor other nonsteroidal anti-inflammatory drugs (NSAIDs) and the presence of Helicobacter pylori bacterial in the gastric antrum (AH Soll, Engl J Med, 322:909, 1990; WL Peterson, N Engl J Med, 324:1043, 1991).
Choice of Cephalosporin
The Medical Letter on Drugs and Therapeutics • November 30, 1990; (Issue 832)
Since the last Medical Letter review of cephalosporin antibiotics (volume 25, page 57, 1983), many new cephalosporins have become available in the...
Since the last Medical Letter review of cephalosporin antibiotics (volume 25, page 57, 1983), many new cephalosporins have become available in the USA.
Treatment of Clostridium Difficile Diarrhea
The Medical Letter on Drugs and Therapeutics • October 20, 1989; (Issue 803)
The gram-positive bacillus Clostridium difficile is the most common identifiable cause of antibiotic-associated diarrhea and pseudomembranous colitis (R Fekety in GL Mandell et al, eds, Principles and...
The gram-positive bacillus Clostridium difficile is the most common identifiable cause of antibiotic-associated diarrhea and pseudomembranous colitis (R Fekety in GL Mandell et al, eds, Principles and Practice of Infectious Diseases, 3rd ed, New York:Churchill Livingstone, 1990, page 863). C. difficile colitis usually develops during or soon after antibiotic treatment. Virtually any antimicrobial agent can cause the disorder, but clindamycin, ampicillin and the cephalosporins have been implicated most frequently. Pseudomembranous colitis was recently reported in five patients who had each taken only a single dose of a cephalosporin (JP Freiman et al, JAMA, 262:902, August 18, 1989).
Topical Metronidazole For Rosacea
The Medical Letter on Drugs and Therapeutics • August 11, 1989; (Issue 798)
A topical formulation of 0.75% metronidazole gel (MetroGel - Curatek), an antibacterial, antiparasitic agent, was recently approved by the US Food and Drug Administration for treatment of...
A topical formulation of 0.75% metronidazole gel (MetroGel - Curatek), an antibacterial, antiparasitic agent, was recently approved by the US Food and Drug Administration for treatment of rosacea.