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Federico Marchetti

Publications and source records attributed to Federico Marchetti.

At least 19 recordsLinked to original sources
PubMed2006

The awareness among paediatricians of off-label prescribing in children: a survey of Italian hospitals.

OBJECTIVE: To investigate paediatricians' perception and awareness of off-label (OL) and unlicensed drug usage in clinical practice. METHODS: We conducted a questionnaire-based, observational study involving 28 departments/specialty units of four tertiary paediatrics Italian hospitals. The questionnaire was sent to a designated paediatrician in each department/specialty unit with the request that they summarise their awareness of OL prescriptions after a group discussion with all paediatricians working in the same department/unit. RESULTS: A total of 95 drugs were identified. The most common perceived reasons detected for OL use were age and formulation. Corticosteroids, ACE-inhibitors, beta-blockers and calcium-antagonists were most frequently indicated as OL for formulation, while ACE-inhibitors, new generation anti-epilepsy drugs, immunosuppressants, ketorolac and propofol as OL for age. Adrenaline, midazolam and ACE-inhibitors were indicated as unlicensed for route of administration. We found a high concordance between the OL drugs identified by physicians and those reported in the "Italian Summary Product Characteristics". CONCLUSIONS: Italian paediatricians perceived different drugs as unlicensed/OL from those identified by existing prescriptions studies. These perceived drugs may represent a priority in tackling the problem of OL usage in the hospital practice. The review of the Italian Summary Product Characteristics of some of the drugs identified, together with the monitoring of permanent clinical practice and with new clinical research, may be a step forward to reduce OL use in children.

Attitude of Health Personnel↗
PubMed2006

Diagnostic challenge of hyper-IgD syndrome in four children with inflammatory gastrointestinal complaints.

OBJECTIVE: Hyper-IgD syndrome (HIDS) is a rare autosomal recessive disease characterized by recurrent fever, lymphadenopathy, diarrhoea, abdominal pain, headache, arthralgia and skin rash. Abdominal symptomatology may mimic inflammatory bowel disease. We report on four patients with HIDS who had been previously investigated for Crohn's disease (CD). The levels of IgD were measured in a series of patients with CD to evaluate the specificity of this assay in the differential diagnosis between the two conditions. MATERIAL AND METHODS: Diagnosis of HIDS was based on clinical criteria as well as immunological or genetic data. IgD levels were measured in the four subjects affected by HIDS, in 59 patients with CD and in a group of 160 healthy controls. RESULT: All patients underwent a variety of gastroenterological investigations because inflammatory bowel disease was suspected. Ultrasonography was pathologic in all the patients, showing enlargement of mesenteric lymph nodes. Abdominal leucocyte scintigraphy displayed diffuse signals of mild to moderate degree. IgD and IgA levels were elevated in three out of four patients. No difference in IgD values was found in CD patients as compared to the control group. CONCLUSIONS: Gastrointestinal complaints associated with recurrent fever and mesenteric adenopathy warrant genetic investigation for HIDS, in order to avoid unnecessary invasive investigations and treatment.

Child↗
PubMed2006

Early discharge of hospitalised patients with community-acquired urosepsis when treated with levofloxacin in sequential therapy.

OBJECTIVES: To compare the sequential therapy with levofloxacin with a standard treatment in the management of urosepsis. MATERIALS AND METHODS: It was a multicenter, randomized, open label, pilot trial in community acquired urosepsis carried out in 7 hospitals. Levofloxacin administered 500 mg twice a day intravenously and then orally was compared to piperacillin/tazobactam 4 g/0.5 g three times a day, both in combination with amikacin 7.5 mg/Kg twice a day, for a maximum of 14 days. Amikacin could be suspended between day 3-7. RESULTS: Both treatments were efficacious and well tolerated in the 47 enrolled patients, even tough the time to clinical stability was shorter in the levofloxacin treated patients (3.9 vs. 4.9 days). In the levofloxacin group the sequential therapy was performed in 19 (82.6%) cases, after 4.8 +/- 1.7 days of parenteral administration (100% in the per-protocol population after 5.1 +/- 1.9 days). CONCLUSIONS: The implementation of the sequential therapy in the levofloxacin group allowed an early hospital discharge in patients with urosepsis and a cost saving in the hospital perspective.

Anti-Bacterial Agents↗
PubMed2005

Synergistic potential of ceftazidime plus amikacin or levofloxacin against Pseudomonas aeruginosa as determined using a checkerboard and a disk diffusion technique.

The synergistic potential of ceftazidime plus amikacin or levofloxacin was assessed against 61 Pseudomonas aeruginosa isolates with variable susceptibility patterns to the 3 antibiotics. A checkerboard broth method and a disk diffusion method were used and compared. The latter, also easy to perform as a triple-disk assay, could be a helpful laboratory screening tool for drug synergism to drive possible combination treatments.

Amikacin↗
PubMed2005

Delayed prescription may reduce the use of antibiotics for acute otitis media: a prospective observational study in primary care.

OBJECTIVES: To evaluate the applicability and the effectiveness of practice guidelines based on a wait-and-see strategy for children with acute otitis media (AOM). POPULATION: Children from 1 to 14 years old having AOM who were referred to primary care pediatric practices. STUDY DESIGN: Prospective observational study. MAIN OUTCOME MEASURE: Proportion of children having a diagnosis of AOM and eligible for symptomatic treatment who, at 72 hours from enrollment, recovered from their symptoms (fever and earache) without receiving antibiotic treatment. RESULTS: One hundred sixty-nine pediatricians participated in the study and enrolled 1672 children. One thousand two hundred seventy-seven children were included in the analysis. One hundred seventy-eight children received antibiotic treatment at first contact according to the practice guidelines criteria (presence of otorrhea or recurrent AOM). Of the 1099 children who were eligible for symptomatic treatment only, 743 (67.6%) recovered without antibiotic treatment at 3 days and 716 (65.1%) at 30 days. No complications were observed. Coexistence of a high fever (temperature > or = 38.4 degrees C) and red and bulging tympanic membrane as well as male sex were significantly associated with antibiotic use. CONCLUSIONS: Practice guidelines based on a wait-and-see strategy for children with AOM are applicable and effective in primary care. This strategy was able to avoid the administration of antibiotic treatment in 2 of 3 children.

Acute Disease↗
PubMed2005

Clinical quiz.

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Adolescent↗
PubMed2005

Tremors and chorea induced by trimethoprim-sulfamethoxazole in a child with Pneumocystis pneumonia.

A 1.5-year-old girl developed high frequency tremors and chorea after receiving a dose of 120 mg/kg/d trimethoprim-sulfamethoxazole (TMP-SMX) for the treatment of Pneumocystis pneumonia. The child was human immunodeficiency virus-negative but immunocompromised because of prolonged immunosuppressive therapy. These symptoms disappeared 3 days after TMP-SMX was discontinued. Pediatricians should be aware of tremors and chorea among the potential adverse effects of high doses of TMP-SMX.

Anti-Infective Agents↗
PubMed2005

Attitudes of children with leukemia toward repeated deep sedations with propofol.

Procedural sedation is generally recommended for children requiring repeated painful diagnostic or therapeutic procedures. A child with leukemia undergoes an average of 20 procedures such as lumbar puncture and bone marrow aspiration through the course of illness. No data are currently available about the psychological impact of repeated sedations on children. The objective of this study was to evaluate the attitudes of patients with leukemia toward repeated deep sedations using propofol. A questionnaire addressing sedation-related distress was given to 30 children with leukemia. Procedure-related distress was evaluated using the Amended Observational Scale of Behavioural Distress. Another questionnaire concerning the same issues was given to an historical group of 39 children who had undergone painful procedures without sedation in previous years. Fear and distress were significantly reduced in the sedation group compared with the historical one. Fear of sedation was reported by 17% of children of this group. Distressed behavior was observed in 27%. In conclusion, sedation-related distress was observed in a subgroup of patients; in these cases, specific strategies could be considered to reduce sedation-related distress.

Adolescent↗
PubMed2005

Pharmacodynamics of levofloxacin in patients with acute exacerbation of chronic bronchitis.

STUDY OBJECTIVES: Levofloxacin is a fluoroquinolone antimicrobial agent for which pharmacodynamic relationships between the maximum serum antibiotic concentration (Cmax)/minimum inhibitory concentration (MIC) ratio and/or the area under the serum concentration-time curve during a 24-h dosing period (AUC(0-24))/MIC ratio and clinical and/or microbiological outcomes have been developed. In this study we examined the relationship between the in vitro bacterial susceptibility to levofloxacin, the achieved levofloxacin serum and sputum concentrations, and the in vivo bacterial eradication in patients with acute exacerbations of chronic bronchitis. PATIENTS AND INTERVENTIONS: Thirty patients received levofloxacin, 500 mg/d po for 7 days. Samples of venous blood and sputum for the determination of levofloxacin concentrations were collected on day 1 immediately prior to dosing, and then at 1, 4, 8, 12, and 24 h. RESULTS: The mean peak concentration in serum (6.5 mg/L) was found 1 h after administration, and at 4 h after administration in sputum (5.1 mg/L). Levofloxacin was always detectable 24 h after administration from both samples. Successful treatment occurred in 90% (27 of 30 patients) when assessed both clinically and bacteriologically. Treatment was successful in eight patients when the AUC(0-24)/MIC ratio was > 40 for serum, and in nine patients when it was > 30 for sputum. Treatment was also successful in seven patients when the Cmax/MIC ratio was > 5.01 for serum, and in nine patients when the Cmax/MIC ratio was > 4.01 for sputum. Treatment was successful in 90% (27 of 30 patients) when the AUC(0-24)/MIC ratio was > 125 for serum and > 100 for sputum, and when Cmax/MIC was > 10.01 for serum and > 8.01 for sputum following the first dose. CONCLUSIONS: The pharmacodynamics values that we have obtained in sputum with levofloxacin may be used as predictors of therapy outcomes.

Acute Disease↗
PubMed2004

A new mutation in two siblings with cystinosis presenting with Bartter syndrome.

Nephropathic cystinosis is a severe autosomal recessive inherited metabolic disease characterized by accumulation of free cystine in lysosomes. Cystinosis can lead to renal failure and multiorgan impairment. Only five cases of cystinosis with associated Bartter syndrome are reported in the literature, and no genetic evaluation has been reported. We describe two siblings with nephropathic cystinosis presenting with features of Bartter syndrome and their genetic pattern.

Bartter Syndrome↗
PubMed2004

Clinical characterization of the prostatitis patient in Italy: a prospective urology outpatient study.

A prospective multi-center Italian urology outpatient survey, undertaken to determine the prevalence of prostatitis in Italy, provided an ideal opportunity to identify and characterize the typical prostatitis patient presenting to Italian urologists. A total of 70 urologists, representing a cross section of urologic centers in Italy, counted and recorded the overall total male patients reported in the clinic and the overall total patients diagnosed with prostatitis over a 5 week period in late 2001. Data on demographics, previous diagnoses, symptoms (frequency and severity), quality of life, physical examination and laboratory data were prospectively collected. A total of 1,148 patients were identified with prostatitis (12.8%). Of these, 1,074 patients had complete data and could be included in this characterization analysis. The mean age of the prostatitis patients was 47.1 years (range 16-83); two thirds had experienced their first symptom within the last year. A family history of prostatitis was reported by 20.4%. The most common urinary diseases were benign prostatic hyperplasia (17.4%), recurrent urinary tract infection (11.2%) and urinary calculogenesis (11.1%), while the most common concurrent diseases were diabetes (7.2%) and depression (6.8%). The most frequently reported and most severe symptoms at the time of evaluation were irritative voiding symptoms, perineal and suprapubic pain and discomfort. Over three quarters of the patients were dissatisfied with their quality of life. Bacteria were cultured in 15.6%, 17.7% and 14.0% of expressed prostatic secretions, urine specimens after prostatic massage and semen specimens, respectively. Prostatitis is a common outpatient diagnosis, comprising over 10% of male outpatient visits to urologists in Italy. This comprehensive characterization of the typical prostatitis patient diagnosed in routine urological outpatient practice can be employed to generate hypothesis-driven studies in diagnosis and treatment.

Adult↗
PubMed2004

Early antibiotic treatment of pseudomonas aeruginosa colonisation in cystic fibrosis: a critical review of the literature.

AIM: To assess the evidence supporting early antibiotic treatment in asymptomatic cystic fibrosis (CF) patients colonised by Pseudomonas aeruginosa (PA). METHODS: We carried out a computerised (Medline, Embase) and hand search of journals for suitable publications. All English-language clinical studies regarding the efficacy of early antibiotic treatment on PA colonisation in asymptomatic patients were considered. Each eligible publications fitting these criteria were assessed for the following outcome measures: frequency of positive PA cultures; serum level of precipitating antibodies; lung function; survival; number of hospitalisations; adverse effects and resistance to antibiotics. RESULTS: Of the 11 studies eventually considered, 3 were randomised-2 versus placebo- and 8 were cohort studies-2 of which had historical controls. Overall, 309 patients (population range 7-91 patients) were recruited. There was a high variability between the individual studies for age, outcome measures, duration of follow-up (1 to 44 months) and treatment (three studies used only aerosol tobramycin, one colistin, four aerosol colistin plus oral ciprofloxacin, one used intravenous treatment and two miscellaneous therapy). An overall evaluation indicated that early antibiotic treatment can reduce the number of positive cultures and the anti-PA antibody titre. In one study, FEV1 was better in the treated group (oral ciprofloxacin and nebulised colistin) than in historical controls, while in one placebo-controlled trial, no effect on lung function was shown after 1 year of tobramycin inhalation. Collateral effects and bacterial resistance were not increased. The short follow-up did not allow definite conclusions with regard to the long-term progression of respiratory insufficiency or survival. CONCLUSIONS: Evidence was found that antibiotic treatment can reduce the rate of positive cultures and of anti-PA antibody titres in asymptomatic CF patients with newly isolated PA. Different therapeutic options have not been directly compared: a multi-centre comparative study needs to be carried out.

Anti-Bacterial Agents↗