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Biomedical subjects

L J Eron

Publications and source records attributed to L J Eron.

At least 37 records · Page 2Linked to original sources
PubMed1988

Topically applied vidarabine sodium phosphate in genital herpes infection.

One hundred and thirty-four patients with recurrences of genital herpes were randomized in a double-blind trial to receive self-applied topical therapy with either vidarabine sodium phosphate in an aqueous gel or placebo gel. No significant differences were noted between the two groups in the duration of viral shedding, in the time to healing of the treated recurrence, in the interval between recurrences, or in the number of recurrences.

Administration, Topical↗
PubMed1988

Iv antibiotic therapy in an outpatient setting: report of a joint venture program.

Intracare, a joint venture between infectious disease consultants and Fairfax Hospital, Virginia, represents an ambulatory model for the delivery of intravenous antibiotics on an outpatient basis. This article reviews the cost effectiveness and clinical effectiveness of the program in the first 2,096 enrollees over a 6-year period. The most commonly treated infection was osteomyelitis and the most frequently used antibiotic was ceftriaxone sodium. The infections responded satisfactorily in 89% of patients in the program. A total of 39,829 hospital days were saved, which represented a cost savings for hospital bed charges alone of $15,931,600. The authors conclude that because of changes in the hospital environment--constraints on the expansion of hospital beds, and the reservation of hospital beds for the most acutely ill patients (a future prediction resulting from an increased elderly population)--Intracare may serve as a prototype of a clinic rendering all types of outpatient care to chronically ill or less acutely ill patients who would ordinarily have been hospitalized.

Ambulatory Care↗
PubMed1987

Ganciclovir for the treatment and suppression of serious infections caused by cytomegalovirus.

Ganciclovir is a congener of acyclovir with in vitro activity against cytomegalovirus. Ninety-seven patients with the acquired immune deficiency syndrome (AIDS) and a serious cytomegalovirus infection received ganciclovir, 3.0 to 15 mg/kg per day. Viremia cleared during drug therapy in 88 percent of patients. Viral shedding from urine and throat ceased or became inapparent during treatment in 78 percent and 68 percent of patients, respectively. Among patients with cytomegalovirus retinitis, 87 percent of evaluable patients had improvement in (30 of 60) or stabilization (22 of 60) of their disease. However, when the drug was discontinued, progression or recurrence of disease always occurred. Long-term suppressive therapy with ganciclovir, 5.0 mg/kg five to seven times weekly, prevented the recurrence of cytomegalovirus disease (p less than 0.001). The drug was eliminated by renal excretion, and in patients without renal impairment (creatinine clearance rates of more than 60 ml/minute/1.73 m2), ganciclovir has a mean half-life of 4.2 hours. Significant neutropenia and leukopenia occurred in 55 percent and 32 percent of patients, respectively.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Therapy of genital herpes with topically applied interferon.

Ninety-four patients with recurrences of genital herpes were randomized in a double-blind trial to receive topical therapy for 5 days with either alpha-2a interferon at 30 X 10(6) IU/ml or 10 X 10(6) IU/ml or placebo six times daily. No differences were noted between either interferon dose and placebo with respect to the duration of viral shedding, the time to crusting, or the time to healing of herpetic lesions. Aqueous solutions of alpha-2a interferon applied topically to unroofed vesicles do not appear to be clinically useful in the treatment of recurrences of genital herpes.

Administration, Topical↗
PubMed1986

Interferon therapy for condylomata acuminata.

Current therapy for condylomata acuminata (genital warts) is not consistently effective. Therefore, we conducted a randomized, double-blind trial to compare interferon alpha-2b with placebo in the treatment of this disorder. Our rationale was that interferon has both antiproliferative and antiviral properties. The placebo or interferon (1 X 10(6) IU) was injected directly into one to three warts three times weekly for three weeks. The injections were well tolerated by both groups of patients. The side effects of fever, chills, myalgia, headache, fatigue, and leukopenia occurred more commonly in the interferon group than in the placebo group, but such effects rarely disrupted daily routines. Only 13 of 296 patients (4 percent) discontinued therapy because of side effects (11 in the interferon group and 2 in the placebo group). Twenty-six other patients were excluded from analysis because of a loss to follow-up or other deviations from protocol, thus leaving 257 patients in the final evaluation. At one week after the completion of therapy, interferon had produced a large and significantly greater reduction in mean wart area (a 62.4 percent decrease), as compared with placebo (a 1.2 percent increase in mean area) (P less than 0.001). At the conclusion of the study (13 weeks after the completion of therapy), the mean wart area was still decreased 39.9 percent below the initial size in the interferon group, whereas it had increased by 46 percent over base-line measurements in the placebo group (P less than 0.001). At the same time, all treated warts had completely cleared in 36 percent of the interferon recipients and in 17 percent of the placebo recipients (P less than 0.001), whereas treated warts progressed in 13 percent of the interferon recipients and in 50 percent of the placebo recipients (P less than 0.001). We conclude that injection of interferon alpha-2b directly into genital warts appears to be an effective and fairly well-tolerated form of therapy.

Adolescent↗
PubMed1986

Interferon in the prevention of genital herpes recurrence.

Patients with genital herpes were treated three times weekly for 12 weeks with 3 X 10(6) IU of alpha 2b interferon (20 patients) or placebo (17 patients) administered by subcutaneous injection in a double-blind trial. Interferon had minimal effects on the suppression of recurrences and moderate toxicity (chills, fever, fatigue, and leukopenia), suggesting that this route and dosage of interferon may not be clinically useful for this indication.

Adult↗
PubMed1986

Single-dose antibiotic prophylaxis in high-risk patients undergoing cesarean section. A comparative trial.

A prospective, double-blind study was performed to evaluate the comparative efficacy of single- and multiple-dose antimicrobial prophylaxis for preventing infection in high-risk patients undergoing cesarean section. One hundred fifty-eight patients were randomly assigned to receive either a single perioperative dose of mezlocillin, three doses of mezlocillin or three doses of cefoxitin. The incidence of endometritis was 5.9%, 4.0% and 4.0%, respectively. The incidence of febrile morbidity was 5.9%, 2.0% and 6.1%, respectively. These differences are not statistically significant. The single perioperative dose of mezlocillin was as effective as the three-dose regimen of either mezlocillin or cefoxitin.

Adult↗
PubMed1985

The therapy of osteomyelitis in outpatient settings.

Because of rising hospital costs, the use of outpatient antibiotic therapy, both oral and parenteral, is increasing. A program for the intravenous administration of antibiotics to outpatients has been established as a freestanding outpatient clinic (Intracare). Some diseases lend themselves to treatment in such a setting better than others. Osteomyelitis accounted for one-third of the diagnoses in the first 1,000 patients treated at Intracare. While patients are usually begun on intravenous antibiotics following initial surgical debridement in the hospital, hospitalization may be avoided entirely in some patients who undergo surgery in outpatient surgical centers and are begun on intravenous antibiotics immediately afterwards at Intracare. For outpatient use, cephalosporins are most frequently used because of their efficacy, safety, and pharmacokinetics, which allows less-frequent administration. Both cefazolin and ceftriaxone were used most frequently in the Intracare program, although the once-daily administration of ceftriaxone was considered most convenient for outpatients and allowed them to return to normal activities even while receiving antibiotic therapy.

Anti-Bacterial Agents↗
PubMed1985

Imipenem/cilastatin therapy of bacteremia.

Imipenem/cilastatin was used to treat 135 patients with bacteremia and signs of infection. Ninety percent responded favorably. The bacteriologic eradication rate was 98 percent among the 153 isolates. Only one patient had breakthrough bacteremia and this was a susceptible Clostridium septicum. In two isolates of Pseudomonas aeruginosa, emergence of resistance to imipenem during therapy was noted and appeared to be responsible for clinical failure. Superinfection occurred in 13 patients and was responsible for two treatment failures.

Adolescent↗
PubMed1985

Ciprofloxacin therapy of infections caused by Pseudomonas aeruginosa and other resistant bacteria.

Ciprofloxacin was administered orally to 48 patients with 24 Pseudomonas aeruginosa infections and 13 other infections caused by cephalothin-resistant gram-negative bacilli. The types of infections treated included those of skin or skin structure, bone, urinary tract, and respiratory tract. In 83% of P. aeruginosa infections, a favorable clinical outcome occurred, compared with 85% for all infections. Failure to achieve a cure correlated with the emergence of resistant P. aeruginosa and Acinetobacter calcoaceticus strains in four instances and superinfection with Candida (two cases) and Streptococcus (two cases) species. Therapy was discontinued in three patients because of the development of nausea. Ciprofloxacin appears to be safe and effective in the therapy of infections caused by resistant gram-negative bacilli.

Administration, Oral↗
PubMed1985

Single-dose antibiotic prophylaxis in high-risk patients undergoing cesarean section.

A prospective, double-blind, placebo-controlled study was performed to determine the effectiveness of single-dose antibiotic prophylaxis in decreasing infectious complications after primary cesarean section. One hundred women at high risk for postoperative infectious morbidity were randomly assigned to receive either placebo or one 2-g dose of ceftizoxime at cord clamping. The incidence of endometritis in the antibiotic group was 6.0 versus 24.5% in the placebo group (P less than .05). The incidence of febrile morbidity in the group receiving one dose of ceftizoxime was 14.0 versus 32.7% in the placebo group (P less than .05). Single-dose ceftizoxime prophylaxis significantly reduced the incidence of endometritis and febrile morbidity in high-risk patients undergoing cesarean section.

Adult↗
PubMed1984

Combined ceftriaxone and surgical therapy for osteomyelitis in hospital and outpatient settings.

The combined medical-surgical approach to therapy for osteomyelitis requires patients to receive intravenous antibiotics three to six times daily for 4 to 6 weeks after initial surgical debridement. The greatly extended half-life of the new cephalosporin, ceftriaxone (6 to 8 hours), enabled its intravenous administration once or twice daily to 76 patients for the treatment of osteomyelitis. Cure or improvement was noted in 66 of the 76 patients (87 percent). Most of the failures occurred in the group of patients with osteomyelitis complicated by vascular insufficiency. The once or twice daily dosing possible with ceftriaxone was particularly advantageous for permitting highly cost-effective at home therapy for 42 of the 76 patients.

Adolescent↗
PubMed1984

Outpatient use of ceftriaxone: a cost-benefit analysis.

Patients who participated in an outpatient intravenous therapy program designed to limit hospitalization for those who could be maintained on ceftriaxone at home were interviewed regarding costs and benefits. Of the 79 patients interviewed concerning 83 therapeutic episodes, 43.4 percent were able to perform their usual activities as soon as they began the program, 28.9 percent were restricted for part of the time, and 27.7 percent never resumed their usual activities. The 83 therapeutic episodes represent a total of 2,409 outpatient days (mean 29.7; standard deviation [SD] 17.7), 1,406 of which represent unrestricted activities. Costs and benefits of the program were calculated separately for four employment groups: not employed; usually employed, but not while on intravenous therapy; employed while on intravenous therapy, with time off for follow-up visits; and employed while on intravenous therapy, no time off for follow-up required. The mean total benefit, weighted across all four groups, was $6,588.14 (SD = $3,802.90) per patient. Mean weighted costs totalled $1,768.02 (SD = $1,129.36). The overall weighted benefit/cost ratio was approximately 5:1. Although private insurers reimbursed 63 percent of the patients for all hospitalization costs, only 39 percent were fully covered for the follow-up physician visits required during outpatient therapy.

Adolescent↗
PubMed1983

Ceftriaxone therapy of serious bacterial infections.

Ceftriaxone, a broad spectrum cephalosporin with a markedly extended half-life, was administered to 68 patients with 71 infections in an open trial. Sixty-three infections (89%) had a satisfactory clinical response with eradication of bacteria present at the initiation of therapy in 62 infections (87%). The eight treatment failures correlated well with the development of resistance to ceftriaxone during therapy in Enterobacter and Pseudomonas species (two cases) and with superinfection with Bacteroides fragilis (three cases). Treatment was discontinued in eight patients because of unwanted effects. Serious side effects included leukopenia, rash, fever, and enterocolitis.

Adolescent↗