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Biomedical subjects

M A Raebel

Publications and source records attributed to M A Raebel.

11 recordsLinked to original sources
PubMed1994

Use of antifungal therapy in hospitalized patients. I. Results prior to the marketing of fluconazole.

OBJECTIVE: To evaluate the use of antifungal agents in hospitalized patients prior to marketing of fluconazole and to assess characteristics associated with their use. DESIGN: A cohort of hospitalized patients receiving topical or systemic antifungal therapy was monitored concurrently. SETTING: Sixty-nine hospitals ranging in size from 100 to more than 500 beds, 70.1 percent affiliated with medical schools. PATIENTS: Participating clinical pharmacists each identified 15 consecutive patients receiving systemic antifungal therapy and 5 consecutive patients receiving topical antifungal therapy at their institutions. Data collection began October 1989 and ended March 1990. INTERVENTION: All data collected were observational in nature, and no patient intervention was required. MEASURES: Characteristics of patients receiving antifungal therapy were compared using t-tests and chi-square tests. Utilization and patterns of use of antifungal therapy were reported. RESULTS: The most common risk factors necessitating antifungal therapy, in descending order, were: administration of broad-spectrum antibiotics and/or presence of invasive catheters, carcinoma, AIDS, leukemia or lymphoma, diabetes mellitus, solid organ or bone marrow transplantation, and chronic obstructive pulmonary disease. Five hundred seventeen patients received systemic therapy and 464 (89.7 percent) received a single systemic agent. Of these, 242 (52.2 percent) received amphotericin B, 215 (46.3 percent) received ketoconazole, 6 (1.3 percent) received flucytosine, and 1 (0.2 percent) received intravenous miconazole. Fifty-three patients received two systemic agents either concurrently or consecutively. Ketoconazole was most often used for presumed or documented oral, urogenital, or esophageal infections and amphotericin B was the preferred agent for disseminated infections and fungemia (p < 0.001). Almost half of the patients receiving amphotericin B or ketoconazole (48.3 percent) received these drugs as empiric therapy. Documented infections were more likely to be treated with amphotericin B (54.8 percent) than with ketoconazole (27.4 percent) (p < 0.001). The predominant fungal isolates were Candida albicans, Candida spp., and unspecified yeasts. Amphotericin B toxicity led to discontinuation of drug therapy in only 5.1 percent of cases. Two hundred sixty-nine patients (34.2 percent) received topical antifungal therapy only. Nystatin oral suspension was prescribed to 65.3 percent of the patients, clotrimazole troches to 23.0 percent, amphotericin B irrigation to 10.9 percent, and nystatin tablets to 0.8 percent. CONCLUSIONS: The utilization patterns of antifungal agents in this survey follow established therapeutic guidelines. Prior to the introduction of fluconazole, amphotericin B was the agent of choice for documented systemic fungal infections. Ketoconazole was more often used for prophylaxis of fungal infections and treatment of oral and esophageal infections.

AIDS-Related Opportunistic Infections↗
PubMed1992

Clindamycin, erythromycin, and the newer macrolides.

Clindamycin continues to be an important agent for the management of infections due to gram-positive cocci and anaerobes. Such pathogens are frequently important in skin, soft tissue, and deep infections of the foot. Erythromycin has an impressive safety record and has retained its activity against many organisms, including several that play a role in infections of the foot. Clindamycin and erythromycin are frequently used as alternatives to the penicillins and cephalosporins. Newer macrolides, in comparison to erythromycin, have similar antimicrobial spectra of activity, improved pharmacokinetic parameters, and better tissue penetration. As new microorganisms emerge as clinical problems, newer macrolides may play a therapeutic role.

Anti-Bacterial Agents↗
PubMed1991

Magnesium sulfate versus phenytoin for seizure prophylaxis in pregnancy-induced hypertension.

Seizure prophylaxis is standard intrapartum therapy for patients with pregnancy-induced hypertension. Magnesium sulfate is used in the United States in spite of limited literature comparing its efficacy with other anticonvulsants. Fifty patients with pregnancy-induced hypertension were prospectively randomized to receive magnesium sulfate or phenytoin for seizure prophylaxis. Patients were observed for toxicity, side effects, and labor outcomes, and the neonates were evaluated for side effects of the therapy. Three patients were excluded with adverse reactions to medications (one in magnesium sulfate group, two in phenytoin group). No differences were found in patient tolerance, adverse reactions, or neonatal outcomes between groups. Maternal free phenytoin levels were 13.0% +/- 0.4% of total phenytoin (serum albumin, 2.5 to 3.5 gm/dl), significantly higher than in nonpregnant patients. Neither free phenytoin levels nor percentage of total phenytoin that was free correlated significantly with maternal albumin levels. The pharmacokinetics of phenytoin loading in the massively obese pregnant patient may differ and require further evaluation. Phenytoin is a well-tolerated alternative to magnesium sulfate for seizure prophylaxis in the patient with mild pregnancy-induced hypertension.

Adult↗
PubMed1987

A clinical pharmacy-oriented drug surveillance network: II. Results of a pilot project.

A nationwide network of clinical pharmacists has been organized for the purpose of collecting drug experience data generated during the routine clinical care of patients. In order to assess the utility of this network a pilot project was performed to obtain a cross-sectional view of antibiotic utilization in the U.S. and to identify potential problems with a more widespread implementation of this program. One hundred eleven pharmacists enrolled in the drug surveillance network participated in this survey and collected information on more than 2000 patients treated with antimicrobial agents over approximately a three-month period (February-April 1987). The most common sites of infection were the lung, genitourinary tract, skin and soft tissue, and the abdomen, and accounted for approximately 75 percent of infections. Overall, the aminoglycosides, the first-generation cephalosporins, and the aminopenicillins remain the most commonly used antibiotics and represent approximately 50 percent of antimicrobials used in the surveyed population. The results of this pilot project suggest that the use of a nationwide network of clinical pharmacists is a promising source of clinically relevant drug experience data. The ability to concurrently evaluate patients and link information regarding patient demographics, drug therapy regimens, diagnosis, and clinical outcomes fills an important gap in our knowledge of clinical drug utilization.

Adult↗
PubMed1985

Twenty-four-hour single-container system for parenteral nutrient admixtures.

Development and implementation of a procedure for preparing parenteral nutrient (PN) solutions in 3-L containers at a 385-bed teaching hospital is described. After identifying problems in procedures for PN therapy, pharmacists collected time and cost data for preparing PN solutions using gravity flow and 1-L containers versus an automated compounding device and 3-L containers. They prepared a proposal for mixing a single daily solution in a 3-L container. A change in hospital policy to permit each PN solution to hang for 24 instead of 12 hours, a change in the pharmacy's schedule for preparing PN solutions, and a policy of hanging all fresh PN solutions between 1800 and 2400 were also proposed. After a one-month trial, the new procedures were adopted. To prepare an average of six PN solutions per day, time decreased from 5.32 to 2.33 hours. Inventory of PN supplies was reduced by 56%. Patients were charged approximately $25 less for three liters of PN solution. Standardized procedures improved efficiency of order filling. A standard procedure for preparing parenteral nutrient solutions in 3-L containers resulted in cost savings for the hospital and the patients and more efficient patient care.

Costs and Cost Analysis↗
PubMed1981

Continuous infusion of naloxone in the treatment of narcotic overdose.

Based on the pharmacokinetic parameters of naloxone and the clinical studies discussed in this paper, it is evident that naloxone infusion may be useful in cases of opiate overdose. The infusion protocol presented in Appendix I was formulated based on the pharmacokinetic data available from the literature including Nelson's animal data. An infusion of naloxone was used with apparent success in the two cases presented. Both patients presented with narcotic overdose; although immediate patient history could not be obtained, the presentations were classic for narcotic overdose. It is of note that it may be possible to keep a patient from relapsing into narcosis after overdose by the use of naloxone infusion. Additionally, the extreme safety of naloxone is certainly an advantage with any administration technique. We feel that the administration of continuous infusion of naloxone is an especially important advance in the overdose treatment of longer-acting agents such as methadone, as well as of other narcotics. Therefore, it is recommended that further clinical trials of naloxone by infusion be undertaken, as suggested by J. Nelson, et al. (A protocol for treatment with continuous infusion of naloxone [Narcan] in selected cases of opiate [narcotic] overdose. Austin: University of Texas; May, 1976, unpublished), to further document the effectiveness of an infusion of naloxone in narcotic overdose.

Adult↗
PubMed1979

Relapsing polychondritis in a Latin American man.

The first known reported case of relapsing polychondritis in a Latin American man is presented. The 35-year-old man, demonstrating auricular chondritis, arthritis, nasal cartilage involvement, episcleritis and respiratory tract chondritis, was admitted to the hospital and treated with 60 mg of prednisone daily, prednisolone acetate 1% ophthalmic drops every waking hour and homatropine hydrobromide 5% ophthalmic drops twice daily. After discharge from the hospital, he received 30 to 60 mg of prednisone daily and prednisolone acetate 1% ophthalmic drops twic daily for about 18 months. A permanent trachestomy was placed, azathioprine, 150 mg daily, was given and prednisone dosage was tapered to 25 mg daily when the patient subsequently was hospitalized for colapsed airway and Cushing's syndrome. The classic symptoms, pathogenesis and treatment of the disease are reviewed. Systemic corticosteroids are the drugs of choice in relapsing polychondritis, with immunosuppressive drugs, azathioprine in particular, being used as adjuvants to lower steroid dosage requirements and to achieve greater control of symptoms in patients with the severe progressive disease. Treatment of the disease with dapsone alone is promising and may offer an alternative to high-dose steroids and immunosuppressive therapy.

Adrenal Cortex Hormones↗
PubMedDate not supplied

Sepsis syndrome and associated sequelae in patients at high risk for gram-negative sepsis.

We conducted a prospective surveillance study of 80 hospitals across the United States to determine the incidence of sepsis syndrome and its associated sequelae in hospitalized patients over age 18 years who were administered antibiotics for suspected or documented gram-negative infection. A sample of 1754 hospitalized patients were followed from onset of antimicrobial therapy to discharge or death. Mortality rates (MR) varied depending on the suspected source of sepsis syndrome. For patients in whom the syndrome was associated with community-acquired urinary tract infections, mortality was 20% (relative risk [RR] = 0.51, p < 0.05), for those with trauma 20.6% (RR = 0.51, p < 0.05), and patients with nosocomial respiratory tract infections 57.1% (RR = 1.66, p < 0.05). More than two complications occurred in 65.2% of patients under age 60 years (MR 31%), 40.8% of those age 60-80 (MR 42%), and 35.6% of patients older than 80 years (MR 33.3%, p > 0.05). Various patient populations had significant differences in both the incidence of the syndrome and its complications, and consequent mortality. Perhaps morbidity as well as mortality should be used as outcomes when testing the efficacy of innovative therapies for sepsis.

Adolescent↗