PubMed Health⌕ Search

Biomedical subjects

R H Dretler

Publications and source records attributed to R H Dretler.

6 recordsLinked to original sources
PubMed1992

Fluconazole compared with ketoconazole for the treatment of Candida esophagitis in AIDS. A randomized trial.

OBJECTIVE: To determine the clinical and endoscopic response of candida esophagitis to antifungal therapy and to compare the two oral antifungal agents, fluconazole and ketoconazole. DESIGN: Multicenter, randomized, double-blind trial. SETTING: Fifteen U.S. centers including university, private practice, and county hospital settings. PATIENTS: A total of 169 patients with the acquired immunodeficiency syndrome (AIDS); odynophagia, dysphagia, or retrosternal pain; white esophageal plaques at endoscopy; and pseudohyphae on esophageal brushings or biopsies. INTERVENTION: Patients were randomly assigned to fluconazole (100 mg/d) or ketoconazole (200 mg/d). Doses were doubled at week 1 or 2 if no symptomatic improvement had occurred during the preceding week. Therapy was continued for 2 weeks after resolution of symptoms or for a maximum of 8 weeks. MEASUREMENTS: Patients were clinically evaluated weekly, and laboratory tests were done every 2 weeks. Endoscopy was repeated within 5 days after the end of therapy. RESULTS: A total of 143 patients were clinically evaluable (assessed within 7 days after therapy), and 129 patients were endoscopically evaluable (endoscopy repeated after therapy). Endoscopic cure occurred in 91% of patients treated with fluconazole and in 52% of those given ketoconazole for a difference of 39% (95% Cl, 24% to 52%; P less than 0.001). Esophageal symptoms resolved in 85% of fluconazole-treated patients and in 65% of ketoconazole-treated patients for a difference of 20% (Cl, 6% to 34%; P = 0.006). Intention-to-treat analyses also yielded statistically significant differences for the comparisons listed above. Side effects were minimal and comparable in the two groups; only one patient in each group had therapy discontinued for adverse effects that were possibly related to the study medications. CONCLUSIONS: Fluconazole is associated with significantly greater rates of endoscopic and clinical cure than ketoconazole in patients with AIDS and candida esophagitis. Both drugs appear to be safe and well tolerated.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Teicoplanin nephrotoxicity: first case report.

A 71-year-old man with type I diabetes mellitus was admitted to the hospital for the treatment of osteomyelitis of the left great toe secondary to methicillin-resistant Staphylococcus aureus. The patient was enrolled in an investigational protocol and was treated with teicoplanin 1200 mg/day. Following 40 days of treatment, the patient developed both markedly elevated serum creatinine and blood urea nitrogen. Urine analysis also showed the presence of protein. The eosinophils were markedly elevated in the blood. The patient was subsequently diagnosed with a probable drug-induced acute interstitial nephritis. Treatment with furosemide and hemodialysis over the next two weeks failed to produce improvement in renal function. The patient was referred for long-term dialysis. The data presented in this report suggest the possible relationship of teicoplanin and the development of renal failure in this patient. Periodic monitoring of renal function and follow-up are probably warranted in patients receiving long-term teicoplanin therapy.

Aged↗
PubMed1990

Seizure activity with imipenem therapy: incidence and risk factors.

Two elderly patients with a history of either cerebral vascular accident (CVA) or head trauma and no evidence of renal disease developed seizures while receiving maximum doses of imipenem/cilastatin. Neither patient had reported previous seizures or seizure-like activity nor was receiving anticonvulsant agents. All seizures were controlled with therapeutic doses of phenytoin. Both patients had received maximum doses of other beta-lactam antibiotics without evidence of seizure activity.

Aged↗
PubMedDate not supplied

Giant esophageal ulcer healed with steroid therapy in an AIDS patient.

AIDS patients have been seen with a variety of ulcerating esophageal lesions, which may be refractory to both diagnostic approaches and empiric medical intervention. There are reports of these ulcers eroding vessels and severely limiting oral nutrition. After the report of success with prednisone therapy for oral and hypopharyngeal ulcers in AIDS patients, we attempted similar treatment of an AIDS patient with a refractory giant esophageal ulcer. The patient responded promptly to this therapy. To our knowledge this is the first report of successful prednisone therapy for giant esophageal ulcer in an AIDS patient.

Acquired Immunodeficiency Syndrome↗