Update in pulmonary disease.
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Amoxicillin↗
Biomedical subjects
S L Aspinall
Publications and source records attributed to S L Aspinall.
Potential interaction between warfarin and fluvastatin.
OBJECTIVE: To report three cases of a suspected interaction between warfarin and fluvastatin. CASE SUMMARIES: Three patients receiving stable warfarin dosages with therapeutic international normalized ratios (INRs) exhibited increased INRs when fluvastatin was added to their maintenance regimens. While none of the patients experienced a bleeding episode, they did require a reduction in their weekly warfarin dosage to achieve an appropriate level of anticoagulation. DISCUSSION: Reports of an interaction between warfarin and lovastatin have been described previously; however, to our knowledge, this is the first published report of a possible interaction between warfarin and fluvastatin. These cases were chosen because other factors that could potentially increase the INR were ruled out as significant contributors. CONCLUSIONS: The exact mechanism for the potential interaction between warfarin and fluvastatin is unknown. Until more is known, it is advisable to monitor patients more frequently when fluvastatin is initiated, discontinued, or adjusted in patients taking warfarin.
Aged↗
Recurrent methicillin-resistant Staphylococcus aureus osteomyelitis: combination antibiotic therapy with evaluation by serum bactericidal titers.
OBJECTIVE: To report on a patient with recurrent methicillin-resistant Staphylococcus aureus (MRSA) osteomyelitis and bacteremia successfully treated with combination antibiotic therapy. CASE SUMMARY: Two sets of blood cultures from a 55-year-old man with fever, malaise, and low back pain grew MRSA. Radiologic studies of the spine showed bony changes consistent with osteomyelitis. Soon after completing 6 weeks of vancomycin, the patient experienced a recurrence of back pain. Laboratory values included an increase in the sedimentation rate to 53 mm/h and positive blood cultures for MRSA. Vancomycin, gentamicin, and rifampin were administered for 8 weeks. Serum inhibitory and bactericidal titers were more than 1:1024 for both the peak and trough concentrations. Radiologic studies of the spine showed healing osteomyelitis. Two years after completion of antibiotic therapy, the infection has not recurred. DISCUSSION: Antibiotic therapy alone was attempted because the patient was considered a risky surgical candidate. Serum inhibitory and bactericidal titers documented the high in vivo activity of the vancomycin, gentamicin, and rifampin combination. Initiation of vancomycin, gentamicin, and rifampin combination. Initiation of vancomycin therapy led to disappearance of the fever and back pain. Cure was documented by sustained normalization of the erythrocyte sedimentation rate and radiologic evidence of healing. CONCLUSIONS: Combination antibiotic therapy with vancomycin, rifampin, and low-dose gentamicin (1 mg/kg q12h) may be useful for deep-seated tissue infection caused by MRSA.
Anti-Bacterial Agents↗