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Biomedical subjects

Stephen Brunton

Publications and source records attributed to Stephen Brunton.

17 recordsLinked to original sources
PubMed2006

Current face of acute otitis media: microbiology and prevalence resulting from widespread use of heptavalent pneumococcal conjugate vaccine.

BACKGROUND: Many causes can be proposed for a change in the microbiologic makeup of a specific disease state. However, when viewed through the scope of recent events, only one is likely to be the true cause of a change in the microbiology of acute otitis media (AOM): the release and widespread use of heptavalent pneumococcal conjugate vaccine (PCV-7). OBJECTIVE: The aim of this report was to review the microbiology and prevalence of AOM before and after the release and widespread use of PCV-7. METHODS: For this brief review, we used a MEDLINE search to identify English-language literature related to the microbiology of AOM before and after the release of PCV-7 in 2000 in the United States (key terms: acute otitis media, AOM, Haemophilus influenzae, H influenzae, Streptococcus pneumoniae, and S pneumoniae; years: 1980-2005). Studies using tympanocentesis to identify the pathogen in recurrent or persistent AOM were examined; US studies reporting AOM microbiology before and after the release of PCV-7 in the same population were considered for the post-PCV-7 analysis. RESULTS: Following the release of PCV-7, a decrease in the overall rates of AOM was noted. This decrease brings into question the resultant effect on the microbiology of AOM. Our literature search revealed 2 studies that examined the microbiology of AOM before and after the release of PCV-7 in the United States. These 2 studies, conducted in dispersed geographic regions (rural Kentucky and Rochester, New York), illustrated a change in the predominant causative pathogen in AOM, from S pneumoniae to H influenzae in the population of children 7 to 24 months of age with recurrent AOM. Given the time period of the change, these shifts could be related to the release and widespread use of PCV-7. CONCLUSIONS: Since the 1990s, the predominant causative pathogen in recurrent AOM changed from S pneumoniae to H influenzae, possibly as a result of the release and widespread use of PCV 7. Although PCV-7 use was slowed from August 2001 to May 2003 and again from February to September 2004 by nationwide shortages, those shortages have now been resolved, and compliance with the full vaccine schedule is expected to increase.

Acute Disease↗
PubMed2006

Acute bacterial rhinosinusitis: a review of U.S. treatment guidelines.

Acute bacterial rhinosinusitis (ABRS) is a common complication of viral upper respiratory tract infections and is associated with a significant socioeconomic burden. Guidelines for the diagnosis and management of ABRS have been produced in association with a number of societies in the United States; these guidelines aim to promote the rational selection of antibiotic therapy to optimize clinical outcomes while minimizing the potential for selection of antibiotic resistance. This article provides an overview of current U.S. guidelines for the treatment of ABRS, focusing on the impact of antibiotic resistance on treatment options.

Anti-Bacterial Agents↗
PubMed2006

Efficacy and central nervous system impairment of newer-generation prescription antihistamines in seasonal allergic rhinitis.

Allergic rhinitis is a highly prevalent disorder and oral antihistamines are often used to manage patient symptoms. Older-generation antihistamines, such as diphenhydramine and chlorpheniramine, are effective at relieving the symptoms of seasonal allergic rhinitis (SAR); however, they are associated with adverse events, including sedation and impairment, at, or above, the recommended dose. Newer-generation antihistamines, such as desloratadine, cetirizine and fexofenadine, were developed to minimize adverse events. In this article, studies examining newer-generation antihistamines in adults and children were reviewed. The clinical evidence confirms that desloratadine, cetirizine and fexofenadine are effective at managing the symptoms of SAR in adults and children; however, cetirizine is more likely to cause sedation. Physician intervention is paramount to SAR symptom management. It is essential that appropriate treatment relieves SAR symptoms with absent or minimal adverse events. This is particularly important for those patients involved in skilled and cognitive activities or safety-critical jobs.

Central Nervous System↗
PubMed2006

Considerations in the use of antibiotics for streptococcal pharyngitis.

Microbiologic testing is recommended to diagnose GABHS pharyngitis and is required to maximize the selection of patients at highest risk of complications from true infection. The primary goal of therapy is eradication of GABHS. Penicillin has been the first-line treatment of choice for nonallergic patients; yet, there may be reason to reexamine the role of penicillin since there are now considerable data from clinical trials, pooled multicenter studies, and meta-analyses demonstrating frequent bacteriologic and clinical failure. While the contribution of pathogen resistance remains unclear, evolving evidence suggests that these failures also may be related to bacterial coaggregation or copathogenicity; GABHS reinfection; antibiotic nonadherence or subtherapeutic drug levels; penicillin tolerance; or blunting of an effective immune response. At the same time, some clinical evidence suggests that treatment failure with some cephalosporins may occur less frequently than with penicillin. Although cephalosporins are generally more expensive than oral penicillin, the benefits of cephalosporins include activity against BLPB and evolving data that support less frequent dosing than penicillin. Consequently, a reassessment of the role of cephalosporins in the treatment of pharyngitis may be appropriate.

Anti-Bacterial Agents↗
PubMed2005

Recent developments in the management of overactive bladder: focus on the efficacy and tolerability of once daily solifenacin succinate 5 mg.

BACKGROUND: Overactive bladder (OAB) is a highly prevalent symptom complex that may be extremely distressing to the patient, and can be associated with co-morbidities and reduced quality of life (QoL). One of the major pathophysiological causes of OAB is overactivity of the detrusor muscle, mediated via muscarinic receptors in the bladder. Urgency is the defining symptom of OAB, yet a significant proportion of patients also suffer from incontinence, which is the most distressing symptom to the patient. As such, restoration of continence should be a primary treatment goal. However, effective treatments should also impact on the other key symptoms of OAB, such as micturition frequency and urgency. Non-pharmacologic interventions to treat OAB can be effective but require patients to be highly motivated. In terms of pharmacologic therapy, treatment with an antimuscarinic agent is the mainstay of current therapy. Solifenacin succinate is a once-daily oral antimuscarinic for the treatment of OAB. The recommended dose is 5mg once daily and can be increased to 10 mg once daily if 5 mg is well tolerated. OBJECTIVES: This paper reviews clinical experience with solifenacin 5 mg in patients with OAB as this is the recommended dose according to FDA product labeling. FINDINGS: In Phase 3 studies, based on data captured in 3-day micturition diaries, greater than half of patients who were incontinent at baseline no longer reported experiencing incontinence episodes after 12 weeks of double-blind treatment with solifenacin 5 mg. Furthermore, compared with placebo, solifenacin treatment resulted in statistically significant reductions in incontinence episodes, micturition frequency and urgency episodes, with significant increases in volume voided (based on an analysis of key symptom outcomes in two pooled Phase 3 studies presented here). The most common treatment-related adverse events were expected anticholinergic side effects (dry mouth, constipation, and blurred vision), and these were generally mild to moderate. Discontinuation rates due to adverse events in the treatment and placebo groups were comparable. CONCLUSION: Solifenacin 5 mg was found to be efficacious and had an acceptable tolerability profile in patients with OAB in these trials and this treatment may provide QoL benefits to patients.

Administration, Oral↗
PubMed2004

Acute exacerbation of chronic bronchitis: a primary care consensus guideline.

OBJECTIVE: To develop consensus on appropriate treatment for acute exacerbation of chronic bronchitis (AECB). CHARACTERISTICS AND ETIOLOGY: Patients with chronic bronchitis have an irreversible reduction in maximal airflow velocity and a productive cough on most days of the month for 3 months over 2 consecutive years. An AECB is characterized by a period of unstable lung function with worsening airflow and other symptoms. Most (80%) cases of AECB are due to infection, with half due to aerobic bacteria. The remaining 20% are due to noninfectious causes such as environmental factors or medication nonadherence. MANAGEMENT: Supportive care should be provided to all patients, which might include removal of irritants, use of a bronchodilator, oxygen, hydration, use of a systemic corticosteroid, and chest physical therapy. Antibacterial treatment should be reserved for patients with at least 1 key symptom (ie, increased dyspnea, sputum production, sputum purulence) and 1 risk factor (ie, age > or = 65 years, forced expiratory volume in 1 second < 50% of the predicted value, > or = 4 AECBs in 12 months, 1 or more comorbidities). A newer macrolide, extended-spectrum cephalosporin, or doxycycline is appropriate for an exacerbation of moderate severity, and high-dose amoxicillin/clavulanate or a respiratory fluoroquinolone should be used for a severe exacerbation. There has been increasing antibacterial resistance by the 3 most prevalent pathogens (Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis). CONCLUSION: Although all AECB patients should receive supportive care, only patients with at least 1 key symptom and 1 risk factor should receive antibiotic therapy.

Acute Disease↗
PubMedDate not supplied

A comprehensive approach to Parkinson's disease. How to manage fluctuating motor and nonmotor symptoms.

Parkinson's disease is challenging to diagnose and treat. Patients are subject to wide fluctuations of motor status as well as an array of nonmotor complications that may be as debilitating as their motor counterparts, or even more debilitating. Levodopa remains the most effective agent for relief of motor symptoms, but long-term levodopa use is associated with development of motor complications, including severe dyskinesias. For this reason, selegiline or a dopamine agonist may be preferred as initial therapy. Carbidopa/levodopa (with or without a COMT inhibitor) can be added within 5 years or as required for relief of motor symptoms. When medical therapy can no longer provide adequate symptom control, surgical intervention needs to be considered.

Antiparkinson Agents↗