Gatifloxacin-associated acute hepatitis.

Gatifloxacin, a fluoroquinolone with extended gram-positive activity, has become extensively used in both the community and hospital environments. Unfortunately, concerns have been raised about the use of certain fluoroquinolones because of adverse drug reactions. A 44-year-old woman developed acute hepatitis while receiving gatifloxacin for chronic sinusitis. After 5 days of receiving antibiotics, the patient developed nausea, lethargy, and abdominal pain, all of which progressed over the next few days. Liver function tests were elevated, with bilirubin peaking at 9.4 mg/dl. The patient also became jaundiced. A percutaneous liver biopsy showed acute hepatitis with eosinophilic infiltrates consistent with drug-induced hepatitis. All other drugs and disease processes were ruled out as likely causes of the patient's hepatitis. Clinicians should be alerted to the possibility that hepatitis may occur with gatifloxacin administration.

Drug-food interactions in clinical practice.

Drug-food interactions are a significant problem in clinical practice. Foods may alter the effects of drugs by interfering with pharmacokinetic processes, such as absorption and elimination. For example, absorption of tetracyclines is decreased when taken with milk or other dairy products. Pharmacologic and pharmacodynamic mechanisms also play an important role in drug-food interactions by altering drug effects. An example is the interaction of warfarin sodium with leafy green vegetables, whereby the hypoprothrombinemic effect of warfarin may be decreased and thromboembolic complications may develop. Similarly, certain drugs may have an effect on food intake, absorption, metabolism, and utilization. Numerous drugs, such as antineoplastic agents, have been shown to suppress appetite, resulting in decreased food intake and nutritional deficiency. It is important that health care providers, such as physicians, pharmacists, and dietitians, recognize and work as a team to prevent significant drug-food interactions. Minimizing adverse drug-food interactions would improve patient care by optimizing therapeutic effects and maintaining proper nutritional status.

Possible severe thrombocytopenia associated with a single dose of plicamycin.

OBJECTIVE: To report a case of possible severe thrombocytopenia associated with administration of a single dose of plicamycin. CASE SUMMARY: A 73-year-old man with prostate cancer was admitted to the hospital with hypercalcemia (total serum calcium concentration 4.02 mmol/L) and a low baseline platelet count (152 x 10(9)/L). Because of his symptomatic hypercalcemia, he was treated with NaCl 0.9%, furosemide, oral inorganic phosphate, and a single dose of plicamycin (15 micrograms/kg). Five days after plicamycin administration his platelet count decreased to 52 x 10(9)/L, and continued to decrease further even after the transfusion of four units of platelets to a nadir of 7 x 10(9)/L (hospital day 20). A second transfusion produced a small increase in his platelet count. The patient's clinical status continued to deteriorate, however, and he subsequently died. DISCUSSION: Plicamycin and other drugs that may induce thrombocytopenia are reviewed. The time course between plicamycin administration and the development of thrombocytopenia in our patient is assessed. Other contributing factors such as a low baseline platelet count and advanced age are also addressed. CONCLUSIONS: It is likely that the severe thrombocytopenia experienced by our patient was caused by a single dose of plicamycin. Adjusting the dosage for a patient's renal function as well as close monitoring of the platelet count are necessary when administering this drug. We report this case to remind clinicians of the potential for the development of severe thrombocytopenia following administration of a single dose of plicamycin.

Famotidine-associated mental confusion in elderly patients.

Central nervous system effects, such as mental confusion and hallucinations, have been reported with both cimetidine and ranitidine. Elderly patients with renal or hepatic dysfunction are more susceptible to these adverse reactions. We report two cases of reversible mental confusion in elderly patients with mild renal insufficiency following intravenous famotidine therapy, possibly explained by an increased permeability of the blood-brain barrier in patients with decreased renal function.

Suprofen-induced acute renal failure.

A case report of acute flank pain with reversible renal failure in a young adult after taking three doses of suprofen is presented. Blood urea nitrogen and serum creatinine values returned to normal from significantly elevated levels on admission.