Occurrence, fate and assessment of polar metamizole (dipyrone) residues in hospital and municipal wastewater.

The occurrence and fate of residues from the therapeutic use of the non-steroidal anti-inflammatory drug metamizole have been studied in investigations of sewage effluents from a military hospital, municipal sewers and a sewage treatment plant (STP) in Berlin, Germany. The loads of the metabolites aminoantipyrin (AA), 4-acetylaminoantipyrin (AAA) and 4-formyl-aminoantipyrin (FAA), rapidly formed after the application of metamizole, were predicted from pharmacokinetic data and based on the evaluation of extensive data sets of on the administration in hospitals and private households. In parallel, the actual concentrations were measured within three field trials. For the military hospital, the estimated average annual discharges of AA/AAA and FAA were 10.5 and 3.2 kg, respectively. For the STP, annual loads of 333 and 133 kg were determined for AA/AAA and FAA, respectively. During sewage treatment, an average decrease of 26% of the loads was measured for AA/AAA whereas no changes were observed for FAA. Generally, the prediction of the loads resulted in an overestimation of the residue levels compared to those measured in the respective sewers. Thus, modeling of predicted loads or concentrations alone will not be sufficient for a realistic assessment. Concerns for human or other mammals' health are not expected from the occurrence of metamizole residues in the aquatic system measured at concentrations up to 7 microg l(-1) in STP effluents. However, a rest of uncertainty remains as it was not possible to derive a no observed effect level for the induction of rare but potentially fatal toxicological side effects reported for metamizole.

Avaliaçäo comparativa da eficácia e tolerabilidade do nimesulide, diclofenaco e dipirona sódica aplicados aos processos inflamatórios do trato respiratório superior em populaçäo pediátrica / Comparative assessment on the efficacy and tolerability of nimesulide, diclofenac potassium and dipyrone applyed to inflammatory processes of the superior respiratory tract in the pediatric population

Em um estudo randomizado, comparativo e prospectivo se analizou a eficácia e a tolerabilidade de dois antiinflamatórios (nimesulide e diclofenaco potássico) e uma droga analgésica/antitérmica (dipirona) diante de processos inflamatórios do trato respiratório superior (faringites e/ou amigdalites) em uma populaçäo pediátrica. Os sinais e sintomas próprios a essas patologias foram analisados e a febre monitorizada durante um período de 24 horas. Observou-se uma melhora significativa e homogênea dos sinais e sintomas em todos os grupos de tratamento. A febre apresentou queda pronunciada após a administraçäo de nimesulide e diclofenaco e também após a administraçäo da dipirona, sendo que ocorreu uma reversäo do efeito da dipirona após algumas horas. Dois pacientes apresentaram efeitos adversos que, no caso do diclofenaco devido a intensidade, forçaram a retirada do medicamento. Os dados obtidos ressaltam a eficácia antipirética do nimesulide tal qual a da dipirona com as vantagens em tolerabilidade que näo säo encontradas com o uso de diclofenaco potássico. Assim concluímos que o nimesulide, além de uma poderosa açäo antitérmica, apresenta vantagens no combate ao processo inflamatório, principalmente com relaçäo a sua segurança.