Use of antibiotics without medical prescription.

UNLABELLED: The inappropriate use of antibiotics for the treatment of infections is a worldwide problem that has implications for the cost of treatment and the development of resistant strains of bacteria. The use of antibiotics should follow specific criteria; they are on top of the list of self-medication drugs in countries that do not control their commercialization. OBJECTIVES: To determine the percentage of pharmacies that attend the public and sell antibiotics without medical prescription in a medium-sized city in Brazil, and analyze the variables involved in this procedure. MATERIALS AND METHODS: 107 of the 136 pharmacies registered in our city were evaluated. These pharmacies were visited by actresses who simulated having a sister with symptoms of a non-complicated rhino-sinusitis, so that they could obtain antibiotics without a medical prescription. Each pharmacy was visited only once; the only variable in the simulated clinical setting was the report of fever temperature, which was randomly assigned between 38.5 and 40 degrees Celsius. RESULTS: Antibiotics were offered in 58% of the pharmacies, and this offer was increased to 74% after the actresses insisted on having them. In 65.4% of the pharmacies, the actresses were attended by a pharmacist, and 84.2% of them said they would sell antibiotics. When the request for antibiotics was denied (26%), only 7.5% was due to absence of prescription. The most frequent reason for refusal to sell antibiotics, was because the attendant deemed it unnecessary (46.6%) CONCLUSION: Antibiotics can be easily bought in the great majority of the pharmacies in our town without a medical prescription and a clear indication. Fever temperature did not modify the attendant's indication of the drug.

Short-term effect of gastric bypass in obese diabetic patients.

OBJECTIVE: To study the effect of gastric bypass on blood glucose levels and the use of antidiabetic medication in obese patients with diabetes. METHODS: We carried out a retrospective cohort study with 44 obese patients with DM2, from 469 patients undergoing gastric bypass from December 2001 to March 2009. The primary endpoints evaluated were fasting glucose and the need for antidiabetic medication. RESULTS: The study population consisted of ten (22.7%) men and 34 (77.3%) women, with a mean age of 45.3 (±8.23) years and a body mass index of 40.9 (±5.03) kg/m². The average time to progression of DM2 was 63.6 (±60.9) months. Of the 40 patients who used medication to control type 2 diabetes, 20 (50%) had their medication discontinued at discharge and 13 (32.5%), until nine months later. In one patient it was not possible to evaluate the use of medication, this being the only exception. Insulin was suspended in ten (100%) patients who used it, six (60%) at discharge. Fasting plasma glucose levels decreased throughout the study period (p <0.05) when compared with preoperative values, and values below 100mg/dl were achieved within seven to nine months. CONCLUSION: Obese patients with DM2 undergoing gastric bypass showed improved glycemic control and reduced use of hypoglycemic agents in the short-term.

Diabetic ketoacidosis complicated by the use of ecstasy: a case report.

INTRODUCTION: Ecstasy (3,4-methylenedioxymethamphetamin), a hallucinogenic amphetamine, is often used by young people, especially at 'raves'. This illicit drug can cause many metabolic changes and its use, when associated with prolonged exercise, may exacerbate ketoacidosis in type 1 diabetic patients. CASE PRESENTATION: This is a case of ketoacidosis complicated by the use of ecstasy in a 19-year-old insulin-dependent diabetic Caucasian woman. CONCLUSION: The use of ecstasy may trigger diabetic ketoacidosis in patients with a preexisting metabolic disorder.

Metformin compared with glyburide for the management of gestational diabetes.

OBJECTIVE: To assess blood glucose control and neonatal outcomes when women with gestational diabetes mellitus (GDM) were treated with metformin or glyburide. METHODS: When an appropriate diet was insufficient to control their blood glucose levels, women with GDM were randomized to a glyburide or a metformin treatment group. If the maximum dose was reached, the assessed drug was replaced by insulin. The primary outcome measures analyzed were maternal glucose levels during pregnancy, birth weight, and neonatal glucose levels. RESULTS: The only significant difference in outcome between the 2 treatment drugs was that maternal weight gain during pregnancy was less in the metformin (n=40) than in the glyburide group (n=32) (10.3 kg vs 7.6 kg; P=0.02). No differences were found in treatment failure, mean level of fasting or postprandial plasma glucose, rate of participants with glycated hemoglobin, birth weight, rate of large-for-gestational-age newborns, or newborns with hypoglycemia. CONCLUSION: The treatment of GDM with metformin or glyburide was found to be equivalent for both women and newborns.