Polypharmacy among patients attending an AIDS clinic: utilization of prescribed, unorthodox, and investigational treatments.

The objective of this study was to describe the utilization and characteristics associated with the use of prescribed, over-the-counter, investigational, and unorthodox treatments among AIDS clinic patients. This report is derived from cross-sectional data obtained using structured telephone surveys. Study participants (n = 197) were recruited from the University of California, San Francisco, Medical Center AIDS clinic. One hundred eighty-nine participants (96%) received 1-24 prescription medications during the 3 months prior to interview. Those with an AIDS diagnosis received a relatively greater number of prescription drugs (p = 0.0001); an average of 5.6 prescribed medications were used by AIDS patients versus 4.8 among AIDS-related complex and 2.3 among asymptomatic patients. Thirty-one percent participated in drug trials during the 3 months before interview, including 18% who were in multiple studies. Twenty-nine percent used unorthodox treatments. Seventy-five (40%) received prescription medication from a provider other than their primary provider. A more advanced stage of illness was associated with the use of unorthodox treatments (p = 0.003): users of these treatments had a greater educational attainment than nonusers (p = 0.03) and were significantly less likely to report that their primary provider was aware of all the treatments they used (odds ratio = 2.1, p less than 0.03). We conclude that use of polypharmacy among some AIDS clinic patients is common, could create an increased risk for adverse drug reactions, and may affect clinical drug trials. Despite having decided to obtain care at a university-based clinic, many of the participants of this study also chose to receive unorthodox therapies and care from nonprimary medical providers.(ABSTRACT TRUNCATED AT 250 WORDS)

Treatment of chancroid with ciprofloxacin. A prospective, randomized clinical trial.

Chancroid is a major sexually transmitted disease in many developing countries. Although single-dose and short-course treatment of chancroid have been described, the increasing resistance of Hemophilus ducreyi to antimicrobial agents requires continuing evaluation of new therapies. Ciprofloxacin is a new quinolone antimicrobial agent with excellent in vitro efficacy against H. ducreyi. A double-blind, randomized clinical trial was conducted comparing a single-dose ciprofloxacin regimen (500 mg) and a three-day regimen of ciprofloxacin (500 mg twice daily) with a three-day regimen of trimethoprim-sulfamethoxazole (160 and 800 mg, respectively, twice daily) for the treatment of chancroid. The three-day ciprofloxacin regimen successfully eradicated H. ducreyi, and resulted in rapid clinical improvement in all 40 patients followed, with no failures. The other two regimens were also effective, but bacteriologic and clinical failure occurred in two and three patients following treatment with single-dose ciprofloxacin and three days of trimethoprim-sulfamethoxazole, respectively. All patients with buboes had resolution of lesions. There were no significant adverse effects associated with ciprofloxacin or trimethoprim-sulfamethoxazole. All three regimens are effective therapy for chancroid and H. ducreyi infections. If resistance to trimethoprim-sulfamethoxazole becomes widespread, ciprofloxacin may become a first-line therapy for chancroid. This study also demonstrates the efficacy of ciprofloxacin in soft tissue infection.