Once-daily fosinopril in the treatment of hypertension.

This multicenter, dose-ranging study evaluated the antihypertensive effectiveness of once-daily administration of fosinopril sodium in 220 patients with supine diastolic blood pressure of 95-115 mm Hg. After a 4-week placebo period, patients were randomly assigned to double-blind therapy with either placebo or 10, 40, or 80 mg fosinopril once daily for 4 weeks. If treatment goals were not met, chlorthalidone 25 mg/day was added for weeks 5 to 8. Thereafter, patients could enter the long-term, open-label phase and receive 10-80 mg/day fosinopril plus chlorthalidone, if needed. After 4 weeks of monotherapy, the average decreases in supine diastolic blood pressure were 9% (10 mg), 11.5% (40 mg), and 12.5% (80 mg) compared with 6% in the placebo group. After 8 weeks, the average decreases, with or without diuretic therapy, were 12.5-18.2%, compared with 10.8% with placebo. Blood pressure continued to be well controlled, and the patients showed no evidence of tachyphylaxis or tolerance through 12-15 months of treatment. Fosinopril was well tolerated. During the short-term phase, no patient withdrew because of adverse events possibly related to fosinopril; during the long-term phase, nine of 148 patients (6.1%) withdrew for that reason. In patients with mild-to-moderate hypertension, once-daily fosinopril (40 and 80 mg) provided significant antihypertensive effects with or without diuretic therapy. The 10 mg dose was effective in some patients and may be considered a starting dose.

Sedative effects of antihistamines: safety, performance, learning, and quality of life.

Antihistamines are frequently part of the treatment regimen for seasonal and perennial allergic rhinitis occurring alone or in conjunction with associated airway disorders, such as asthma, sinusitis, and otitis media with effusion. These agents are also frequently prescribed for the treatment of urticaria to eliminate the need for long-term corticosteroids. This paper reviews the side-effect profile of the sedating and nonsedating agents (a classification given these drugs by the US Food and Drug Administration) in terms of patient satisfaction and quality-of-life parameters. Because the sedating antihistamines cross the blood-brain barrier more quickly and easily than the nonsedating antihistamines, they produce more central nervous system (CNS) effects, further exacerbating the decreases in decision-making, verbal learning, and psychomotor skills already experienced by the patient with allergic rhinitis. In contrast the now-preferred nonsedating agents do not readily cross the blood-brain barrier, do not produce CNS side effects, and, therefore, do not cause sedation or performance impairment. The nonsedating agents provide a safer alternative for patients with allergic rhinitis. Their use can increase patient satisfaction with the health care received.

A multicenter trial comparing the efficacy and safety of cefuroxime axetil and cefaclor in pneumonia of adults.

The 185 hospitalized patients (aged 19 to 95 years) with pneumonia were randomly assigned to receive 500 mg of cefuroxime axetil orally (250 mg q12h), 1,000 mg of cefuroxime axetil orally (500 mg q12h), or 1,500 mg of cefaclor orally (500 mg q8h), daily, for a mean of nine days. Among the 151 evaluable patients, clinical cure was noted in 58% of the 500-mg cefuroxime axetil group, 94% of the 1,000-mg cefuroxime axetil group, and 88% of the cefaclor group, and clinical improvement in 32%, 4%, and 9%. Bacteriologic outcome was similar in the three groups. Adverse events were minor and comparable among the treatment groups. Cefuroxime axetil is a safe and effective oral antimicrobial for the treatment of pneumonia in adults.

Clinical trials of cefprozil for treatment of skin and skin-structure infections: review.

Limitations of currently used antimicrobial agents for the treatment of skin and skin-structure infections (e.g., increased resistance to penicillin and erythromycin and inconvenient dosing schedules) have led to an adjustment in the kinds of antimicrobial agents prescribed for these diseases. Three recently completed clinical studies have demonstrated some therapeutic advantages of cefprozil, a new broad-spectrum oral cephalosporin, over cefaclor and erythromycin in the treatment of skin and skin-structure infections. Specifically, cefprozil offers clinical efficacy equivalent to those of cefaclor and erythromycin both at lower total doses and on a less frequent dosing schedule (once or twice daily vs. three to four times daily). The advantage of once-daily or twice-daily dosing with cefprozil may contribute to patient convenience and compliance.

Clinical evaluation of cefotetan in the treatment of lower respiratory tract infections.

Cefotetan, a new cephamycin antibiotic, was evaluated for the treatment of lower respiratory tract infections. Intravenous cefotetan (2 g every 12 h) was administered for 4 to 8 days (mean, 5.8 days) to 56 hospitalized adult patients. Of the 41 evaluable patients, the clinical response was satisfactory in 38 (93%) and the bacteriological response was satisfactory in 36 (88%). The drug was well tolerated, and there were minimal complaints or changes in clinical laboratory values. From these preliminary results, cefotetan appears to be safe and effective for the treatment of lower respiratory tract infections.

Efficacy of ciprofloxacin in the treatment of various bacterial infections.

The efficacy and safety of ciprofloxacin (500 mg administered every 12 hours) were evaluated in 62 patients enrolled in a prospective, open study. Fifty-three courses in the treatment of 56 infection sites suitable for evaluation were assessed. The infection sites involved were skin and skin structure (28), respiratory tract (21), urinary tract (5), and gastrointestinal tract (2). Bacterial isolates included 16 Pseudomonas aeruginosa, 13 Staphylococcus aureus, and 8 Escherichia coli. Signs and symptoms of infection completely resolved in 46 (82%) of the infection sites. Nine (16%) improved, and one (2%) failed to respond. Ciprofloxacin was well tolerated.

Comparison of aztreonam and tobramycin in the treatment of lower respiratory tract infections caused by gram-negative bacilli.

A comparison of aztreonam and tobramycin was carried out in 49 hospitalized patients with lower respiratory tract infections caused by gram-negative bacilli. Patients were randomly assigned to the treatment drug. Clindamycin was given concomitantly until the pathogen was identified and the presence of a gram-positive microorganism was ruled out. Samples of sputum were obtained for culture from the lung parenchyma by deep expectoration or transtracheal aspiration. A pathogen was defined as an organism that showed heavy growth and predominated in the culture. Pseudomonas aeruginosa was the most frequently isolated pathogen, followed by Haemophilus influenzae and Proteus mirabilis. A variety of less common pathogens were represented. Thirty-five patients were treated with intravenous aztreonam (1-2 g every 8 hr) and 14 with intravenous tobramycin (3-5 mg/kg per day) until they were afebrile and sputum cultures had been free of the pathogen for 48 hr. The minimum duration of treatment was five days. In the aztreonam group, only two (5%) of the 37 gram-negative pathogens--one P. aeruginosa and one Escherichia coli--persisted. In the tobramycin group, seven (50%) of the 14 pathogens persisted. Clinical response paralleled microbiologic response. Adverse effects in both treatment groups were minor and transient. In this trial aztreonam was effective and safe for treatment of lower respiratory tract infections caused by P. aeruginosa and a variety of other gram-negative bacilli.