Sunday, July 6, 2008

“Do It Yourself”: Patients Treating Themselves for UTIs

Return to Medscape coverage of: 41st Interscience Conference on Antimicrobial Agents and Chemotherapy  |  Daily Session Coverage


"Do It Yourself": Patients Treating Themselves for UTIs


Disclosures

Mary Beth Nierengarten, MA   



Chicago, Tuesday, December 18, 2001 — Escherichia coli bugs women, particularly their urinary tracts. Of all the pathogens that lead to urinary tract infections (UTIs), E coli is the main culprit. Two studies presented in a slide session at the 41st ICAAC focused on UTIs in 2 particular populations: women with recurrent infections, and those with diabetes.

Self-initiated Antibiotic Therapy for Recurrent UTIs


Self-initiated antibiotic therapy is an attractive option for controlling recurrent UTIs in women, and it can be safe and effective. One major drawback, however, is the potential risk for developing antibiotic resistance. Dr. Gupta from the University of Washington, and colleagues[2] conducted a study to evaluate the prevalence of antimicrobial resistance to E coli infections in women given either ofloxacin (OFL) or levofloxacin (LVX) to self-administer as needed. Of 172 women in the study, 144 had confirmed cases of UTI, primarily due to E coli (73% as sole pathogen, 12% as copathogen) during the study period. E coli isolates were resistant to trimethoprim-sulfamethoxazole (TMP/SMX) (12%), ampicillin (AMP) (31%), ampicillin/clavulanate (AMC) (10%), and cephalothin (CEP) (12%). None of the strains were resistant to cefotaxime, ciprofloxacin, ofloxacin, levofloxacin, or nitrofurantoin. These results are similar to those reported for sporadic uncomplicated cystitis.

The investigators also looked at resistance problems to different antibiotics in a subset of 103 women with 185 confirmed cultures, 85% of which were E coli. The report was encouraging, said Dr. Grupta, because of the finding that 62% of the E coli strains were not resistant to multidrug therapy; only 12% were resistant to 3 or more antimicrobials (ie, multidrug resistant).

Because an increased risk of antibiotic resistance is always a factor in managing UTIs, these data are encouraging for patients who wish to initiate their own therapy.

Women with Diabetes Mellitus


Can a vaccine prevent the high prevalence of bacteriuria in women with diabetes mellitus (DM)? Dr. Meiland, from the University Medical Center Utrecht, The Netherlands,[1] says it's time to clinically evaluate a vaccine that has shown promising results in the lab.

Due to an increased type of a particularly virulent strain of E coli (type 1-fimbriated), which binds to the uroepithelial cells of women with DM, the prevalence of bacteriuria is higher in these women than in women without this metabolic disorder. Developing a vaccine for these women is therefore highly attractive.

To clinically evaluate a vaccine to reduce and prevent E coli infections in diabetic women, Dr. Meiland and colleagues isolated 2 E coli strains — Ctr39 and NU14 — from uroepithelial cells of women with DM. After incubation with anti-FimCH antiserum diluted 1:50, 1:100, or 1:200, the investigators found that adherence of E coli to the uroepithelial cells of diabetic women was inhibited for both the Ctr39 (65%, 56%, and 41% by dilution ratios, respectively) and NU14 (23%, 8%, and 3% by dilution ratios, respectively) strains. These data show that a vaccine-induced anti-FimCH antiserum can inhibit adherence of E coli to uroepithelial cells of women with DM.

[A phase 2 clinical trial of a vaginal mucosal vaccine against 10 pathogenic strains of E coli and other organisms was presented on Monday (see Pushing the Envelope: A UTI Vaccine, Suppressive Herpes Therapy, and Linezolid Resistance).]

References


Meiland R, Geerlings SE, Brouwer EC, Coenjaerts FEJ, Langermann S, Hoepelman IM. Adherence of Escherichia coli to uroepithelial cells of women with diabetes mellitus (DM) can be inhibited by vaccine-induced anti-FimCH antiserum. Program and abstracts of the 41st Interscience Conference on Antimicrobial Agents and Chemotherapy; December 16-19, 2001; Chicago, Illinois. Abstract 1349.Gupta T, Hooton TM, Roberts PL, Stamm WE. Antimicrobial resistance in uropathogens from patients utilizing self-initiated therapy for recurrent UTI. Program and abstracts of the 41st Interscience Conference on Antimicrobial Agents and Chemotherapy; December 16-19, 2001; Chicago, Illinois. Abstract 1352.

 
 
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Beethoven moves to microfiche

acid in the stomach A priceless collection of manuscripts by Ludwig van Beethoven will be available for public viewing next year for the first time when the Berlin State Library commits them to microfiche.

Some 100 works by the German composer featuring 14,600 pages of fragile hand-written scores to major symphonies and 1,800 pages of notes will be filmed,and published as The Beethoven Collection.

"Because the works will be reproduced in color with sections crossed out (by Beethoven) and subsequently corrected, the manuscripts can be studied down to the last detail," the library said in a statement.

Linkin Park singer talks of illness

Linkin Park singer Chester Bennington has said he is physically sick every time he sings due to a condition called hiatus hernia, say reports.

He will undergo surgery for the illness when the band have finished their summer tour, according to website Dotmusic.com.

The condition occurs when part of the stomach moves above the diaphragm, freeing stomach acid into the oesophagus.

"There's a lot of burning that happens every once and a while. But I'll pretty much be nauseous forever. It's going to be that way indefinitely," said Bennington.

Bollywood star leaves hospital

Bollywood star Vivek Oberoi, who broke his shin while filming a motorbike stunt, has been discharged from hospital.

The actor was operated on successfully but developed lung complications before making a recovery.

His rehabilitation means that he will be away from work for three months, which could seriously affect the film he was working on, directed by Mani Ratnam.

"He will not be able to dance around for at least 90 days, but he might do less strenuous shooting before that," said Hinduja hospital doctor Sanjay Agarwala.

Libertines singer on burglary charge

A singer with rock group The Libertines, Pete Doherty, has appeared in court on a burglary charge.

The vocalist and guitarist, who has been absent from the band's line-up in recent months because he was "unwell", is accused of burgling an address in Harley Street, central London.

He made a brief appearance at Horseferry Road Magistrates' Court on Monday, where he was listed as having no fixed address, and is reported to have been bailed to return on 11 August.

The Libertines are one of the most successful new British rock bands of the last year, with four top 40 singles.

Rowling gives up shoes for charity

Harry Potter author JK Rowling is to auction off a pair of her shoes for charities which campaign against domestic violence.

Singer Barbara Dickson and Olympic curling star Rhona Martin are also among the group of famous Scottish women who are donating their shoes for YWCA Scotland, Women's Aid and Rape Crisis.

The pairs of empty shoes will be exhibited at the Edinburgh Fringe Festival and represent the 104 women who die in Britain each year as a result of domestic violence.

Mary Dundas, of YWCA Scotland, told the Sunday Herald: "We consulted someone about how much JK Rowling's might be worth and they said they could go for around £3,500."

P Diddy goes to number one

Rapper P Diddy has claimed his third number one album in the US with his Bad Boys II soundtrack.

The album has sold 324,000 copies in its first week, and is the first soundtrack to debut at number one since Eminem's 8 Mile in October.

The success of the album coincides with Bad Boys II entering the US box office chart at number one in its opening week.

Rap artist Chingy came in at number two on the album chart with first-week sales of 157,000 copies.


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Essential oils ‘combat superbug’

bacterial infections Tests of new machine at a hospital have found it could be effective in the battle against the superbug MRSA.

Consultants at Wythenshawe Hospital found that using a vaporiser to spray essential oils into the atmosphere killed off micro-organisms.

Airborne bacterial counts dropped by 90% and infections were reduced in a nine-month trial at the burns unit.

The recipe of oils used in the machine was refined by microbiologists at Manchester Metropolitan University.

Scent Technologies, the Wigan-based company which makes the machine, developed the device to mask smells on wards but found it had a beneficial effect on infections.

The study was started after the recipe of oils was modified by the university team, in conjunction with Wythenshawe consultant Ken Dunn.

"Many people will be aware that there are decades of experience with the use of essential oils to control infection," said Mr Dunn.

"I think the novelty of this is putting the two researched technologies together and being able to affect a really surprisingly large area of the ward with a single machine."

There were no MRSA infections in the burns unit while the machine was being used with the recipe of oils.

In the final two months the natural essence blend was removed from the machines and MRSA levels in the air increased - and there was an MRSA outbreak in the ward.

More tests

But despite the apparent success of the trial, MRSA campaigners have urged healthcare professionals to continue with strict cleaning regimes.

Bev Hurst, whose mother Margaret died from an MRSA infection, said: "If this is something that is going to help then that's brilliant.

"But it has to be in conjunction with everything else - it can't just be a machine on a ward."

The National Audit Office estimates hospital-acquired infections contribute to some 5,000 deaths annually.

Further tests are now being carried out.
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Thursday, July 3, 2008

Evaluating and Optimizing Treatment Response

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Return to Medscape coverage of: Digestive Disease Week 2003  |  Posters and Abstracts: Clinical Applications of Proton-pump Inhibitors


Evaluating and Optimizing Treatment Response


Disclosures

Emma Hitt, PhD   



Evaluation of Treatment Response


An appropriate scale evaluating gastroesophageal reflux disease (GERD) symptom response to treatment has not been established. Monnikes and colleagues[1] developed a self-administered questionnaire called ReQuest (Reflux Questionnaire). The test consisted of questions in 7 dimensions: (1) general well-being, (2) acid complaints, (3) upper abdominal/stomach complaints, (4) lower abdominal/digestive complaints, (5) nausea, (6) sleep disturbances, and (7) other complaints. Each of the dimensions was tested by a leading question about frequency and intensity. A long version of the test comprised 67 symptom descriptions assigned to each of the 7 dimensions. ReQuest was validated in a clinical trial of 349 patients with erosive esophagitis (Los Angeles [LA] Grade A-D) receiving pantoprazole. On the basis of factor analyses, the long version of the test was reduced to a 60-item scale. The study authors concluded that the test was highly reproducible, valid, and responsive.

Another study evaluated the reliability and validity of a questionnaire on upper gastrointestinal symptoms. Kuo and colleagues[2] tested the questionnaire in patients on chronic acid suppression identified from pharmacy billing. They modified 7 questions taken from previously validated questionnaires about upper gastrointestinal symptom frequency. Questions collected information on heartburn, supine heartburn, use of antacids, stomach pain, bloating, pain after eating, and nausea or vomiting. The first 3 symptom domains involved GERD, and the third through seventh symptom domains involved dyspepsia. Validity was tested via correlation with standard quality-of-life questions. A total of 812 patients (53% of eligible patients) completed the questionnaire. The internal consistency reliability was reasonable, and the Pearson correlation coefficients between the symptom questions and the quality-of-life questions were modest to moderate (P < .0001 for all). The strongest correlations were with heartburn and dyspepsia symptoms and interference of normal activities. The study authors concluded that this test is convenient and has psychometric characteristics comparable to other upper gastrointestinal disease-specific questionnaires.

Quality of Life


Compared with the general population, GERD patients experience impaired health-related quality of life (HRQOL). But what is the effect of proton-pump inhibitors (PPIs) in ameliorating this health indicator?

A study by Calleja and colleagues[3] demonstrated that pantoprazole rapidly relieved symptoms in patients with GERD and resulted in a sustained improvement of HRQOL, which correlated with heartburn relief. These investigators conducted a 12-month multicenter study in 656 moderate-to-severe GERD patients taking once-daily pantoprazole 40 mg. They assessed HRQOL at baseline and at weeks 8, 24, and 48. Symptom relief occurred in an average of 2.0 days for heartburn, 2.1 days for regurgitation, 2.2 days for dysphagia, and 2.1 days for chest pain. Both the SF-12 scale, used to measure general well-being, and the GERD-HRQOL scale indicated significant improvement at the end of the study compared with baseline. For both scales, the improvement was greater in the first month of treatment. No serious adverse events were reported.

On-Demand Therapy


On-demand-treatment of GERD, also known as symptom-driven treatment, may offer an alternative option to continuous therapy in patients with mild-to-moderate disease. This strategy appears to reduce symptoms, improve quality of life, and to be cost-effective. One analysis has found that an on-demand strategy may be suitable for approximately 60% of newly diagnosed patients with GERD for the long-term management of symptomatic disease of mild or moderate severity.[4] Two studies presented during this year's Digestive Disease Week meeting further evaluated an on-demand strategy with PPIs.

Kaspari and colleagues[5] conducted a trial of 536 patients with endoscopically confirmed GERD stage 0 or I (Savary/Miller modified by Siewert). For symptom relief, patients were initially treated for 4 weeks with once-daily pantoprazole 20 mg. In a subsequent 6-month (long-term) phase, if symptoms relapsed, patients who were initially symptom-free took either pantoprazole 20 mg on-demand (n = 175) or placebo (n = 182). Antacids were available as rescue medication. The 4 weeks of continuous treatment with once-daily pantoprazole 20 mg provided complete relief of GERD symptoms in 86% of patients. In the subsequent comparison trial, GERD symptom score remained significantly lower among patients taking pantoprazole on demand as compared with those taking placebo (P = .007). These patients also used significantly fewer antacids (P </= .0001).

In another study evaluating on-demand therapy, Arguello and colleagues[6] found that symptom-driven treatment with rabeprazole was effective and improved HRQOL in patients with mild GERD. The study authors evaluated symptomatic patients with GERD (heartburn more than 2 days per week). Of the patients evaluated, 19 had esophagitis LA Grade A, 19 had esophagitis LA Grade B, and 17 had normal endoscopy but an abnormal 24-hour ambulatory esophageal pH recording. All patients received a maximum dose of once-daily rabeprazole 20 mg over a period of 8 or 4 weeks, depending on the presence or absence of esophagitis (acute phase), respectively. The 51 patients who responded to the acute-phase treatment entered an on-demand maintenance phase in which they received rabeprazole 20 mg on demand when heartburn was present. During on-demand treatment, 51%, 53%, and 41% patients had no symptoms when examined at 1, 3, and 6 months, respectively. The remaining patients had occasional heartburn (defined as once per week). Esophagitis relapsed in 3 patients who were symptomatic during on-demand treatment. An average of 0.36, 0.33, and 0.26 tablets per day (rate of drug consumption) were consumed at 1, 3, and 6 months, respectively. Patient satisfaction and HRQOL increased after acute therapy and were maintained or improved by the end of the study.

References


Monnikes H, Bardhan KD, Stanghellini V, et al. Request: Development and psychometric validation of a new evaluative symptom-scale in gastroesophageal reflux disease (GERD). Gastroenterology. 2003;124:A-535. [Poster #T1624] Kuo B, Ferris T. Reliability and validity of a modified questionnaire of upper GI symptoms utilized in a disease management program of patients on chronic acid suppression. Gastroenterology. 2003;124:A-505. [Poster #T1295] Calleja JL, Martin J, Banos F, et al. Rapid relief of symptoms and sustained improvement in health related quality of life (HRQOL) in moderate-severe gastroesophageal reflux disease (GERD) patients treated with pantoprazole. Gastroenterology. 2003;124:A-231. [Poster #S1612] Bardhan KD. Intermittent and on-demand use of proton pump inhibitors in the management of symptomatic gastroesophageal reflux disease. Am J Gastroenterol. 2003;98:S40-S48. Kaspari S, Kupcinskas L, Fischer R, et al. On-demand therapy with pantoprazole 20 mg as effective long-term management of patients suffering from mild GERD. Gastroenterology. 2003;124:A-538. [Poster #T1640] Arguello L, Pons V, Ponce M, et al. On demand therapy with rabeprazole in patients with mild gastroesophageal reflux disease (GERD): evaluation of effectiveness and patient-centered measures. Gastroenterology. 2003;124: A-227. [Poster #S1588]

 
 
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Radical Prostatectomy for Clinical T3 Disease

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Discussion of Diagnosis


The appropriate treatment for men with locally advanced prostate cancer remains controversial. Although PSA screening has resulted in a dramatic shift toward the diagnosis of earlier stage prostate cancer, the importance of cT3 disease has not decreased, because these patients have a poorer prognosis than those with clinically organ-confined disease. Cancer control is particularly important for patients with locally advanced prostate cancer, as these patients are at risk for symptomatic local and systemic progression.  Printer- Friendly Email This

Nat Clin Pract Urol.  2007;4(8):451-454.  ©2007 Nature Publishing Group
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Nocturnal Acid Breakthrough — Approach to Management

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Nocturnal Acid Breakthrough — Approach to Management


Previous Page In This ArticleAbstract and IntroductionWhat Is Nocturnal Acid Breakthrough?Clinical Importance of Nocturnal Acid BreakthroughTreatment of Nocturnal Acid BreakthroughConclusionFiguresReferences

Conclusion


In conclusion, nocturnal acid breakthrough frequently occurs in H pylori-negative patients taking daily or twice-daily PPIs. In asymptomatic patients on PPI therapy with uncomplicated GERD, the clinical importance of nocturnal acid breakthrough is likely low. However, in patients with complicated GERD, Barrett's esophagus, esophageal motility abnormalities, and symptomatic patients on PPI therapy, nocturnal acid breakthrough should be investigated and treated. In our experience, we have found bedtime H2RAs to be an effective treatment for nocturnal acid breakthrough.Previous PageSection 5 of 5 
Medscape General Medicine.  2004;6(4):11.  ©2004 Medscape


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Thursday, May 15, 2008

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