A controlled trial of aerosolized ribavirin in infants receiving mechanical ventilation for severe respiratory syncytial virus infection

Article Abstract:

Respiratory syncytial virus is an important cause of respiratory infection in infants and children. The drug ribavirin was shown to be effective against this virus, and was approved in December 1986 for the treatment of respiratory syncytial virus infection. However, approval of ribavirin was based on studies testing its effectiveness in infants who were breathing normally, or without the aid of respiratory equipment. The studies consisted of three clinical trials, or human studies, including two with normal infants and one with infants who had underlying disease. These studies were criticized for problems in design and inability to show the effects of ribavirin on mortality, duration of hospitalization or treatment, and need for respiratory assistance. Because ribavirin may precipitate, or accumulate, in respiratory equipment, it is not approved for use in infants who require mechanical assistance. The effects of ribavirin were assessed in infants with respiratory syncytial virus infection who required assisted breathing. A system was designed to deliver ribavirin to infants without the accumulation of ribavirin in the respiratory equipment. The study involved 28 infants, including 7 infants with underlying diseases and 21 infants who were previously healthy. The duration of assisted breathing was 4.9 days in ribavirin-treated infants and 9.9 days in infants who were given an inactive placebo. The average duration of oxygen therapy was 8.7 days in ribavirin-treated patients and 13.5 days in placebo-treated patients. The duration of hospitalization was 13.3 days in ribavirin-treated patients and 15 days in the placebo group. Among the 21 normal infants, the period of hospitalization was 9 days those given ribavirin, compared with 15.3 days for those who received the placebo. These findings show that ribavirin reduces the duration of assisted breathing, oxygen treatment, and hospitalization. (Consumer Summary produced by Reliance Medical Information, Inc.)

Respiratory syncytial virus, Dosage and administration, Ribavirin

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Emerging resistance to fluoroquinolones in staphylococci: an alert

Article Abstract:

The repeated use of antibiotics can lead to the development of strains of bacteria that are resistant to drug treatment, that is, certain strains of bacteria are no longer killed by particular antibiotics. Staphylococci are an important cause of infections that are acquired within the community and in the hospital. Staphylococcal infections have been difficult to control because these bacteria are able to develop resistance to new antibiotic treatments. A bacteria can develop resistance to a drug by a mutation or alteration in a gene, or by acquiring a small piece of DNA (genetic material), called a plasmid, from another bacteria. Resistance can spread among bacteria by exchanging plasmids, and among patients by the transmission of different strains from person to person. In these ways, staphylococci have become resistant to treatment with antibiotics such as penicillin. A newer generation of antibiotics called the fluoroquinolones have been very effective in treating gram-negative bacterial infections and infections caused by bacteria that are resistant to other antibiotics. Examples of fluoroquinolones include ciprofloxacin, norfloxacin, ofloxacin and pefloxacin. In the past, these drugs have been effective in killing methicillin-resistant strains of Staphylococcus aureus (S. aureus). However, new strains of S. aureus that are resistant to treatment with fluoroquinolones began to appear in 1985. These resistant strains initially appeared during treatment with the fluoroquinolones, and then became more widespread as the strains were passed from person to person. The use of several different types of antibiotics (combination therapy) may be beneficial for treating resistant strains. The authors recommend that fluoroquinolones by themselves not be used for the treatment of staphylococcal infections. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Genetic aspects, Staphylococcus aureus, Drug resistance in microorganisms, Microbial drug resistance, Staphylococcal infections, editorial

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Drug therapy: fluoroquinolone antimicrobial agents

Article Abstract:

Several fluoroquinolone antimicrobial agents (also called quinolones) have been approved for use in the United States. How the drugs work and their activity in a test tube environment are discussed, as well as their action in human subjects. The quinolones can be given by mouth, and are effective for infections of the genital and urinary tracts and the digestive system. The efficacy of various types of quinolones is discussed for a variety of conditions. The quinolones are effective against bacterial prostatitis, sexually transmitted diseases (gonococcal, rectal and throat infections, chlamydia, chancroid, and pelvic inflammatory disease). Digestive system infections amenable to treatment with quinolones are Escherichia coli and shigella, major causes of ''traveller's diarrhea.'' Quinolones are also effective against typhoid, bacterial enteritis in nontravellers, and several foodborne illnesses. Respiratory tract infections, including chronic bronchitis, influenza, and pneumonia also yield to treatment with these drugs. Osteomyelitis (bone inflammation) can be cured by the quinolones, although mixed infections sometimes do not respond to therapy. There have been both successes and failures in the treatment of bed sores, ulcers caused by lack of circulation, and wound infections, and some bacteria have become resistant to drug therapy. So far the quinolones seem to cause side effects no more often, and possibly less often than conventional antibiotics. The side effects and laboratory findings are detailed, as are drug interactions, including theophylline-induced toxicity. One week of treatment with quinolones costs from $25 to $50, more than most generic oral antibiotics. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Sexually transmitted diseases, Finance, Ulcers, Gastrointestinal diseases, Osteomyelitis, Prostatitis

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