Efficacy and tolerability of once-daily telithromycin compared with high-dose amoxicillin for treatment of community-acquired pneumonia

BACKGROUND

This randomized, double-blind study compared the efficacy and tolerability of the new ketolide antimicrobial telithromycin with that of high-dose amoxicillin in the treatment of community-acquired pneumonia (CAP).

PATIENTS AND METHODS

Adult patients (n = 404), with signs and symptoms of CAP and radiologic confirmation were randomized to receive telithromycin 800 mg once daily (n = 199) or amoxicillin 1,000 mg three times a day (n = 205) for 10 days. Clinical and bacteriologic outcomes were assessed at post-therapy test-of-cure (days 17-24) and late post therapy (days 31-36).

RESULTS

The clinical cure rate for telithromycin-treated patients (per protocol) pst therapy (days 17-24) was 141/149 (94.6%) and compared well with that for amoxicillin (137/152 (90.1%)). Subset analysis of patients (per protocol) showed high clinical cure rates for patients aged >/= 65 years (telithromycin 21/24, 87.5%; amoxicillin 22/29, 75.9%); those with documented pneumococcal bacteremia (telithromycin 10/10, 100%; amoxicillin 7/9, 77.8%); and patients with a Fine score >/= III (telithromycin 31/34, 91.2%; amoxicillin 38/47, 80.9%). Bacterial eradication rates were comparable between treatments (telithromycin 42/48, 87.5%; amoxicillin 39/45, 86.7%), with 22/23 vs 18/21 Streptococcus pneumoniae strains 9/12 vs 11/13 Haemophilus influenzae strains and all Moraxella catarrhalis isolates (five and three patients, respectively) eradicated at the test-of-cure visit. Both treatments were generally well tolerated.

CONCLUSION

Telithromycin 800 mg once daily is a convenient, optimal-spectrum, first-line treatment for CAP in adults, at least as effective and well tolerated as high-dose amoxicillin.

Telithromycin is as effective as amoxicillin/clavulanate in acute exacerbations of chronic bronchitis

This randomized, double-blind study evaluated the efficacy and safety of a short, 5-day course of telithromycin, a new ketolide antibacterial, compared with a standard 10-day course of amoxicillin/clavulanate, in the treatment of acute exacerbations of chronic bronchitis (AECB). The study enrolled 325 adult patients with AECB and a history of chronic obstructive pulmonary disease (COPD). Patients received either telithromycin 800 mg once daily (qd) for 5 days (followed by placebo for 5 days) or amoxicillin/clavulanate 500/125 mg three times daily (tid) for 10 days. Clinical cure rates for telithromycin post-therapy (Days 17-21, test-of-cure) and late post-therapy (Days 31-36) were 86.1 and 78.1%, respectively; 82.1 and 75.0% for amoxicillin/clavulanate. Excellent clinical cure rates were also observed for high-risk patients. Bacteriologic outcome was satisfactory for 69.2% of telithromycin recipients vs 70.0% for amoxicillin/clavulanate recipients. Both treatments were generally well tolerated, although the frequency of drug-related adverse events was almost two-fold higher for amoxicillin/clavulanate (25.0 vs. 13.1%). Thus, a 5-day course of telithromycin 800 mg qd is an effective and well-tolerated alternative to a standard 10-day course of amoxicillin/clavulanate 500/125 mg tid for first-line empiric treatment of AECB in adults with COPD.

Efficacy of short-course therapy with the ketolide telithromycin compared with 10 days of penicillin V for the treatment of pharyngitis/tonsillitis

This randomized, double-blind study compared the efficacy and safety of a 5-d course of the new ketolide antimicrobial, telithromycin, with those of a standard 10-d course of penicillin V (phenoxymethylpenicillin) in patients with group A beta-hemolytic streptococci (GABHS) pharyngitis/tonsillitis. Patients aged 15-65 y (n = 395) with clinical signs and symptoms of pharyngitis/tonsillitis and a positive streptococcal antigen test or throat culture for GABHS were randomized to receive either telithromycin 800 mg once daily for 5 d (n = 198) or penicillin V 500 mg three times daily for 10 d (n = 197). Clinical and bacteriologic outcomes were assessed at post-therapy, test-of-cure (Days 16-20) and late post-therapy (Days 38-45) visits. Telithromycin for 5 d was equivalent to 10 d of penicillin V in terms of bacteriologic and clinical outcome (per-protocol): at post-therapy, test-of-cure visit, bacteriologic outcome was satisfactory in 84.3% and 89.1% of patients in the telithromycin and penicillin V groups, respectively, while clinical cure was achieved in 94.8% and 94.1% of patients, respectively. At late post-therapy, 82.4% of patients treated with telithromycin achieved a satisfactory bacteriologic outcome, compared with 84.7% of penicillin V recipients. The GABHS eradication rates for telithromycin and penicillin post-therapy were 85.2% and 89.1%, respectively, and 86.1% and 86.5%, respectively at late post-therapy. Both treatments were well tolerated, with a similar overall incidence of treatment-emergent adverse events. Short-course (5 d) therapy with telithromycin 800 mg once daily is comparable to a standard 10 d course of penicillin V for the treatment of GABHS pharyngitis/tonsillitis in adults and adolescents.

Efficacy and tolerability of once-daily therapy with telithromycin for 5 or 10 days for the treatment of acute maxillary sinusitis

BACKGROUND

The efficacy and tolerability of oral telithromycin 800 mg once daily for 5 vs. 10 days were assessed in patients with acute maxillary sinusitis (AMS).

METHODS

Adults (n = 341) with confirmed AMS diagnosed on clinical signs and symptoms and sinus X-ray showing total opacity or air-fluid level were randomized to receive oral telithromycin for 5 days (followed by placebo for 5 days; n = 170) or 10 days (n = 171). Causative pathogens were isolated by pretreatment sinus puncture (day 1). Clinical and bacteriologic outcomes, and safety and tolerability endpoints were assessed.

RESULTS

Clinical cure rates post-therapy (per-protocol; days 17-21) were comparable (91.1% in the 5-day group, n = 123; 91.0% in the 10-day group, n = 133). Bacteriologic eradication rates (per-protocol) were also similar (90.7 vs. 91.3%). Both regimens were well tolerated.

CONCLUSIONS

A 5-day course of telithromycin 800 mg once daily is an effective, well-tolerated treatment for adults with AMS, comparable to a 10-day regimen.

Locus for autosomal recessive nonsyndromic persistent hyperplastic primary vitreous

PURPOSE

To map the disease locus in a six-generation, consanguineous Pakistani family affected by nonsyndromic autosomal recessive persistent hyperplastic primary vitreous (arPHPV). All affected individuals had peripheral anterior synechiae and corneal opacities with variable degrees of cataract and a retrolenticular white mass behind the lens.

METHODS

Genomic DNA from family members was typed for alleles at more than 400 known polymorphic genetic markers, by polymerase chain reaction. Alleles were assigned to individuals, which allowed calculation of lod scores.

RESULTS

A maximum two-point lod score of 4.07 was obtained with marker D10S1225 with no recombination. Two recombinations with marker D10S208 and D10S537 localized the disease within a region of approximately 30 centimorgans (cM). However, homozygosity across the region refined the arPHPV locus to 13 cM.

CONCLUSIONS

Linkage analysis shows localization of nonsyndromic arPHPV to chromosome10q11-q21.

[Anesthetic management of obstetrical labor in a parturient with muscular carnitine palmitoyl transferase deficiency]

We report a case of a patient with carnitine palmityl deficiency in active labour. We discuss the metabolic and energetic implications of obstetrical labour in regard with the mitochondrial myopathy and we propose an optimal management. Neuroaxial analgesia and glucose infusion are indicated in early labour because it is necessary to alleviate stress and pain in order to avoid rhabdomyolysis associated with CPT deficiency. Combined spinal epidural analgesia using intrathecal opioid alone then epidural naropein should be a relevant choice because of a minimal motor blockage. Monitoring of myolysis using serum creatinine phosphokinase levels must take in account CK and MB fractions releases to the circulation during obstetrical labour.

Cerium(IV)-Catalyzed Deprotection of Acetals and Ketals under Mildly Basic Conditions

Smooth and quantitative deprotection of a wide range of acetals and ketals [Eq. (a); R, R(1)=alkyl, aryl, H] under neutral to mildly basic conditions was achieved with catalytic quantities of cerium ammonium nitrate (CAN). The reaction conditions are compatible with a variety of sensitive functional groups, and aldehydes can be liberated from acetals without being oxidized to the corresponding carboxylic acids.

Histological demonstration of haemosiderin deposits in lungs and liver from victims of chronic physical child abuse

In the context of chronic physical child abuse, two entities have been described based on macroscopical and radiological criteria: the battered baby syndrome and the shaken baby syndrome. However, in some autopsy cases, clinico-radiological information may not be available. In these cases, histological examinations are necessary to look for sequelae of repeated haemorrhages, particularly in organs likely to have suffered traumatisms such as the lungs, or in organs belonging to the mononucleated macrophage resorption system, such as the liver and the spleen. We examined a series of 15 young children who died from proven chronic child abuse and compared them with 15 sex and age-matched control subjects who died from natural causes with no history of child abuse. Using Perl's stain for iron, we identified haemosiderin deposits in pulmonary, hepatic and splenic samples and the deposits were evaluated qualitatively and quantitatively. Haemosiderin deposits were significantly (P < 0.001) more abundant in the lungs and liver of the chronic abuse victims than in those of the control subjects. However, they were not significantly more abundant in the spleens of child abuse victims than in controls. We conclude that haemosiderin deposits in lungs and liver could be proposed as a marker for chronic physical child abuse. This study stresses the importance of systematic histological examination to look for pulmonary and hepatic haemosiderin deposits in cases in which chronic child abuse is suspected.

[Post-partum suppurating thrombophlebitis of the ovarian vein presenting with pleuropulmonary manifestations]

Following a normal delivery, a 22-year-old primigravida experienced fever resistant to antibiotic therapy. On the tenth post partum day, thoracic pain and chest X-ray were in favour of acute pneumonitis of left inferior lobe. Considering the extension to the right lung and a normal bronchic fibrescopy, a computed tomography (CT) was performed which showed a right ovarian vein thrombophlebitis, right minor subpleural opacities and left pneumopathy. The final diagnosis was post partum ovarian vein suppurated thrombophlebitis with pulmonary septic metastases from haematogenic diffusion. Post partum thrombophlebitis is a rare event with an incidence of 1 per 2,000 deliveries. Pulmonary inaugurating symptoms result rather from pulmonary embolism than from septic metastases. Post partum persisting and unexplained fever should be explored with abdominal CT-scan.

Renal granulomatous sarcoidosis in childhood: a report of 11 cases and a review of the literature

We analysed retrospectively 11 children with renal granulomatous sarcoidosis confirmed by renal histology in order to describe the course and prognosis of the disease. Symptomatic sarcoidosis was diagnosed at a mean age of 10.1 years. Nine children had renal involvement at the time of diagnosis. In the course of the disease, nine patients developed renal failure and mild proteinuria, seven had transient sterile leukocyturia, four showed microscopic haematuria, seven had a urinary concentrating defect, and enlarged kidneys were seen in three patients. One child had hypercalcaemia and hypercalciuria, none had hypertension. Light microscopy of the kidney showed interstitial infiltration by mononuclear cells in all children, interstitial fibrosis in nine patients, epithelioid granulomas in seven, tubular involvement in eight, and mild glomerular involvement in seven patients. Renal immunofluorescence was negative. Ten children received prednisone for 1-11 years. After a mean follow up of 5.5 years, three patients had entered end-stage renal failure and one had chronic insufficiency after interruption of medical supervision and prednisone therapy.

CONCLUSION

Renal failure, proteinuria, leukocyturia, haematuria, and concentration defect are the prominent features of renal granulomatous sarcoidosis in children. Steroid therapy, adjusted according to disease activity, may prevent end-stage renal failure.

Clinical and genetic characteristics of a five-generation family with a novel form of myotonic dystrophy (DM2)

We report the clinical and genetic characteristics of a five-generation family (MN1) with an unusual form of myotonic dystrophy (DM). Affected individuals have clinical features that are similar to DM including myotonia, distal weakness, frontal balding, polychromatic cataracts, infertility and cardiac arrhythmias. Genetic analyses reveal that affected individuals do not have the CTG expansion associated with DM, nor is the disease locus linked to the DM region of chromosome 19. We have also excluded the MN1 disease locus from the chromosomal regions containing the genes for the muscle sodium (alpha- and beta-subunits) and chloride channels, both of which are involved in other myotonic disorders. We have recently mapped the disease locus (DM2) in this family to a 10 cM region of chromosome 3q [Ranum LPW, Rasmussen PF, Benzow KA, Koob MD, Day JW. Nat Genet 1998;19:196-198]. The genetically distinct form of myotonic dystrophy in the MN1 kindred shares some of the clinical features of previously reported families with proximal myotonic myopathy (PROMM). The size of the MN1 family (25 affected individuals) makes it a unique resource for both clinical and genetic studies. This second form of myotonic dystrophy may help resolve the confusion that remains about how the CTG repeat expansion in the 3' untranslated portion of the myotonin protein kinase gene causes the multisystem involvement of DM.

Quantification of plasma lipoprotein fractions by wavelet transform time-domain data processing of the proton nuclear magnetic resonance methylene spectral region

Quantitative analysis of lipoprotein major fractions, LDL, VLDL and HDL, is of great interest for medical purposes, for instance in liver or heart diseases, diet management or cancer. The presently available biochemical methods require time consuming ultracentrifugation. A potentially automated method is proposed, using time domain quantification by Wavelet Transform (WT-NMR) method. The aim of the present study was to evaluate, on a preliminary series of nine human plasmas, the potential interest of WT-NMR in the quantification of both NMR-visible lipids and total lipoprotein fractions. The correlation coefficients between low and intermediate density (LDL+IDL), very low density (VLDL) and high density (HDL) lipoprotein visible lipid quantifications, obtained on nine human plasmas with WT-NMR and standard biochemical methods, were 0.79, 0.84 and 0.92, respectively. For the total lipoprotein assay, i.e. including an estimation of non NMR-visible protein and free cholesterol, the correlation between WT-NMR and the biochemistry were 0.87 for LDL+IDL, 0.81 for VLDL and 0.88 for HDL.

[The Pfannenstiel incision in colorectal surgery]

A parietal incision derived from Pfannenstiel's incision has been used since 1983 for surgery of the left colon and rectum. We conducted a prospective study in 100 patients with a mean age of 61 years who underwent surgery from 1984 to 1987 to assess the parietal outcome, postoperative pain and respiratory impact. The most frequent procedures were: sigmoidectomy (n = 48), anterior resection of the rectum (n = 24), rectopexia (n = 12), amputation of the rectum (n = 5) and total colectomy (n = 5). The splenic angle was mobilized in 23 cases. The operation also included a procedure to relieve occlusion in 4 patients. Operative mortality was nil. Parietal complications were bleeding (n = 4) or infection (n = 8). Seven early reoperations used the same access. Mean follow-up for 61 patients was 75 months. No cases of eventration were observed despite factors predictive of failure. Ventilatory impact, as measured by spirometry showed ventilatory peak-flow and blood gases comparable to those observed after a medial hypogastric incision. Pain, assessed on the bases of a visual analog scale and use of antalgesics, was considered to be mild on day 1, low on day 2 and absent on day 5. Sixty-five percent of the patients did not require antalgesics. In conclusion, this incision creates a hypogastric minilaparotomy allowing midline sub- and peri-umbilical, or even xyphoidial access with little pain and operative risk as the parietal risk is eliminated. Oral nutrition and activity can be resumed rapidly, reducing surgical stress in a protocol for minimally-invasive surgery.

[Digestive manifestations in hemolytic uremic syndrome in children]

BACKGROUND

Gastro-intestinal manifestations are relatively frequent during the course of hemolytic uremic syndrome (HUS), some of them requiring special supportive care. This work was aimed at retrospectively studing gastrointestinal manifestations of HUS and determining their place in the prognosis.

PATIENTS

Thirty-seven children aged 4 months to 11 years (22 girls and 15 boys) were included in the study.

RESULTS

All children but one had gastrointestinal prodromes. During the course of HUS, various manifestations were seen: bloody diarrhea in 32% of patients, ileo-ileal intussusception in 3%, rectal prolapse in 8% and hepatic cytolysis in 38%. Seven patients with bloody diarrhea had a complicated course, lethal in one. Comparison between these seven children and the 30 others revealed some indicators of severe gut involvement: female sex, short duration of gastrointestinal prodromes, hemorrhagic colitis with rectal prolapse, high WBC count, high neutrophils count and less important degree of anemia at admission. Severity of the gastrointestinal lesions was correlated with that of the outcome of the renal disease.

CONCLUSION

Gastrointestinal tract is frequently affected in HUS and severe complications can appear, potentially leading to death. Total parenteral nutrition could prevent occurrence of gastrointestinal complications. Severe gastrointestinal lesions are associated with a poor renal outcome.

Neuropsychological aspects of Marfan syndrome

We evaluated the neuropsychological status of 13 adults patients with Marfan syndrome. All subjects were administered the same neuropsychological test battery that included nine measures covering a broad range of cognitive abilities such as attention and concentration, learning and memory, and verbal and non-verbal abilities. Compared to a control group of 13 healthy subjects matched for sex, age and verbal intelligence, Marfan patients only performed significantly worse on tests measuring sustained visual attention and visuoconstruction. Although these tests use visual material and depend on visual perception and processing, the visual acuity problems associated with the syndrome could not explain these differences, nor could the use of beta-blocking medication or the presence of joint hypermobility. The findings suggest that problems with sustained visual attention and visuoconstruction may be present in Marfan syndrome over and above visual acuity problems and other phenomena associated with the disease. Further research on the neuropsychological aspects of Marfan syndrome is needed, using larger patient groups and more adequate control groups such as non-affected siblings and matched controls with similar visual impairment.

Azathioprine-induced pulmonary haemorrhage in a child after renal transplantation

We report a case of azathioprine-induced haemorrhagic alveolitis, in a 14-year-old boy, after renal transplantation. On day 25 the patient developed haemoptysis, fever and hypoxaemia. Chest X-ray showed diffuse reticulo-nodular shadows in both lung fields. Bronchoalveolar lavage samples were haemorrhagic and demonstrated a relative neutrophilia and a mild lymphocytosis, with a normal CD4/CD8 ratio. Azathioprine was discontinued on day 26. The patient required mechanical ventilation for 4 days. A positive leucocyte migration inhibition test and the recurrence of the symptoms after a second short course of azathioprine therapy suggested a cell-mediated mechanism. This patient is, to our knowledge, the first child to suffer from azathioprine-induced pulmonary haemorrhage.

[Transient correction of partial congenital factor V deficiency in nephrotic syndrome]

Plasma concentration of several hemostatic proteins may be modified during the acute phase of nephrotic syndrome. The case of such a syndrome in a patient with congenital factor V deficiency is presented. CASE REPORT--A 5 year-old girl with partial congenital factor V deficiency (level: 30%), was admitted for nephrotic syndrome complicating Henoch-Schönlein purpura. Urine protein excretion was 4 g/24 h. Initial plasma concentrations were: protein: 5.5 g/dl; albumin: 3.3 g/dl; factor II: 85%; factor V: 56%; factors VII + X: 80%. The patient was given methylprednisolone (1 g/1.73 m2) followed by prednisone (2 mg/kg/day). Under this treatment, the plasma concentrations were: protein: 4.5 g/dl; albumin: 2.0 g/dl; factor II: 180%; factor V: 84%; factors VII + X: 120%. Values at the onset of remission were: albumin: 3.4 g/dl; factor V: 49%. CONCLUSION--This observation suggests that hypoalbuminemia may enhance liver synthesis of factor V as known for some other coagulation factors, and transiently correct the hereditary deficiency.

Intrauterine growth retardation leads to a permanent nephron deficit in the rat

Intrauterine growth retardation (IUGR) was induced in Sprague-Dawley rats by partial artery ligation of one uterine horn in the mother on day 17 of gestation or by feeding the mother a 5% protein diet from day 8 of gestation. The controls were pups of the contralateral uterine horn or pups born to mothers fed a normal (22%) protein diet. The number of nephrons present at birth and the final number of nephrons in 2-week-old rats were counted throughout the entire kidney. The number of nephrons present at birth and the final number of nephrons were significantly correlated with birth weight for growth-retarded rats of both groups and their corresponding controls (P < 0.02 for the poorest correlation). Clearance experiments and morphometric studies of 2-week-old rats born to mothers with uterine artery ligation indicated that, despite a large compensatory hypertrophy of the nephrons in those animals born with a nephron deficit of about 30%, the overall renal function was impaired. We conclude that IUGR is accompanied by a nephron deficit which may not be fully compensated for within the first weeks after birth.

[Acute urine retention: a rare mode of revelation of cervico-dorsal syringomyelia caused by cyproheptadine]

BACKGROUND

Syringomyelia is rare in children aged less than 10 years, and bladder dysfunction is an unlikely first manifestation. This report describes a case of repeated episodes of acute urinary retention in a young girl revealing syringomyelia and Arnold-Chiari malformation.

CASE REPORT

A 2.5 year-old girl was admitted because she was suffering from acute urinary retention. Her poor appetite had been treated with cyproheptadine, a histamine type I blocking drug. Clinical investigation revealed no local cause for this bladder dysfunction except moderate spasticity of the legs. Cystography showed no vesicoureteral reflux. Because the episodes of urinary retention recurred each day, magnetic resonance imaging (MRI) was performed; this showed the typical features of syringomyelia extending from C5 to T11 plus Arnold-Chiari malformation. The cyproheptadine was discontinued and the urinary retention disappeared.

CONCLUSION

Cyproheptadine may have revealed latent neurogenic bladder in this case, although urodynamic studies, performed 3 months later, detected no bladder dysfunction.

[Treatment of urinary infection in children]

Urinary tract infection in children includes several and totally different diseases which must be managed according to circumstances. In all cases of acute pyelonephritis the patients must be investigated for abnormalities of urinary tract structures. A strong and prolonged treatment reduces the risk of scars. Lower urinary tract infection without potential deleterious effects on the renal parenchyma requires an oral antimicrobial therapy of not more than 7 days duration. Asymptomatic infection with normal urinary tract structures does not need an antimicrobial treatment. Long-term prophylactic antimicrobial treatment administered in full doses produces bacterial selection. Very low doses are sufficient to reduce the virulence of the pathogen and the risk of infection, without altering the gastrointestinal flora.

[A rare cause of bone pain in children: primary hyperparathyroidism caused by adenoma]

BACKGROUND

Primary hyperparathyroidism is rare in children and adolescents. Bone changes may produce pain in the back or extremities, but this is rarely the first symptom of the disease.

CASE REPORT

A 13 year-old girl suffered from pain in the back and lower extremities. Progressive bilateral genu valgum appeared. One year later, she became lame because of the deformity. ECG showed cardiac arrhythmia with atrial extra systoles. The serum calcium concentrations were 3.36 and 3.8 mmol/l, phosphate 0.76 mmol/l and alkaline phosphatases 6,612 U/I (N: 90-300). Urinary excretion of calcium was 17 and 26 mg/kg/day and the renal tubular reabsorption of phosphate was 77%. Radiological studies revealed resorption of subperiosteal bone, best seen along the margins of the phalanges, demineralization of the skull vault, bilateral coxa vara and zones of calcification on knee metaphyses. The serum concentration of parathyroid hormone (PTH) was 1,066 pg/ml (N: 10-55) and that of 1-25(OH)2D3 was 125 ng/ml (N: 20-80). Ultrasonography showed a heterogeneous mass, 23 x 15 mm, suggesting a parathyroid adenoma. This adenoma was independent of the left inferior parathyroid. It was removed and the biochemical findings gradually returned to normal. Bone demineralization also disappeared and the knee deformities were surgically corrected 9 months later.

CONCLUSIONS

Bone changes may occasionally cause severe pain, indicating demineralization and hypercalcemia: hyperparathyroidism is one cause of such changes.

[Effect of the treatment with human recombinant erythropoietin on anemia in children with end-stage kidney failure. French multicenter study]

BACKGROUND

The production of recombinant erythropoietin, has made large quantities of pure protein available for clinical studies. Published reports have concentrated on patients with end-stage renal disease, who develop transfusion-dependent anemia.

MATERIAL AND METHODS

A total of 58 children aged less than 18 years (mean age: 11.48 +/- 4.62 years) with end-stage renal disease (hereditary in 9, congenital in 21 and acquired in 28) treated between July 1987 and February 1990, were included in the study. The mean duration of dialysis (hemodialysis in 56, peritoneal dialysis in 2) at the onset of the study was 35 +/- 28 months. 3 children had undergone bilateral nephrectomy, and 2 were infected with HIV. 54 children were given a phosphate-binder, 10 were given iron and 20 were given folic acid supplements. During the 6 months preceding the study, 51 patients received at least one blood transfusion (40 received 1 to 4 and 11 received 5 to 9 transfusions of packed red blood cells). Recombinant human erythropoietin (rHu EPO) (40 units/kg) was given intravenously three times per week for at least 6 weeks, with the exception of the first 9 patients who were given 80-100 units/kg. When the hematocrit increased less than 0.5% per week (or 3% for 6 weeks), the dose of rHu EPO was increased in stages, without exceeding 200 units/kg/injection. When the hematocrit reached 30 to 35%, the dose of rHu EPO was decreased by half, then gradually adjusted to maintain the hematocrit within this range.

RESULTS

The mean value of reticulocytosis increased from 4.88 to 10.58% and the hematocrit increased from 19.34 to 29.95% during the study. The patients also reported that their appetites and general condition improved. The need for transfusion dramatically decreased after the first month of treatment. The main adverse effect of the rHu EPO administration was an increase in the number of patients with hypertension (31/45 versus 19/45), indicating the need for good control of blood pressure before treatment.

CONCLUSION

Erythropoietin treatment increases packed blood volume in a dose-dependent fashion. Most patients need no further transfusion and the quality of life clearly improves.