[Diuretic and antihypertensive activity of azosemide]

The results of a study conducted using a new loop diuretic, Azosemide, on a group of 45 patients suffering from hypertension and oedema are reported. Thirty patients were studied in an open trial and in association with other drugs. The remaining 15 exclusively hypertensive patients, were studied in a controlled trial against Indapamide. The patient's standing and recumbent arterial pressure was monitored and all were given periodic weight checks. In the 1st group, Azosemide brought about a significant reduction in arterial pressure, without modifying body weight, but caused considerable weight loss (from 71 to 64 kg) (P less than 0,01) in the oedema patients without altering arterial pressure. In the 2nd group of hypertensive patients, a significant fall in arterial pressure (from 166 to 138 mmHg) was observed, most notably after Azosemide treatment. None of the patients revealed side effects, or alterations in laboratory parameters. It is therefore suggested that Azosemide--given its effectiveness and ease of application--is particularly useful for the diuretic treatment of hypertensive and oedematous patients.

Efficacy and safety of clorsulon used concurrently with ivermectin for control of Fasciola hepatica in Florida beef cattle

The safety and anthelmintic efficacy of clorsulon (7 mg/kg of body weight, orally) given concurrently with ivermectin (0.2 mg/kg, subcutaneously) for control of Fasciola hepatica were evaluated in 75 crossbred beef cattle. Twenty-three control animals were given only ivermectin. Fluke egg counts were significantly lower (P less than 0.0001) in clorsulon-treated animals by day 14 after treatment than before treatment (base line) and were significantly lower (P less than 0.005) after treatment in clorsulon-treated animals than in controls. There was no significant change in fluke egg counts of controls after treatment. The efficacy of clorsulon in reducing F hepatica egg counts was 99%. Clorsulon showed poor efficacy against paramphistomes. Adverse reactions were not observed.

Prophylactic efficacy of clorsulon against Fasciola hepatica in calves and sheep

A daily oral 5 mg kg-1 dose of clorsulon for 28 days in calves given Fasciola hepatica cysts at 3, 5, and 7 days after initiation of treatment was highly effective in reducing worm burdens (98%) and preventing liver pathology. In similarly infected and treated sheep, clorsulon showed little effect as a prophylactic for delaying the onset of liver pathology. The size of flukes recovered from treated sheep was reduced. Although clorsulon prevented development of fascioliasis in treated calves, the host antibody response was qualitatively similar to that of untreated infected calves, but the magnitude of the response was reduced. Blood clorsulon levels in calves rose to 2.90 micrograms ml-1 within the first week of treatment then fluctuated between 2.65 and 2.90 micrograms ml-1 for the next two weeks. Clorsulon levels in sheep were 0.50-0.60 micrograms ml-1 lower than those in calf blood. The difference in bioavailability of clorsulon between sheep and calves may have contributed to differences in efficacy of the drug.

Which component of sulphasalazine is active in rheumatoid arthritis?

Sulphasalazine is known to be effective as a second line agent in the treatment of rheumatoid arthritis. The two chemical constituents of sulphasalazine (sulphapyridine and 5-aminosalicylic acid) were assessed separately in the treatment of rheumatoid arthritis. Over 24 weeks sulphapyridine showed a pronounced second line effect comparable with sulphasalazine and with a similar toxicity profile, whereas 5-aminosalicylic acid showed only a weak first line effect. Thus sulphapyridine appears to be the active moiety responsible for the second line effect of sulphasalazine in rheumatoid arthritis. The efficacy of the antibacterial component of sulphasalazine yet again permits speculation about the role of a bacterial pathogen in the aetiopathogenesis of rheumatoid disease.

Aspects of pharmacology in the neonatal foal

Other therapeutic agents used in foals for specific diseases are discussed elsewhere. The marked effect of species, age, and degree of maturity on drug metabolism in the neonate reinforces the danger of interspecies extrapolation of pharmacology, the need for information specific for the foal, and the necessity for monitoring drug levels in the individual. Suggested antimicrobial doses are listed in Tables 3, 4, and 6. Recommended doses of anticonvulsants and sedatives are listed in Table 8 and in the article "Intensive Care of the Neonatal Foal." The following are recommendations for drug therapy in the neonate: Avoid unnecessary administration of drug to the dam at parturition because of possible placental transfer of the drug with subsequent effects on the neonate. If possible, avoid unnecessary drug therapy in foals under 30 days of age. Select a drug that undergoes minimal biotransformation (hepatic metabolism) and is not highly protein bound. Owing to probable immunodeficiency in the neonate, broad-spectrum, bactericidal drugs are preferred for treatment of life-threatening infections. Every attempt should be made to identify the etiologic agent so that drug therapy can be based on cultures and sensitivity test results to maximize the benefit-risk ratio. Parenteral (intramuscular or intravenous) drug administration is preferable to oral. Avoid drugs that are known oxidants, which may produce hemolysis or methemoglobinemia. In general, the same or a slightly higher initial dose should be employed in the neonate, but it should be given less frequently than in the adult if it has a high potential to cause toxicity. When possible, individual monitoring of serum levels of potentially toxic drugs should be employed in premature and newborn foals unless specific drug pharmacokinetics are known for that age group.

The course of chronic bullous disease of childhood

We followed three children who met the clinical, histologic, and immunologic criteria for chronic bullous disease of childhood (linear IgA dermatosis). All patients were able to discontinue therapy after two months to two years. Two have continued to experience transient mild episodes of blistering that have not required reinstitution of systemic therapy. In our opinion, children with this condition have a benign course with disease-free remissions and can be expected to discontinue all therapy eventually.

Falciparum malaria treated with a fixed combination of mefloquine, sulfadoxine and pyrimethamine: a field study in adults in Burma

In a field study conducted in Burma, 54 semi-immune adults suffering from falciparum malaria (mean parasite count, 15 328/mm(3) before treatment) were given a single dose of a fixed combination of 750 mg mefloquine base, 1500 mg sulfadoxine, and 75 mg pyrimethamine (3 tablets of Fansimef). All these patients were cleared of asexual parasites by day 7, giving a cure rate of 100%; the mean clearance time was 2.6 days. Reappearance of parasitaemia occurred in 10 patients on or before day 7 and persisted for one day in 8 of them and for two days in 2 patients. It eventually disappeared without further treatment. No recrudescence occurred during the follow-up time of four weeks despite the fact that there was active transmission of Plasmodium falciparum in the area throughout the whole of the study period. The drug was generally well tolerated, though mild to moderate giddiness was reported by 49 patients (90.7%) and severe giddiness by 3 patients (5.5%). Nausea occurred in 25 patients (46.3%) and vomiting in 17 (31.5%).

Effect of a new sulfa-trimethoprim combination (trimethoprim-sulfamethopyrazine) in typhoid fever. A double-blind study on 72 adult patients

A double-blind study on 72 adult patients affected by typhoid fever was done utilizing a new sulfa-trimethoprim combination (trimethoprim-sulfamethopyrazine) versus the well-known combination trimethoprim-sulfamethoxazole. The dosage used for the new drug was 2 capsules (250 mg trimethoprim + 200 mg sulfamethopyrazine per capsule) the 1st day and 1 capsule for the following 14 days or 2 capsules (trimethoprim 80 mg + sulfamethoxazole 400 mg per capsule) twice daily for 15 days. Both drugs proved to be very effective according to the parameters considered. No complications (intestinal bleeding, perforation, etc.) occurred in any of the patients, and untoward effects were not observed. It is therefore our opinion that treatment of typhoid fever with a sulfa-trimethoprim combination is both effective and safe.

A phase I clinical trial of Fansimef (mefloquine plus sulfadoxine-pyrimethamine) in Brazilian male subjects

A double-blind, randomized phase I clinical trial was carried out to compare Fansimef (a fixed-dose combination of mefloquine, sulfadoxine, and pyrimethamine) with sulfadoxine and pyrimethamine (Fansidar) for safety and tolerance. Twenty adult male Brazilian subjects from malaria endemic areas were studied for a period of 66 days, which included 2 days before and 63 days after drug administration.Both drugs were well tolerated and safe, as seen from the absence of drug-induced changes in the various laboratory, haematological, and biochemical parameters measured. Fansimef produced a complete clearance of parasites on day 3, with an "S" type response in one subject who had blood smears which were positive for Plasmodium falciparum on day 0. Two subjects in the sufladoxine-pyrimethamine group also had P. falciparum infections on day 0; the parasitaemia was cleared on day 2 in one of these subjects and on day 3 in the other, but an early RI response (recrudescence) was observed in the former case. Relapses due to P. vivax occurred in both groups.Side-effects due to Fansimef included mild dizziness, nausea, and vomiting. The incidence of dizziness and nausea was similar in the sulfadoxine-pyrimethamine group. In both groups, these side-effects were mild, short-lived and did not require specific treatment. Thus, Fansimef in an oral dose of three tablets (total of 750 mg mefloquine (base) plus 1500 mg sulfadoxine plus 75 mg pyrimethamine) was found to be well tolerated and safe.

In vivo assessment of the sensitivity of Plasmodium falciparum to sulphadoxine/pyrimethamine combination (Fansidar) in six localities in Tanzania where chloroquine-resistant P. falciparum has been detected

The sensitivity of Plasmodium falciparum strains to Fansidar (500 mg sulphadoxine/25 mg pyrimethamine) was tested in vivo in six localities in the United Republic of Tanzania where chloroquine-resistant P. falciparum strains have been demonstrated by both in vivo and in vitro tests. Single doses as recommended by the manufacturers achieved 100% clearance of parasitaemia in five localities with mean clearance period of between 2.2 and 2.9 days. In one locality (Gonja) the recommended dose failed to clear parasitaemia in two of the 38 cases (5.3%) within seven days. The possibility of using this drug combination for the treatment of chloroquine-resistant P. falciparum strains in the United Republic of Tanzania is discussed.

An open, randomized, phase III clinical trial of mefloquine and of quinine plus sulfadoxine-pyrimethamine in the treatment of symptomatic falciparum malaria in Brazil

The clinical and parasitological response of adult male patients to mefloquine and to a combination of quinine and sulfadoxine-pyrimethamine during the treatment of falciparum malaria was compared. These patients were from an area in Brazil where Plasmodium falciparum is showing increasing resistance to quinine and to sulfadoxine-pyrimethamine. The drugs were administered to 100 patients (50 in each group), based on a randomized study design.The rates of clearance of parasitaemia and fever were similar in both groups. However, the parasitological cure rate ("S" response) was 100% for mefloquine but only 92% for quinine plus sulfadoxine-pyrimethamine. Tolerance was good in both groups. The main side-effects (nausea, vomiting, abdominal pain, and dizziness) were mild, transient and required no specific treatment. Nausea and vomiting were more frequent in patients who received quinine plus sulfadoxine-pyrimethamine, while abdominal pain and loose stools or mild diarrhoea were more frequent in the mefloquine group. Tinnitus and hearing difficulty were observed following the administration of quinine plus sulfadoxine-pyrimethamine, but not after mefloquine treatment. Laboratory tests of various haematological and biochemical parameters were not adversely affected in either group after drug administration.It can be concluded that mefloquine, given in a single oral dose of 1000 mg, is highly effective, well tolerated, and safe for the treatment of falciparum malaria in adult males in Brazil.

Efficacy of oral clorsulon in the treatment of Fasciola hepatica infections in calves

Twenty calves at each of 2 Arkansas locations were inoculated with infective Fasciola hepatica metacercariae. After 56 days, the calves at each site were randomly assigned by weight to 2 treatment groups of 10 calves/group; vehicle control or clorsulon at the rate of 7 mg/kg of body weight. All treatments were given orally as a suspension. Calves were killed 6 weeks after treatment and F hepatica counts were performed for all animals. At the 2 sites, mean levels of efficacy were 96% and 91%. Adverse reactions to clorsulon or the vehicle were not observed in the calves.

[Polyresistant Enterobacteriaceae strains and their plasmids in a hospital. Medical and theoretical aspects]

The properties and origin of multiple resistant strains of Enterobacteriaceae found in the intestine and nasopharynx of infants admitted to the hospital for premature infants were studied. The strains of E. coli of different serovars isolated at various periods contained similar conjugative R plasmids with a molecular weight of 80 Md belonging to the O incompatibility group controlling resistance to kanamycin and physically independent small plasmids controlling resistance to ampicillin (7 Md) and streptomycin-sulfanilamides (4 Md). Multiple drug resistance in the strains of K. pneumoniae was controlled by single large (100-120 Md) plasmid cointegrates with 6-8 resistance markers. Such cointegrates consisted of several potentially independent plasmids, sometimes dividing on transformation of plasmid DNA of the recipient strains of E. coli K12. The small plasmids controlling resistance to ampicillin and streptomycin-sulfanilamides similar to the respective plasmids of E. coli were the constant components of the plasmids cointegrates. The multiple drug resistance in the above strains was combined with high capacity for colonization in premature infants. The medical staff and mothers were the sources of bacterial strains with single plasmids controlling definite types of resistance. It is suggested that the multiple resistant strains of Enterobacteriaceae are formed in hospital as a result of accumulation of the plasmids or plasmid markers and selection. One of the conditions for successive acquisition of new plasmid markers by definite bacterial strains was their high capacity for colonization in patients, which provided constant contacts and genetic exchange of such strains with a wide range of immigrant strains during colonization in the newly admitted patients.

Tolerability of long-term prophylaxis with fansidar: a randomized double-blind study in Nigeria

A randomized double-blind study was performed to compare the side effects of long-term chemoprophylaxis of malaria with Fansidar (1 tablet a week) with those of a 300-mg weekly chloroquine regimen. This study was designed as a field trial with Austrian industrial workers in Nigeria and included 173 volunteers, 86 taking Fansidar and 87 taking chloroquine for 6 to 22 months. Only a few complaints were reported during that time, gastrointestinal disorders predominating in the Fansidar group and insomnia in the chloroquine group (3 cases each). The other complaints in both groups included one case each of skin rash and of visual disturbance, as well as one case of facial erythema after alcohol consumption in the Fansidar group and one of hair loss in the chloroquine group. Laboratory checks were performed at 3-monthly intervals, and included white and red cell counts, platelet counts and determination of GOT, GPT and alkaline phosphatase. There were no signs of drug-associated liver damage. In the Fansidar group there occurred a slight and transient decrease in the red cell count and in the chloroquine group a slight and transient decrease in the white cell count. Although statistically significant, these changes were without clinical significance. It is noteworthy that there were no cases of leucopenia in the Fansidar group. With the exception of one volunteer, who had discontinued his prophylactic drug regimen, malaria did not occur. Antibodies against blood stage parasites as determined by the indirect immunofluorescence test (IIFT), however, could be found at different stages of the study, which indicates that these two antimalarials are not causal prophylactic agents.

Efficacy of clorsulon for treatment of mature naturally acquired and 8-week-old experimentally induced Fasciola hepatica infections in cattle

In a dose-titration study against experimentally induced 8-week-old Fasciola hepatica infection (study A), 20 calves were allotted to 5 groups, each of 4 calves, and treated with different doses of an injectable formulation of clorsulon or its vehicle: group 1--controls, no drug; group 2--2 mg of clorsulon /kg; group 3--4 mg of drug/kg; group 4--8 mg/kg; and group 5--16 mg/kg. Mean numbers of flukes recovered from 4 calves in each treatment group were as follows: group 1--112.2, group 2--42, group 3--4.8, group 4--3.0, and group 5--0.2. Percentages of fluke reductions for groups 2, 3, 4, and 5 ( clorsulon -treated) calves were 62.6%, 95.7%, 97.3%, and 99.8%, respectively. Against naturally acquired mature (greater than 14-week-old) F hepatica infections (study B), a total of 161 flukes were recovered from 7 vehicle-treated control calves (group 6; mean fluke recovery = 23) and no flukes were recovered from 9 calves (group 7) given orally a formulation containing 7 mg of clorsulon /kg of body weight. Eggs were not found in the feces of clorsulon -treated calves at 20 to 21 days after treatment as compared with a mean of 7.4 eggs per gram (epg) in group 6 (control) calves. Mean bile egg recoveries were 13,532 (456 to 66,861) from group 6 calves as compared to recovery of a total of 162 (0 to 160) eggs from 3 of the 9 treated calves.(ABSTRACT TRUNCATED AT 250 WORDS)

[Chloroquine and pyrimethamine/sulfadoxine resistant malaria tropica in a child with diabetes mellitus]

A 16-year old girl with insulin-dependent diabetes mellitus (8 years' duration) developed tropic malaria 7 weeks after her return from Kenya despite a longtime prophylaxis using pyrimethamine and sulfadoxine (Fansidar). The disease was detected during an episode of ketoacidosis which proved exceptionally difficult to manage. Adequate chloroquine therapy resulted in temporary recovery. A recurrence of malaria four weeks later was successfully treated with quinine and doxycycline. Intraleucocytary parasites were found during both these episodes. Already prior to antimalarial drug therapy the girls' preexisting retinopathy was found to have deteriorated.

Clinical efficacy of sulfadoxine-pyrimethamine in the treatment of falciparum malaria in Sabah, Malaysia

One hundred and ten consecutive patients with falciparum malaria were treated with Fansidar and primaquine. Of the 61 patients who were followed up at one week, 4 (6.6%) failed to clear their parasitaemia (1 R III and 3 R II treatment failures). Of the subsequent 40 patients who were seen again at one month, another 3 (7.5%) had recrudesced (R I treatment failure). A total of 7 patients thus experienced some form of treatment failure in the cohort of 40 who completed the one month follow up. Only 1 of these 7 patients (with R III treatment failure) failed to respond to repeat Fansidar treatment, and may be the only one with true Fansidar resistance. The overall treatment failure rate of 17.5% (95% confidence interval: 6-29%) in the cohort who completed the study is consistent with the known clinical efficacy of Fansidar. These results suggest no significant Fansidar resistance in falciparum malaria found in Sabah.

[Congenital toxoplasmosis. Tolerability of the sulfadoxine-pyrimethamine combination. 24 cases]

The pyrimethamine-sulfadoxine combination, active against acute toxoplasmosis in the mouse, was administered to 24 children with congenital toxoplasmosis in doses of 500 mg sulfadoxine and 25 mg pyrimethamine per 20 kg bodyweight once every fortnight. The drug appeared to be as effective as other sulfonamide-pyrimethamine combinations. It was generally well tolerated and was withdrawn in only 3 patients on account of minor side-effects. Giving pyrimethamine-sulfadoxine together with folinic acid is a much simpler treatment of congenital toxoplasmosis than the usual ones.

Evaluation of a mixture of trimethoprim and sulphaquinoxaline for the treatment of poultry: safety and palatability studies

The safety of a 1:3 mixture of trimethoprim (TMP) and sulphaquinoxaline (SQX) for administration in food or water was assessed in broiler chickens, chicks of an egg laying strain and breeding fowl. The only effects recorded in six-week-old broilers medicated for seven days at levels ranging from 16 to 133 mg TMP plus SQX per kg bodyweight were decreases in water or food consumption, probably caused by unpalatability at overdosage levels, and associated decreases in weight gain and packed cell volume at an achieved overdose level of 4.4 times the recommended use concentration (RUC). Breeding fowl medicated at levels of 1 X or 3 X RUC for 14 days showed slightly reduced reproductive performance reflected by lowered egg production, egg weight and hatchability. These effects were temporary and performance equal to that of unmedicated birds was re-established by 14 days after medication ceased. Week-old chicks medicated for five days at levels from 0.7 to 4.7 X RUC showed normal growth rate over 12 days. Eleven-day-old chicks could not distinguish medicated from unmedicated water.

A multi-centre trial comparing a sulfamethopyrazine/trimethoprim combination with co-trimoxazole in respiratory tract infections

A double-blind, multi-centre trial was carried out in 72 patients with acute or chronic infections of the lower respiratory tract to compare the efficacy and tolerance of a sulfamethopyrazine (200 mg)/trimethoprim (250 mg) combination with that of the established combination co-trimoxazole (400 mg sulphamethoxazole plus 80 mg trimethoprim). Patients received treatment for 10 days either with 2 capsules of co-trimoxazole twice daily or in the newer combination group with 2 capsules on Day 1 but then only 1 capsule daily for the remainder of the treatment period. The results of clinical, bacteriological and functional tests showed an excellent or good response in over 90% of patients in each group. There was no statistically significant difference in effectiveness of treatment with the once-daily sulfamethopyrazine/trimethoprim regime compared with co-trimoxazole given twice daily, and both treatments were well tolerated, with only a few mild side-effects, mainly gastro-intestinal ones, being reported.

Evaluation of a mixture of trimethoprim and sulphaquinoxaline for the treatment of bacterial and coccidial diseases of poultry

Representative experiments from work undertaken to develop a synergistic mixture of trimethoprim and sulphaquinoxaline for the preventive treatment of certain poultry diseases are described. Sulphaquinoxaline in the diet for four days was shown to achieve at least an 85 per cent higher blood level than nine other sulphonamides in chicks, and the efficacies of various trimethoprim/sulphaquinoxaline regimes in the diet or in the drinking water were demonstrated against pasteurellosis, colisepticaemia and five kinds of coccidiosis. Regimes for bacterial diseases were begun one day before infection but those for coccidial diseases were begun on the same day as infection or later. Overall, a total dose of 30 mg/kg bodyweight/day (trimethoprim/sulphaquinoxaline = 1:3) controlled these seven diseases. The same treatment was also shown to control sulphaquinoxaline-resistant strains of Escherichia coli and Eimeria acervulina. Although both drinking water and food were used for drug administration, twice the inclusion rate was required in food to that in water for equivalent efficacy. The significance of different modes of expression of dosages for bacterial and coccidial diseases is explained.

Efficacy of a benzenedisulfonamide against experimental Fasciola hepatica infections in calves

The anthelmintic efficacy of a benzenedisulfonamide was evaluated by administering the drug parenterally at dosage levels of 2, 4, 8, and 16 mg/kg of body weight to crossbred Brahman calves with experimental Fasciola hepatica infections. In the 3-week period after treatment, fluke ova counts of treated calves were markedly reduced from counts obtained just before treatment. At necropsy, the mean fluke recovery for all 4 benzenedisulfonamide dosages were significantly (P less than 0.01) reduced. The efficacy of benzenedisulfonamide against F hepatica at dosage levels of 2, 4, 8, and 16 mg/kg was 97.5%, 99.5%, 100%, and 100%, respectively.

Fansidar resistant Plasmodium falciparum infection in Surinam

The first cases of Fansidar resistant Plasmodium falciparum infection in Surinam are reported after chloroquine-resistance was reported in 1972. The resistant cases were suspected by physicians and confirmed after performing the 35-day extended standard WHO 7-day in vivo-test. The distribution of drug resistant P. falciparum in Surinam is presented. The problem that drug resistance causes in the Malaria Eradication Program in Surinam is discussed.

Clinical assessment of a trimethoprim-sulfamethopyrazine combination (Kelfiprim) in lower respiratory tract infections

The new combination of trimethoprim 250 mg and sulfamethopyrazine 200 mg was used in fourteen out-patients and eighteen in-patients with acute exacerbation of chronic bronchitis, pneumonia or bronchopneumonia due to sensitive bacteria. The drug was given for 1 to 2 weeks as one capsule daily (following a double loading dose on the first day), and ampicillin, 500 mg capsules q.i.d., was administered to another group of eleven in-patients for comparison. Overall results, based on clinical, radiological and laboratory findings, were excellent or good in 85% and 67%, respectively, of out- and in-patients receiving the combination drug; definite failures were one out of fourteen and two out of eighteen cases, and the remainder were assessed as fair. In three out of thirty-two patients mild to moderate gastro-intestinal side-effects were observed during treatment. The drug compared favourably to ampicillin for both effectiveness and safety.

[Changes in fatty tissue sensitivity to insulin in the process of diabetes mellitus compensation using sulfanilurea derivatives]

During incubation of an isolated adipose tissue, obtained by surgical biopsy from the left inguinal region, it was shown that insulin in concentrations of 50 and 100 microU/ml does not stimulate glucose-14C inclusion into the tissue lipids in patients with decompensated diabetes mellitus in contrast to that of healthy humans. Insulin effect on the lipid synthesis is restored up to the normal level after diabetes mellitus compensation by means of sulfaniluria derivatives. It is concluded that an elevated tissue sensitivity to insulin plays an important role in the antidiabetic action of sulfanilurea derivatives.