School age outcome of hospitalisation with respiratory syncytial virus infection of prematurely born infants

BACKGROUND

Hospitalisation due to respiratory syncytial virus (RSV) infection in the first 2 years after birth has been associated with increased healthcare utilisation and associated costs up to 5 years of age in children born prematurely at less than 32 weeks of gestation who developed bronchopulmonary dysplasia (BPD). A study was undertaken to determine whether hospitalisation due to RSV infection in the first 2 years was associated with increased morbidity and lung function abnormalities in such children at school age, and if any effects were influenced by age.

METHODS

Healthcare utilisation and cost of care in years 5-7 were reviewed in 147 children and changes in healthcare utilisation between 0 and 8 years were assessed also using results from two previous studies. At age 8-10 years, 77 children had their lung function assessed and bronchial hyper-responsiveness determined.

RESULTS

Children hospitalised with RSV infection (n = 25) in the first 2 years had a greater cost of care related to outpatient attendance than those with a non-respiratory or no admission (n = 72) when aged 5-7 years (p = 0.008). At 8-10 years of age, children hospitalised with RSV infection (n = 14) had lower forced expiratory volume in 0.75 s (FEV(0.75)) (p = 0.015), FEV(0.75)/forced vital capacity (p = 0.027) and flows at 50% (p = 0.034) and 75% (p = 0.006) of vital capacity than children hospitalised for non-RSV causes (n = 63). Healthcare utilisation decreased with increasing age regardless of RSV hospitalisation status.

CONCLUSIONS

In prematurely born children who had BPD, hospitalisation due to RSV infection in the first 2 years is associated with reduced airway calibre at school age.

Comparison of once- and twice-daily clarithromycin in the treatment of adults with severe acute lower respiratory tract infections

BACKGROUND

Although the modified-release (MR) formulation of clarithromycin has demonstrated bioequivalence to the immediate-release (IR) formulation and thus can be prescribed for lower respiratory tract infections (LRTIs), a MEDLINE search from 1995 through 1998 and information on file with the manufacturer indicate that no data are available on the effectiveness of this new formulation in the treatment of severe LRTIs such as community-acquired pneumonia.

OBJECTIVE

This study was designed to compare clinical success rates (percentage of patients with clinical cure or improvement) with once- and twice-daily regimens of clarithromycin in the treatment of patients with severe, acute LRTIs requiring oral antibiotic therapy.

METHODS

In this multicenter, investigator-blinded, randomized, parallel-group study, adult patients with clinical evidence suggesting severe, acute LRTI were recruited from 22 general practices in the United Kingdom. Patients were randomly allocated to receive either clarithromycin 500 mg BID (IR tablets) or clarithromycin 1 g OD (two 500-mg MR tablets) for 7 to 14 days. The outcome measures were resolution of or improvement in clinical signs and symptoms (including resolution of cough), unscheduled visits for the same symptom, days to resumption of normal activities, and improvements in quality of life (assessed using the EQ-5D version of the EuroQoL questionnaire). Clinical, microbiologic, and serologic assessments were performed before, during, and after treatment. Efficacy and safety data were analyzed on an intent-to-treat basis.

RESULTS

One hundred sixty men (n = 83) and women (n = 77) between the ages of 19 and 88 years took part in the study, 78 receiving clarithromycin 500 mg BID and 82 receiving clarithromycin 1 g OD. At 4 weeks after the start of treatment, the high clinical success rates were comparable between groups: 84.6% with clarithromycin 500 mg BID and 90.2% with clarithromycin 1 g OD. No significant differences in outcome measures were noted between the 2 regimens. Both treatments were well tolerated, with taste disturbance being the most commonly reported adverse event (10.6% vs 6.1% with clarithromycin 500 mg BID and 1 g OD, respectively).

CONCLUSIONS

The 2 clarithromycin regimens were equally efficacious and well tolerated in the treatment of severe, acute LRTIs. However, caution should be exercised in applying these results to the general population, because the study excluded certain categories of patients who would normally be treated. In addition, the small sample size may have obscured clinically significant differences between the 2 regimens.

Prevention of atmospheric contamination during isoflurane sedation

With a view to minimising staff exposure to exhaled isoflurane which had been used for sedation, we assessed the efficacy of either activated charcoal adsorption or active or passive mechanical scavenging systems in intensive care units (ICUs). Personal monitoring revealed minimal exposure of staff to the sedating agent. Infra-red analyses of ambient air rarely showed isoflurane levels greater than 26 ppm, with mean concentrations of around 1 ppm. Small spillages during vaporiser filling were of no polluting significance. The activated charcoal adsorbers functioned highly efficiently for at least 12-hour periods. With simple scavenging techniques, atmospheric isoflurane contamination during sedation with the agent remains well within an acceptable range and is unlikely to pose a health risk to nursing and medical staff.

A multicentre, hospital study of the efficacy and safety of terazosin and its effects on the plasma cholesterol levels of patients with untreated essential hypertension

The safety, efficacy and the effect on the plasma total cholesterol of once-daily terazosin hydrochloride administered as monotherapy was evaluated in 69 patients with mild-moderate untreated essential hypertension in this open, hospital, multi-centre, 3 month study. Patients initially received 1 mg of terazosin followed by dose titration, if necessary, to a maximum of 10 mg over the first six weeks depending upon blood pressure control. Patients then continued treatment for a further six weeks on their optimum dosage. At the end of 12 weeks' treatment, there were highly significant mean reductions in systolic and diastolic blood pressures of 14.5 and 12.9 mmHg (P less than 0.001), respectively, as well as a significant reduction in the mean total cholesterol of -0.56 mmol/l (-9.5%, P less than 0.01). No serious toxicity or safety problems were observed. Once daily administration of terazosin proved to be safe and effective in reducing the blood pressure of patients with mild-moderate essential hypertension and favourably reduced the total plasma cholesterol level.