Drugs online research references
Clin Pharmacol Ther. 1998 Nov;64(5):569-74.
Antiulcer drug prescribing in hospital successfully influenced by "immediate concurrent feedback".
Kumana CR, Ching TY, Cheung E, Kong Y, Kou M, Chan CK, Chu KM, Seto WH, Lam SK.
Department of Medicine, University of Hong Kong, Hong Kong.
OBJECTIVE: To determine whether immediate concurrent feedback (ICF) focused on inpatient omeprazole prescribing achieved more rational and cost-effective antiulcer drug prescribing and usage. METHODS: In a 1400-bed teaching hospital, an audit (by specially trained personnel) was conducted to monitor inpatient prescribing of omeprazole (1) in preference to H2-antagonists and other drugs according to agreed criteria (Helicobacter pylori eradication, severe reflux esophagitis, rapid ulcer healing deemed urgent because of severe symptoms or complications, high-dose steroid therapy of > or =30 mg/day prednisolone) and (2) appropriateness of intravenous dosing (oral route not feasible or contraindicated). After baseline monitoring for 1 month, followed by relevant antiulcer drug therapy education, ICF was instituted for 1 year. This entailed explanatory memoranda requesting a change in prescribing issued to the respective medical teams of patients whose omeprazole prescription did not "conform." The main outcomes of the study were omeprazole prescription numbers per month and the proportion conforming, defined daily doses of antiulcer drugs used and corresponding expenditures, and pertinent antiulcer drug utilization data from 9 other local hospitals. RESULTS: Baseline omeprazole prescribing conformed in 32 of 173 (18%) of the patients compared with 451 of 546 (83%) during institution of ICF (P < 0001; chi2 test). Correspondingly, average overall omeprazole and ranitidine usage (inpatient and outpatient) and expenditure decreased (44% and 45%, respectively); collectively, use of less expensive alternatives increased about 61%. Estimated savings averaged about HK$150,000 ($20,000) per month. No comparable changes in usage were noted in 9 other local hospitals. CONCLUSION: Regarding hospital antiulcer drugs, this ICF strategy was associated with more rational prescribing and usage, and an important saving of resources.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9834050&dopt=Abstract
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J Clin Gastroenterol. 1998;27 Suppl 1:S183-6.
Gastric urease activity is inversely associated with the success of treatment for Helicobacter pylori: effect of sofalcone.
Suzuki M, Kitahora T, Nagahashi S, Suzuki H, Mori M, Hibi T, Ishii H.
Division of Gastroenterology, National Tokyo Medical Center and National Ookura Hospital, Japan.
Eradication therapy for Helicobacter pylori (H. pylori) has been established. However, the physiological factors influencing the success of treatment remain unclear. The aim of this study was to analyze these factors and to evaluate the efficacy of sofalcone on H. pylori eradication therapy. Forty-four H. pylori-infected and peptic ulcer patients were enrolled in this study. Twenty-seven patients were treated with lansoprazole (LPZ, 30 mg o.d. for 1-8 weeks) and amoxicillin (AMPC, 500 mg q.i.d, 1-2 weeks), followed by 8 weeks of treatment with famotidine (FAM, 20 mg o.d.). Moreover, sofalcone (SOF, 100 mg t.i.d) was administered to 17 patients throughout the therapeutic period. Endoscopic and serologic evaluations and the urea breath test (UBT) were performed before therapy. At the endoscopic examination, mucosal samples were biopsied and then tissue myeloperoxidase (MPO) content, an index of neutrophil infiltration was measured. Cure of H. pylori infection was determined 8 weeks after the cessation of LPZ. This eradication regimen afforded an overall cure rate of 63.0% (17/27) without SOF and 76.5% (13/17) with SOF. In the control group, treatment success was inversely associated with pre-UBT value (gastric urease activity), whereas this association was not observed in the SOF group. Furthermore, in the patients exhibiting a high preUBT value (>40%), a twofold higher eradication rate was obtained by the administration of SOF. In patients who were successfully eradicated, mucosal MPO level was slightly higher than those of unsuccessful cases, whereas there was no significant association with serum pepsinogen (PG I, PG II) concentration and its ratio (PG I/PG II). These results suggest that a low UBT value is a factor predicting treatment success. SOF administration may improve the eradication rate, especially in the high-UBT subgroup.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9872519&dopt=Abstract
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J Clin Gastroenterol. 1988;10 Suppl 1:S114-9.
Gastric mucosal blood flow and mucosal protection.
Holm L.
Department of Physiology and Medical Biophysics, Uppsala University, Sweden.
Prostaglandins (PGs) and omeprazole, both applied intraluminally, have been shown to induce mucosal protion, independently of their inhibitory effects on acid secretion. To investigate the influence of these groups of agents on the gastric mucosal microcirculation, quantitative intravital microscopy of the rat gastric mucosal microcirculation was performed. Single vessel blood flow, calculated from red blood cell velocity and diameter measurements, increased when PGE1, PGE2, 16,16-dimethyl-PGE2, or omeprazole were applied intraluminally. These results suggest that the increase in blood flow may, at least in part, be the reason for the protective action of these substances. A considerably reduced blood flow, such as occurs during hemorrhagic shock, is known to induce gastric bleeding, and also to induce neutrophil adherence to the endothelial wall. Neutrophil antiserum was used to determine whether neutropenia offered protection against hemorrhagic shock-induced gastric bleeding in anesthetized rats. Depletion of neutrophils resulted in higher blood flow during the ischemic period and also attenuated reperfusion-induced gastric damage. Maintenance of blood flow at the same level in untreated rats resulted in a similar reduction of mucosal damage. Thus, the major mechanism by which neutrophils appeared to increase damage in this model of gastric mucosal injury was by increasing microvascular resistance, thereby presumably intensifying tissue hypoxia. This paper is a summary review of previous studies.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3183335&dopt=Abstract
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