Rational use of sulfonylureas.

The clinical use of sulfonylureas described in this article is both rational and effective for diabetic patients. Sulfonylureas are not used (1) in patients with insulin-dependent (type I) diabetes, because they are completely ineffective or (2) in patients with non-insulin-dependent (type II) diabetes who respond satisfactorily to diet, because they are unnecessary. In a patient with type II diabetes who has few or no symptoms but does not respond satisfactorily to diet, a sulfonylurea is introduced at a low dose, with gradual increases until a satisfactory response occurs, thus avoiding hypoglycemia. When symptoms of type II diabetes are marked, initiation of therapy with maximum doses of a sulfonylurea quickly distinguishes patients who need insulin therapy from those who have a good chance of responding to an oral drug. Abuse of sulfonylureas occurs when patients who could benefit from diet alone are treated with the drugs unnecessarily or, more often, when patients with poorly controlled disease continue to take maximum doses of the drugs. The usual situation is one in which the patient refuses insulin therapy or the physician does not suggest starting it. In other cases, the poorly controlled patient may be allowed to continue with a combination of a sulfonylurea and an ineffective dose of insulin. In this circumstance, the oral drug should be discontinued and insulin doses increased until control is more satisfactory. Because evidence is so compelling that near euglycemia has a beneficial effect on diabetic retinopathy, nephropathy, and neuropathy, physicians really do patients a disservice by misusing sulfonylureas.     

The use of antidepressants in school-age children.

Approximately 5% of the pediatric population suffers from depression. Children suffering from depression should be treated first with some type of psychotherapy, cognitive therapy, and/or education. Pharmacotherapy (medications) should be used only as a last resort for those children suffering from severe, chronic, or recurring depression. The only antidepressant approved by the U.S. Food and Drug Administration for the treatment of depression in children is fluoxetine (Prozac), a selective serotonin reuptake inhibitor. In the school setting, children should be monitored closely upon the initiation of antidepressant therapy and changes in dosing or medication. They also should be monitored for side effects of the medication, response to therapy, and new signs of depression or worsening symptoms. After starting an antidepressant, children must be monitored closely for any changes in behavior, especially increased preoccupation with suicide. Any changes should be reported to the physician immediately for follow-up.     

口服降糖药的合理使用

糖尿病（DM）是严重危害身体健康的全球性疾病,合理使用口服降糖药对于有效控制血糖、减少或延缓糖尿病并发症的发生、降低糖尿病患者的死亡率有重要意义。1降糖药物的分类及临床应用1.1磺酰脲类磺脲类药物作为治疗非胰岛素依赖型糖尿病（NIDDM）的口服降糖类药已有40多年的历史,     

Rational use of sedative/hypnotics

Among medications targeted at the central nervous system, sedative/hypnotics are the most widely prescribed. The use of sedative/hypnotics is reviewed in the context of historical influences on prescribing practice and from a current neuroscience perspective. Recommendations are made regarding appropriate applications for these drugs, and the principles for choosing one drug over another are emphasized.     

喹诺酮类抗菌药在泌尿生殖系感染中的应用

喹诺酮类(qunolones)抗菌药是指人工合成的含有4-喹酮母核的一类抗菌药物,因其抗菌谱广、抗菌作用强、生物利用度高、与其他类抗生素无交叉耐药性而广泛应用于临床.自 1962年美国 Sterling-Winthrop研究所 Lesher等发现第1个喹诺酮类抗菌药萘啶酸以来,许多学者致力于研究开发这类药物.于1973年合成了第二代喹诺酮类抗菌药吡哌酸等,1978年合成了第三代喹诺酮类抗菌药.第三代喹诺酮类抗菌药的共同特点是在化学结构萘啶环的7位上连有哌嗪环、6位处又引入了氟原子,故又称氟喹诺酮类(fluoroquinolones).此结构提高了抗菌活性、增宽了抗菌谱,同时成本低廉、不良反应小.第四代喹诺酮类抗菌药主要是近年来上市的莫西沙星和加替沙星等,是环丙沙星的8甲氧基衍生物.     

Rational use of antiepileptic drug levels.

Antiepileptic drug (AED) levels are obtained frequently in clinical practice, but their complex relation to seizures or drug toxicity often makes interpretation of the results difficult. Research studies have not always taken into account clinical, as well as pharmacokinetic and pharmacodynamic, factors which may influence the drug level-effect relationship. AED levels should be drawn at an appropriate time in relation to drug ingestion and clinical symptoms. Systematic investigations in selected patients, during which several levels are obtained, may be more rewarding than routine measurements in a large clinic population.     

糖皮质激素在病毒性肺炎的合理应用

病毒性肺炎主要表现为急性间质性肺炎,部分进展为急性呼吸窘迫综合征,常需应用糖皮质激素（激素）抑制炎症反应,改善病情;但合理应用激素的指征、时机,以及激素的类型、剂量、给药时间、疗程、疗效和负效应的评价皆无明确依据。本文主要基于生物学和生理学分析对激素在病毒性肺炎中的应用进行分析和总结。     

喹诺酮类抗菌药在外科感染中的应用

喹诺酮类药物在外科感染治疗中占有一定地位.在国际上得到认可的适用范围包括腹腔感染(腹膜炎,腹腔脓肿)、皮肤及软组织感染、某些骨-关节感染、ICU的严重感染等.     

喹诺酮类抗菌药在传染病中的应用

自第1个喹诺酮类药物--萘啶酸上市以来,喹诺酮类药物在临床应用已经有47年的历史,尤其是1979年第1个含氟喹诺酮类药物诺氟沙星诞生以来,具有广谱、高效、低毒的新氟喹诺酮类药物不断涌现,并被广泛应用于治疗各种感染性疾病.其中部分品种还能抑制结核分枝杆菌DNA旋转酶A亚单位,具有抗结核菌活性.由于临床应用日益广泛,细菌耐药性不断增加.本文就氟喹诺酮类药物在传染病治疗中的合理应用问题作一简述.     

Guidelines for the use of antidepressants in painful rheumatic conditions.

OBJECTIVES: Antidepressants are widely used to treat painful chronic rheumatic conditions but, contrary to neuropathic conditions, little is known about their true analgesic properties and value in these situations. Our group, which focuses on pain in rheumatology, aimed to develop recommendations for the use of antidepressants in rheumatology, based on evidence-based review of published data and expert opinion. METHOD: We identified relevant drugs and conditions and searched Medline, Embase and Pascal (1966-2003) for relevant publications in a number of European languages. We scored each study for quality, and used an expert consensus approach to formulate recommendations. RESULTS: We identified 77 studies and 12 meta-analyses and literature review on the use of antidepressant to treat painful rheumatological conditions. Forty-nine of these clinical studies were considered valid and were used to develop the recommendations. When evidence was lacking we based recommendations on our clinical experience. CONCLUSIONS: These recommendations for the treatment of painful rheumatological conditions with antidepressants were developed using evidence-based and expert consensus approaches and are the first of their kind in this field. Our review of the literature highlights the need for further, well-designed clinical studies of the use of antidepressants to treat painful rheumatological conditions.     

Rational use of sublingual opioids in palliative medicine

The sublingual administration of opioid analgesics has been a mainstay in the pain management of homebound dying hospice patients who are no longer able to swallow. It is also a potentially useful route of administration in other situations in which the oral route is not available and other routes are impractical or inappropriate. Potential advantages of the sublingual route include rapid analgesic onset and avoidance of hepatic first-pass metabolism. Pharmacokinetic and pharmacodynamic studies have yielded widely disparate data on sublingual morphine. Other opioids have been less studied. Available data suggests limited sublingual availability of hydrophilic opioids (e.g., morphine, oxycodone, and hydromorphone) and superior absorption of the lipophilic opioids (e.g., methadone and the fentanils). Buprenorphine, a potent, lipophilic, partial mu-opioid receptor agonist, appears promising but awaits further study.     

喹诺酮类抗菌药在呼吸系统感染中的合理应用

一、喹诺酮类药物使用现状与存在的问题 喹诺酮类药物问世已有40多年,早期人工合成的口服喹诺酮类药物受抗菌谱及药动学特点的限制,仅用于尿路感染和肠道感染的治疗.20世纪80年代初含氟喹诺酮类药物的发展,使该类药物的用途日益扩大[1].     

抗生素的合理使用与遏制细菌耐药性的发展

由病原微生物引起的感染仍然是人类健康的主要威胁。根据1998年世界卫生组织的统计资料,感染死亡人数占全部死亡人数的第二位。而在全球因感染死亡人数中,发展中国家几乎占到二分之一。 尽管抗生素的发展大大地降低了感染的发病率和病死率,但细菌耐药性的出现和蔓延却严重影响和破     

Rational use of antimicrobial agents and diagnostic microbiology facilities

During a two month period doctors' motives for prescribing antimicrobial chemotherapy were studied. Of the 1775 patients admitted, 374 (21%) received antimicrobial agents for 384 infective episodes. In 44 (11.5%) no infection could be subsequently proven. Of the remaining 340, drug selection was based on a susceptibility report in 120 (35%), on the advice of a medical microbiologist with the aid of a Gram stain in 66 (19%), and without this assistance in 51 (15%). In 103 (30%) episodes the clinician selected the agent without advice and laboratory tests. Infection was proven in 237 of 238 episodes in which therapy was started following a known susceptibility result or the advice of the microbiologist. Four (1.7%) of these later required a change of therapy, compared with 22 (21%) of the 103 courses started without such help (P less than 0.0005). This study has shown that the use of the laboratory and consultation with a medical microbiologist improves the rational prescribing of antimicrobial chemotherapy.     

血液透析患者血管通路的合理建立和使用

建立有效的血管通路是保证血液透析患者充分透析的基本条件。使用和护理好已有的血管通路 ,可以明显降低其相应的并发症 ,延长使用期限 ,同时也减少了患者的痛苦 ,降低了花费。Bresciah和Cimino在 196 6年首先将桡动脉与头静脉行皮下吻合 ,建立了动静脉内瘘 ,这种内瘘被称为标准内瘘[1] 。标准内瘘的创立为血液透析的发展作出了重要贡献。标准内瘘采取动脉与静脉侧侧吻合 ,吻合口大小可以选择 ,血流量丰富 ,不易形成血栓 ,也保持了血管的连续性 ,但容易导致窃血综合征引起手背静脉怒张 ,手指瘀血、肿胀 ,严重者可致溃烂、坏死 ;现在一般较…