Studies on the chemotherapy of human opisthorchiasis in Thailand: I. Clinical trial of praziquantel

Praziquantel (Embay 8440) was found to be effective in eliminating egg of Opishtorchis viverrini. from the stools of 49 patients. Two regimens were used: Group I patients received 25 mg/kg body weight three times daily after meals for two consecutive days: and Group II patients received 25 mg/kg body weight three times daily after meals for one day. In both groups eggs were not detected in the faeces by day 60 and up to 4-8 months post treatment. Mild transient side effects were present in approximately 80% of patients of Group I, with milder side effects reported in Group II. Severe diarrhoea was present on day 0 in one patient from each group. Side reactions included headache, dizziness, myalgia and lassitude, however, no laboratory evidence of toxicity was detected.     

Aspirin administered to women at 100 mg every other day produces less platelet inhibition than aspirin administered at 81 mg per day: implications for interpreting the women’s health study

Objective We aimed to determine the relative level of platelet inhibition achieved with low-dose aspirin (81 mg daily) compared with a very low-dose (100 mg every other day). Background The Womens Health Study (WHS) found that a dose of 100 mg every other day of aspirin provided protection against stroke as primary prophylaxis, but not myocardial infarction. In the United States, the most commonly prescribed dose of aspirin for primary prophylaxis is 81 mg per day. As a result, it is important to know whether these doses are equivalent before extrapolating the results of the WHS to women in the U.S. Methods To achieve this goal, we have studied the effects of these two dosing regimens on platelet function in healthy women meeting the WHS inclusion criteria using a randomized design. We enrolled 49 healthy female volunteers and used a sequential, crossover design to compare the two regimens. The participants received a 17-day course of each aspirin-dosing regimen separated by a 7-day washout period. The degree of platelet inhibition was measured on days 14–17 of each dosing regimen using a point-of-care platelet function assay utilizing arachidonic acid to activate platelets (VerifyNow-Aspirin). Results Participants platelet response, expressed as Aspirin Response Unit (ARU) attained a significantly greater level of platelet inhibition on days 14–17 while taking aspirin 81 mg daily compared to aspirin 100 mg every other day (31.3% vs. 12.7%, P < 0.0001) with mean ± SD ARU values of 445 ± 50 and 570 ± 68, P < 0.0001. Significantly more daily readings in participants were ≥550 ARU, a value correlated with clinical outcomes in several studies, with the 100 mg every other day regimen (72.0% vs. 6.4% with 81 mg daily, P < 0.0001), and this alternate-day regimen also resulted in more day-to-day variability in platelet function (P = 0.0002). Conclusion We found significantly less inhibition of platelet function with the dose used in the WHS than the usual U.S. dose. We observed that the degree of platelet inhibition was significantly less with aspirin 100 mg every other day compared with aspirin 81 mg daily, suggesting that results of the Women’s Health Study may have underestimated both the efficacy and toxicity of aspirin as it is commonly administered. These data need to be considered when developing recommendations about the use of aspirin in the primary prevention of cardiovascular disease in women. Accumetrics is the manufacturer of the VerifyNow System, the platelet function analyzer used in this study and the authors are employees of Accumetrics.     

The efficacy of the 1-day treatment of enterobiasis with medamine

The Soviet anthelminthic agent medamine has been synthesized at the Institute of Medical Parasitology and Tropical Medicine, USSR Ministry of Public Health and the Institute of Plant Chemistry, Academy of Sciences of the Uzbek SSR and is produced at the Tashkent Chemical Pharmaceutical Plant. It is used for one-day treatment of enterobiasis which is to be repeated in 2-3 weeks. A daily drug dose is 10 mg per kg body weight, given 3 times a day after meals. The efficacy of therapy was 92 +/- 4% and 100 +/- 2% after the first and second course of treatment, respectively.     

恩他卡朋双多巴治疗中晚期帕金森病疗效观察

目的观察对22例中晚期帕金森病(PD)患者采用恩他卡朋双多巴(LCE)治疗的效果。方法选择中晚期PD患者22例,先给予多巴丝肼片62.5 mg餐前1 h口服,3次/天,依据症状改善情况加量至125 mg餐前1 h口服,3次/天。待临床症状改善时,替换为LCE片口服,1片/次,2~3次/天,均在餐前1 h服用。分别于治疗前、治疗4周时,使用统一帕金森病评分(UPDRS)量表评价临床疗效及PD症状改善情况,用日常生活能力(ADL)量表评价PD患者的ADL,用PD生活质量问卷(PDQL-39)评价PD患者生活质量。结果22例中晚期PD患者治疗4周时的总有效率为100%(22/22)。治疗后UPDRS评分、ADL评分均低于治疗前(t分别为29.76、17.40,P均<0.01),治疗后PDQL-39评分高于治疗前(t=-12.06,P<0.01)。结论LCE可以显著改善PD中晚期患者的症状,提高ADL及生活质量。     

A Mother Speaks

Eosinophilic pneumonia was confirmed by bronchoalveolar lavage fluid examination and transbronchial lung biopsy. Aspergillus niger was cultured from the patient's pharyngeal swab and bronchoalveolar lavage fluid. Inhalation bronchoprovocation test with A. niger antigen was positive. Although the patient's condition improved promptly with 10 mg/day prednisolone administration, dry cough recurred approximately 2 months after completion of this therapy. Severe coughing disappeared on oral cleansing with 300 mg/day amphotericin B, and he recovered completely on 100 mg/day amphotericin B administration. Oral cleansing with amphotericin B may be efficacious in preventing relapses of eosinophilic pneumonia caused by allergic reaction to fungal antigen.     

Comparison of erythromycin ethylsuccinate and co-trimoxazole for treatment of pertussis

Summary Fifty-five ambulatory children with early culture-proven pertussis were treated for two weeks either with erythromycin ethylsuccinate (n=28) (50–80 mg/kg/day in three doses during meals) or with co-trimoxazole (n=27) (6–10 mg trimethoprim/kg/day in two doses after meals). After completion of treatment, all patients in the erythromycin group were culture-negative, while in the co-trimoxazole group one child was still culture-positive. In this case vomiting may have played a role. Both agents appear to be able to eradicateBordetella pertussis from the nasopharynx of patients with early whooping cough.

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Vergleich der Wirksamkeit von Erythromycin-Äthylsuccinat und Co-trimoxazol bei Pertussis

Zusammenfassung Fünfundfünfzig ambulante Kinder mit kulturell bestätigtem Keuchhusten im Frühstadium wurden zwei Wochen lang entweder mit Erythromycin-Äthylsuccinat (n=28) (50–80 mg/kg/Tag in drei Einzeldosen während der Mahlzeiten) oder mit Co-trimoxazol (n=27) (6–10 mg Trimethoprim/kg/Tag in zwei Einzeldosen nach den Mahlzeiten) behandelt. Nach Therapieende waren alle Patienten in der Erythromycin-Gruppe kulturnegativ, während bei einem Kind in der Co-trimoxazol-Gruppe die Kultur noch positiv war. In diesem Fall hat möglicherweise Erbrechen eine Rolle gespielt. Beide Testmedikamente scheinen in der Lage zu sein,Bordetella pertussis aus dem Nasopharynx von Patienten mit frühem Keuchhusten zu eliminieren.

     

An analysis of plasma estradiol concentrations during clomiphene citrate-human menopausal gonadotropin stimulation in an in vitro fertilization-embryo transfer program

We report here a range of plasma estradiol (E2) concentrations suitable for use in an in vitro fertilization (IVF) program. This range was derived from nonparametric analysis of plasma E2 levels using plasma E2 measurements beginning 10 days before the anticipated day of the midcycle LH surge (midpoint), as calculated from each patient's six previous menstrual cycles, during which time the patients all received the same ovarian stimulation regimen. The regimen consisted of 100 mg clomiphene citrate/day for 5 days, beginning 10 days before the anticipated midpoint, plus 150 IU human menopausal gonadotropin, commencing the day after clomiphene. A consecutive series of 102 IVF conception cycles induced in this standardized fashion were analyzed in this study. The 5th-95 percentile envelope of plasma E2 concentrations was derived as a valid clinical indicator of satisfactory folliculogenesis during IVF treatment. Five women had plasma E2 concentrations below the 5th percentile of the E2 range on at least 3 consecutive days of ovarian stimulation, while six women had E2 levels above the 95th percentile of this range on at least 3 consecutive days. This plasma E2 range defined objectively the diagnoses of ovarian hyperstimulation and inadequate stimulation in an IVF program. These criteria should help clinicians in managing ovarian responses during IVF superovulation stimulation treatment.     

Accuracy of the Kato-Katz, adhesive tape and FLOTAC techniques for helminth diagnosis among children in Kyrgyzstan

The purpose of this study was to assess the accuracy of three copro-microscopic techniques for helminth diagnosis: Kato-Katz, adhesive tape and FLOTAC. A total of 163 children from a peri-urban municipality near Bishkek, Kyrgyzstan, participated and submitted multiple stool samples and adhesive tapes. Ninety children supplied at least two stool samples and two adhesive tapes. Three stool samples and three adhesive tapes were available from 71 and 64 children, respectively. From each stool sample, a single Kato-Katz thick smear was prepared and examined quantitatively. Additionally, the first stool sample was subjected to the FLOTAC technique and helminth eggs were counted. Adhesive tapes were checked for the presence of Enterobius vermicularis eggs. Using pooled results as a diagnostic ‘gold’ standard, the prevalence of Ascaris lumbricoides, E. vermicularis, Hymenolepis nana and Dicrocoelium dendriticum were 54.4%, 13.3%, 11.1% and 11.1%, respectively. Infection intensities were low. When compared to triplicate Kato-Katz, a single FLOTAC was more sensitive for the diagnosis of A. lumbricoides (89.5% versus 39.5%) and D. dendriticum (88.9% versus 33.3%), but less sensitive for H. nana (66.7% versus 88.9%). For E. vermicularis, three adhesive tapes showed much higher sensitivity than a single FLOTAC (92.9% versus 14.3%). FLOTAC yielded significantly higher faecal egg counts than Kato-Katz for A. lumbricoides and D. dendriticum. Overall results suggest that, although FLOTAC represents a promising technique for helminth diagnosis in Kyrgyzstan, the repeated adhesive tape test remains so far the method of choice for diagnosing E. vermicularis.     

Clinical observation on brittle diabetes

The brittleness of 100 severe diabetics was calculated as the mean of differences of blood glucose between two consecutive days at four time points (fasting, one and two hours after breakfast, and two hours after lunch). Mean daily difference (MDD) had a unimodal distribution; 15 patients with a MDD greater than 100 mg/100 ml were classified as most brittle. There was no correlation between MDD and insulin requirement. The brittle diabetics received 26 to 48 units of insulin/day. The insulin-resistant patients had low MDD values. No difference was found between seven patients with brittle diabetes and seven stable matched controls in insulin-binding capacity or total insulin. In two groups of six patients each with brittle diabetes, it was found that the stable dosage caused less brittleness than a sliding-scale regimen and that routine injection of 4 units of regular insulin before meals slightly decreased the mean diurnal glycemia level but increased the number of hypoglycemias. In two brittle diabetics, the blood glucose level was stabilized on intravenously administered insulin infusion, and in these patients, meals caused only a moderate hyperglycemia.     

钩虫病不同防治方案的现场研究

为了探索简便而有效的群众性防治钩虫病的方法,于1971—1990年在广西壮族自治区武鸣县陆斡镇和太平乡采用单纯查治、查治结合粪管和全民服用甲苯达唑药盐3种防治方案观察其防治钩虫病的效果。结果:单纯查治法经过10年的实施,居民钩虫感染率从42.6％降至3.9％,地方感染程度克粪虫卵数(EPG)从 425.6个降至1.6个,再经查治未继续下降;查治结合粪管法经过7年的实施,居民感染率从58.7％降至10.9％,地方感染程度 EPG从111.5个下降至8.5个,中断查治3年后感染率回升至 14.5％;全民服用甲苯达唑药盐法分别采用服药 100mg/d·30d 和 50dmg/d·30 d 两种方案,服完后 1年居民感染率分别从 36％、36％下降至 2％、1.3％、地方感染程度 EPG 从110.3个、246 个下降至 1.3个和 0.24个,经过3年的远期观察,感染率仍控制在 2％以下,感染程度 EPG在1个虫卵以下。上述结果表明全民服甲苯达唑药盐,其方法简便易行,能巩固防治效果、适用于群众性防治。     

Ten-day sequential therapy is more effective than proton pump inhibitor-based therapy in Korea: a prospective, randomized study

Background and Aims: The eradication rate of proton pump inhibitor (PPI)‐based triple therapy for Helicobacter pylori (H. pylori) infection has decreased, mainly due to increasing antibiotic resistance, especially against clarithromycin. It has been reported that a 10‐day sequential strategy can produce good outcomes. The aim of this prospective study was to assess the efficacy of sequential therapy as the first‐line treatment for the eradication of H. pylori in Korea. Methods: A total of 116 patients with proven H. pylori infection received 10‐day sequential therapy (20 mg rabeprazole and 1 g amoxicillin, twice daily for the first 5 days, followed by 20 mg rabeprazole, 500 mg clarithromycin, and 500 mg metronidazole, twice daily for the remaining 5 days); 130 patients received 7‐day triple therapy (20 mg rabeprazole, 500 mg clarithromycin, and 1 g amoxicillin, twice daily for 7 days). Eradication was evaluated by the ¹³C‐urea breath test, 4 weeks after the completion of treatment. Compliance and adverse events were assessed. Results: The eradication rates of 10‐day sequential therapy and PPI‐based triple therapy were 79.3% (92/116) and 63% (82/130) by intention‐to‐treat analysis, respectively (P = 0.005), and 81.9% (91/111) and 64.5% (82/127) by per protocol analysis, respectively (P = 0.003). Mild adverse events occurred in both therapy groups (27.5% vs 23.8%), but both treatments were well tolerated. Conclusion: The eradication rate of the 10‐day sequential therapy regimen was significantly higher than that of PPI‐based triple therapy in the Korean population. Ten‐day sequential therapy might be effective as a first‐line treatment for H. pylori infection in Korea.     

Colonization of caesarean section babies by excherichia coli

Summary Eight babies all delivered by Caesarean section were observed for evidence of colonization byE. coli from birth until discharge from hospital 10 to 14 days later. Faecal specimens were cultured daily forE. coli as were swabs from the rectum, groin, umbilicus, head, hands und mouth. Different serotypes ofE. coli were isolated from four babies on day 1, one baby on day 2, one baby on day 7 and two babies on day 9. Three babies excreted more than one serotype ofE. coli. Serotypes ofE. coli isolated from the faeces and rectum were usually isolated from the groin but less often from the umbilicus. Other sites were rarely colonized. In all instances except one the primary site of colonization appeared to be the gastrointestinal tract. Colonization byE. coli was influenced by antibiotic therapy and possibly by the method of feeding.

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Die Besiedlung von durch Kaiserschnitt entbundenen Säuglingen durch Escherichia coli

Zusammenfassung Acht Neugeborene, die durch eine Sectio entbunden wurden, kamen im Hinblick auf ihreE. coli-Besiedlung von der Geburt bis zur Entlassung zu einer kontinuierlichen Beobachtung. Es wurdenE. coli-Untersuchungen vom Stuhl sowie von Rektal-, Leisten-, Nabel-, Kopf-, Hand- und Mundabstrichen durchgeführt. Von vier Säuglingen wurden am 1. Tag verschiedeneE. coli-Serotypen isoliert, bei einem Neugeborenen am 2. Tag, bei einem Neugeborenen am 7. Tag und bei zwei Neugeborenen am 9. Tag. Drei Säuglinge schieden mehr als einen Serotyp aus. Die Serotypen, die aus dem Stuhl und Rektum isoliert wurden, konnten in der Regel aus der Leistenbeuge, jedoch weniger häufig vom Nabel isoliert werden. Andere Lokalisationen waren selten besiedelt. Bis auf einen Fall war die Erstbesiedlung im Gastrointestinaltrakt nachweisbar. Die Kolonisierung vonE. coli wurde durch die Chemotherapie und die Ernährungsweise beeinflußt.

     

Effects of differing absolute and relative doses of progesterone and estrone on implantation and fetal survival in ovariectomized rats

Rats were inseminated, then ovariectomized and treated with different doses of progesterone (P) and estrone (E), to determine the minimal and optimal daily doses of P and E required for implantation and fetal survival in ovariectomized rats. The minimal daily dose of P and E required for an optimal rate of implantation and fetal survival in ovariectomized rats was between 0.4 and 4.0 mg of P, and 0.1 and 1.0 microgram of E. The daily 5.0 micrograms E dose was too high to realize implantation or fetal survival when it was injected with P beginning on the day after insemination. If, however, 7 days of daily P treatment preceded the daily 5.0 micrograms E, combined with 20 mg P, delayed implantation was realized but subsequent fetal survival was not. High P doses alone did not substitute for combining E with lower P doses.     

The effect of phenobarbital on biliary lipid metabolism and hepatic microsomal drug metabolism in patients with cholesterol cholelithiasis

Six patients with cholesterol cholelithiasis were studied before and after 3 weeks treatment with phenobarbital, 120 mg/day. The kinetics of cholic and chenodeoxycholic acid and biliary lipid composition were not significantly affected by phenobarbital treatment although hepatic mixed-function oxidase was stimulated by the treatment as shown by increased breath output of ¹⁴ CO ₂ after administration of [ ¹⁴ C]aminopyrine. It is concluded that treatment with phenobarbital is unlikely to be effective therapy for patients with cholesterol cholelithiasis.This work was supported in part by grant AM 17303 from the National Institutes of Health.     

Local cellular and immune response by antral mucosa in patients undergoing treatment for eradication ofHelicobacter pylori

Thirty-six patients with nonhealing or recurrent duodenal ulcers (DU) were treated with omeprazole; 20 mg/day for one month followed by triple therapies (metronidazole, 400 mg three times a day, tetracyclin, 500 mg four times a day with either colloidal bismuth, 120 mg four times a day or sucralfate 1 g four times a day. At least two gastric mucosal samples were collected from the antral portion of the stomach and from the duodenum before and immediately after omeprazole therapy and four weeks after completion of triple therapies. Samples were fixed in buffered formaldehyde and glutaraldehyde and examined histologically and histochemically for inflammation, density ofH. pylori colonization, and immunohistochemically for the density of gastrin-secreting cells, immunoglobulins (IgA, IgG, IgM), kappa and lambda light chains and T-lymphocyte population.H. pylori colonization of the antral mucosa before treatment was noted in 100% and active gastritis in 86% of patients. The histologically assessed clearance rate after omeprazole treatment was 47.3%, and after triple therapies, 69.5%. The prevalence of gastritis was observed in 63.9% and 33.3% respectively. All therapies were associated with an accumulation of serous fluid, increased population of lymphocytes and plasma cells, and secretion of immunoglobulins, particularly IgG and IgM in the upper part of the lamina propria. These changes, together with increased numbers of T lymphocytes within the crypt epithelium and the lamina propria, were associated with the presence ofH. pylori organisms. Increased cellular response of the lamina propria and accumulation of immunoglobulins in the upper part of mucosa-even with histologically assessed clearance-may indicate a lack of complete eradication ofH. pylori and predict relapse of DU. Omeprazole-treated patients had hyperplasia of gastrin-secreting cells in the antrum, irrespective of the presence or absence ofH. pylori.This study was supported by the SA Medical Research Council.     

Association experiments with aerobic and anaerobic pathogens: a model of in-vitro susceptibility testing in mixed infections. Activity of enoxacin,clindamycin, and metronidazole

Summary In infections of polymicrobial etiology, it seems mandatory to combine an antibiotic with marginal activity against anaerobes with an anti-anaerobic drug, e. g. metronidazole or clindamycin. We investigated the effect of associations of anaerobic and facultatively anaerobic pathogens on MBCs of enoxacin, clindamycin, metronidazole, and combinations of enoxacin plus clindamycin or metronidazole. Single testing, and associations ofBacteroides fragilis withEscherichia coli orEnterococcus faecalis revealed MBCs of 64 mg/l for enoxacin. However, investigating metronidazole, MBCs forB. fragilis increased from 0.5–1 mg/l to 2–4 mg/l in association withE. coli. The combination of enoxacin with metronidazole restored MBCs of 0.5 and 1 mg/l for theB. fragilis strains.B. fragilis associated withE. faecalis showed MBCs of 2 to 64 mg/l for metronidazole, an increase of up to 64-fold. The enoxacin MBCs forE. coli in association withB. fragilis were up to eight-fold higher than forE. coli alone (2 mg/l compared to 0.25 mg/l). Association ofE. coli withE. faecalis andB. fragilis showed a low to moderate increase for MBCs ofE. coli when enoxacin was tested alone or in combination with metronidazole or clindamycin. In contrast, MBCs forE. faecalis did not change significantly with any of the associations or combinations tested. It is evident thatin vitro antimicrobial susceptibility of associations of pathogens can be modified by interactions between strains, and/or antimicrobials.

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Zusammenfassung Bei polymikrobiellen Infektionen ist es wesentlich, Chemotherapeutika ohne oder mit nur schwacher Wirksamkeit gegen Anaerobier mit Metronidazol oder Clindamycin zu kombinieren. Die Auswirkungen der Assoziationen von anaeroben und fakultativ anaeroben Erregern auf die MBK von Enoxacin, Clindamycin, Metronidazol und den Kombinationen Enoxacin plus Clindamycin oder Metronidazol wurde untersucht. Die MBK vonBacteroides fragilis sowohl in Einzel- als auch in Assoziationstestung mitEscherichia coli oderEnterococcus faecalis betrug für Enoxacin 64 mg/l. Bei der Testung von Metronidazol stiegen die MBKs vonB. fragilis in Assoziation mitE. coli von 0.5–1 mg/l auf 2–4 mg/l, während sich in der Kombination Enoxacin plus Metronidazol wieder MBKs von 1 mg/l ergaben. In den AssoziationenB. fragilis mitE. faecalis zeigteB. fragilis bei der Untersuchung von Metronidazol MBKs von 2 bis 64 mg/l, ein bis zu 64facher Anstieg gegenüber der Einzeltestung. Die Enoxacin-MBKs fürE. coli in Assoziation mitB. fragilis waren bis zu achtfach höher als in Einzeltestung (z. B. Anstieg von 0.25 auf 2 mg/l). Assoziationen vonE. coli mitE. faecalis undB. fragilis ergaben fürE. coli einen geringeren Anstieg der MBKs für Enoxacin, Enoxacin plus Metronidazol oder Clindamycin. BeiE. faecalis konnten keine wesentlichen Veränderungen der MBKs in den verschiedenen Assoziationen beobachtet werden. Aus den Versuchen kann geschlossen werden, daß dieIn-vitro-Empfindlichkeit gegen antimikrobielle Substanzen bei Erregerassoziationen durch Interaktionen zwischen den Stämmen und/oder den antimikrobiellen Substanzen beeinflußt werden kann.

     

Dientamoeba fragilis An unusual intestinal pathogen

Summary This is a case report of a gastrointestinal infection caused byDientamoeba fragilis. It is a flagellate protozoan that is an uncommon etiology of gastrointestinal disease. Primarily characterized by diarrhea and abdominal pain, other symptoms such as flatulence, nausea, vomiting, fatigue, malaise, and weight loss occur. Diagnosis is made using multiple fresh stool samples that are preserved and permanently stained looking for the typical binucleate trophozoite. Since there is a distinct association withEnterobius vermicularis (possibly the mode of protozoan transmission), the human pinworm is also sought. Treatment of choice consists of diiodohydroxyquin in adults and metronidazole in children.     

Intravenous Omeprazole/Amoxicillin and Omeprazole Pretreatment in Helicobacter pylori-Positive Acute Peptic Ulcer Bleeding: A Pilot Study

Adamek RJ, Freitag M. Opferkuch W, Rühl GH, Wegener M. Intravenous omeprazole/amoxicillin and omeprazole pretreatment in Helicopter pylori-positive acute peptic ulcer bleeding. A pilot study. Scand J Gastroenterol 1994;29:880-883.

Background: The aims of this study were to evaluate a Helicobacter pylori eradication schedule for H. pylori-positive gastroduodenal ulcer bleeding, which could be commenced intravenously after endoscopic diagnosis, and to assess the effect of omeprazole pretreatment on bacterial eradication. Methods: In a prospective study 20 consecutive patients with H. pylori-positive acute peptic ulcer bleeding, who were managed conservatively including endoscopic injection therapy, were treated with a 2-week regimen consisting of either 40 mg omeprazole three times daily (with the exception of the loading dose of 80 mg) and 2 g amoxicillin three times daily intravenously for 3 days and 20 mg omeprazole twice daily and 1 g amoxicillin twice daily orally for 11 days (n = 10) or only with 40 mg omeprazole three times daily (with the exception of the loading dose of 80 mg) intravenously for 3 days and 20 mg omeprazole twice daily and 1 g amoxicillin twice daily orally for 11 days (n = 10). Subsequently, both groups received 20 mg omeprazole twice daily orally for 4 weeks. Results: H. pylori eradication, defined as negative bacterial findings in urease test, culture and histology, or ¹³C-urea breath test at least 4 weeks after cessation of omeprazole medication, was achieved in 100% (10/10) of patients in the first group but only in 30% (3/ 10) of patients in the second group (p < 0.01). Ulcer healing was endoscopically confirmed in all but one patient in the second group. Conclusions: For the first time a promising concept for H. pylori eradication in H. pylori-positive ulcer bleeding is available by using a combined intravenous and oral omeprazole/amoxicillin therapy, which can be started intravenously immediately after an emergency upper GI endoscopy. In addition, these data imply that omeprazole pretreatment may not be wise when H. pylori eradication is attempted.     

Rufloxacin once daily in acute exacerbations of chronic bronchitis

Summary In this open study the efficacy and tolerability of rufloxacin in a single dose of 400 mg the first day and 200 mg the nine consecutive days was studied in 26 patients with an acute exacerbation of chronic bronchitis. Twenty-two patients were evaluable for efficacy. Four patients stopped treatment prematurely after five days because of clinical cure. At the enrollment visit a pathogen was isolated in the sputum sample in 19 of 22 evaluable patients. The predominant pathogens wereStreptococcus pneumoniae andMoraxella catarrhalis. In 17 of these 19 bacteriologically evaluable patients the initial infecting organism was eradicated from specimens obtained within 48 hours after the end of therapy. There was one case of persistent infection caused byS. pneumoniae (MIC 4 mg/l), one patient had a superinfection withSerratia marcescens (MIC 1 mg/l) susceptible to rufloxacin and therapy was stopped after five days due to clinical failure. One week after the end of therapy, 15 patients remained free from infection whilst one patient experienced reinfection withKlebsiella pneumoniae (MIC 0.5 mg/l). Clinical cure or improvement was observed in 21 of 22 patients. Mild adverse events were reported by two of 26 enrolled patients. In one patient, complaining of headache and dizziness, the adverse events were considered possibly study drug related. No abnormal laboratory findings were reported. Nadir plasma levels of rufloxacin were measured and no accumulation in plasma was observed during treatment. A ten day course of an oral single dose of rufloxacin proved efficacious and was well tolerated in patients with an acute exacerbation of chronic bronchitis. A multicentre, multinational, double-blind study is now in progress to compare the efficacy and tolerability of rufloxacin with amoxycillin in patients with acute exacerbations of chronic bronchitis.

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Rufloxacin bei chronischer Bronchitis

Zusammenfassung In einer offenen Studie wurden 26 Patienten mit akuter Exazerbation einer chronischen Bronchitis mit Rufloxacin in einmal täglicher Applikation von 400 mg am ersten und 200 mg an den weiteren neun Therapietagen behandelt. Die Verträglichkeit der Therapie wurde bei allen, die Wirksamkeit bei 24 Patienten ausgewertet. Wegen frühzeitiger klinischer Heilung beendeten vier Patienten die Behandlung vorzeitig am fünften Tag. Aus den vor der Therapie entnommenen Sputumproben wurde in 19 von 22 Fällen ein Erreger angezüchtet, vorwiegendStreptococcus pneumoniae undMoraxella catarrhalis. 48 Stunden nach Therapieende war bei 17 dieser 19 Patienten der initial isolierte Erreger aus dem Sputum verschwunden. In einem Fall persistierteS. pneumoniae (MHK 4 mg/l), ein Patient hatte eine Superinfektion mit einemin vitro empfindlichenSerratia marcescens-Stamm, sprach aber auf Rufloxacin nicht an, daher wurde das Antibiotikum nach fünf Tagen abgesetzt. Eine Woche nach Therapieende waren 15 Patienten ohne Infektion, in einem Fall war eine Reinfektion durchKlebsiella pneumoniae (MHK 0,5 mg/l) aufgetreten. Bei 21 der 22 Patienten trat eine klinische Heilung oder Besserung ein. Zwei der 26 Patienten berichteten über leichte Nebenwirkungen, die in einem Fall von Kopfschmerzen und Benommenheit als möglicherweise therapiebedingt angesehen wurden. Laborwertveränderungen waren nicht festzustellen. Aus den Meßwerten der Rufloxacin-Talspiegel ergab sich kein Hinweis für eine Kumulation von Rufloxacin im Plasma. Die zehntägige Behandlung mit Rufloxacin in Einmaltagesdosierung erwies sich bei Patienten mit akuter Exazerbation einer chronischen Bronchitis als wirksam und gut verträglich. Eine doppelblind geführte Vergleichsstudie zur Wirksamkeit und Sicherheit von Rufloxacin im Vergleich zu Amoxicillin bei Patienten mit akuter Exazerbation einer chronischen Bronchitis wird derzeit international multizentrisch durchgeführt.

     

Efficacy of Reduced Dosage of Rabeprazole in PPI/AC Therapy for Helicobacter pylori Infection

Proton pump inhibitor (PPI)- based triple therapy has been a recent trend for treatment of Helicobacter pylori infection, with the PPI–amoxicillin–clarithromycin (PPI/AC) regimen being one of the most popular. We have reported the effectiveness of PPI/AC regimens in the Japanese population and have demonstrated that the effectiveness of 40 mg rabeprazole, a recently developed PPI, is similar to that of 40 mg of omeprazole and 60 mg of lansoprazole when used in combination with amoxicillin and clarithromycin. In this study, we focused on whether 20 mg of rabeprazole is effective in our patient population by comparing that dosage with 40 mg of rabeprazole and 60 mg of lansoprazole. In all, 308 H. pylori-infected patients [236 men and 72 women; age (mean ± sem) 49.3 ± 0.6 years] with peptic ulcer disease (N = 270) or nonulcer dyspepsia (N = 38) were randomly assigned to one of three different PPI/AC regimens for seven days: LAC (N = 104), consisting of lansoprazole 30 mg twice a day, amoxicillin 500 mg three times a day, and clarithromycin 200 mg twice a day; RAC (N = 104), consisting of rabeprazole 20 mg twice a day, amoxicillin 500 mg three times a day, and clarithromycin 200 mg twice a day; and the R1/2AC regimen (N = 100), which included rabeprazole 10 mg twice a day, amoxicillin 500 mg three times a day, and clarithromycin 200 mg twice a day. Cure of the infection was determined by the [¹³C]urea breath test one month after completion of the treatment. Intention-to-treat based and per-protocol based cure rates for the LAC, RAC, and R1/2AC regimens were 82.7 (95% CI, 74–89) and 88.7% (81–94), 85.6 (77–92) and 89.8% (82–95), and 87.0 (79–93) and 89.7% (82–95), respectively. Although adverse effects were reported by 20.3% of the patients, these affected compliance in only five patients in the RAC and LAC regimens and none in the R1/2AC group. Overall complete compliance was achieved in 94.7% of interviewed patients. In conclusion, the effectiveness of the PPI/AC regimen with 20 mg of rabeprazole is comparable with and even safer than that of 40 mg of rabeprazole and 60 mg of lansoprazole in our patient population.