DOCSLIB.ORG

Antibiotic Therapy in Small Intestinal Bacterial Overgrowth: Rifaximin Versus Metronidazole

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Antibiotic Therapy in Small Intestinal Bacterial Overgrowth: Rifaximin Versus Metronidazole European Review for Medical and Pharmacological Sciences 2009; 13: 111-116 Antibiotic therapy in small intestinal bacterial overgrowth: rifaximin versus metronidazole E.C. LAURITANO, M. GABRIELLI, E. SCARPELLINI, V. OJETTI, D. ROCCARINA, A. VILLITA, F. FIORE, R. FLORE, A. SANTOLIQUIDO, P. TONDI, G. GASBARRINI, G. GHIRLANDA, A. GASBARRINI Internal Medicine Department, Catholic University of the Sacred Heart, Rome (Italy) Abstract. – Background and Objectives: Few controlled trials on antibiotic therapy for GBT: glucose breath test small intestinal bacterial overgrowth are avail- H2: hydrogen able at present. Aim of the study was to assess IBS: irritable bowel syndrome efficacy, safety and tolerability of rifaximin with respect to metronidazole for the treatment of small intestinal bacterial overgrowth. Material and Methods: We enrolled 142 con- secutive patients with diagnosis of small intesti- Introduction nal bacterial overgrowth. Diagnosis of small in- testinal bacterial overgrowth based on the clini- Small intestinal bacterial overgrowth (SIBO) is cal history and the positivity of glucose breath a common clinical syndrome due to an increased test. Patients were randomised to two 7-day level of bacteria exceeding the presence of more treatment groups: rifaximin 1200 mg/day and than 105 CFU/mL of intestinal aspirate or of metronidazole 750 mg/day. Glucose breath test colonic-type species within the small bowel1,2. was reassessed 1 month after. Compliance and side-effect incidence were also evaluated. SIBO symptoms could be many and variably Results: One drop-out was observed in rifax- associated; abdominal pain or discomfort, bloat- imin group. Five drops-out occurred in metron- ing, diarrhoea and/or signs of malabsorption are idazole group. The glucose breath test normal- the most common1,2. Recent findings suggest that ization rate was significantly higher in the rifax- SIBO is highly prevalent in patients with IBS and imin with respect to the metronidazole group that SIBO decontamination is associated to a sig- (63.4% versus 43.7%; p<0.05; OR 1.50, 95% CI nificant improvement of IBS symptoms3-5. 1.14-4.38). The overall prevalence of adverse events was significantly lower in rifaximin with The culture of jejunal aspirates, regarded by respect to metronidazole group. many as the gold standard for the SIBO diagno- Discussion: Rifaximin showed an higher SIBO sis, has several limitations such as the potential decontamination rate than metronidazole at the for contamination by oropharyngeal bacteria dur- tested doses, both with a significant gain in ing intubation, and the fact that SIBO may be terms of tolerability. Either the present study or patchy and thus missed by a single aspiration. In recent evidencies suggest that rifaximin repre- sents a good choice for the management of pa- addition, it is too much invasive, expensive and tients affected by SIBO. difficult and too little reproducible to be pro- posed as a routine diagnostic test for SIBO in the Key Words: clinical practice, especially for patients with non- Bacterial overgrowth, Glucose breath test, Rifax- specific symptoms or those requiring repeated 1,2 imin, Metronidazole. testing . The GBT is considered a simple tool for SIBO diagnosis, since it is non invasive, highly repro- ducible and inexpensive when compared to the culture of jejunal aspirates. In addition, the speci- Abbreviatons ficity and the sensitivity of GBT are acceptable for screening studies (77-100% and 67-98% re- 6-8 SIBO: small intestinal bacterial overgrowth spectively) . The H2 produced in the human CFU: colony-forming unit body after glucose ingestion derives entirely Corresponding Author: Antonio Gasbarrini, MD; e-mail: [email protected] 111 E.C. Lauritano, M. Gabrielli, E. Scarpellini, V. Ojetti, D. Roccarina, A. Villita, et al. from intestinal bacterial fermentation. The ap- Major organic gastrointestinal disorders were pearance of an early increase in breath H2 con- ruled out on the basis of: history collection; full centration suggests the presence of SIBO6-8. physical examination; laboratory tests (total An effective antibiotic decontamination regi- blood count, erythrocyte sedimentation rate, re- men should include one or more drugs with ac- active C protein, stool examination for occult tivity against both aerobic and anaerobic bacte- blood, ova and parasites, anti-transglutaminase ria since SIBO may occur either by a mix of aer- antibodies); abdominal ultrasonography and obic and anaerobic flora or by purely aerobic colonoscopy when alarm symptoms were present flora in a minority of cases1,2,9-11. Empirical (fever, gastrointestinal bleeding, weight loss, courses of broad-spectrum antibiotics are widely anemia, abdominal mass). used at present for SIBO decontamination, since The Rome II criteria were used to verify the few well-conducted trials have been performed diagnosis of IBS or other functional bowel disor- up today to verify which is the best antibiotic ders19. regimen1,2,11,12. The exclusion criteria were: previous antibiot- Metronidazole is effective against Gram-nega- ic treatment associated to SIBO diagnosis; age tive and Gram-positive anaerobic bacteria such <18 years; use of antimicrobial agents within the as Bacterioides, Fusobacterium and Peptostrep- previous 3 months; hypersensitivity to the antibi- tococci13. These characteristics make it potential- otics used in the present study; pregnancy or ly useful for the treatment of small bowel bacter- breast-feeding; evidence of major concomitant ial overgrowth as confirmed by literature data14. diseases (including tumours and hepatic and/or Rifaximin is a rifamycin derivative with an- renal insufficiency). tibacterial activity caused by inhibition of bacter- Exclusion criteria were: age <18 years; hyper- ial synthesis of RNA15. It is active against gram- sensitivity to the antibiotics; pregnancy or breast- positive and gram-negative bacteria, including feeding; evidence of major concomitant diseases both aerobes and anaerobes15-17. Less than 0.1% (including tumours and hepatic and/or renal in- of the oral dose is absorbed16. Rifaximin at a sufficiency). Consecutive patients with positive dosage of 1200 mg per day for 1 week is associ- GBT were included in the present study after in- ated to a significant gain in terms of therapeutic formed consent. efficacy in SIBO contamination without increas- The procedures followed were in accordance ing the incidence of side-effects with respect to with with the Helsinki Declaration of the World lower dosages (600 and 800 mg per day for the Medical Association. same treatment period)18. The aim of the present study was to assess the Laboratory Parameters efficacy, safety and tolerability of the non-ab- Total blood cell count, liver and kidney func- sorbable antibiotic rifaximin with respect to the tion were assessed in all patients at enrolment systemic antibiotic metronidazole in patients af- and 3 days after the end of the treatment. fected by SIBO. Breath H2 Testing GBT was performed under standard condi- tions. In the month preceding the test patients Material and Methods should not have received antibiotics or laxatives. To minimize basal H2 excretion, patients were This prospective parallel-group randomized asked to follow a carbohydrate-restricted dinner trial was conducted between February 2005 and on the day before the test and to fast for at least August 2007 in consecutive out-patients from 12 hours. On the day of testing, patients did a the Gastroenterology and Internal Medicine De- mouthwash with 20 ml of chlorhexidine 0.05%. partments of the Catholic University of Rome, Smoking and physical exercise were not allowed Italy. for 30 minutes before and during the test. End- alveolar breath samples were collected immedi- Inclusion/Exclusion Criteria ately before glucose ingestion. A dose of 50 g of Patients referring to our centre for the pres- glucose in the form of iso-osmotic solution was ence of gastrointestinal symptoms (bloating, ab- administered and samples were taken every 10 dominal pain, flatulence and diarrhoea) since ≥ 6 min for 2 hours respectively using a two-bag months were evaluated. system. The two-bag system is a device consist- 112 Antibiotic therapy in small intestinal bacterial overgrowth: rifaximin versus metronidazole ing of a mouthpiece, a T valve and two collapsi- domly assigned to one of the two 7-day treatment ble bags, the first one collects dead space air, the groups: second one collects alveolar air. The breath sam- ple was aspirated from this bag into a 20 ml 1. Rifaximin 1200 mg/day (2 tablets tid; group 1: plastic syringe. Samples were analyzed immedi- n=71) ately using a model Quintron Gas Chromato- 2. Metronidazole 750 mg/day (1 tablet tid; group graph (Quintron Instrument Company, Milwau- 2: n=71). kee, WI). The test was considered as indicative of the Data Analysis presence of SIBO when the peak, that is the in- For the purpose of the analysis, the incidence crease over the baseline of H2 levels, was of side-effects was considered as a binomial vari- >12 p.p.m.7. able (present/absent). To detect differences in The GBT was repeated 1 month after the end GBT normalization rates and the incidence of of therapy to assess GBT normalization. side-effects, the Χ2 or Fisher’s exact tests were used. Odds Ratio (OR) for achieving GBT nor- Outcomes malization with 95% confidence intervals (95% The primary outcome of the present study was CI) was calculated. The statistical analysis was the GBT normalization rate using rifaximin or performed using STATA 6.0. metronidazole. Secondary outcomes were patient’s compli- ance and incidence of side-effects in the two therapeutic schemes. Results Compliance was assessed by an interview (ad- ministered by a trained physician) performed af- Patients Characteristics and ter the end of the therapy and by a pill count of Overall Compliance the drugs boxes returned at the same interview. A total of 142 patients were enrolled. Charac- Low compliance was defined as more than 20% teristics of the study groups are summarized in of pills returned.
Load more

Recommended publications
  • Antibiotic Treatment in Inflammatory Bowel Disease: Rifaximin, a New Possible Approach
    European Review for Medical and Pharmacological Sciences 1999; 3: 27-30 Review – Antibiotic treatment in inflammatory bowel disease: rifaximin, a new possible approach P. GIONCHETTI, F. RIZZELLO, A. VENTURI, F. UGOLINI*, M. ROSSI**, P. BRIGIDI**, R. JOHANSSON, A. FERRIERI***, G. POGGIOLI*, M. CAMPIERI Clinica Medica I, Nuove Patologie, Bologna University (Italy) *Istituto di Clinica Chirurgica II, Bologna University (Italy) **Dipartimento di Scienze Farmaceutiche, Bologna University (Italy) ***Direzione Medica Alfa Wassermann, Bologna (Italy) Abstract. – The etiology of inflammatory ported the presence of a breakdown of toler- disease is still unknown, but a body of evidence ance to the normal commensal intestinal flora from clinical and experimental observation indi- in active IBD2-3. Reduction of microflora by cates a role for intestinal microflora in the pathogenesis of this disease. Reduction of mi- antibiotics, bowel rest and fecal diversion de- croflora using antibiotics, bowel rest and fecal creases inflammatory activity in Crohn’s dis- diversion decreases activity in Crohn’s disease ease and to a lesser extent in ulcerative colitis and in ulcerative colitis. Several trials have been (UC). The pathogenetic role of intestinal mi- carried out on the use of antibiotic treatment in croflora is further suggested by the observa- patients with active ulcerative colitis with con- tion that experimental colitis, in germ-free or trasting results. A number of trials have been antibiotic treated animals, is less severe com- carried out using Rifaximin, a non-absorbable broad-spectrum antibiotic, confirming the ab- pared to that inducible in normal animals or sence of systemic bioavalaibility of the drug at times is not inducible at all.
    [Show full text]
  • FDA Warns About an Increased Risk of Serious Pancreatitis with Irritable Bowel Drug Viberzi (Eluxadoline) in Patients Without a Gallbladder
    FDA warns about an increased risk of serious pancreatitis with irritable bowel drug Viberzi (eluxadoline) in patients without a gallbladder Safety Announcement [03-15-2017] The U.S. Food and Drug Administration (FDA) is warning that Viberzi (eluxadoline), a medicine used to treat irritable bowel syndrome with diarrhea (IBS-D), should not be used in patients who do not have a gallbladder. An FDA review found these patients have an increased risk of developing serious pancreatitis that could result in hospitalization or death. Pancreatitis may be caused by spasm of a certain digestive system muscle in the small intestine. As a result, we are working with the Viberzi manufacturer, Allergan, to address these safety concerns. Patients should talk to your health care professional about how to control your symptoms of irritable bowel syndrome with diarrhea (IBS-D), particularly if you do not have a gallbladder. The gallbladder is an organ that stores bile, one of the body’s digestive juices that helps in the digestion of fat. Stop taking Viberzi right away and get emergency medical care if you develop new or worsening stomach-area or abdomen pain, or pain in the upper right side of your stomach-area or abdomen that may move to your back or shoulder. This pain may occur with nausea and vomiting. These may be symptoms of pancreatitis, an inflammation of the pancreas, an organ important in digestion; or spasm of the sphincter of Oddi, a muscular valve in the small intestine that controls the flow of digestive juices to the gut. Health care professionals should not prescribe Viberzi in patients who do not have a gallbladder and should consider alternative treatment options in these patients.
    [Show full text]
  • Formulary Additions
    JUNE 2016 FORMULARY ADDITIONS MELOXICAM (MOBIC®) Rationale for Addition: Meloxicam is a once daily NSAID used for the treatment of rheumatoid arthritis and osteoarthritis. Meloxicam will provide another oral NSAID option to Celecoxib for patients who are being discharged home and whose insurance does not cover celecoxib. Adverse Effects: abdominal pain, diarrhea, dyspepsia, flatulence, nausea, edema, influenza-like symptoms, dizziness, headache, rash Contraindications: peri-operative pain in setting of coronary artery bypass graft surgery Drug Interactions: other NSAIDS, antiplatelet agents, calcium polysterene sulfonate, cyclosporine, digoxin, lithium, methotrexate, vancomycin, vitamin K antagonist, corticosteroids Dosage & Administration: meloxicam 7.5 mg PO daily, some patients my experience some benefit by increasing to 15 mg PO daily Renal Impairment: not recommended in patients with renal function ≤ 20 mL/min Dosage Form & Cost: meloxicam 7.5 mg tablet $0.02/day meloxicam 15 mg $0.03/day IVABRADINE (CORLANOR®) *Restrictions*: restricted to cardiology only for initiation of therapy Rationale for Addition: Ivabradine blocks the funny current leading to a reduction in heart rate at the sinoatrial node. Ivabradine is indicated to reduce the risk of hospitalization for worsening heart failure in patients with stable symptomatic chronic heart failure with LVEF ≤ 35% who are in sinus rhythm with resting heart rate (HR) ≥ 70 beats per minute and either on maximally tolerated doses of β-blockers or have a contraindication to β-blockers.
    [Show full text]
  • Tetracycline and Sulfonamide Antibiotics in Soils: Presence, Fate and Environmental Risks
    processes Review Tetracycline and Sulfonamide Antibiotics in Soils: Presence, Fate and Environmental Risks Manuel Conde-Cid 1, Avelino Núñez-Delgado 2 , María José Fernández-Sanjurjo 2 , Esperanza Álvarez-Rodríguez 2, David Fernández-Calviño 1,* and Manuel Arias-Estévez 1 1 Soil Science and Agricultural Chemistry, Faculty Sciences, University Vigo, 32004 Ourense, Spain; [email protected] (M.C.-C.); [email protected] (M.A.-E.) 2 Department Soil Science and Agricultural Chemistry, Engineering Polytechnic School, University Santiago de Compostela, 27002 Lugo, Spain; [email protected] (A.N.-D.); [email protected] (M.J.F.-S.); [email protected] (E.Á.-R.) * Correspondence: [email protected] Received: 30 October 2020; Accepted: 13 November 2020; Published: 17 November 2020 Abstract: Veterinary antibiotics are widely used worldwide to treat and prevent infectious diseases, as well as (in countries where allowed) to promote growth and improve feeding efficiency of food-producing animals in livestock activities. Among the different antibiotic classes, tetracyclines and sulfonamides are two of the most used for veterinary proposals. Due to the fact that these compounds are poorly absorbed in the gut of animals, a significant proportion (up to ~90%) of them are excreted unchanged, thus reaching the environment mainly through the application of manures and slurries as fertilizers in agricultural fields. Once in the soil, antibiotics are subjected to a series of physicochemical and biological processes, which depend both on the antibiotic nature and soil characteristics. Adsorption/desorption to soil particles and degradation are the main processes that will affect the persistence, bioavailability, and environmental fate of these pollutants, thus determining their potential impacts and risks on human and ecological health.
    [Show full text]
  • Sexually Transmitted Diseases Treatment Options
    Sexually transmitted disease (STD) treatment options PREFERRED & ALTERNATIVE OPTIONS Many clinical partners are operating in a limited capacity during the COVID-19 pandemic. Below are preferred (in clinic or other location where injections can be given) and alternative (when only oral medicines are available 1) treatments for STDs. Syndrome Preferred Treatments Alternative Treatments Follow-up Male urethritis syndrome Ceftriaxone 250mg intramuscular (IM) x 1 PLUS Men who have sex with men (MSM) and transgender women2: Patients should be counseled to azithromycin 1g PO x 1 Cefixime 800 mg PO x 1 PLUS doxycycline 100 mg PO BID x 7 days be tested for STDs once clinical Presumptively treating: care is resumed in the local If azithromycin is not available: doxycycline 100 Men who have sex with women only: gonorrhea clinics. Clients who have been mg PO BID for 7 days (except in pregnancy3) Cefixime 800mg PO x 1 PLUS azithromycin 1g PO x 1 referred for oral treatment If cephalosporin allergy5 is reported, gentamicin If cefixime is unavailable, substitute cefpodoxime 400mg PO q12h should return for 240mg IM x 1 PLUS azithromycin 2g PO x 1 x 2 for cefixime in above regimens4 comprehensive testing and screening and linked to services If oral cephalosporin not available or history of cephalosporin at that time. allergy5: azithromycin 2g PO x 1 If azithromycin is not available: doxycycline 100 mg PO BID for 7 days (except in pregnancy3) Patients should be advised to abstain from sex for 7 days Treatment typically guided by examination and For presumptive therapy when examination and laboratory following completion of Vaginal discharge syndrome treatment.
    [Show full text]
  • The Nitroimidazole Family of Drugs
    Br J Vener Dis: first published as 10.1136/sti.54.2.69 on 1 April 1978. Downloaded from British Journal of Venereal Diseases, 1978, 54, 69-71 Editorial The nitroimidazole family of drugs In 1955 an antibiotic complex isolated from a operative infection caused by susceptible anaerobes, strain of Streptomyces on the island of Reunion particularly in gynaecological surgery, appendi- was found by research workers of Rhone-Poulenc in cectomy, and colonic surgery. Paris to contain a trichomonacidal antibiotic- Real innovations in chemotherapy, such as azomycin. It had previously been isolated in Japan metronidazole, always attract attention from other (Maeda et al., 1953) and identified as 2-nitroimi- research groups. Although interest was slow to dazole (Ia see Table) (Nakamura, 1955). At the develop, research workers have sought analogous, time, and for some years after, this remarkably structurally-modified compounds which might afford simple compound defied synthesis, but it stimulated some advantage in clinical use-for example, the workers at Rhone-Poulenc to prepare and test greater potency, better tolerance and freedom from the activity of the more readily accessible isomeric side effects, a broader spectrum of action, a longer 5-nitroimidazoles (II). It was their good fortune in duration of action, or in some other characteristic. 1957 to find that these isomers were more active This effort has been concerned with important antiprotozoal agents than the natural product veterinary uses of 5-nitroimidazoles as well as the (Cosar and Julou, 1959). In a series of 150 related applications in human medicine. compounds, the one with a P-hydroxyethyl group Metronidazole has been a difficult target to in the 1-position gave the best compromise between improve upon, but several other drugs of this activity and toxicity and this brand of metroni- chemical family have been introduced to clinical dazole was introduced as Flagyl.
    [Show full text]
  • Profiling the Effects of Rifaximin on the Healthy Human Colonic Microbiota Using A
    bioRxiv preprint doi: https://doi.org/10.1101/828269; this version posted November 1, 2019. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under aCC-BY-NC-ND 4.0 International license. 1 1 Profiling the effects of rifaximin on the healthy human colonic microbiota using a 2 chemostat model 3 4 Ines B. Mouraa#, Anthony M. Buckleya, Duncan Ewina, Emma Clarka, Suparna Mitraa, Mark 5 H. Wilcoxa,b, Caroline H. Chiltona 6 7 aLeeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, 8 Leeds, UK; 9 bDepartment of Microbiology, Leeds Teaching Hospitals NHS Trust, The General Infirmary, 10 Leeds, UK 11 12 Keywords: Rifaximin, gut microbiota, chemostat model, 16S rRNA sequencing 13 14 # Corresponding Author: Dr Ines Moura 15 Healthcare Associated Infection Research Group 16 Leeds Institute of Medical Research 17 University of Leeds 18 Microbiology, Old Medical School 19 Leeds General Infirmary 20 Leeds LS1 3EX, UK 21 Tel +44 113 392 8663 22 Email: [email protected] 23 24 25 bioRxiv preprint doi: https://doi.org/10.1101/828269; this version posted November 1, 2019. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under aCC-BY-NC-ND 4.0 International license. 2 26 Abstract 27 28 Rifaximin is a low solubility antibiotic with activity against a wide range of bacterial 29 pathogens.
    [Show full text]
  • Prevention of Post-Metronidazole Candidosis with Amphotericin B Pessaries*
    Br J Vener Dis: first published as 10.1136/sti.45.2.163 on 1 June 1969. Downloaded from Brit. J. vener. Dis. (1969), 45, 163 PREVENTION OF POST-METRONIDAZOLE CANDIDOSIS WITH AMPHOTERICIN B PESSARIES* BY LEONARD Z. OLLER St. Luke's Hospital, Bradford Trichomonas vaginalis and Candida albicans are vagina in about 80 per cent. of cases treated with the two organisms most commonly responsible for one pessary nightly for 14 days. Although similar an excessive irritating vaginal discharge (Danezis results, a cure rate of 78 per cent., were attained and Marsellou, 1960). It has been suggested that in by Csonka (1967), he found Nystatin somewhat the last few years, as a result of the widespread more effective when comparing the effect of one use of antibiotics, Candida infection has become amphotericin B pessary with that of two Nystatin the principal cause of vulvovaginitis (Rohatiner, pessaries inserted nightly for 15 days. 1966; Rohatiner and Grimble, 1967). Metronida- zole has also been incriminated in this way. Vaginal Clinical Material and Methods candidosis developed during treatment in three of copyright. At the Venereal Diseases Clinic, St. Luke's Hospital, 42 women treated with the drug by Moffett and Bradford, during a period of 4 months in 1966 and one McGill (1960), giving rise in two cases to severe or of 5 months in 1967 (with an interval of 7 months during moderately severe symptoms. The number of which the clinic was under reconstruction), 113 women patients with C. albicans demonstrated in the were found at some stage of their attendance to have a vaginal discharge after treatment with metronida- trichomonal infestation.
    [Show full text]
  • Rifaximin (XIFAXAN)
    Rifaximin (XIFAXAN) for Irritable Bowel Syndrome with Diarrhea National Drug Monograph March 2016 VA Pharmacy Benefits Management Services, Medical Advisory Panel, and VISN Pharmacist Executives The purpose of VA PBM Services drug monographs is to provide a focused drug review for making formulary decisions. Updates will be made when new clinical data warrant additional formulary discussion. Documents will be placed in the Archive section when the information is deemed to be no longer current. FDA Approval Information Description/Mechanism of Minimally absorbed, broad-spectrum antibacterial that inhibits bacterial RNA Action synthesis. The specific mechanism of action of rifaximin in irritable bowel syndrome (IBS) has not been determined. The most likely mechanism of rifaximin is reduction in overall bacterial load, particularly in the large bowel1; however, rifaximin also seems to modulate gut microenvironment and produce cytoprotective effects.2 Indication(s) Under Review in Treatment of IBS with diarrhea (IBS-D) in adults this Document Dosage Form(s) Under 550 mg tablet Review REMS REMS No REMS Postmarketing Requirements Pregnancy Rating No data available on pregnant women to inform any drug associated risks. Executive Summary Efficacy Rifaximin had a small, statistically significant beneficial effect relative to placebo in global IBS symptom response using pooled data: 40.7% vs. 31.7%, with a difference of 9.0 percentage points, p < 0.001; NNT = 11. Rifaximin had a small, statistically significant beneficial effect relative to placebo in terms of the response rate for adequate relief of bloating (the key secondary efficacy measure): 40.2% vs. 30.3%, difference of 9.9 percentage points, p < 0.001; NNT = 10 (pooled results).
    [Show full text]
  • What's New with ADHD?
    winter 2020 | volume 34 | issue 1 A journal of Dayton Children’s Hospital what’s new with ADHD? by Mollie Walton, MD and Craig Boreman, MD 1 learning objectives recommended (CPG) and the 2011 behavioral rating scales revision, the AAP Following the completion of this article, to help establish the collaborated with the reader should be able to: diagnosis, and outlined several organizations 1. Utilize the updated clinical practice standards for follow-up to form an ADHD guideline for diagnosis and treatment and monitoring.12 The subcommittee un- of ADHD. guidelines were revised der the oversight of 2. Describe the approach to the evaluation in 2011 and published the AAP Council on and treatment of ADHD in the primary with an accompany- Quality Improvement practice setting. ing process of care and Patient Safety.13 3. Give examples of co-existing conditions algorithm (PoCA). The This subcommittee’s associated with ADHD. major change with this membership included revision was the appli- representation of a cable age for diagnosis wide range of primary Attention-deficit/ toms tend to persist.1, 2 and treatment, previ- care and subspecial- hyperactivity Learning and language ously 6-12 years of age, ty groups. The group difficulties are common and was broadened met over a 3.5-year disorder (ADHD) comorbid conditions to include age 4- to period (2015-2018) to is one of the most associated with ADHD.3 6-year-olds and review practice chang- common neuro- Boys are twice as likely as adolescents up to es and newly identified behavioral girls to receive the ADHD age 18 years.12 Since issues since the 2011 4, 5, 6 disorders of diagnosis, perhaps the release of the guidelines.
    [Show full text]
  • Common Oral Antibiotics for Horses Antibiotics Are Commonly Used In
    Common Oral Antibiotics for Horses Antibiotics are commonly used in horses for a variety of conditions. In order to determine which antibiotic is appropriate for a specific condition, a culture of the affected area needs to be performed. The culture is sent to a lab where the bacteria are grown and identified. A sensitivity test is then performed to find out which antibiotics will be effective. Some of the more common oral antibiotics in horses include trimethoprim sulfa, metronidazole, enrofloxacin, and chloramphenicol. Trimethoprim sulfa (SMZ, TMS, sulfa tabs) is an antibiotic which has a broad spectrum of activity against a variety of bacteria. It is broken down by the liver and excreted in the urine. Side effects of this drug include diarrhea, allergic reactions, and effects on the blood, including decreased number of red blood cells (anemia), decreased number of platelets (thrombocytopenia), and decreased number of white blood cells (leucopenia). Trimethoprim sulfa commonly comes in 960mg tablets. The dose range for horses is 15-30 mg/kg. Generally, 10 tablets administered orally for a 1000lb horse is effective. This medication is given twice a day (every 12 hours) and is best absorbed if given without food. Trimethoprim sulfa may be prescribed by your veterinarian for simple wounds, such as those on the face or legs. Metronidazole is an antibiotic commonly used for anaerobic (bacteria which can grow in the absence of oxygen) infections. For example, deep puncture wounds, respiratory infections, peritonitis, soft tissue infections, and abscesses are infections that often involve anaerobic bacteria.. It is broken down by the liver and excreted in the urine and in the feces.
    [Show full text]
  • Therapeutic Class Overview Irritable Bowel Syndrome and Constipation Agents
    Therapeutic Class Overview Irritable Bowel Syndrome and Constipation Agents INTRODUCTION Irritable bowel syndrome (IBS) is a gastrointestinal disorder that most commonly manifests as chronic abdominal pain and altered bowel habits in the absence of any organic disorder (Wald 2017). IBS may consist of diarrhea-predominant (IBS-D), constipation-predominant (IBS-C), IBS with a mixed symptomatology (IBS-M), or unclassified IBS (IBS-U). Switching between the subtypes of IBS is also possible (Ford et al 2018). IBS is a functional disorder of the gastrointestinal tract characterized by symptoms of abdominal pain, discomfort and bloating, and abnormal bowel habits with bouts of diarrhea and/or constipation. The exact pathogenesis of the disorder is unknown; however, it is believed that altered gastrointestinal tract motility, visceral hypersensitivity, autonomic dysfunction, and psychological factors indicate disturbances within the enteric nervous system, which controls the gastrointestinal system (Andresen et al 2008, Ford et al 2009, Quigley et al 2012, World Gastroenterology Organization [WGO] 2015). Prevalence estimates of IBS range from 10 to 12%, and it typically occurs in young adulthood (Ford et al 2018). IBS-D is more common in men, and IBS-C is more common in women (WGO 2015). Symptoms of IBS often interfere with daily life and social functioning (WGO 2015). The general goals of therapy in IBS are to alleviate the patient’s symptoms and to target any specific exacerbating factors (eg, medications, dietary changes), concerns about serious illness, stressors, or potential psychiatric comorbidities that may exist (Wald 2017). Non-pharmacological interventions to combat IBS symptoms include dietary modifications such as exclusion of gas- producing foods (eg, beans, prunes, Brussel sprouts, bagels, etc.), and consumption of probiotics, as well as psychosocial therapies (eg, hypnosis, biofeedback, etc.) (Ford et al 2018).
    [Show full text]