Fomepizole as an Antidote for Ethylene Glycol Poisoning

2002 ◽  
Vol 36 (6) ◽  
pp. 1085-1089 ◽  
Author(s):  
Marisa Battistella
Keyword(s):  
Ethylene Glycol ◽  
English Language ◽  
Case Reports ◽  
Controlled Trial ◽  
Prospective Trial ◽  
Data Synthesis ◽  
Medline Search ◽  
Randomized Controlled ◽  
Search Terms ◽  
Ethylene Glycol Poisoning

OBJECTIVE: To assess the use of fomepizole in the treatment of ethylene glycol poisoning in the absence of hemodialysis. DATA SOURCES: A MEDLINE search (1966–May 2001) of English-language literature pertaining to the use of fomepizole in ethylene glycol poisoning was performed. Key search terms included fomepizole, ethylene glycol poisoning, and hemodialysis. References cited in those articles were also evaluated. DATA SYNTHESIS: Results from a number of case reports and a prospective trial suggest that fomepizole is a safe and effective antidote in the treatment of ethylene glycol poisoning. CONCLUSIONS: Case reports and 1 prospective trial have shown that, in the absence of both renal dysfunction and significant metabolic acidosis, the use of fomepizole should obviate the need for hemodialysis. However, the decision to add hemodialysis in the treatment of ethylene glycol poisoning based on plasma ethylene glycol concentrations is still debatable. A randomized, controlled trial is needed to determine the exact criteria for adding hemodialysis.

Phenytoin in the Treatment of Epidermolysis Bullosa

1997 ◽  
Vol 13 (1) ◽  
pp. 10-14
Author(s):  
Mersedeh Moshfeghi ◽  
Ghazala M Contractor
Keyword(s):  
Clinical Study ◽  
Epidermolysis Bullosa ◽  
English Language ◽  
Case Reports ◽  
Data Extraction ◽  
Controlled Trial ◽  
Controlled Study ◽  
Data Synthesis ◽  
Medline Search ◽  
Randomized Controlled

Objective: To review the efficacy of phenytoin in the treatment of epidermolysis bullosa (EB). Data Sources: English-language clinical study reports, abstracts, case reports, and review articles pertaining to the use of phenytoin in the treatment of EB (MEDLINE search, January 1973-August 1996). Data Extraction: Clinical study and case reports evaluating the effect of phenytoin in the treatment of EB were reviewed, and the methodology, results, and conclusions of the studies were evaluated. Because of the limited number of randomized, controlled study reports, all available case reports were reviewed, and information we considered pertinent was synthesized. Data Synthesis: Results of studies of EB suggest that the blister fluid and fibroblasts in patients with this disease produce an increased amount of collagenase, which is thought to induce blistering. Phenytoin inhibits collagenase synthesis and/or secretion and, therefore, is used to treat patients with EB. Data regarding the use of phenytoin in patients with EB, especially those with recessive dystrophic EB, revealed that phenytoin may reduce the number of blisters in these patients. Dosage recommendations and monitoring parameters are also discussed. Conclusions: More randomized, controlled trials are needed to determine the true efficacy of phenytoin in the treatment of EB. Although the only available report of a randomized, controlled trial reported a lack of phenytoin efficacy in patients with EB, it does not rule out the possibility of success in selected patients.

Levodopa Therapy and the Risk of Malignant Melanoma

2000 ◽  
Vol 34 (3) ◽  
pp. 382-385 ◽  
Author(s):  
Jolene F Siple ◽  
Diana C Schneider ◽  
Wendy A Wanlass ◽  
Burton K Rosenblatt
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Malignant Melanoma ◽  
English Language ◽  
Case Reports ◽  
Levodopa Therapy ◽  
Data Sources ◽  
Data Synthesis ◽  
Medline Search ◽  
Search Terms

OBJECTIVE: To evaluate the use of levodopa therapy in patients with Parkinson's disease and malignant melanoma. DATA SOURCES: A MEDLINE search (January 1966–September 1999) of English-language articles was conducted. Key search terms included levodopa, melanoma, and Parkinson's disease; 34 case reports were identified. DATA SYNTHESIS: Carbidopa/levodopa continues to be a mainstay in the treatment of Parkinson's disease. Since the late 1970s, a warning has appeared in the prescribing literature for levodopa regarding the risk of activating malignant melanoma. An evaluation was conducted of the case reports in which a causal relationship between levodopa and melanoma was suggested. CONCLUSIONS: There is an unlikely association between levodopa and induction or exacerbation of malignant melanoma.

Isoniazid-Associated Psychosis: Case Report and Review of the Literature

1993 ◽  
Vol 27 (2) ◽  
pp. 167-170 ◽  
Author(s):  
Karen A. Pallone ◽  
Morton P. Goldman ◽  
Matthew A. Fuller
Keyword(s):  
Case Report ◽  
English Language ◽  
Case Reports ◽  
Data Extraction ◽  
Data Sources ◽  
Review Of The Literature ◽  
Data Synthesis ◽  
Medline Search ◽  
Study Selection ◽  
Language Literature

Objective To describe a case of isoniazid-associated psychosis and review the incidence of this adverse effect. Data Sources Information about the patient was obtained from the medical chart. A MEDLINE search of the English-language literature published from 1950 to 1992 was conducted and Index Medicus was manually searched for current information. Study Selection All case reports describing isoniazid-associated psychosis were reviewed. Data Extraction Studies were evaluated for the use of isoniazid, symptoms of psychosis, onset of symptoms, and dosage of isoniazid. Data Synthesis The case report is compared with others reported in the literature. The incidence of isoniazid-associated psychosis is rare. Conclusions The mechanism of isoniazid-associated psychosis is uncertain. It appears that isoniazid was associated with the psychosis evident in our patient and in the cases reviewed.

Dexrazoxane: A New Cardioprotective Agent

1998 ◽  
Vol 14 (5) ◽  
pp. 182-190 ◽  
Author(s):  
Beverly D Abbott ◽  
Cindy M Ippoliti
Keyword(s):  
Supportive Care ◽  
English Language ◽  
Bolus Dose ◽  
Cardiac Tissue ◽  
Data Extraction ◽  
Data Synthesis ◽  
Medline Search ◽  
Search Terms ◽  
Study Selection ◽  
Clinically Significant

Objective: To review the literature discussing the use of dexrazoxane (e.g., Zinecard, ICRF-187) to prevent doxorubicin-induced cardiotoxicity. Data Sources: Pertinent English-language reports of studies in humans were retrieved from a MEDLINE search (January 1980-January 1997); search terms included chelating agents, razoxane, dexrazoxane, Zinecard, ICRF-187, ADR-529, and ICRF-159. Study Selection: Representative articles discussing the chemistry, pharmacology, pharmacokinetics, dosing, and administration of dexrazoxane and those discussing clinical trials were selected. Data Extraction: Data were extracted and analyzed if the information was relevant and consistent. Studies were selected for review in the text on the basis of study design and clinical end points. Data Synthesis: Dexrazoxane is a chemoprotective agent developed to prevent cardiac tissue toxicity. Dexrazoxane exerts a cardioprotective effect with some clinically significant toxicities; it may also interfere with the antitumor activity of doxorubicin. Until there are sufficient data to support its use in first-line supportive care therapy, dexrazoxane should be reserved for use in patients responding to doxorubicin-based chemotherapy but who have risk factors for cardiac toxicity or have received a cumulative doxorubicin bolus dose of 300 mg/m2. Conclusions: The management of doxorubicin-induced cardiotoxicity has led to the development of supportive care drugs that specifically counteract the dose-limiting toxicities. Dexrazoxane may not completely eliminate the concern about doxorubicin-induced cardiotoxicity, but it may open new avenues for continuing doxorubicin-based chemotherapy.

Drug-Associated Guillain-Barré Syndrome: A Literature Review

1996 ◽  
Vol 30 (2) ◽  
pp. 173-180 ◽  
Author(s):  
Ingrid E Awong ◽  
Kenneth R Dandurand ◽  
Christopher A Keeys ◽  
Felix A Khin Maung-Gyi
Keyword(s):  
English Language ◽  
Human Subjects ◽  
Case Reports ◽  
Guillain Barre Syndrome ◽  
Current Management ◽  
Data Synthesis ◽  
Search Terms ◽  
Chemically Induced ◽  
Guillain Barré Syndrome ◽  
Guillain Barré

OBJECTIVE: To present an overview of reported drug-associated Guillain-Barré syndrome (GBS) and current management of the disease. DATA SOURCES: Case reports and reviews of drug-associated GBS published in the English-language literature from 1982 through 1994 were retrieved from MEDLINE. An additional search was done through the Iowa Drug Information System for the same period. This search yielded incidents that occurred as early as 1976. The key search terms were GBS, polyneuropathy, chemically induced polyradiculoneuropathy, and etiology of GBS. The searches were limited to human subjects. DATA SYNTHESIS: Drugs that have been associated with GBS are presented, and although no definite relationships have been established, selected reports attempt to show an increased incidence of GBS after drug therapy. Outcome of medical management of GBS has been variable; however, death occurs in less than 10% of those affected. CONCLUSIONS: GBS and clinically similar states have been reported to occur with a variety of drugs and biologics; however, because of the paucity of available data a well-defined cause and effect relationship has not been established between GBS and any drug. There appears to be no treatment of choice for this disorder. Further comparative studies should be done to determine the therapy with the most consistent outcome.

Acetazolamide in the Treatment of Seizures

1996 ◽  
Vol 30 (5) ◽  
pp. 514-519 ◽  
Author(s):  
William G Reiss ◽  
Karen S Oles
Keyword(s):  
English Language ◽  
Adverse Reactions ◽  
Case Reports ◽  
Data Synthesis ◽  
Medline Search ◽  
Study Selection ◽  
Clonic Seizures ◽  
Antiepileptic Medications ◽  
Patients With Epilepsy ◽  
Dosage Administration

OBJECTIVE: TO summarize the pharmacology, pharmacokinetics, efficacy, and safety of acetazolamide and to evaluate its therapeutic role in patients with epilepsy. DATA SOURCES: A computerized search of the MEDLINE (OVID) database (1966–1994) was used to identify publications regarding acetazolamide. The MEDLINE search was supplemented by information from textbooks. STUDY SELECTION: Included were English-language review articles, clinical trials, cohort studies, and case reports. Topics investigated included basic pharmacology, therapeutics, toxicology, adverse reactions, dosage, administration, and pharmacokinetics of acetazolamide. DATA SYNTHESIS: Acetazolamide, a carbonic anhydrase inhibitor, has been approved for the treatment of epilepsy since 1953. Acetazolamide is primarily used in combination therapy with other antiepileptic medications in both children and adults although it may be used as monotherapy. Drug concentration monitoring has not been found to be routinely beneficial. Adverse effects include kidney stones, metabolic acidosis, lethargy, appetite suppression, paresthesias, and rare blood dyscrasias. Partial tolerance may develop to the antiepileptic activity. CONCLUSIONS: Acetazolamide is a beneficial adjunctive agent in the pharmacotherapy of epilepsy and should be considered in refractory epilepsy. Although it may be useful in partial, myoclonic, absence, and primary generalized tonic—clonic seizures uncontrolled by other marketed agents, acetazolamide has been inadequately studied by current standards and its use has been limited.

Mitomycin-Induced Pulmonary Toxicity: Case Report and Review of the Literature

1992 ◽  
Vol 26 (4) ◽  
pp. 481-484 ◽  
Author(s):  
Donna C. Linette ◽  
Karen H. McGee ◽  
James A. McFarland
Keyword(s):  
Pulmonary Toxicity ◽  
English Language ◽  
Case Reports ◽  
Data Extraction ◽  
Vinca Alkaloid ◽  
Corticosteroid Treatment ◽  
Data Synthesis ◽  
Medline Search ◽  
Pulmonary Response ◽  
Study Selection

OBJECTIVE: This report describes a case of mitomycin-induced pulmonary toxicity and reviews the incidence of this adverse effect, reported patterns of toxicity and associated dosages of the drug, and the use of corticosteroids in the management of pulmonary toxicity. DATA SOURCES: Information about our patient was obtained in part from the medical chart; we had also treated him personally in the past. We conducted a MEDLINE search of the English language literature (restricted to human studies) from 1966 to 1991 and manually searched Index Medicus for current information. STUDY SELECTION: All case reports that described pulmonary toxicity possibly associated with mitomycin were reviewed. DATA EXTRACTION: Studies were evaluated for the dosages of mitomycin given to patients, the nature and onset of symptoms, management course, and corticosteroid use. DATA SYNTHESIS: Our case is similar to others described in the literature. The incidence of mitomycin-induced pulmonary toxicity has been reported to range from 2 to 38 percent. Concurrent vinca alkaloid administration may potentiate the risk of an acute pulmonary insult secondary to mitomycin use. The toxicity is usually of slow onset and the average total dosage of drug implicated is 78 mg. A formal evaluation of corticosteroid treatment has not been performed, but various authors have reported success with different regimens. CONCLUSIONS: The incidence of pulmonary toxicity associated with mitomycin is unpredictable, but more likely to occur at higher dosages. Treatment with corticosteroids is encouraged to improve pulmonary response.

Challenges in Treating Chlamydia trachomatis, Including Rectal Infections: Is It Time to Go Back to Doxycycline?

2021 ◽  
pp. 106002802110299
Author(s):  
S. Lena Kang-Birken
Keyword(s):  
Chlamydia Trachomatis ◽  
Treatment Failure ◽  
English Language ◽  
Treatment Guidelines ◽  
Case Reports ◽  
Controlled Trial ◽  
Absolute Difference ◽  
Cochrane Library ◽  
Increased Risk ◽  
Meta Analyses

Objective: To evaluate recent publications on efficacy of single-dose azithromycin and 7-day doxycycline when treating Chlamydia trachomatis. Data Sources: A literature search of MEDLINE, EMBASE, PubMed, and Cochrane library was conducted (1990 to June 13, 2021) using the terms: Chlamydia trachomatis, genital chlamydia, rectal chlamydia, extragenital chlamydia, azithromycin, doxycycline, and treatment guidelines. ClinicalTrials.gov was searched to identify ongoing trials. Study Selection and Data Extraction: English language studies, including controlled studies, retrospective analyses, systematic reviews, meta-analyses, and case reports, reporting microbiological or clinical outcomes in adolescents and adults were considered. Data Synthesis: Systemic reviews and meta-analyses of randomized trials reported azithromycin efficacy of 96% to 97% in genital chlamydia. However, reports of treatment failure have emerged, especially among symptomatic males, with an increased risk of microbiological failure after azithromycin than doxycycline (relative risk = 2.45; 95% CI = 1.36-4.41). Retrospective analyses and prospective observational cohort studies reported lower efficacy range following azithromycin than doxycycline (74%-87% vs 92%-100%, respectively) in rectal chlamydia. First randomized controlled trial comparing azithromycin and doxycycline reported significantly higher microbiological cure following doxycycline, with absolute difference of 26% (95% CI = 16%-36%; P < 0.001). The proposed 2021 Centers for Disease Control and Prevention treatment guidelines designate doxycycline as the preferred agent for treatment at any site. Relevance to Patient Care and Clinical Practice: A growing body of evidence for treatment failure following azithromycin, especially in rectal chlamydia supports updating current practice. Conclusions: Doxycycline continues to achieve high efficacy in genital and rectal chlamydia. Clinicians should consider efficacy with convenience of dosing regimen, medication compliance, and sexual behavior risks when treating chlamydia infections.

The Need for Routine Bleomycin Test Dosing in the 21st Century

2005 ◽  
Vol 39 (11) ◽  
pp. 1897-1902 ◽  
Author(s):  
Masha SH Lam
Keyword(s):  
Clinical Trials ◽  
English Language ◽  
Case Reports ◽  
Mail Survey ◽  
Signs And Symptoms ◽  
Test Dose ◽  
Host Cells ◽  
High Grade Fever ◽  
Search Terms ◽  
E Mail

OBJECTIVE To review the clinical evidence for routine use of bleomycin test dosing. DATA SOURCES English-language review articles, references from retrieved articles, case reports, and clinical trials were identified from a MEDLINE literature search (1966–July 2005). Key search terms included bleomycin, test dose, anaphylactic reactions, and hypersensitivity. Information from an unpublished E-mail survey, the manufacturer, and the Internet was also used. DATA SYNTHESIS Early clinical trials and isolated case reports suggest that bleomycin-induced acute hypersensitivity reactions occur in 1% of patients with lymphoma and <0.5% of those with solid tumors. The reactions are mainly characterized by high-grade fever, chills, hypotension, and in a few cases, cardiovascular collapse, which can lead to death. The exact mechanism of these reactions is unclear, but is thought to be related to the release of endogenous pyrogens from the host cells. Evidence does not suggest any correlation between doses and the onset or severity of the reactions. Supportive care, including hydration, steroids, antipyretics, and antihistamines, may resolve the symptoms. However, it may not completely prevent recurrences. CONCLUSIONS The incidence of acute hypersensitivity or hyperpyrexic reactions associated with bleomycin is very low, but the reaction is potentially fatal. Clinicians should monitor their patients for any signs and symptoms of acute hyperpyrexic reactions during bleomycin administration. Since the onset of the reactions can occur with any dose of bleomycin and at any time, routine test dosing does not seem to predict when drug reactions may occur.

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