Augmentin :: Multiple pharmacies comparison.

Pamphlet by: National Kidney and Urologic Diseases Information Clearinghouse - Urinary tract infection in adults - Pamphlet

admin — Tue, 02 Dec 2008 08:11:02 +0000

Beta-lactam antibiotics include penicillins, cephalosporins and related compounds. As a group, these drugs are active against many gram-positive, gram-negative and anaerobic organisms. Information based on “expert opinion” and antimicrobial susceptibility testing supports certain antibiotic choices for the treatment of common infections, but less evidence-based literature is available to guide treatment decisions. Evidence in the literature supports the selection of amoxicillin as first-line antibiotic therapy for acute otitis media. Alternative drugs, such as amoxicillin-clavulanate, trimethoprim-sulfamethoxazole and cefuroxime axetil, can be used to treat resistant infections. Penicillin V remains the drug of choice for the treatment of pharyngitis caused by group A streptococci. Inexpensive narrow-spectrum drugs such as amoxicillin or trimethoprim-sulfamethoxazole are first-line therapy for sinusitis. Animal and human bites can be treated most effectively with amoxicillin-clavulanate. For most outpatient procedures, amoxicillin is the preferred agent for bacterial endocarditis prophylaxis. Beta-lactam antibiotics are usually not the first choice for empiric outpatient treatment of community-acquired pneumonia. Based on the literature, the role of beta-lactam antibiotics in the treatment of bronchitis, skin infections and urinary tract infections remains unclear. (Am Fam Physician 2000;62:611-20.)

“I Do Not Have Health Insurance”

admin — Sat, 29 Nov 2008 16:41:05 +0000

Several times per week, I have a posting on the Ear, Nose, and Throat message board that mentions that the person posting does not have insurance, or does not have the financial resources to pay for a medical visit. With the economic crisis we are all facing at this time in history, I suspect we will see more and more uninsured Americans. One physician in our office stated just today that three of his patients lost their jobs, along with their insurance, and would not be returning for on-going care. This is just the tip of the financial iceberg.For the most part, medical care in the United States is embarrassingly expensive. Since I am on the inside, I am often in a position to justify many of those charges to my patients. Insurance is equally as expensive and not all people have insurance benefits with their jobs. In most states, automobile insurance is required - it is the law. Health insurance is optional. I find that inconsistent with common sense since a liver transplant is considerably more expensive than fixing your bent bumper. Unless you have unlimited resources, going without health insurance will devastate your family in the event of a medical crisis. The government will end up paying the costs for the uninsured only after your resources have been depleted. The U.S. does not have universal health insurance, so those people without insurance must pay for their medical care.When I was a child back in the 1950’s, we had one general practitioner in our town. I don’t believe my parents had any insurance. An office visit was $3.00 (this included medications in most cases), and a house call was $5.00. Even at those prices, adjusted for the 1950’s, this was still a pretty good deal. We were a lower income family; so fortunately, I did not have to utilize medical care very often. At age 18, I had appendicitis, but my mother must have had health insurance by that time, otherwise she would have told me how much it cost.The cost of a routine office visit in my practice is $141.00, or at least this is what is billed to the insurance companies. Insurance companies typically negotiate these fees and will reimburse considerably less. A cash-paying patient will pay about $98. There are some quick-clinics at the local pharmacy that charges about $65. An urgent care clinic will charge about $75. People who have insurance will typically pay a co-payment of $10 - $30 for their entire out-of-pocket expenses.Like medical care itself, insurance premiums are astronomical. I have many infants and children in my practice, some who were born with special needs. A parent of a 2-year-old child last week told me that her medical bills are over three million dollars (so far). It only takes a few of those for insurance companies to raise their rates on healthy people to make up for it. In Ancient China, doctors were paid a fee to keep people well. If you became sick, the doctor had to pay you!I have always been very sensitive about charges, but in my current practice, I have no control over fees that are charged by the medical foundation. I am on salary. If I were in private practice, I would have been bankrupt from giving away free or discounted care. The cost of routine medical care has skyrocketed to the point of embarrassment. The cost of using liquid nitrogen to freeze off ONE common wart is about a $150, and one treatment may not do the job.When I see a patient or perform a procedure, I put down a billing code that represents what I have done, the complexity of the visit, and the time spent. This code is translated into a bill, either sent to the patient or the insurance carrier. I am basically out of the loop.Medical providers can “down-code”. In other words, they can put down a lesser billing code than what was done. Providers can also not charge for certain “simple and quick” procedures, like removing ear wax. The cost of removing earwax in my office is well over a hundred dollars for the procedure alone. If it only takes me a minute or so to clear out that ear canal so that I can properly see the eardrum, then I do not charge extra. However, if I spend a half hour digging out an impacted amount of earwax from some obsessive Q-tip user, I am going to charge extra - about the cost of 30 boxes of Q-tips.When I know that a patient is private-pay (paying with cash or credit card), I tend to down-code or cut them a break if I can. If I have samples, I tend to give it to them. There is nothing like paying for an expensive office visit, only to be dinged again at the pharmacy. Medication costs have skyrocketed, too.When the antibiotic Augmentin first came out, it was expensive compared to plain ‘ol amoxicillin. A full-course to treat a middle ear infection in a child could be $65 to $80 or more; amoxicillin was only about $10 or $15. My wife and I were traveling in New Zealand years ago, so I compared some of those prices with a Kiwi pharmacist (chemist). Augmentin in New Zealand only cost about $8.00 and was from the same pharmaceutical company. Why? According to the chemist, the entire country of New Zealand negotiated a lower price - and the cost is not increased to the consumer. In the U.S., we pay top dollar for the same medication. Of course, Augmentin is generic now, and the price has dropped (sort of).The Veterans Administration and some large HMOs do negotiate for cheaper medications for their patients. When I worked for the VA years ago, it would drive me crazy. I would get someone controlled on one blood pressure medication, only to discover that it was now not available. I would have to change it to another one. Six months later, I would be told that that medication is not available, and I would have to go back to the original one that is now suddenly available again, now at a cheaper cost the government, of course.The cost of medications has driven many Americans across the border to Canada or Mexico looking for deals. This practice is highly discouraged by our government, and is really illegal in some respects. People on fixed incomes who are paying more than half of their monthly income for medications for cholesterol, blood pressure, or diabetes are desperately looking for ways to reduce their costs. Smuggling medications across the border happens every day. I have personally witnessed people being hassled over a bottle of blood pressure medications they bought in Mexico, while tons of cocaine and marijuana seem to make it across okay.Our government sites safety as their primary concern. Fake medications made in China are showing up everywhere, even in the U.S. Look-alike medications are being sold by the ton in Mexico to tourists. When someone shells out some cold hard cash for a bottle of Viagra before the cruise ship leaves, there is little recourse when those little blue pills fail to work. Maybe you get the real Viagra, but maybe your little blue pill is just that - a little blue placebo from China. Personally, I would not have any problem buying medication in Canada, but I would be a bit leery of some of those Mexican pharmacies along the border.When it comes to buying food or buying gasoline, someone without health insurance tends to set priorities. Food comes first, followed by rent or mortgage. Then comes automobile costs. The lowest on the list tends to be routine medical and preventative health care. Emergency medical care tends to get attention, even in the worst of economies. When you have an arrow sticking out of your head, you don’t typically wait a few days to see if it goes away on its own. A guy in a neighboring community was shooting arrows into the air. Not understanding gravity, he inadvertently hit himself in the head with one of those falling arrows. He hesitated going to the ER because he did not have insurance. I am surprised that the arrow didn’t go all the way through since there appeared to be nothing inside his skull.If you don’t have auto insurance, you are screwed if you wreck your car. If you blow your engine because you can’t afford routine maintenance and oil changes, you are screwed because auto insurance does not pay for repairs. If you do not have health insurance, and choose to ignore your crushing chest pain, you may not need health insurance anymore - you so need life insurance for your family. If you do not go to the doctor because you have a cold, you will probably be fine. Colds are self-limiting and you don’t really need a doctor to tell you that again and again. Of course, if your cold seems to be turning into pneumonia, you are going to have to make a big decision. Should I take the chance of dying, or use my credit card or hard-earned cash to get some medical care? Get the care. Borrow some money or worry about paying the credit card later.My auto mechanic charges $90 per hour (even if he fixes my car in five minutes). He is a high school graduate and makes more than my own hourly rate in my clinic. Is it fair? Probably; he can fix my car - I cannot. Of course, when he cuts open his head when he slips on some grease, I am not going to reduce his cost by down-coding him. I am going to get even.Related Topics: 45.7 Million in U.S. Lack Health InsuranceHealth Insurance Costs Climb Again

Journal of Orthopaedic Surgery - Nocardia nova septic arthritis following total knee replacement: a case report

admin — Fri, 28 Nov 2008 10:01:02 +0000

ABSTRACT
We describe a case of Nocardia nova septic arthritis following a total knee replacement. A 55-year-old obese woman was admitted to hospital 5 months after knee surgery with a 3-week history of pain, swelling, and restricted mobility in her left knee but no preceding trauma/injury. 30 ml of cloudy joint fluid was aspirated and an arthroscopic examination showed extensive fibrin formation and synovitis. An arthroscopic washout was carried out using 16 litres of saline, followed by total synovectomy and intensive antibiotic therapy (clarithromycin 500 mg twice daily and co-trimoxazole [sulphamethoxazole 400 mg and trimethoprim 80 mg] once daily and augmentin duo forte 875 mg twice daily). At 2.5 years, the patient had recovered completely with no prosthetic loosening.

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Key words: arthritis, infectious; arthroplasty, replacement, knee; Nocardia
INTRODUCTION
The Nocardia species belong to the actinomycetaceae family, which are saprophytes found in soil. They are environmentally ubiquitous, and have been found in soil, water (fresh and salt), decaying vegetation, animal faecal deposits, and dust.1,2 They are gram positive and strictly aerobic and seen as variably acid-fast, filamentous, branching rods (Fig.) They were first described by Nocard in 1888 in a case of bovine lymphadenitis. Approximately half of the nocardial species are recognised human and/or animal pathogens able to cause a wide range of diseases from cutaneous infections through inoculation/trauma to infections of the central nervous system, myocardium, joints, ocular (retina) system, renal system, bones and lungs.3,4 They can also infect debilitated or immunocompromised individuals.5,6 Few cases of Nocardia joint infections have been reported.7,8 One case was reported in the hip prosthesis of a patient with severe systemic lupus erythematosus. We report a case of sepsis in a total knee replacement caused by cutaneous nocardiosis.
CASE REPORT
A 55-year-old obese woman (body mass index, 45.2) presented with bilateral, severe knee osteoarthritis causing pain, restriction in mobility and range of movement, and bilateral 15 valgus deformities. She had a history of well-controlled hypertension and non-symptomatic gout. Her right knee was successfully managed with a cemented total knee replacement in March 2001. Nine months later she underwent arthroplasty to her left knee.
A midline incision and subvastus approach was used. The femoral and tibial surfaces were prepared and an uncemented Natural porous femoral component (Zimmer, Warsaw [IN], US) and an uncemented tibial component were inserted with screws and a cemented patella button. No drains were used. She was given a cocktail of local anaesthetic agents and a pain catheter was left in situ for 24 hours, then removed before discharge.
She made an uneventful recovery and at the 5- week follow-up had a well-healed surgical scar with no signs of infection, was mobilising fully weight bearing, independently and unaided with a range of movement of 3 to 110 (which improved to 0-125 6 weeks later). The knee was stable with good patellar tracking. The postoperative radiographs were satisfactory, showing the prosthesis well seated.
Five months after the left knee surgery, she was admitted to hospital with a 3-week history of pain, swelling and restricted mobility in her left knee, but no preceding trauma or injury. She had a temperature of 38C, and the knee was swollen and reddened by a local effusion and in fixed flexion of 15 with a maximum flexion of 40. Her white cell count (WCC) was 12.3×109/l, C-reactive protein (CRP) was 95 mg/l, and the erythrocyte sedimentation rate (ESR) was 92 mm/hr. Plain radiographs showed no evidence of loosening. Needle aspiration of the left knee under sterile conditions yielded 30 ml of cloudy joint fluid, which was sent for microbiological analysis. A diagnosis of septic arthritis was made and the knee was aspirated again. An arthroscopic examination through standard anteromedial and anterolateral portals showed extensive fibrin formation and synovitis. An arthroscopic washout using 16 litres of saline was carried out, followed by a total synovectomy.
A staphylococcal infection was suspected and the patient was given high dose intravenous vancomycin until the results of the aspirate culture became available. She continued to receive oral rifampicin 300 mg twice daily and sodium fucidate 250 mg 3 times daily.
The aspirate revealed pus cells, but no organisms were seen on microscopy. A mycobacterium-like organism grew on broth cultures. Direct cultures grew an organism branching on gram and acid fast bacilli staining at 24 and 48 hours, with white central aerial hyphae. Nocardia nova was eventually isolated.
Ten days after the knee washout, while sensitivities were still pending, the patient was commenced on clarithromycin 500 mg twice daily and co-trimoxazole (sulphamethoxazole 400 mg and trimethoprim 80 mg) once daily. The knee swelling reduced and the range of movement increased so the patient was discharged after 10 days. On discharge her WCC was 11.95 x109/l, CRP 45.3 mg/l, and ESR 108 mm/hr. She was closely monitored post-discharge by both the operating surgeon and microbiologist.

Chain Drug Review - Generic access.(Generic Drugs)(GlaxoSmithKline PLC cases)(Brief Article)

admin — Sat, 22 Nov 2008 12:26:03 +0000

An 18-year-old Caucasian woman came to the emergency department with a pruritic rash and localized swelling, most marked in the periorbital area. The rash had started 5 days earlier on her upper lip and subsequently spread to her face and upper chest.
Two days before, the patient was treated with amoxicillin/clavulanate (Augmentin), prednisone, and hydroxyzine (Atarax), but her symptoms worsened. She said she felt feverish but did not have any visual disturbances. She had no contacts with others ill with herpes or Varicella, although she did admit to having an unprotected sexual encounter 2 weeks before the rash’s onset. Her medical history was significant for untreated atopic dermatitis.

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On exam, the patient was afebrile and had a diffuse maculopapular rash with areas of confluence over her face and hands (Figure 1). The face and hands also showed crusting and scaling. Discrete lesions were found on her upper and lower back (Figure 2), chest, volar wrist, and popliteal fossa. No vesicular lesions were present, although some isolated scabbed areas suggested previous vesicular lesions. The facial lesions were tender to palpation, and there was periorbital edema. No oral lesions were seen. Wound cultures grew methicillin-resistant Staphylococcus aureus.
[FIGURES 1-2 OMMITTED]
* WHAT IS THE DIAGNOSIS?
* HOW CAN THE DIAGNOSIS BE CONFIRMED?
* HOW SHOULD THIS DISEASE BE TREATED?
* DIAGNOSIS: ECZEMA HERPETICUM
Eczema herpeticum is an overwhelming herpesvirus infection on skin already affected by atopic dermatitis. It is a dermatologic emergency–untreated infections may lead to complications, including herpes keratitis and disseminated herpes simplex virus (HSV) infections with visceral involvement. Mortality is 1%-9%, (1) although before antiviral therapy it was as high as 75%. (2)
The rash begins as dome-shaped vesicles, which subsequently disappear and become punched-out excoriations, crusts, and erythematous plaques. The head, neck, and trunk are the most commonly affected areas. Systemic symptoms such as fever and malaise usually accompany the rash.
Causes of eczema herpeticum
The cause of eczema herpeticum is always HSV type I. (3) The exact pathophysiology is unknown, but it is thought to involve HSV entering the skin when skin barrier function is compromised due to dermatitis. Defective cytokine secretion in the affected skin also plays an important role. (3)
The severity of preexisting eczema does not seem to dictate the severity of eczema herpeticum. (4) Secondary bacterial skin infections are very common. A mixture of aerobic and anaerobic bacteria are commonly isolated, the most common being S aureus, Group A [beta]-hemolytic Streptococcus, Pseudomonas, and Peptostreptococcus. (6,7)
Risks
It is not clear which patients with atopic dermatitis are more at risk for developing eczema herpeticum. High total serum immunoglobulin E (IgE) and early age of onset are 2 risk factors that have been identified. (7,8)
Some researchers have suggested that use of topical corticosteroids predisposes those with atopic dermatitis to develop eczema herpeticum, but larger studies do not support this. (8) However, topical calcineurin inhibitors do seem to pose a higher risk and are thus contraindicated during an eczema herpeticum infection. (9)
* DIFFERENTIAL DIAGNOSIS
Kaposi’s varicelliform eruption is a disseminated eruption of HSV on skin already affected with another dermatitis; eczema herpeticum refers specifically to the occurrence of an eruption on skin affected by atopic dermatitis. Thus, other types of Kaposi’s varicelliform eruption should be considered in the differential diagnosis. These include HSV infections on skin affected by Darier-White disease, pemphigus foliaceus, and mycosis fungoides. A good history taken from the patient regarding coexisting skin disorders makes the difference clear.
Other generalized vesicular eruptions such as Varicella should also be considered before making the diagnosis. Since distinct vesicles are not often present by the time the patient presents for care, the rash may also be confused with impetigo or other bacterial infections.
* LABORATORY TESTS
Several tests are available to detect the presence of HSV in the skin lesions of eczema herpeticum. These include polymerase chain reaction (PCR), immunofluorescence, and electron microscopy. Electron microscopy is not widely available and PCR can take several days, so often it is helpful to do direct fluorescent antibody testing while PCR results are pending. Light microscopy can be used to do a Tzanck test, which looks for multinucleated giant cells in blister fluid.
Serologies are often ordered, but results are nonspecific. Viral cultures are not very sensitive and take a while to get results. Aerobic and anaerobic bacterial cultures should be done because superinfection is common.
* TREATMENT: SYSTEMIC ANTIVIRALS, ANTIBIOTICS
Systemic antiviral medications are the mainstay of treatment for eczema herpeticum. Before the advent of acyclovir, the mortality rate of eczema herpeticum was 75%. (2)

Will Allegra Give Me Relief From All My Allergies?

admin — Thu, 20 Nov 2008 19:21:02 +0000

What would we do without the internet? That is the way most people see it today, when it comes to communication, searching, and shopping the internet has just made our lives easier. Now buying medication has become easier as well, right on the internet. However, for several different reasons, people are choosing to buy medicine from a Canadian pharmacy.

The first reason people are choosing a Canadian pharmacy online is the time that it saves. Many people simply do not have the time to wait at the doctors office for hours on end just to get a refill prescription on medicines they need right away nor do some really have the time to even make an appointment with the doctor. In fact, some people lack the ability to go to the doctor every time they are in need of a refill rather it is because of transportation, work, or health reasons.

Which Medicines can I buy online?

Before we get into the medicines you can buy, you must first understand that in order to order from any pharmacy, including a Canadian pharmacy, you must possess a valid prescription, written by your doctor. There is no way around this, because of the laws that apply to shipping and sales of a controlled substance this is required by law. Now, assuming that you already have a doctor written prescription or you need to purchase an over-the-counter medication, there are several different types of medicines that can be purchased right on the internet.

Yes, people do turn to the internet for buying over-the-counter medicines as well, simply because a Canadian pharmacy can save you a great deal of money. Some OTC drugs that can be purchased online include Tylenol, Advil, and other types of non-controlled drugs. If you have a valid, doctor written prescription you can purchage controlled substances such as Proamatine, Augmentin, Allegra, Albuterol, Tylenol 3 with Codeine, or any other prescription medicines used to treat ailments and disorders.

Cheaper Drugs?

Medicines purchased at a Canadian Pharmacy, tends to be a great deal cheaper than those purchased within pharmacies in the United States. One reason for this is the fact that the U.S. dollar is worth more in Canada, which means more bang for your buck. In fact, at any point in time, the U.S. dollar could be worth as much as seventy cents more than the Canadian dollar.

A Canadian pharmacy is also popular because laws in Canada prevent pharmacutical companies and pharmacies from advertising to consumers. This means that American citizens save money because a Canadian pharmacy does not have to raise prices to cover advertisements. The comparison between an American pharmacy and a Canadian pharmacy is such that the U.S. allows drugs companies to advertise using the television, newspapers, and other such media, whereas in Canada it is against the law.

Summary:

ArticleSource: ArticlesAlley.com

Baby Has an Ear Infection

admin — Fri, 14 Nov 2008 12:51:04 +0000

Feb. 18, 2002 — No matter how conscientious parents are,
babies are likely to come down with colds during their first year, and colds
often lead to ear infections.
“The signs and symptoms can be very general, so they need
to be looked at, especially in really young children less than 2 months of
age,” says Anthony Magit, MD, associate clinical professor at the
University of California, San Diego, and the Children’s Hospital and Health
Center. Left untreated, ear infections can lead to more serious problems,
including meningitis and hearing loss.
The typical ear infection — called otitis media — occurs when
a cold or allergy causes swelling of the baby’s eustachian tube, causing
blockage that allows bacteria to grow in the middle ear.. Otitis media is
particularly common in babies because their immune systems are immature and
their eustachian tubes may not effectively drain fluid from the middle ear.
There are two types of middle ear infections. Acute otitis
media often causes pain, fever, and a bulging red eardrum. Otitis media with
effusion (OME) occurs when the middle ear doesn’t drain properly and fluid is
trapped behind the eardrum. A child may not experience pain with OME. Both
types of infection sometimes clear up without treatment.

The Latest in Ears
Because they’re so run-of-the-mill, you may think you know all
you need to know about ear infections. But treatment and prevention strategies
have changed in the past year, so a refresher course may be in order. You
should know that:

There’s now a vaccination for children under 2 to help ward off one of the
most common bacterial causes of ear infections.
Doctors are using antibiotics more conservatively in an effort to prevent
drug resistance.
There’s a new laser surgery that might be worth considering in certain
cases of recurring ear infections.

The newest weapon in the battle against otitis media is the
pneumococcal vaccine. According to new American Academy of Pediatrics
guidelines, all children under age 2 years should receive the vaccine, along
with other recommended immunizations, at 2, 4, and 6 months and between 12 and
15 months.
“It’s not 100 percent [effective], but it seems to result
in about a 20% reduction in ear infections,” says Albert Park, MD,
assistant professor of pediatric otolaryngology at Loyola University Medical
Center in Maywood, Ill. The vaccine is also recommended for children ages 2 to
5 who are at high risk for developing pneumococcal infections.
Antibiotic Balancing Act
If your child hasn’t been vaccinated, or gets an infection
anyway, your pediatrician will typically prescribe the antibiotic amoxicillin.
The most acute symptoms should subside within 24 to 48 hours, but since the
pain may continue for several days, acetaminophen and warm compresses may help
relieve discomfort.
Make sure to administer the antibiotics for the prescribed
time, or the infection might stick around, and your baby could need a new round
of antibiotics, possibly a different kind, such as Ceclor, Augmentin, Ceftin,
and Rocephin.

Antibiotic Use Varies by Region, Doctor

admin — Tue, 11 Nov 2008 01:14:39 +0000

Feb. 11, 2003 — The chances of walking out of your doctor’s office with a prescription for a powerful antibiotic to treat a cold, cough, or sore throat may depend on where you live and what type of doctor you see.

A new study shows internists are nearly two and half times more likely than family or general physicians to prescribe broad-spectrum antibiotics in treating acute respiratory tract infections, such as the common cold, sore throats, sinus infections, and sinusitis. In addition, doctors in the Northeast and South are also more than twice as likely to choose an antibiotic in treating these conditions.

In most cases, researchers say the use of such powerful antibiotics is usually not necessary to treat these types of infections unless there are other complications. But even in cases where use of an antibiotic may be justified, many experts have expressed concern over the current overuse of the newer antibiotics, including Cipro, Augmentin, and Biaxin, which are effective against broad ranges of bacteria.

According to researchers, use of these antibiotics as a first-line of treatment against these relatively mild types of infections could promote the growth of bacteria that is resistant to treatment, as well as increase healthcare costs. Despite these risks, statistics show that the antibiotics are commonly used, but little is known about the doctors who prescribe them or the people who take them.

In the study, published in the Feb. 17 issue of The Journal of the American Medical Association, researchers used data from the National Ambulatory Medical Care Survey of 1,981 adults who were seen by doctors between 1997 and 1999 for the common cold or other nonspecific upper respiratory tract infections.

Researcher Michael A. Steiman, MD, of the VA Medical Center in San Francisco, Calif., and colleagues found that antibiotics were prescribed to 63% of patients with these conditions, ranging from 46% of patients with a common cold to 69% of those with sinusitis.

More powerful, broad-spectrum antibiotics were selected for 54% of patients who were prescribed an antibiotic, including more than half of those with a common cold.

Most colds are caused by viruses, which do not respond to antibiotics. Antibiotics only fight bacterial infections.

Researchers found the most powerful predictors of prescribing a broad-spectrum antibiotic were the physician’s specialty and geographic locations. Internists were 2.4 times more likely to prescribe these drugs than general and family practitioners, and doctors in the Northeast and South were both about two and a half times more likely to do the same.

Factors that made an antibiotic prescription less likely to happen in these cases were black race, lack of health insurance, and membership in a health maintenance organization.

Researchers say this wide variety in antibiotic use suggests that there’s a lot of room for improvement in doctor prescribing patterns.

SOURCE: The Journal of the American Medical Association, Feb. 17, 2003.

Business Wire - IMPAX Receives Final FDA Approval for Generic Version of Wellbutrin SR 150 MG

admin — Sat, 08 Nov 2008 04:20:00 +0000

LYON, France — Reportlinker.com announces that a new market research report related to the Pharmaceutical industry industry is available in its catalogue.
GlaxoSmithKline plc company profile
To order that report:
www.reportlinker.com/p064471/GlaxoSmithKline- plc-PharmaVitae-Profile.html
(Due to its length, this URL may need to be copied/pasted into your Internet browser’s address field. Remove the extra space if one exists.)
Introduction
This analysis examines the historical and forecast performance for GSK in the ethical pharmaceutical sector. The profile encompasses global company strategy, portfolio and pipeline analysis and assessment of financial performance, with 1-6 year sales forecasts for key drugs. An interactive forecasting and analysis tool provides continually updated quantitative and qualitative information.

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Scope
Highlights
Reasons to Purchase
Benchmark GlaxoSmithKline’s performance against key rivals in the ethical pharmaceutical sectorAnalyze the factors that will underscore a forecast ethical pharmaceutical sales CAGR of -2.1% for GlaxoSmithKline over 2006-12Assess the generic threat faced by GlaxoSmithKline over the period 2006-12 and how this compares to generic risk across the Big Pharma peer set
CHAPTER 1 EXECUTIVE SUMMARY 2
Key findings 2
Historical and forecast ethical sales performance 3
Therapeutic strategy 5
Launch and expiry outlook 10
Externalization, geographic and molecule type strategies 13
Externalization strategy 14
Geographic strategy 15
Molecule type strategy 16
SWOT analysis 17
Strengths 17
Weaknesses 18
Opportunities 19
Threats 21
CHAPTER 2 CORPORATE HISTORY 24
Key findings 24
Background 25
M&A history 25
Wellcome 25
Glaxo 25
Glaxo Wellcome 26
Beecham 26
Smith Kline 26
SmithKline Beecham 27
Key historical drug launches by component GSK companies 28
M&A strategy 29
R&D overview 32
Current corporate structure 34
CHAPTER 3 HISTORICAL PERFORMANCE 35
Key findings 35
Introduction 36
Revenue and growth rate analysis, 2001-06 36
Revenue and growth rate vs. peer set 37
Product analysis, 2001-06 39
Growth drivers 39
Seretide/Advair 39
Avandia 40
Flixotide 40
Lamictal 40
Growth resistors 40
Seroxat 40
Augmentin 41
Serevent 41
Operating revenue and cost analysis, 2001-06 42
Operating revenue/cost analysis 43
CHAPTER 4 FORECAST PERFORMANCE 45
Key findings 45
Introduction 46
Revenue and growth rate, 2006-12 46
Product analysis, 2006-12 48
Growth drivers 53
Tykerb 53
Cervarix 54
Growth resistors 54
Seretide/Advair 54
Avandia 55
Wellbutrin 55
Zofran 56
Imigran 56
Therapy area analysis, 2006-12 58
Oncology 61
Urology & sexual health 61
Infectious disease 62
Respiratory 62
CNS 62
Endocrine, metabolic & genetic disorders 63
Therapy area focus 63
Launches and expiries analysis, 2006-12 68
Launch portfolio 69
Core portfolio 72
Expiry portfolio 74
Launch/core/expiry configuration 77
Externalization analysis, 2006-12 81
Geographic analysis, 2006-12 86
Molecule type analysis, 2006-12 89
CHAPTER 5 KEY PRODUCTS AND COMPETITORS 95
Key findings 95
Overview 96
Respiratory 97
Seretide/Advair 97
Overview 97
Sales forecast 98
Newsflow 98
Oncology 103
Tykerb 103
Overview 103
Sales forecast 104
Newsflow 104
Cervarix 107
Overview 107
Sales forecast 108
Newsflow 108
Zofran 112
Overview 112
Sales forecast 113
Newsflow 113
CNS 115
Lamictal 115
Overview 115
Sales forecast 116
Newsflow 116
Gepirone ER 119
Overview 119
Sales forecast 120
Newsflow 120
Trexima 122
Overview 122
Sales forecast 123
Newsflow 124
Wellbutrin 126
Overview 126
Sales forecast 127
Newsflow 127
Imigran 130
Overview 130
Sales forecast 131
Newsflow 131
Endocrine, metabolic & genetic disorders 133
Avandia 133
Overview 133
Sales forecast 134
Newsflow 135
Infectious disease 139
Rotarix 139
Overview 139
Sales forecast 140
Newsflow 140
CHAPTER 6 APPENDIX 143
IMS vs. company-reported data reconciliation 143
References 146
Datamonitor reports 146
Abbreviations 146
Exchange rates 147
List of Tables
Table 1: Peer set overview 37
Table 2: Operating revenue/cost analysis ($m), 2001-06 42
Table 3: Operating cost ratio analysis (% of total revenues), 2001-06 43
Table 4: Product portfolio overview, sales ($m), 2006-12 48
Table 5: Therapy area overview, sales ($m), 2006-12 58
Table 6: Launch portfolio overview, sales ($m), 2006-12 69
Table 7: Core portfolio overview, sales ($m), 2006-12 73
Table 8: Expiry portfolio overview, sales ($m), 2006-12 75
Table 9: Externally developed portfolio ($m), 2006-12 81
Table 10: Molecule type overview, sales ($m), 2006-12 89
Table 11: Key products overview 96
Table 12: Seretide/Advair: overview 97
Table 13: Seretide/Advair: sales forecast ($m), 2006-12 98
Table 14: Seretide/Advair: news flow 98
Table 15: Tykerb: overview 103
Table 16: Tykerb: sales forecast ($m), 2006-12 104
Table 17: Tykerb: news flow 104
Table 18: Cervarix: overview 107

American Family Physician - Levofloxacin appears safe and effective for CAP in children

admin — Sun, 02 Nov 2008 02:40:52 +0000

Background: Levofloxacin (Levaquin) is not approved by the U.S. Food and Drug Administration for use in children, but historical data on fluoroquinolones in children suggest an adverse event rate similar to that found in adults. Growing resistance in some bacteria that commonly cause community-acquired pneumonia (CAP) in children has increased the need for alternative antibiotics. Because levofloxacin has a broad spectrum of activity against bacterial and atypical pathogens and because it has an acceptable safety profile in adults, Bradley and colleagues studied the safety and effectiveness of levofloxacin to treat CAP in children.
The Study: This randomized, multicenter, open-label study evaluated children six months to 16 years of age in seven countries, including the United States. Children were eligible to participate if they had a clinical diagnosis of CAP based on positive radiographic findings and the presence of two or more clinical findings of pneumonia (e.g., fever, dyspnea, cough, chest pain, abnormal white blood cell count, physical signs on examination). Children in outpatient and inpatient settings were included.
Children were excluded if they received systemic antibiotics for more than 24 hours immediately before enrollment, if they required antibiotics other than the study drugs, or if they had an infection suspected to be resistant to the study drugs. Children were not eligible to participate if they were residents of long-term care facilities, had recent hospitalization or presumed nosocomial pneumonia, or were suspected to have a central nervous system infection. Because musculoskeletal complications were the primary safety concerns with levofloxacin in children, any patients with a history of periarticular disease or with musculoskeletal signs or symptoms were also excluded to avoid confounding the safety evaluation.
Children were randomized to receive levofloxacin or a comparator antibiotic (that varied with patient age) at a ratio of 3 to 1, respectively. The randomization was stratified by age group and country to ensure balance between treatment groups. All antibiotics were prescribed for 10 days; dosing depended on patient age (see accompanying table). Patients were allowed to switch between intravenous and oral therapy within treatment arms.
Symptoms and signs were assessed at presentation, three to five days into treatment, one to three days after completing treatment, and at a test-of-cure visit occurring 10 to 17 days after the last antibiotic dose. The primary end point was clinical cure rate at the test-of-cure visit and was based on resolution of clinical symptoms and signs of pneumonia and resolution or stabilization of radiographic findings. Microbiologic response was determined by sputum Gram stain and culture with sensitivities when available and by serum acute and convalescent titers for Mycoplasma pneumoniae and Chlamydia pneumoniae. Microbiologic eradication data were assessed with clinical cure rates.
Adverse events or symptoms were evaluated by investigators within 72 hours of onset and were designated by severity and the likelihood of an association with the study drug.
Results: The study met statistical criteria to detect a difference in effectiveness between levofloxacin and standard-of-care antibiotics. Both groups reflected a more than 90 percent cure rate for clinical and microbiologic resolution, which persisted across stratified risk groups. The levofloxacin and comparator groups also experienced similar rates and types of adverse events, including musculoskeletal symptoms.
Conclusion: It appears that levofloxacin works as well as standard-of-care antibiotics (typically amoxicillin/clavulanic acid [Augmentin] or a macrolide) for treating CAP in children. The authors conclude that, in this study, the safety profile of levofloxacin in children (2 percent rate of treatment-limiting adverse events) is similar to that of nonfluoroquinolone antibiotics.
AMY CRAWFORD-FAUCHER, MD
Source: Bradley JS, et al. Comparative study of levofloxacin in the treatment of children with communityacquired pneumonia. Pediatr Infect Dis J. October 2007;26(10):868-878.
Table. Dosing Regimens for Levofloxacin (Levaquin)

Group Comparator drug and dosage

Six months to 22.5 mg per kg amoxicillin/clavulanic acid
younger than [Augmentin] oral suspension twice daily (maximal
five years dosage: 875 mg per day) *
or
25 mg per kg ceftriaxone (Rocephin) IV every
12 hours (maximal dosage: 4 g per day)

Five to 16 years 7.5 mg per kg clarithromycin (Biaxin) oral
of age suspension twice daily or 250-mg tablet twice
daily (maximal dosage: 250 mg twice daily)
or
25 mg per kg ceftriaxone IV every 12 hours
(maximal dosage: 4 g per day) plus 10 mg per kg
erythromycin IV every six hours (maximal dosage:
4 g per 24 hours) or 7.5 mg per kg clarithromycin
oral suspension twice daily or 250-mg tablet
twice daily (maximal dosage: 250 mg
twice daily)

Group Levofloxacin dosage

Six months to 10 mg per kg oral suspension twice daily
younger than (maximal dosage: 500 mg per day)
five years or
10 mg per kg IV every 12 hours (maximal
dosage: 500 mg per day)

Five to 16 years 10 mg per kg oral suspension once daily
of age (maximal dosage: 500 mg per day)
or
250-mg tablet once daily (for children weighing
49.6 to 60.6 Ib [22.5 to 27.5 kg]) or two
250-mg tablets once daily (for children
weighing more than 100.3 Ib [45.5 kg])
or
10 mg per kg IV every 24 hours (maximal
dosage: 500 mg per day)

IV = intravenous.

*–Dosage was determined by calculating amoxicillin component.

Business Wire - GSK Receives Approvable Letter for Topical Antibiotic, Altabax™ , 1%

admin — Thu, 30 Oct 2008 09:56:16 +0000

PHILADELPHIA — GlaxoSmithKline (GSK) announced today that the U.S. Food and Drug Administration has issued an approvable letter for its topical antibacterial, Altabax (retapamulin ointment), 1%, for the treatment of secondarily-infected traumatic lesions (SITL). SITL is a type of skin and skin structure infection most commonly caused by Staphylococcus aureus and Streptococcus pyogenes.
In the letter to GSK, the FDA requested additional information to complete its assessment of Altabax as a treatment for SITL; no safety concerns were noted. GSK intends to respond in full to the FDA’s requests and work with the agency to pursue approval of Altabax for the treatment of SITL.