Choosing Drug Therapy for Patients with Hyperlipidemia - American Family Physician
Almost 13 million American adults require drug therapy to meet the low-density lipoprotein goals set by the National Cholesterol Education Program. Attempts to achieve these goals through diet and exercise are often unsuccessful. Major studies in recent years have demonstrated that statins decrease low-density lipoprotein levels, coronary events and overall mortality. Statins are the most commonly prescribed lipid-lowering agents because they are effective, well tolerated and easy to administer. Niacin has beneficial effects on all of the main lipid components, and new extended-release tablets have fewer adverse effects. Fibrates remain the most effective agents in lowering triglyceride levels and should be limited to this use. Bile acid sequestrants are seldom prescribed because of their adverse gastrointestinal effects and cumbersome administration.
Effect of bile acid sequestrants on glycaemic control: protocol for a systematic review with meta-analysis of randomised controlled trials | BMJ Open
Introduction In addition to the lipid-lowering effect of bile acid sequestrants (BASs), they also lower blood glucose and, therefore, could be beneficial in the treatment of patients with type 2 diabetes mellitus (T2DM). Three oral BASs are approved by the US Food and Drug Administration (FDA) for the treatment of hypercholesterolaemia: colestipol, cholestyramine and colesevelam. The BAS colestimide/colestilan is used in Japan. Colesevelam was recently approved by the FDA for the treatment of T2DM. We plan to provide a systematic review with meta-analysis of the glucose-lowering effect of BASs with the aim to evaluate their potential as glucose-lowering agents in patients with T2DM. Methods and analysis In accordance with the preferred reporting items for systematic reviews and meta-analyses statement, a systematic review with meta-analysis of randomised clinical trials of BASs (vs placebo, oral antidiabetes drugs or insulin), reporting measures of glycaemic control in adult patients with T2DM, will be performed. Change in glycated haemoglobin constitutes the primary endpoint, and secondary endpoints include changes in fasting plasma glucose, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, total cholesterol, triglycerides, body weight and body mass index and adverse events. Electronic searches will be performed in The Cochrane Library, MEDLINE and EMBASE, along with manual searches in the reference lists of relevant papers. The analyses will be performed based on individual patient data and summarised data. The primary meta-analysis will be performed using random effects models owing to expected intertrial heterogeneity. Dichotomous data will be analysed using risk difference and continuous data using weighted mean differences, both with 95% CIs. Ethics and dissemination The study will evaluate the potential of BASs as glucose-lowering agents and possibly contribute to the clinical management of patients with T2DM. Results The study will be disseminated by peer-review publication and conference presentation. Protocol registration PROSPERO CRD42012002552.
Synthesis of tailor-made bile acid sequestrants by supplemental activator and reducing agent atom transfer radical polymerization - RSC Advances (RSC Publishing)
This work reports the synthesis of tailor-made polymeric bile acid sequestrants (BAS) by supplemental activator and reducing agent atom transfer radical polymerization (SARA ATRP) using ecofriendly conditions. The new materials were based on amphiphilic poly(methyl acrylate)-b-poly((3-acrylamidopropyl)trimethylammo
Appropriate Use of Ceftriaxone in the Emergency Department of a Veteran’s Health Care System
Background: Ceftriaxone is a third-generation cephalosporin commonly
utilized as an empiric antibiotic treatment option in the emergency department
(ED). Overuse can lead to decreased susceptibility and emergence of
multidrug-resistant pathogens, increased ...
1g versus 2 g daily intravenous ceftriaxone in the treatment of community onset pneumonia – a propensity score analysis of data from a Japanese multicenter registry | BMC Infectious Diseases | Full Text
Background Community-onset pneumonia (COP) is a combined concept of community acquired pneumonia and the previous classification of healthcare-associated pneumonia. Although ceftriaxone (CRO) is one of the treatment choices for COP, it is unclear whether 1 or 2 g CRO daily has better efficacy. We compared the effectiveness of 1 g with 2 g of CRO for COP treatment. We hypothesized that 1 g CRO would show non-inferiority over 2 g CRO. Methods This study was an analysis of prospectively registered data of the patients with COP from four Japanese hospitals (the Adult Pneumonia Study Group-Japan: APSG-J). We included subjects who were initially treated solely with 1 or 2 g of CRO. The propensity score was estimated from the 33 pre-treatment variables, including age, sex, weight, pre-existing comorbidities, prescribed drugs, risk factors for aspiration pneumonia, vital signs, laboratory data, and a finding from chest xrays. The primary endpoint was the cure rate, for which a non-inferiority analysis was performed with a margin of 0.05. In addition, we performed three sensitivity analyses; using data limited to the group in which CRO solely was used until the completion of treatment, using data limited to inpatient cases, and performing a generalized linear mixed-effect logistic regression analysis to assess the primary outcome after adjusting for random hospital effects. Results Of the 3817 adult subjects with pneumonia who were registered in the APSG-J study, 290 and 216 were initially treated solely with 1 or 2 g of CRO, respectively. Propensity score matching was used to extract 175 subjects in each group. The cure rate was 94.6 and 93.1% in the 1 and 2 g CRO groups, respectively (risk difference 1.5%; 95% confidence interval − 3.1 to 6.0; p = 0.009 for non-inferiority). The results of the sensitivity analyses were consistent with the primary result. Conclusions The propensity score-matched analysis of multicenter cohort data from Japan revealed that the cure rate for COP patients treated with 1 g daily CRO was non-inferior to that of patients treated with 2 g daily CRO.
pharmacokinetics of once-daily dosing of ceftriaxone in critically ill patients | Journal of Antimicrobial Chemotherapy | Oxford Academic
Abstract. The aim of this study was to determine the pharmacokinetic profile of the normal recommended dose of ceftriaxone in critically ill patients and to est
A Comparison of Ceftriaxone and Cefuroxime for the Treatment of Bacterial Meningitis in Children | NEJM
Original Article from The New England Journal of Medicine — A Comparison of Ceftriaxone and Cefuroxime for the Treatment of Bacterial Meningitis in Children
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