Journal of Pharmacy Technology

To discuss the chemistry, mechanism of action, in vitro activity, pharmacology, clinical efficacy, and toxicity of rifabutin, a new rifamycin, in the prevention and treatment of disseminated mycobacterial infection in patients with AIDS.

The English-language literature was searched from 1980 through October 1993 using MEDLINE, International Pharmaceutical Abstracts (IPA), Index Medicus, and bibliographic reviews of relevant textbooks and review articles.

One published report of two identical randomized, prospective, double-blind trials of rifabutin to prevent disseminated mycobacteremia is available. Other literature reviewed included a clinical case series of patients treated with rifabutin for documented or presumed mycobacterial infection.

Clinical trial and case series were evaluated for study design, efficacy, and toxicity.

In two trials, rifabutin has been shown to prolong the onset of mycobacteremia (caused by Mycobacterium avium-intracellulare or M. avium complex) in adult AIDS patients with CD4-lymphocyte counts <200 cells/mm³. The prolongation of time to bacteremia is significant compared with placebo as the CD4 count declines. However, overall survival is not prolonged by rifabutin prophylaxis in these patients. No blind, randomized studies are available evaluating the efficacy of rifabutin in treating documented mycobacteremia in AIDS patients, or in treating pulmonary infections caused by Mycobacterium tuberculosis.

Rifabutin should be added to the prophylactic regimens of HIV-positive patients with CD4 counts <100 cells/mm³. Prophylactic treatment prolongs the period of time before dissemination of mycobacterial infection occurs (bacteremia), with associated delays in onset of fever and fatigue, decline in performance score, and hospitalization. Rifabutin is usually well tolerated in patients given 300 mg/d. Rifabutin is a weaker enzyme inducer than rifampin, but drug interactions with rifabutin should be monitored under circumstances of concomitant therapy with anticoagulants or anticonvulsants.

To examine the use of prostaglandin F₂ alpha in treating cyclophosphamide-induced hemorrhagic cystitis.

An English language literature search using MEDLINE 1982–1993 and bibliographic reviews of related textbooks and review articles.

Articles containing pertinent information regarding the therapeutic use and effects of prostaglandin F₂ alpha as a treatment for cyclophosphamide-induced hemorrhagic cystitis in humans.

Resources were evaluated and information was extracted independently.

A review of human cases suggests that intravesical administration of prostaglandin F₂ alpha may be an effective bedside therapy for cyclophosphamide-induced hemorrhagic cystitis. Adverse reactions are limited primarily to local effects. The optimal dosage regimen of intravesical prostaglandin F₂ alpha is not clearly established.

Patients with intractable vesical hemorrhage secondary to cyclophosphamide administration may benefit from bedside intravesical instillation of prostaglandin F₂ alpha. Information in the literature regarding prostaglandin bladder irrigation is scarce, and confined to case reports. Clinical studies are needed to endorse and/or refute the efficacy of intravesical instillation of prostaglandin F₂ alpha as a treatment modality for hemorrhagic cystitis.

To provide the reader with an update on the disposition of nitroprusside in the body and the current therapy in managing cyanide and thiocyanate toxicity.

Currently available literature reports were used to provide readers with a comprehensive framework that will enable them to monitor for, prevent, and if needed, treat patients with cyanide and/or thiocyanate toxicity. Additional sources were used to provide risk factors, which enable practitioners to identify patients predisposed to such toxicities while receiving nitroprusside.

The continuously changing climate in healthcare and the added visibility of pharmacologic agents in the treatment and prevention of disease have increased pressure on pharmacy departments to provide therapeutic agents that are cost-effective and at the same time result in minimal adverse reactions. Members of the healthcare professions must be able to identify situations that warrant close therapeutic monitoring to prevent extended hospital stays caused by iatrogenic diseases. Nitroprusside is a frequently used agent that can result in extended hospital stays, increased resource use, and even death caused by cyanide and/or thiocyanate toxicity. The identification of patients at risk, methods to monitor therapy, and treatments for toxicity will help reduce such reactions and provide maximal therapeutic response with minimal toxic consequences when using nitroprusside.

Vulvovaginitis is a common gynecologic complaint with millions of women seeking medical attention for this disorder. Bacterial vaginosis (BV) is the most common form of vaginal infection. Its nonspecific symptomatology and its diagnostic and therapeutic controversies pose many challenges.

A 10-question self-administered survey was mailed to family physicians in West Virginia. The survey assessed the occurrence of BV, diagnostic criteria, and treatment options. The results were reported as descriptive statistics.

Overall, 107 physicians responded to the survey. Seventy-nine surveys were used in the tabulation of results. All respondents diagnosed vaginitis on a weekly basis. On average, BV is diagnosed in 25 percent of women with vaginal problems. Discharge, odor, and irritation were the most common signs/symptoms. History, physical examination, and microscopic examination of vaginal secretions were employed routinely for diagnosis. A detectable odor, a homogeneous discharge, and vaginal pH >4.5 were inconsistent objective clinical findings. However, the presence of clue cells was noted in the majority of patients. The preferred drug for the treatment of BV was metronidazole, usually administered in a dosage of 500 mg/d po bid for seven days. Fifty percent of the respondents treat men partners, and again, the drug of choice was metronidazole. The majority do not treat asymptomatic BV during pregnancy nor asymptomatic nonpregnant women during routine gynecologic examination. Recurrence was noted in fewer than 30 percent of treated women.

On the basis of the results, BV is a common gynecologic diagnosis. Classic signs/symptoms were universally present and the diagnostic approach was consistent with established medical norms. The usual objective clinical findings were not always evident, although the presence of clue cells was a frequent finding. The therapeutic approach to the patient with BV was also consistent with contemporary medical practice in 1991. Whether the small sample size or inconsistent reporting affected the study results remains indeterminate. Future research will be directed toward larger patient populations and assessment of newer therapeutic modalities and their costs.

To report a case of foscarnet-induced penile ulcerations and review literature related to this adverse effect.

Case reports and review articles identified by a computerized search (MEDLINE) and manual search (Index Medicus).

Foscarnet is a pyrophosphate analog antiviral agent that is approved by the Food and Drug Administration for treating cytomegalovirus retinitis in patients with AIDS. It also is used investigationally for other indications and human herpesvirus infections. Adverse effects include nephrotoxicity, anemia, ionized calcium abnormalities, and penile ulcerations. The majority of penile ulcers have developed within two weeks following initiation of foscarnet therapy with dosages of 180–200 mg/kg/d. Most cases required discontinuation of foscarnet to resolve the penile lesions. A postulated mechanism for this effect is inflammatory contact dermatitis from exposure to urine with elevated concentrations of foscarnet. We report a case of foscarnet-induced penile ulcerations that resolved after discontinuing this agent.

Foscarnet can induce penile ulcerations. Increased awareness of this phenomenon, along with meticulous genital hygiene and urination practices, are required for its prevention.