摘要：Low doses of aspirin are now a standard part of the management of patients with thromboembolic disease. One risk of taking even low doses is bleeding from the gut, and various aspirin formulations are marketed with claims that they reduce this problem. In this article we review the formulations available and consider their relative safety.
摘要：Glaucoma is one of the commonest causes of blindness in the world. In the UK, about 7% of people over the age of 75 years have primary open angle glaucoma, the most common type of glaucoma and the cause of visual impairment in about 13% of those registered blind. Early detection and treatment can usually prevent blindness. However, half of all patients with primary open angle glaucoma in the UK do not present until vision has begun to deteriorate. Here we consider ways of improving detection and management.
摘要：β_2-selective adrenoceptor agonists (β_2-stimulants) have been used for 30 years for the relief of symptoms in patients with all grades of asthma. They can also be used before activities likely to precipitate airway narrowing and are sometimes taken as regular treatment by patients with chronic asthma. The first β_2-stimulants to be introduced were shorter-acting drugs such as salbutamol and terbutaline. The longer-acting β_2-stimulants, salmeterol and ▼eformoterol were developed more recently and their role in treating asthma is not yet fully defined. In this article we review the current place of β_2-stimulants in asthma management.
摘要：Around one in 20,000 adults in the UK will develop amyotrophic lateral sclerosis, the commonest variant of motor neurone disease. Riluzole (▼Rilutek - Rhone-Poulenc Rorer) was launched in the UK in August 1996 as "the first anti-excitotoxic agent proven to extend life in amyotrophic lateral sclerosis". We review the clinical data on the effectiveness of riluzole and assess its place in the management of amyotrophic lateral sclerosis, a condition that is invariably fatal and has a median survival time from symptom onset of about 2.5 years.
摘要：Radiotherapy is a standard part of cancer management. Irradiation often causes acute unwanted reactions, such as nausea, diarrhoea or redness of the skin, which, although troublesome, normally resolve within a few weeks. Acute bone marrow depression can also occur, particularly following irradiation of the whole body, but this too may be transient. In some patients, unwanted reactions develop months or years after treatment is completed. Here we review these late complications and consider how they can be prevented or managed.
摘要：Generic prescribing is steadily increasing, a change which we and others encourage. The proportion of prescriptions written in general practice in England using the generic (approved) name increased from 35% in 1985 to 55% in 1995. Where a product is prescribed generically, the alternatives that could be supplied should be equivalent, to ensure that patients are not put at risk. In this article, wereview how the equivalence and quality of generic drugs are assured and consider whether the process is adequate.
摘要：The optimal management of post-term pregnancy (gestation lasting 42 weeks or more) is not resolved. The risk to the fetus increases as pregnancy continues post term and this has to be balanced against the risks associated with induction. Here we consider whether routine induction at around 42 weeks has any advantages over expectant management, in which pregnancy is allowed to run its natural course unless the fetus (or mother) develops features ofdistress.
摘要：Eradication of Helicobacter pylori helps prevent ulcer recurrence in patients with duodenal or gastric ulcers but its value is less clear in those with other causes of dyspepsia. A quick and reliable test for diagnosing infection should simplify management. Several testing kits are now being used and in this article we assess their validity.
摘要：The number of people with problems related to drug misuse has risen since we last discussed this topic 12 years ago. New drugs such as 'crack' (the smokeable form of cocaine) and ecstasy have appeared, while the abuse of diamorphine (heroin), amphetamines and benzodiazepines has become more widespread. By sharing needles and syringes, those injecting drugs are at risk of infection with hepatitis B, hepatitis C and the human immunodeficiency virus (HIV). Here we discuss the drugs that are commonly misused and the priorities in management. We consider the potential role of GPs and the primary care team in that management.
摘要：Budesonide is a glucocorticoid with high local activity but much lower systemic availability than prednisolone. Topical formulations have long been licensed for use in asthma and rhinitis. Here we discuss anew orally active controlled-release preparation of budesonide (Entocort CR - Astra) formulated specifically for treating patients with Crohn's disease affecting the ileum and/or ascending colon. The manufacturer claims that the preparation "targets the ileum and ileocaecal area, achieving rapid results equivalent to prednisolone" with a "low level of systemic steroid side effects".
摘要：Eight drugs are now marketed in the UK for the treatment of human immunodeficiency virus (HIV) infection. Here we discuss these drugs and review the evidence that they delay HIV disease progression and prolong survival. HIV exists in two forms: HIV-1 which causes most HIV disease worldwide and HIV-2 which is confined mainly to West Africa. The virus infects its key target, the CD4-positive T lymphocyte, by first attaching to the CD4 receptor and other cell membrane molecules and then introducing its RNA into the cell. The viral enzyme reverse transcriptase uses this RNA as a template to generate DNA, which is then incorporated into the host's DNA and, in turn, transcribed to produce viral RNA.
摘要：Moxonidine (Physiotens-Solvay) was introduced last year as the first of a new class of centrally-acting antihypertensive agents, the selective imidazoline receptor agonists. The manufacturer claims that moxonidine "accurately targets imidazoline receptors at the cardiovascular control centre in the brainstem" and is "as effective as current first-line therapies for essential hypertension". Other claims suggest that it causes fewer unwanted effects than older centrally-acting antihypertensive drugs such as clonidine and methyldopa. Is moxonidine a useful addition to the growing number of antihypertensives on the market?
摘要：Six aminoglycosides (amikacin, gentamicin, kanamycin, netilmicin, streptomycin and tobramycin) are licensed for parenteral use in the UK. As a group, they remain effective against infections caused by aerobic gram-negative organisms and Staphylococcus aureus, including species commonly resistant to beta-lactam antibiotics. However, their use is limited by the severity of their unwanted effects and by their route and frequency of administration; traditionally, they have been given intravenously two to four times daily. Increasingly, they are being given once daily in an attempt to simplify treatment without reducing efficacy or increasing toxicity. Here we evaluate the advantages and disadvantages of this once-daily approach.
摘要：Mycophenolate mofetil (CellCept - Roche) is a new immunosuppressant indicated "in combination with cyclosporin and corticosteroids for the prophylaxis of acute transplant rejection in patients receiving allogeneic renal transplants". Here we review mycophenolate mofetil and assess whether it offers any additional benefits to conventional therapy.
摘要：Decision-making in health provision is rarely straightforward. Choices are probably easiest when trial data are clear and the consequences essentially trivial. As information becomes more speculative, outcomes more critical and the environment more hostile, dilemmas arise. These and related issues were addressed in the fifth annual Drug and Therapeutics Bulletin symposium 'Key Dilemmas in Prescribing and the Provision of Health,' which was held in March. Here we summarise the key views raised in the talks and subsequent discussion.
摘要：Three years ago we reviewed paclitaxel (Taxol - Bristol-Myers Squibb), the first taxoid cytotoxic drug to be marketed. At that time it was licensed for the treatment of women with metastatic ovarian cancer resistant to standard platinum-containing therapy; we concluded that any benefits of paclitaxel were unproven. Since then the licence has been extended to include first-line treatment (in combination with cisplatin) of advanced ovarian cancer and treatment of metastatic carcinoma of the breast in patients who have failed, or are not candidates for, standard anthracycline-containing therapy. A second taxoid, docetaxel (Taxotere - Rhone-Poulenc Rorer) was launched in 1996. It is licensed for the treatment of patients with breast cancer that is locally advanced or metastatic, and which is either resistant to, or has recurred after, cytotoxic therapy, or has relapsed during adjuvant cytotoxic therapy. In each case, the previous cytotoxic therapy should have included an anthracycline drug (such as doxorubicin). Here we review the place of the two taxoids in the treatment of ovarian and breast cancer.
摘要：Each year about 100,000 people present to UK hospitals with deliberate self-harm, the most common form of which is poisoning with medicines or other pharmacologically active substances. As many as 95% of self-poisonings are intentional drug overdoses but only around 40% of patients who poison themselves express a wish to die. In many instances, the final outcome is determined by the speed with which treatment is started. Here we concentrate on the legal issues facing doctors when the patient declines treatment.
摘要：Since peak flow meters were first made available on FP10 prescription in 1990, they have become widely used in general practice for the diagnosis and monitoring of asthma. Patients can also use them at home as part of a self-management plan. Now there is increasing interest in the use of spirometers in general practice for diagnosing chronic obstructive pulmonary disease and monitoring patients' progress. We consider how peak flow monitoring and spirometry can be used to greatest advantage in general practice.
摘要：Drug-induced agranulocytosis is a rare, potentially fatal idiosyncratic reaction that can occur unpredictably with a wide variety of drugs when taken in a conventional dose. In this article, we discuss its diagnosis and management and we consider the drugs most commonly involved and ways of minimising risk. We do not consider the dose-related granulocytopenia that commonly complicates treatment with cytotoxic and other myelosuppressant drugs, nor the rarer reaction, aplastic anaemia.
摘要：▼Anastrozole (Arimidex - Zeneca) and ▼letrozole (Femara - Novartis) are the first selective, oral, non-steroidal aromatase inhibitors. They are licensed for the treatment of advanced breast cancer in postmenopausal women where tamoxifen or other anti-oestrogen therapy has failed. The manufacturers of both drugs claim that their products are more effective, less toxic and better tolerated than the progestogen megestrol acetate, the standard therapy in this clinical situation. We assess these claims.