A prospective, comparative, multicentre trial was performed to study the efficacy and safety of c... more A prospective, comparative, multicentre trial was performed to study the efficacy and safety of ceftibuten in respiratory and complicated urinary tract infections. Patients (n = 152) requiring parenteral 2nd or 3rd generation cephalosporine therapy were randomly assigned to continue parenteral therapy (Group A) or to receive oral ceftibuten 400 mg, or 9 mg/kgbw/day (Group B) from the 3.-5. days on. The patients, whose conditions have not improved significantly at day 3-5, were omitted from the study, so the number of evaluated patients was 131. In Group A, out of 59 patients 51 were clinically cured, the bacteriological eradication rate was 47/54. In Group B, out of 72 patients 67 were cured and 62 out of 66 pathogens were eradicated. The cost of step-down therapy was 44.3% less than the parenteral one. No adverse effect was observed that could surely be attributed to ceftibuten. According to these data, ceftibuten can be used in step-down therapy in respiratory and urinary tract infections requiring parenteral therapy at first and that offers a safe and less expensive therapeutic approach.
The main tasks of the clinician (diagnosis, prognosis, treatment, and ongoing monitoring) are not... more The main tasks of the clinician (diagnosis, prognosis, treatment, and ongoing monitoring) are not distinct entities. For example, one possible test for a diagnosis is to make a presumptive diagnosis of a disease, treat for that disease, and monitor to see whether the patient is cured. Conceptually, however, it is useful to consider diagnosis as a distinct element of patient management upon which the success of the others depends.
The development of medicine has been accompanied by the increase of the proportion of immunocompr... more The development of medicine has been accompanied by the increase of the proportion of immunocompromised patients and as a consequence of antibiotic use, bacterial resistance has reached an unexpected level. Along with these changes, we have been witnessing the rapid development of antimicrobial therapy that comprises several components besides the development of new molecules. The learning of pharmacodynamic effects of particular antibiotic classes can improve the efficacy of therapy and a better cure rate can be achieved in empiric therapy by the knowledge of risk factors and local resistance patterns. It has become clear that an antibiotic policy based exclusively on restriction would result in increased bacterial resistance rate after a temporary decrease of antibiotic cost and was unable to prevent the emerge and spread of multiresistant strains. The solution is the rational and adequate use of antimicrobials, based on the modern theory and practice of antibiotic policy and infection control, that cannot be carried out without the activities of experts in this field.
The effect of multiple-dose ciprofloxacin on antipyrine metabolism was studied in patients suffer... more The effect of multiple-dose ciprofloxacin on antipyrine metabolism was studied in patients suffering from bacterial infections. The patients were given antipyrine 15 mg/kg intravenously before and after ciprofloxacin treatment. The dosage of ciprofloxacin was 500 mg bd by mouth for 8-10 days. Blood samples were taken at 0, 2, 4, 6, 10 h. Antipyrine total clearance was significantly decreased after ciprofloxacin treatment (0.85 +/- 0.45 vs. 0.52 +/- 0.24 ml/min/kg): elimination rate constants for antipyrine were decreased in all patients after ciprofloxacin, whereas no change in volume of distribution was observed. The average half-life of antipyrine was increased from 9.45 +/- 3.74 h to 14.92 +/- 3.32 h. In two males with advanced chronic hepatic failure the antipyrine half-lives were extremely prolonged. Our results support the hypothesis that ciprofloxacin inhibits intrinsic hepatic drug-metabolizing capacity and may be a source of clinically important drug interactions, particularly in patients with liver disease.
This paper overviews the architecture of rule-based consultation systems and illustrates how such... more This paper overviews the architecture of rule-based consultation systems and illustrates how such systems work by an Antibiotic Advisor. Knowledge representation and the inference engine implemented in the program are briefly described along with a sample consultation with the system. The paper is concluded with an analysis of the advantages and limitations of rule-based reasoning in clinical decision support.
In Chapter 1, we attempted to illustrate the complexity of the information processing and decisio... more In Chapter 1, we attempted to illustrate the complexity of the information processing and decision making associated with patient management. Before starting the detailed analysis of the therapeutic process, which is the subject of Chapter 4, we present in this chapter a general introduction to data and knowledge representation and manipulation. The aim is to sketch, in general terms, the basic methodologies that can be used in clinical information processing and problem solving.
The focus of this chapter is an analysis of the process associated with treating a patient. Let u... more The focus of this chapter is an analysis of the process associated with treating a patient. Let us begin by considering the flowchart shown in Fig. 4.1. This scheme is a simplification of the clinical decision process, since, for instance, in some cases the severity of the patient’s illness may require immediate action before a final diagnosis can be made (Wulff, 1981; Shortliffe and Barnett, 1990).
Bevezetes: A Clostridium difficile az antibiotikum asszocialta hasmenesek leggyakoribb korokozoja... more Bevezetes: A Clostridium difficile az antibiotikum asszocialta hasmenesek leggyakoribb korokozoja, aminek kezelesere az elmult evtizedekben keves uj szer kerult kifejlesztesre, es a tudomanyos bizonyitekok korlatozott mertekben es nehezen osszehasonlithato modon allnak rendelkezesre. Celkitűzes: A Clostridium difficile okozta fertőzes terapiajanak hatasossagi es biztonsagossagi vegpontjainak elemzese a metronidazol, vancomycin es a fidaxomicin alkalmazasa eseten. Modszer: A szakirodalom attekintese es az eredmenyek metaanalizise. Eredmenyek: A metaanalizis szerint a klinikai gyogyulas vegpontban nincs szignifikans kulonbseg a harom terapia kozott (eselyaranyok: fidaxomicin vs. vancomycin 1,19, vancomycin vs. metronidazol 1,69 es fidaxomicin vs. metronidazol 2,00). A rekurrencia es a globalis gyogyulas vegpontokban a fidaxomicin szignifikansan hatasosabbnak bizonyult, mint a vancomycin es a metronidazol (eselyaranyok: fidaxomicin vs. vancomycin 0,47, vancomycin vs. metronidazol 0,91 es fidaxomicin vs. metronidazol 0,43). A biztonsagossagi vegpontokat tekintve nem volt szignifikans kulonbseg az antibiotikumok kozott. Kovetkeztetesek: A klinikai gyogyulas eseteben a vizsgalt antibiotikumok hatasossaga hasonlo. A rekurrens fertőzesek megakadalyozasaban jelenleg a fidaxomicin a leghatasosabb terapias alternativa. Orv. Hetil., 2013, 154, 890–899. | Introduction:Clostridium difficile is the leading cause of antibiotic associated infectious nosocomial diarrhoea. Limited number of new pharmaceutical products have been developed and registered in the past decades for the treatment of Clostridium difficile infection. The available scientific evidence is limited and hardly comparable. Aim: To analyse the clinical efficacy and safety of metronidazole, vancomycin and fidaxomicin in the therapy of Clostridium difficile infection. Methods: Systematic review and meta-analysis of the literature data. Results: Meta-analysis of literature data showed no significant difference between these antibiotics in clinical cure endpoint (odss ratios: fidaxomicin vs. vancomycin 1.19; vancomycin vs. metronidazol 1.69 and fidaxomicin vs. metronidazol 2.00). However, fidaxomicin therapy was significantly more effective than vancomicin and metronidazol in endpoints of recurrence and global cure (odds ratios: fidaxomicin vs. vancomycin 0.47; vancomycin vs. metronidazol 0.91 es fidaxomicin vs. metronidazol 0.43). There was no significant difference between fidaxomicin, vancomycin and metronidazole in safety endpoints. Conclusions: Each antibiotic similarly improved clinical cure. Fidaxomicin was the most effective therapeutic alternative in lowering the rate of recurrent Clostridium difficile infections. Orv. Hetil., 2013, 154, 890–899.
Introduction:C. difficile causes 25 percent of the antibiotic associated infectious nosocomial di... more Introduction:C. difficile causes 25 percent of the antibiotic associated infectious nosocomial diarrhoeas. C. difficile infection is a high-priority problem of public health in each country. The available literature of C. difficile infection’s epidemiology and disease burden is limited. Aim: Review of the epidemiology, including seasonality and the risk of recurrences, of the disease burden and of the therapy of C. difficile infection. Method: Review of the international and Hungarian literature in MEDLINE database using PubMed up to and including 20th of March, 2012. Results: The incidence of nosocomial C. difficile associated diarrhoea is 4.1/10 000 patient day. The seasonality of C. difficile infection is unproved. 20 percent of the patients have recurrence after metronidazole or vancomycin treatment, and each recurrence increases the chance of a further one. The cost of C. difficile infection is between 130 and 500 thousand HUF (430 € and 1665 €) in Hungary. Conclusions: The importance of C. difficile infection in public health and the associated disease burden are significant. The available data in Hungary are limited, further studies in epidemiology and health economics are required. Orv. Hetil., 2013, 154, 1188–1193.
A prospective, comparative, multicentre trial was performed to study the efficacy and safety of c... more A prospective, comparative, multicentre trial was performed to study the efficacy and safety of ceftibuten in respiratory and complicated urinary tract infections. Patients (n = 152) requiring parenteral 2nd or 3rd generation cephalosporine therapy were randomly assigned to continue parenteral therapy (Group A) or to receive oral ceftibuten 400 mg, or 9 mg/kgbw/day (Group B) from the 3.-5. days on. The patients, whose conditions have not improved significantly at day 3-5, were omitted from the study, so the number of evaluated patients was 131. In Group A, out of 59 patients 51 were clinically cured, the bacteriological eradication rate was 47/54. In Group B, out of 72 patients 67 were cured and 62 out of 66 pathogens were eradicated. The cost of step-down therapy was 44.3% less than the parenteral one. No adverse effect was observed that could surely be attributed to ceftibuten. According to these data, ceftibuten can be used in step-down therapy in respiratory and urinary tract infections requiring parenteral therapy at first and that offers a safe and less expensive therapeutic approach.
The main tasks of the clinician (diagnosis, prognosis, treatment, and ongoing monitoring) are not... more The main tasks of the clinician (diagnosis, prognosis, treatment, and ongoing monitoring) are not distinct entities. For example, one possible test for a diagnosis is to make a presumptive diagnosis of a disease, treat for that disease, and monitor to see whether the patient is cured. Conceptually, however, it is useful to consider diagnosis as a distinct element of patient management upon which the success of the others depends.
The development of medicine has been accompanied by the increase of the proportion of immunocompr... more The development of medicine has been accompanied by the increase of the proportion of immunocompromised patients and as a consequence of antibiotic use, bacterial resistance has reached an unexpected level. Along with these changes, we have been witnessing the rapid development of antimicrobial therapy that comprises several components besides the development of new molecules. The learning of pharmacodynamic effects of particular antibiotic classes can improve the efficacy of therapy and a better cure rate can be achieved in empiric therapy by the knowledge of risk factors and local resistance patterns. It has become clear that an antibiotic policy based exclusively on restriction would result in increased bacterial resistance rate after a temporary decrease of antibiotic cost and was unable to prevent the emerge and spread of multiresistant strains. The solution is the rational and adequate use of antimicrobials, based on the modern theory and practice of antibiotic policy and infection control, that cannot be carried out without the activities of experts in this field.
The effect of multiple-dose ciprofloxacin on antipyrine metabolism was studied in patients suffer... more The effect of multiple-dose ciprofloxacin on antipyrine metabolism was studied in patients suffering from bacterial infections. The patients were given antipyrine 15 mg/kg intravenously before and after ciprofloxacin treatment. The dosage of ciprofloxacin was 500 mg bd by mouth for 8-10 days. Blood samples were taken at 0, 2, 4, 6, 10 h. Antipyrine total clearance was significantly decreased after ciprofloxacin treatment (0.85 +/- 0.45 vs. 0.52 +/- 0.24 ml/min/kg): elimination rate constants for antipyrine were decreased in all patients after ciprofloxacin, whereas no change in volume of distribution was observed. The average half-life of antipyrine was increased from 9.45 +/- 3.74 h to 14.92 +/- 3.32 h. In two males with advanced chronic hepatic failure the antipyrine half-lives were extremely prolonged. Our results support the hypothesis that ciprofloxacin inhibits intrinsic hepatic drug-metabolizing capacity and may be a source of clinically important drug interactions, particularly in patients with liver disease.
This paper overviews the architecture of rule-based consultation systems and illustrates how such... more This paper overviews the architecture of rule-based consultation systems and illustrates how such systems work by an Antibiotic Advisor. Knowledge representation and the inference engine implemented in the program are briefly described along with a sample consultation with the system. The paper is concluded with an analysis of the advantages and limitations of rule-based reasoning in clinical decision support.
In Chapter 1, we attempted to illustrate the complexity of the information processing and decisio... more In Chapter 1, we attempted to illustrate the complexity of the information processing and decision making associated with patient management. Before starting the detailed analysis of the therapeutic process, which is the subject of Chapter 4, we present in this chapter a general introduction to data and knowledge representation and manipulation. The aim is to sketch, in general terms, the basic methodologies that can be used in clinical information processing and problem solving.
The focus of this chapter is an analysis of the process associated with treating a patient. Let u... more The focus of this chapter is an analysis of the process associated with treating a patient. Let us begin by considering the flowchart shown in Fig. 4.1. This scheme is a simplification of the clinical decision process, since, for instance, in some cases the severity of the patient’s illness may require immediate action before a final diagnosis can be made (Wulff, 1981; Shortliffe and Barnett, 1990).
Bevezetes: A Clostridium difficile az antibiotikum asszocialta hasmenesek leggyakoribb korokozoja... more Bevezetes: A Clostridium difficile az antibiotikum asszocialta hasmenesek leggyakoribb korokozoja, aminek kezelesere az elmult evtizedekben keves uj szer kerult kifejlesztesre, es a tudomanyos bizonyitekok korlatozott mertekben es nehezen osszehasonlithato modon allnak rendelkezesre. Celkitűzes: A Clostridium difficile okozta fertőzes terapiajanak hatasossagi es biztonsagossagi vegpontjainak elemzese a metronidazol, vancomycin es a fidaxomicin alkalmazasa eseten. Modszer: A szakirodalom attekintese es az eredmenyek metaanalizise. Eredmenyek: A metaanalizis szerint a klinikai gyogyulas vegpontban nincs szignifikans kulonbseg a harom terapia kozott (eselyaranyok: fidaxomicin vs. vancomycin 1,19, vancomycin vs. metronidazol 1,69 es fidaxomicin vs. metronidazol 2,00). A rekurrencia es a globalis gyogyulas vegpontokban a fidaxomicin szignifikansan hatasosabbnak bizonyult, mint a vancomycin es a metronidazol (eselyaranyok: fidaxomicin vs. vancomycin 0,47, vancomycin vs. metronidazol 0,91 es fidaxomicin vs. metronidazol 0,43). A biztonsagossagi vegpontokat tekintve nem volt szignifikans kulonbseg az antibiotikumok kozott. Kovetkeztetesek: A klinikai gyogyulas eseteben a vizsgalt antibiotikumok hatasossaga hasonlo. A rekurrens fertőzesek megakadalyozasaban jelenleg a fidaxomicin a leghatasosabb terapias alternativa. Orv. Hetil., 2013, 154, 890–899. | Introduction:Clostridium difficile is the leading cause of antibiotic associated infectious nosocomial diarrhoea. Limited number of new pharmaceutical products have been developed and registered in the past decades for the treatment of Clostridium difficile infection. The available scientific evidence is limited and hardly comparable. Aim: To analyse the clinical efficacy and safety of metronidazole, vancomycin and fidaxomicin in the therapy of Clostridium difficile infection. Methods: Systematic review and meta-analysis of the literature data. Results: Meta-analysis of literature data showed no significant difference between these antibiotics in clinical cure endpoint (odss ratios: fidaxomicin vs. vancomycin 1.19; vancomycin vs. metronidazol 1.69 and fidaxomicin vs. metronidazol 2.00). However, fidaxomicin therapy was significantly more effective than vancomicin and metronidazol in endpoints of recurrence and global cure (odds ratios: fidaxomicin vs. vancomycin 0.47; vancomycin vs. metronidazol 0.91 es fidaxomicin vs. metronidazol 0.43). There was no significant difference between fidaxomicin, vancomycin and metronidazole in safety endpoints. Conclusions: Each antibiotic similarly improved clinical cure. Fidaxomicin was the most effective therapeutic alternative in lowering the rate of recurrent Clostridium difficile infections. Orv. Hetil., 2013, 154, 890–899.
Introduction:C. difficile causes 25 percent of the antibiotic associated infectious nosocomial di... more Introduction:C. difficile causes 25 percent of the antibiotic associated infectious nosocomial diarrhoeas. C. difficile infection is a high-priority problem of public health in each country. The available literature of C. difficile infection’s epidemiology and disease burden is limited. Aim: Review of the epidemiology, including seasonality and the risk of recurrences, of the disease burden and of the therapy of C. difficile infection. Method: Review of the international and Hungarian literature in MEDLINE database using PubMed up to and including 20th of March, 2012. Results: The incidence of nosocomial C. difficile associated diarrhoea is 4.1/10 000 patient day. The seasonality of C. difficile infection is unproved. 20 percent of the patients have recurrence after metronidazole or vancomycin treatment, and each recurrence increases the chance of a further one. The cost of C. difficile infection is between 130 and 500 thousand HUF (430 € and 1665 €) in Hungary. Conclusions: The importance of C. difficile infection in public health and the associated disease burden are significant. The available data in Hungary are limited, further studies in epidemiology and health economics are required. Orv. Hetil., 2013, 154, 1188–1193.
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