One-day Quadruple Therapy Compared With 7-day Triple Therapy For Helicobacter Pylori Infection
clarithromycin; cure; duodenal-ulcer disease; eradication; follow-up; General & Internal Medicine; nonulcer dyspepsia; peptic-ulcer; proton-pump inhibitor; term; united-states; urea breath test
Background: Eradication of Helicobacter pylori infection has had an impact on the treatment and recurrence rates of peptic ulcer disease and malignancies such as mucosa-associated lymphoid tissue lymphoma. Treatment options are cumbersome, expensive, and associated with side effects. Methods: Randomized, prospective, open-labeled equivalence trial with a parallel-group design to compare eradication rates of H pylori with a 1-day, 4-drug regimen with a 7-day, 3-drug regimen. A total of 160 patients with dyspepsia and a Glasgow Dyspepsia Severity Score of at least 3 had a urea breath test labeled with carbon 14. Patients who tested positive were randomized to 1 of the 2 study groups. The study was designed to test the therapeutic equivalence of 1-day and 7-day regimens based on the percentage of H pylori eradication in each group at 5 weeks. Results: The 1-day treatment group (n = 80) had a slightly higher eradication percentage (95%) than the 7-day group (90%). The possible inferiority of the 1-day treatment relative to the 7-day treatment, a 15% difference in the number of patients whose infection was not eradicated at 5 weeks, was rejected (P < .001; 90% confidence interval, 2.7%-11%). Both groups demonstrated a mean decrease of 7.5 points in the Glasgow Dyspepsia Severity Score. The 2 groups showed no significant differences in side effects. Patients whose treatment failed (4 in the 1-day treatment group and 7 in the 7-day treatment group) were retreated for 10 days. One patient from the 7-day treatment group still tested positive after the second treatment. Conclusions: The 1-day treatment proved to be statistically similar to the 7-day treatment for the eradication of H pylori in patients with dyspepsia and a positive urea breath test. Further evaluation will be necessary to determine whether the 1-day regimen is adequate for patients with peptic ulcer disease, mucosa-associated lymphoid tissue lymphoma, or gastric adenocarcinoma.
Lara L F; Cisneros G; Gurney M; Van Ness M; Jarjoura D; Moauro B; Polen A; Rutecki G; Whittier F
Archives of Internal Medicine
2003
2003-09
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1001/archinte.163.17.2079" target="_blank" rel="noreferrer noopener">10.1001/archinte.163.17.2079</a>
Improving Clinical Practice Guidelines-the Answer Is More Clinical Research
General & Internal Medicine; infectious-diseases-society
Deresinski S; File T M
Archives of Internal Medicine
2011
2011-08
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1001/archinternmed.2011.345" target="_blank" rel="noreferrer noopener">10.1001/archinternmed.2011.345</a>
UNSUSPECTED PULMONARY TUBERCULOSIS IN A COMMUNITY TEACHING HOSPITAL
General & Internal Medicine
Counsell S R; Tan J S; Dittus R S
Archives of Internal Medicine
1989
1989-06
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1001/archinte.149.6.1274" target="_blank" rel="noreferrer noopener">10.1001/archinte.149.6.1274</a>
PROPHYLAXIS OF UPPER GASTROINTESTINAL-TRACT BLEEDING IN MECHANICALLY VENTILATED PATIENTS - A RANDOMIZED STUDY COMPARING THE EFFICACY OF SUCRALFATE, CIMETIDINE, AND ANTACIDS
General & Internal Medicine
Cannon L A; Heiselman D; Gardner W; Jones J
Archives of Internal Medicine
1987
1987-12
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1001/archinte.147.12.2101" target="_blank" rel="noreferrer noopener">10.1001/archinte.147.12.2101</a>
STAPHYLOCOCCUS-AUREUS ENDOCARDITIS AT A COMMUNITY TEACHING HOSPITAL, 1980 TO 1991 - AN ANALYSIS OF 106 CASES
acquired infective endocarditis; bacteremia; bacterial-endocarditis; drug-users; experience; General & Internal Medicine; manifestations; neurologic complications; prognostic-factors; transesophageal echocardiography; vancomycin
Background: The clinical diagnosis of infective endocarditis due to Staphylococcus aureus can be difficult, and many patients with this disease are only diagnosed post mortem. There are few published reports of large series of patients with S aureus endocarditis and none from a community hospital. I reviewed the clinical and laboratory findings of a large number of patients with S aureus endocarditis in a community hospital. Methods: I reviewed medical records identified through consultation records, International Classification of Diseases, Ninth Edition codes, and autopsy records of patients who fulfilled the criteria for the diagnosis of S aureus endocarditis during 1980 to 1991. Results: During the 12-year period, there were 106 cases, for a prevalence of 0.34 per 1000 admissions. Ninety-three (87.7%) of these patients were seen by me. The patients' ages ranged from 12 to 83 years (median, 61 years). Eighteen cases were nosocomial (15 were associated with intravascular catheters). Twenty-one patients were injecting drug users. Severe back pain was the chief complaint in nine patients. Twenty-seven patients had no heart murmur at the time of diagnosis. The overall mortality was 25.5%. Conclusions: Age 60 years or older, female gender, community-acquired infection, absence of heart murmur, presence of congestive heart failure, or central nervous system involvement was associated with higher mortality. Tricuspid valve endocarditis alone was associated with lower mortality.
Watanakunakorn C
Archives of Internal Medicine
1994
1994-10
Journal Article
<a href="http://doi.org/10.1001/archinte.154.20.2330" target="_blank" rel="noreferrer noopener">10.1001/archinte.154.20.2330</a>
Adult bacteremic pneumococcal pneumonia in a community teaching hospital, 1992-1996 - A detailed analysis of 108 cases
acquired pneumonia; antimicrobial resistance; diagnosis; disease; General & Internal Medicine; penicillin-resistant pneumococci; polysaccharide vaccine; risk-factors; sputum culture; Streptococcus pneumoniae; united-states
Objectives: To review the clinical and laboratory findings of 108 adult patients with bacteremic pneumococcal pneumonia admitted to a community hospital and to determine the value of sputum Gram stains and cultures in the diagnosis of pneumococcal pneumonia in this setting. Methods: Using the laboratory logbooks to identify adult inpatients with pneumococcal bacteremia from January 1, 1992, to June 30, 1996, we reviewed medical records. Results: We found 108 patients. There was an apparent increase in prevalence from 1995 to 1996 compared with 1992 to 1994. Patients included 44 men and 64 women. Ages ranged from 20 to 95 years (median, 70 years). The fatality rate was 24.1% and increased with advancing age (no patient younger than 45 years died, and 36.8% of patients aged 85-95 years died). Cigarette smoking, cardiovascular disease, chronic obstructive lung disease, malignant disease, and diabetes mellitus were major underlying conditions. Fever, dyspnea, and cough were the most common presenting symptoms. Sputum Gram stain was useful in the diagnosis when moderate to abundant Gram-positive diplococci were seen. Sputum culture was less useful. Factors associated with higher fatality rate were being 65 years of age or older, APACHE II (Acute Physiologic and Chronic Health Evaluation II) score greater than 15, intensive care unit admission, low or normal leukocyte count, thrombocytopenia, renal dysfunction, diffused infiltrates on chest radiography, bilateral pneumonia, and sputum culture positive for Streptococcus pneumoniae. Conclusions: We found a recent increase in the prevalence of bacteremic pneumococcal pneumonia in adults. Gram stain of sputum is useful, but sputum culture is less sensitive in the diagnosis of pneumococcal pneumonia. The fatality rate remains high. More effort should be made at prevention using pneumococcal immunization.
Watanakunakorn C; Bailey T A
Archives of Internal Medicine
1997
1997-09
Journal Article
<a href="http://doi.org/10.1001/archinte.157.17.1965" target="_blank" rel="noreferrer noopener">10.1001/archinte.157.17.1965</a>
Azithromycin vs cefuroxime plus erythromycin for empirical treatment of community-acquired pneumonia in hospitalized patients - A prospective, randomized, multicenter trial
adults; chlamydia-pneumoniae; diagnosis; epidemiology; etiology; General & Internal Medicine; guidelines; in-vitro activities; management; resistant streptococcus-pneumoniae; therapy
Objective: To compare the efficacy and safety of azithromycin dihydrate monotherapy with those of a combination of cefuroxime axetil plus erythromycin as empirical therapy for community-acquired pneumonia in hospitalized patients. Methods: Patients were enrolled in a prospective, randomized, multicenter study. The standard therapy of cefuroxime plus erythromycin was consistent with the American Thoracic Society, Canadian Community-Acquired Pneumonia Consensus Group, and Infectious Disease Society of America consensus guidelines. The doses were intravenous azithromycin (500 mg once daily) followed by oral azithromycin (500 mg once daily), intravenous cefuroxime (750 mg every 8 hours), followed by oral cefuroxime axetil (500 mg twice daily), and erythromycin (500-1000 mg) intravenously or orally every 6 hours. Randomization was stratified by severity of illness and age. Patients who were immunosuppressed or residing in nursing homes were excluded. Results: Data from 145 patients (67 received azithromycin and 78 received cefuroxime plus erythromycin) were evaluable. Streptococcus pneumoniae and Haemophilus influenzae were isolated in 19% (28/145) and 13% (19/145), respectively. The atypical pathogens accounted for 33% (48/145) of the etiologic diagnoses; Legionella pneumophila, Chlamydia pneumoniae, and Mycoplasma pneumoniae were identified in 14% (20/ 145), 10%;, (15/145), and 9% (13/145), respectively. Clinical cure was achieved in 91% (61/67) of the patients in the azithromycin group and 91% (71/78) in the cefuroxime plus erythromycin group. Adverse events (intravenous catheter site reactions, gastrointestinal tract disturbances) were significantly more common in patients who received cefuroxime plus erythromycin (49% [30/78]) than in patients who received azithromycin (12% [8/67]) (P<.001). Conclusions: Treatment with azithromycin was as effective as cefuroxime plus erythromycin in the empirical management of community-acquired pneumonia in immunocompetent patients who were hospitalized. Azithromycin was well tolerated.
Vergis E N; Indorf A; File T M; Phillips J; Bates J; Tan J; Sarosi G A; Grayston J T; Summersgill J; Yu V L
Archives of Internal Medicine
2000
2000-05
Journal Article
<a href="http://doi.org/10.1001/archinte.160.9.1294" target="_blank" rel="noreferrer noopener">10.1001/archinte.160.9.1294</a>
Risk factors for domestic acquisition of Legionnaires disease
community-acquired pneumonia; cooling-tower; evaporative condenser; General & Internal Medicine; hot; legionella-pneumophila serogroup-1; monoclonal-antibody; outbreak; potable water; tap water; united-states; water-systems
Background: Legionnaires disease is a common cause of adult pneumonia. Outbreaks of legionnaires disease have been well described, but little is known about sporadically occurring legionnaires disease, which accounts for most infections. Exposure to contaminated residential water sources is 1 plausible means of disease acquisition. Methods: Employing a matched case-control study design in 15 hospitals in 2 Ohio counties, we prospectively enrolled 146 adults diagnosed as having nonepidemic, community-acquired legionnaires disease and compared each with 2 hospital-based control patients, matched for age, sex, and underlying illness category. An interview regarding potential exposures was followed by a home survey that included sampling residential sources for Legionella. Interview and home survey data were analyzed to estimate the risk of acquiring legionnaires disease associated with various exposures. Results: Multivariate analysis showed that a nonmunicipal water supply (odds ratio [OR], 2.26; 95% confidence interval [CI], 1.17-4.37), recent residential plumbing repair (OR, 2.39; 95% CI, 1.10-5.18), and smoking (OR, 3.48; 95% CI, 2.09-5.79) were independent risk factors for legionnaires disease. Univariate analysis suggested that electric (vs gas) water heaters (OR, 1.97; 95% CI, 1.10-3.52), working more than 40 hours weekly (OR, 2.13; 95% CI, 1.12-4.07), and spending nights away from home before illness (OR, 1.68; 95% CI, 1.03-2.74) were additional possible risk factors. Lower chlorine concentrations in potable water and lower water heater temperatures were associated with residential Legionella colonization. Conclusions: A proportion of sporadic cases of legionnaires disease may be residentially acquired and are associated with domestic potable water and disruptions in residential plumbing systems. Potential strategies to reduce legionnaires disease risk include consistent chlorination of potable water, increasing water heater temperatures, and limiting exposure to aerosols after domestic plumbing repairs.
Straus W L; Plouffe J F; File T M; Lipman H B; Hackman B H; Salstrom S J; Benson R F; Breiman R F; Baird I; Emerick J; Gianakopoulos G; Herbert M; Parsons J; Anderson C J; Bollin G E; Farkas S A; Francis S J; Gardner W G; Myers J P; Signs D J; Tan J S; Thomson R B; Barbaree J; Fields B; Morrill W; Moyenuddin M; Pruckler J; StJohn A
Archives of Internal Medicine
1996
1996-08
Journal Article
<a href="http://doi.org/10.1001/archinte.156.15.1685" target="_blank" rel="noreferrer noopener">10.1001/archinte.156.15.1685</a>
INFECTIONS DUE TO CORYNEBACTERIUM GROUP-D2 - REPORT OF A CASE
General & Internal Medicine
Roncikoenig T J; Tan J S; File T M; Thomson R B
Archives of Internal Medicine
1990
1990-09
Journal Article
<a href="http://doi.org/10.1001/archinte.150.9.1965" target="_blank" rel="noreferrer noopener">10.1001/archinte.150.9.1965</a>
Human zoonotic infections transmitted by dogs and cats.
Animals; Dogs; Cats; Bacterial Infections; Disease Vectors; Ectoparasitic Infestations; Bacterial Infections – Transmission; Ectoparasitic Infestations – Transmission; Helminthiasis – Transmission; Protozoan Infections – Transmission; Zoonoses – Transmission
Tan J S
Archives of Internal Medicine
1997
1997-09-22
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1001/archinte.157.17.1933" target="_blank" rel="noreferrer noopener">10.1001/archinte.157.17.1933</a>
The treatment of herpes simplex infections: an evidence-based review.
Risk Factors; Recurrence; Drug Resistance; Microbial; Medical Practice; Valine; Evidence-Based; Acyclovir – Therapeutic Use; Antiviral Agents – Therapeutic Use; Herpes Simplex – Drug Therapy; Acyclovir – Analogs and Derivatives; Herpes Genitalis – Drug Therapy; Purines – Analogs and Derivatives; Purines – Therapeutic Use; Valine – Therapeutic Use
Cernik C; Gallina K; Brodell R T
Archives of Internal Medicine
2008
2008-06-09
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Nosocomial fungemia in a large community teaching hospital.
Adult; Humans; Middle Aged; Retrospective Studies; Teaching; Amphotericin B/therapeutic use; *Cross Infection; Candidiasis/complications/drug therapy/*etiology/mortality; Hematologic Diseases/complications/drug therapy/*etiology/mortality; Sepsis/complications; Community; *Hospitals
This report reviews 48 episodes of hospital-acquired fungemia that occurred over a four-year period at a large community teaching hospital. The incidence of hospital-acquired fungemia increased eightfold during the study period. Candida albicans (58%), Candida tropicalis (25%), and Candida parapsilosis (15%) were the most common fungal pathogens isolated from blood cultures. Twenty-one patients (44%) had concomitant bacteremia. Intravascular catheters (100%), antibiotic administration (98%), urinary catheters (81%), surgical procedures (65%), parenteral alimentation (60%), and corticosteroid administration (54%) were the most common predisposing factors. The overall mortality rate was 75%. Hospitalization on the medical service, age greater than 60 years, and hospital stay less than 100 days were associated with a significantly increased mortality rate.
Harvey R L; Myers J P
Archives of Internal Medicine
1987
1987-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1001/archinte.147.12.2117" target="_blank" rel="noreferrer noopener">10.1001/archinte.147.12.2117</a>
Enalapril-induced cough.
Humans; Retrospective Studies; Sex Factors; Antitussive Agents/therapeutic use; Cough/*chemically induced/drug therapy; Enalapril/*adverse effects
A retrospective analysis of records from an outpatient medical practice was undertaken to determine the incidence and features of cough resulting from the use of enalapril maleate. Of 209 patients taking enalapril, 22 (10.5%) required discontinuation of therapy because of an intractable, dry cough. Cough was more than twice as common in women; 16 (14.6%) of 109 women and 6 (6%) of 100 men stopped taking enalapril because of cough. The cough resolved in 21 of 22 patients within 2 weeks of discontinuation of enalapril therapy. When the patients with cough were compared with the others, there was no significant difference in age, smoking status, creatinine levels, enalapril dosage, associated cardiopulmonary disease, or concomitant administration of medications. Among the 187 study patients who did not discontinue taking enalapril because of cough, many developed a persistent, dry cough that to date has not been severe enough to require discontinuation of therapy, after a mean follow-up period of 16 months. The enalapril-induced cough is insidious, dry, persistent, benign, and reversible on discontinuation of therapy. It is important to distinguish enalapril-induced cough from cough resulting from acute illness, reactive airway disease, and congestive heart failure. Optimal clinical application of enalapril in the treatment of hypertension and congestive heart failure will require increased awareness of this incessant cough, which requires discontinuation of the therapy in about 10% of patients.
Gibson G R
Archives of Internal Medicine
1989
1989-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1001/archinte.149.12.2701" target="_blank" rel="noreferrer noopener">10.1001/archinte.149.12.2701</a>
The treatment of herpes simplex infections: an evidence-based review.
2-Aminopurine/analogs & derivatives/therapeutic use; Acyclovir/analogs & derivatives/therapeutic use; Antiviral Agents/*therapeutic use; Drug Resistance; Evidence-Based Medicine; Famciclovir; Herpes Genitalis/*drug therapy; Herpes Labialis/*drug therapy; Humans; Recurrence; Risk Factors; Valacyclovir; Valine/analogs & derivatives/therapeutic use; Viral
Genital and labial herpes simplex virus infections are frequently encountered by primary care physicians in the United States. Whereas the diagnosis of this condition is often straightforward, choosing an appropriate drug (eg, acyclovir, valacyclovir hydrochloride, or famciclovir) and dosing regimen can be confusing in view of (1) competing clinical approaches to therapy; (2) evolving dosing schedules based on new research; (3) approved regimens of the Food and Drug Administration that may not match recommendations of the Centers for Disease Control and Prevention or of other experts; and (4) dissimilar regimens for oral and genital infections. The physician must first choose an approach to treatment (ie, intermittent episodic therapy, intermittent suppressive therapy, or chronic suppressive therapy) based on defined clinical characteristics and patient preference. Then, an evidence-based dosing regimen must be selected. In this review, data from all sources are tabulated to provide a handy clinical reference.
Cernik Christina; Gallina Kelly; Brodell Robert T
Archives of Internal Medicine
2008
2008-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1001/archinte.168.11.1137" target="_blank" rel="noreferrer noopener">10.1001/archinte.168.11.1137</a>
Human zoonotic infections transmitted by dogs and cats.
*Cats; *Disease Vectors; *Dogs; Animals; Bacterial Infections/transmission/veterinary; Cat Diseases/transmission; Dog Diseases/transmission; Ectoparasitic Infestations/transmission/veterinary; Helminthiasis/transmission; Humans; Protozoan Infections/transmission; Zoonoses/*transmission
Dogs and cats are the 2 most common household pets. However, they may be a direct or indirect source of human infections. This article aims to familiarize physicians with some common and uncommon bacterial, rickettsial, parasitic, and fungal zoonotic infections of dogs and cats. Animal bites with or without infection continue to be a common problem. Treatment of infected animal bites must include early debridement and concern for organisms from the mouth flora of the animal. The diagnosis and treatment of cat-scratch disease have become easier since Bartonella henselae has been established as the main causal agent. Less common bacterial and rickettsial zoonotic infections are included to increase the reader's awareness. Parasitic infections, such as creeping eruptions, visceral larva migrans, cryptosporidiosis, and toxoplasmosis, are diseases associated with contact with dogs and cats. Pets can also be the source of dermatophyte infections. An increase in awareness that some of these diseases may be associated with animals could provide a better plan for the prevention and treatment of common and uncommon zoonotic infections.
Tan J S
Archives of Internal Medicine
1997
1997-09
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1001/archinte.157.17.1933" target="_blank" rel="noreferrer noopener">10.1001/archinte.157.17.1933</a>