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Wiesbaden, Germany

Rifampicin is an effective and important antibiotic in the treatment of tuberculosis. Due to its activity e. g. against resistant staphylococci (MRSA) it is increasingly used as a combination partner in the treatment of MRSA infections. Regardless of a still limited evidence in this indication, it is possible, that serious, clinically relevant pharmacokinetic interactions will occur. Due to its potency to induce CYP enzymes and transport proteins Rifampicin shows one of the highest potential for such drug interactions. Given the complex and diverse influences on metabolism and transport of other drugs, physicians should be aware of these interactions with concomitantly administered drugs. In general, for substances with a narrow therapeutic index the dosage of that medication has to be adjusted after the start and after discontinuation of rifampicin therapy. For some drugs the concomitant administration of rifampicin is contraindicated. The article provides an updated overview of the possible interactions. Source

Stolz E.,Justus Liebig University | Hamann G.F.,Dr. Horst Schmidt Kliniken GmbH | Kaps M.,Justus Liebig University | Misselwitz B.,Geschaftsstelle Qualitatssicherung Hessen
Deutsches Arzteblatt | Year: 2011

Background: Using data from the mandatory quality assurance program for stroke care in Hesse, we analyze regional differences in thrombolysis rates and infer some ways in which care can be improved. Methods: We identified 7707 patients with acute ischemic stroke who were admitted to hospital within 3 hours of symptom onset in 2007 and 2008, and we determined the local thrombolysis rate district by district. In order to exclude the possibility that the observed local differences in thrombolysis rates might be accounted for, in large part, by off-label thrombolysis procedures, we further narrowed down the subgroup of patients who underwent thrombolysis to the 1108 patients admitted within 2 hours of symptom onset. We also analyzed the local thrombolysis rates for patients who were primarily referred to stroke units. Results: The overall thrombolysis rate among patients admitted within 3 hours of symptom onset was 19%, varying locally from 6% to 35%. Among patients admitted within 2 hours of symptom onset, the local thrombolysis rate ranged from 13% to 85%. Even in patients primarily referred to stroke units, the local thrombolysis rate ranged from 8% to 44% in the 3-hour group and from 16% to 62% in the 2-hour group. Conclusion: Local thrombolysis rates vary unexpectedly widely across the state of Hesse. The care of patients with acute stroke after they reach the hospital urgently needs critical reappraisal and improvement. Source

Critically ill patients in the intensive care unit (ICU) are predisposed to pharmacokinetic drug interactions because of the complexity of the drug regimens received in the intensive care setting. Drugs may affect the absorption, distribution, metabolism and/or elimination of an object drug and consequently alter the intended pharmacologic response and potentially lead to an adverse event. The paper presents an overview of pharmacokinetic drug-drug interactions which can occur with commonly used drugs in the ICU and outlines the underlying types and mechanisms. © 2012 Springer-Verlag. Source

Stein M.,Justus Liebig University | Misselwitz B.,Institute of Quality Assurance Hesse | Hamann G.F.,Dr. Horst Schmidt Kliniken GmbH | Scharbrodt W.,Justus Liebig University | And 2 more authors.
Stroke | Year: 2012

Background and Purpose-In most European societies and in the United States, the percentage of patients ≥80 years has been rising over the past century. The present study was conducted to observe this demographic change and its impact on patients with intracerebral hemorrhage (ICH). Methods-We reviewed patients' data with the diagnosis of ICH from January 2007 to December 2009. All data were collected out of a prospective stroke registry covering the entire state of Hesse, Germany. Incidence rates and absolute numbers of patients with ICH for 2009 to 2050 were calculated. Results-Of 3448 patients, 34% had an age ≥80 years. Hospital mortality was 35.9% for patients ≥80 years and 20.0% for patients <80 years. Unfavorable outcome (modified Rankin Scale score >2) was more often found in patients ≥80 years compared with patients <80 years (84.9% versus 74.8%). By the year 2050, the proportion of all patients with ICH ≥80 years will be 2.5-fold higher than in 2009. The total number of ICH cases will increase approximately 35.2% assuming that ICH probability stays the same. The number of patients who die in the hospital will increase approximately 60.2%. The total number of patients with severe disability due to ICH will increase approximately 36.8%. Conclusions-If current treatment strategies according to age remain unchanged, an increase of in-hospital mortality and a higher proportion of patients who need lifelong care after ICH can be expected in the coming decades. © 2012 2012 American Heart Association, Inc. Source

Al-Nawas B.,Universitatsmedizin Mainz | Grotz K.A.,Dr. Horst Schmidt Kliniken GmbH
Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz | Year: 2011

Due to changing demographics in our society, there are an increasing number of patients with risk factors presenting for dental care. Unfortunately valid screening instruments to identify these patients are lacking. Especially in elderly patients, there is often an association between the high number of prescribed medications and oral symptoms. Using supportive therapy in oncology (e.g., radio(chemo)therapy) as an example, the role of modern dentistry and its interaction with general medicine is illustrated. Modern substances, e.g., antiangiogenetics, with still unknown side effects represent challenging new developments in the field of oral medicine. Even with some examples of positive representation of patients with risk factors in the health systems, e.g., § 28 SGB V, it is clear that the pressure on the costs in the health systems leads to an undertreatment of patients with risk factors. Only by adapting dental and postgraduate training with respect to these aspects, together with better financial reimbursement of the additional efforts, will this trend be overcome. © 2011 Springer Medizin Verlag. Source

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