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This nonsystemic, gastrointestinal-selective oral antibiotic exerts its effect by binding to the beta-subunit of bacterial DNA- dependent RNA polymerase. Rifaximin was approved on May 25, 2004, for the treatment of travelers’ diarrhea caused by noninvasive strains of Escherichia coli in patients aged 12 years and older.

Common and serious comorbidities in chronic kidney disease include bone and mineral disorders, especially hyperphosphatemia and secondary hyperparathyroidism, and cardiovascular calcification and cardiovascular disease. Managing these complications typically requires the use of phosphate-binding compounds and vitamin D analogues. The selection and use of phosphate-binding agents in particular requires careful consideration of various factors such as calcium load and increased risk of subsequent cardiovascular calcification. Currently available calcium-containing phosphate binders have been demonstrated to contribute to patient calcium loads, and their use in hemodialysis patients has been associated with significant and progressive cardiovascular calcification. Thus, there is increasing interest in the use of calcium-free products, which can effectively bind phosphate without enhancing the risk for cardiovascular calcification.

The intravenous (IV) formulation of esomeprazole, the S-isomer of the proton pump inhibitor (PPI) omeprazole, is currently under FDA review for the short-term treatment of gastroesophageal reflux disease (GERD) as an alternative in patients unable to continue taking oral esomeprazole. Clinical studies have shown esomeprazole to be equivalent to the other currently available PPIs with respect to safety. The intravenous formulation, given either as a 30-minute infusion or 3-minute injection, has been found to be comparable to the oral dosage form based on pharmacokinetic and pharmacodynamic studies in healthy subjects. Limited studies suggest that IV esomeprazole 40 mg/d may provide a more effective antisecretory profile than either IV lansoprazole 30 mg/d or IV pantoprazole 40 mg/d. Data on clinical efficacy is limited to 1 abstract that reported no significant differences in healing rates in subjects with erosive esophagitis administered esomeprazole either 40 mg orally or IV daily. More clinical studies are needed to define its limited role as an alternative in those patients with acid-related disorders unable to tolerate the oral formulations.

July Desktop Resource Chart

The pain associated with a degenerative hip condition had 37-year-old Gerald Amaral taking several prescription pain tablets on a daily basis to manage his discomfort. It's hard to believe that doctors say this former competitive mountain bike racer has the hip of a 70-year-old man.

Sean Sullivan and Gregg Lehman understand the true value of having a healthy work force.

What you don't know might hurt you

In the first half of this year, there have been several significant business transactions in the managed care industry that have either been completed or announced. Just to name a few, Anthem and WellPoint Health Networks are merging; UnitedHealthcare acquired Mid-Atlantic Medical Services; Humana acquired Ochsner Health Plan; UnitedHealthcare announced the acquisition of Oxford Health Plans; and Molina Healthcare announced its acquisition of Cimarron Health Plan. In this highly regulated industry, these types of transactions require various regulatory approvals. With so much activity this year, it is important to highlight some of the necessary procedures for potential acquirers and targets.

According to Greek legend, a poor peasant named Gordius became the king of the Asian country of Phrygia because of a rather vague prophecy. An oracle had prophesied that the nation’s future ruler would come riding into town on a wagon, so when Gordius and his wife arrived in the public square driving an ox cart, the populace named him king.

Predictive modeling offers a tremendous opportunity for healthcare. With healthcare expenditures exceeding 15% of the gross domestic product (GDP), and the aging baby-boom generation entering their “high-utilization years,” strategies for targeting healthcare resources toward those who could benefit most have become a strong necessity for a health plan’s economic survival.

More state governments and public health agencies that are facing funding cutbacks are looking for ways to obtain less expensive pharmaceuticals from Canada in order to reduce spending on pharmaceuticals. So far this year, 21 states have considered drug reimportation bills or resolutions, according to the National Conference of State Legislatures.

Findings from a newly released Women's Health Initiative (WHI) study suggest that conjugated equine estrogen (CEE) alone should not be used for chronic disease prevention, specifically coronary heart disease (CHD), in postmenopausal women. The study, published in the Journal of the American Medical Association, found that CEE increased the risk of stroke by 39% and offered no protection against heart disease.

Acetaminophen use is associated with an increased rate of newly diagnosed adult-onset asthma, according to a study published in the American Journal of Respiratory and Critical Care Medicine. The study findings, from the Nurses Health Study, confirmed and extended the results of similar cross-sectional studies, although the authors stated that it would be premature to recommend the avoidance of acetaminophen for all adults with asthma.

More than half the women suffering from early-stage breast cancer (ESBC) are at increased risk of recurrence or death because of substantial reductions-planned or unplanned-in relative dose-intensity (RDI) when treated with adjuvant chemotherapy, according to a study published in the Journal of Clinical Oncology.

Combination use of clopidogrel and aspirin the night before undergoing carotid endarterectomy (CEA) may significantly reduce the risk of cerebral emboli, according to a study published in the journal Circulation.

Perindopril, an angiotensin-converting enzyme (ACE) inhibitor, can help stop or delay the progress of white matter lesions (WML) in patients with prior cerebrovascular disease, according to research presented at the annual meeting of the American Academy of Neurology.

Adjusted-dose warfarin compared to aspirin more effectively reduces the high risk of secondary stroke in atrial fibrillation (AF) patients who have a history of transient ischemic attack (TIA), according to a study published in the journal Stroke.

It remains to be seen how these importation proposals could affect R&D and drug development over the long run.

Disease-free survival in postmenopausal women with primary breast cancer significantly improved when tamoxifen monotherapy treatment was switched to exemestane therapy after 2-3 years, according to a study published in the New England Journal of Medicine. The existing treatment paradigm calls for tamoxifen, an estrogen-receptor modulator, to be taken alone for all 5 years, but some patients have experienced relapse.

First therapy approved for “off” episodes in advanced Parkinson’s disease

First therapy approved for “off” episodes in advanced Parkinson’s disease

Biologic approved for plaque psoriasis

Two published studies from the 1970s describe a higher inappropriate use of antimicrobials among surgeons compared to internal medicine physicians. If this assertation is indeed true, institutions with limited resources should focus interventions on surgical services to improve antimicrobial use. The appropriateness of antimicrobial use in internal medicine and general surgical patients over a 10-month period was evaluated at the University of Louisville Hospital (Louisville, Ky) based upon established institutional antimicrobial guidelines. Antimicrobial selection and dose were evaluated for 1,300 antimicrobial courses. Compliance to institutional guidelines for antimicrobial selection and dose were found in 448 (93%) of 480 courses prescribed by internal medicine services and 728 (88%) of 820 courses prescribed by surgical services (P=.009). Although we were able to identify a 5% difference among specialties, we did not consider this to be a clinically significant difference. We concluded that focused interventions to improve antimicrobial use at the University of Louisville should be applied equally to medical and surgical specialties.

Darifenacin (Enablex, Novartis) is a muscarinic antagonist in phase 3 clinical trials for the treatment of overactive bladder (OAB). Darifenacin demonstrates relative selectivity for the M3 muscarinic receptor subtype over the M1 and M2 subtypes. In clinical trials, darifenacin has been compared to placebo for the treatment of symptoms of OAB in adult men and women. Patients treated with darifenacin experienced significantly greater reductions in the number of incontinence episodes per week, nocturnal awakenings, and warning time before micturitions. It appears to have similar efficacy to available anticholinergic agents for the treatment of OAB. Commonly reported adverse events include dry mouth and constipation, and preliminary data suggest that darifenacin may be associated with decreased impairment of salivary flow versus oxybutynin. Darifenacin has not been found to have an effect on the cardiovascular system or cognition in clinical trials. Further research is needed to determine the efficacy of darifenacin compared to other available anticholinergic agents such as oxybutynin and tolterodine, as well as emerging therapies. In addition, further investigation of the adverse effect profile in elderly patients is warranted.

Systems integration has evolved to become much more than a technology issue

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