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Antibiotic therapy has undergone enormous changes since the discovery of penicillin by Sir Alexander Fleming in 1928. 1. Today, clinicians face increasing reports of antibiotic resistance. Optimizing antibiotic regimens can maximize effectiveness and minimize adverse effects while decreasing the likelihood of the development of resistance. The task of designing optimal antibiotic dosing regimens incorporates pharmacodynamics (PDs), pharmacokinetics (PKs), and microbiological principles. PKs consist of absorption, distribution, metabolism, and excretion, with these parameters reflecting drug exposure over time. The relationship between drug exposure and the physiologic effect of the drug encompasses the principles of PDs. With antibiotic therapy, PDs incorporate exposure to the antibiotic and antimicrobial effect. The intricate relationship between these principles enhances the understanding of the efficacy of antibiotic therapy.

HMO industry is currently in a state of flux or transition

Enrollment data as of January 2002

Mike Cascone has spent his entire career -- more than 35 years -- with the fortunate BCBS of Florida.

Partnerships between public health entities and private managed care systems have proven crucial for tracking public health trends. Now that the Centers for Disease Control and Prevention (CDC) is preparing to go live with its National Bioterror Syndromic Surveillance Demonstration Project, MCOs continue to shape the country's ability to recognize and respond to health threats, including ones posed by biological, chemical and radiological agents.

Michael Cascone Jr. must be a big fan of Charles Darwin. When asked to identify the single most important issue facing healthcare today, the CEO of Blue Cross Blue Shield of Florida (BCBSF) replied, "Keeping the government out of benefits definition, and allowing people to shape the marketplace according to the benefits they want."

Osteoporosis affects more than 10 million Americans and accounts for 1.5 million fractures annually. Several treatment options have been shown to prevent fractures and improve outcomes in patients with osteoporosis. Alendronate and risedronate clearly reduce fractures and are good initial choices in many patients. Raloxifene and calcitonin reduce the risk of vertebral fractures and may be appropriate in certain patients. Teriparatide was recently approved by FDA for the treatment of osteoporosis and may offer another treatment option. Combination therapy has been shown to increase bone mineral density; however, a reduction in the risk of fractures remains to be established. Zoledronic acid may offer an advantage of reduced frequency of administration.

Omalizumab appears effective in patients with poorly controlled allergic asthma.

New agent reduces PTH levels in hemodialysis patients with secondary hyperparathyroidism.

Congress to weigh Medicare reform plan and patient safety; FDA addresses product risk and quality

Recommendations for approval, approvable designations, Fast-track designations

Two options are available for patients requiring treatment for arthritis who are at risk for ulcer disease: nonsteroidal anti-inflammatory drugs (NSAIDs) that are selective for cyclooxygenase-2 (COX-2) or the combination of a non-selective NSAID with a proton-pump inhibitor. A recent study of representative members from these therapeutic classes has offered findings that the two alternatives are statistically similar in their efficacy with respect to the prevention of recurrent ulcer bleeding.Celecoxib, a COX-2-selective NSAID, was given to 144 patients through random assignment. Another group of patients (N=143) were randomly assigned to receive a combination of diclofenac (a nonselective NSAID) plus omeprazole (a proton-pump inhibitor) during the 6-month trial.

An ingredient in dozens of cough syrups, which the FDA says is not dangerous,never underwent the current drug approval process because it was introducedbefore FDA efficacy guidelines were in place. The drug, extended-releaseguaifenesin, is marketed as an expectorant by 66 companies in prescriptioncough syrups.

Corticosteroid therapy is an effective treatment for asthma sufferers, but the use of systemic corticosteroids is known to increase the risk of osteoporotic fractures. A recent study published in the Journal of Allergy and Clinical Immunology suggests that moderate doses of inhaled corticosteroids (ICs) carry less risk than traditional oral corticosteroid (OC) therapy with respect to reduction of bone mineral density (BMD) in postmenopausal women. This assertion is based on the premise that the lowest daily dose of IC sufficient to control the patient's asthma is used.

Enfuvirtide (Fuzeon, Roche/Trimeris) is the first member of a unique class of antiretrovirals known as the fusion inhibitors to gain FDA approval for the treatment of human immunodeficiency virus type-1 (HIV-1) infection. Enfuvirtide is indicated for use in combination with other antiretroviral agents in the treatment of HIV-1 infection in treatment-experienced patients with evidence of HIV-1 replication despite ongoing antiretroviral therapy. Phase 3 trials demonstrated that adding enfuvirtide 90 mg twice daily to an optimized background regimen chosen with genotypic and phenotypic resistance testing improved the surrogate end points of HIV ribonucleic acid (RNA) levels, CD4 cell counts, and the proportion of patients reaching clinically undetectable HIV RNA levels (<400 and <50 copies/mL) through 24 weeks. Enfuvirtide?s efficacy in treatment-experienced patients when added to an optimized background regimen makes it a promising choice for salvage therapy. Further studies will be required to support enfuvirtide?s use in treatment-naïve patients.

He first became interested in healthcare because of its growth and ever-changing dynamics. What has kept Bob Tremain interested for the last 30 years, however, is the industry's unique mission of improving public health through better outcomes.

With a forte for everything from anthropology to accounting to medicine, it's understandable if today's pharmacy directors feel like every piece of the managed care equation is in their hands at any given time.

When it comes to sheer inspiration, Rocky Balboa doesn't have anything on Dr. Edson Bueno. Boxers always have a "puncher's chance" to land a knockout blow, but what chance does a poor -- and poorly educated -- Brazilian boy have of becoming the leader of his nation's biggest health plan?

Information exchange can optimize the flow of data and help create a patient-friendly environment

With tips from countries that haveless to work with, the U.S. healthcare industry moves toward major reform

Fear of ever-growing health care costs leads the way in Kaiser&s latest Health Security Watch health poll report.

Fear of ever-growing health care costs leads the way in Kaiser&s latest Health Security Watch health poll report.

New indications: Leukotriene blocker approved for treatment of seasonal allergic rhinitis

Vardenafil (Levitra, Bayer AG/GlaxoSmithKline) is a selective inhibitor of phosphodiesterase 5 (PDE5) currently under review by FDA for the treatment of erectile dysfunction (ED). If approved, vardenafil will become the third PDE5 inhibitor to be marketed in the United States and the fourth oral agent approved for the treatment of ED. Vardenafil has been studied in subjects of various ages (<45 and >65 years of age), with different etiologies and different baseline severity of ED. Studies evaluating vardenafil have determined it to be safe and effective at doses of 5 mg to 40 mg, including subjects with diabetes mellitus and subjects who have undergone radical prostatectomy. Vardenafil has a pharmacokinetic profile similar to that of sildenafil (Viagra, Pfizer). The drug appears to be well tolerated. In clinical trials, headache, dyspepsia, and flushing were the most common adverse effects reported by subjects taking vardenafil. No adverse hemodynamic or visual effects have been reported during clinical trials of vardenafil; however, further investigation, including post-marketing surveillance, will be required. Further research and clinical experience with the newer PDE5 inhibitors (vardenafil and tadalafil [Cialis, Lilly/ICOS]) will be needed before their roles in the treatment of ED can be determined.

Pulmonary arterial hypertension (PAH) is a progressive, debilitating disorder associated with poor quality of life and shortened life span. For many years, medical therapy consisted of calcium channel blockers, warfarin, supplemental oxygen, and digitalis glycosides. A better understanding of the pathophysiology of PAH has led to the recent development of effective treatments for this disorder. Therapeutic agents target the pathophysiologic mechanisms of PAH: pulmonary vasoconstriction, pulmonary vascular remodeling, and in situ thrombosis. With better understanding of the pathogenesis of PAH, recent advances in pharmacotherapy have been introduced for the treatment of PAH. Data are presented on efficacy and safety of newer approved and investigational agents: prostacyclin analogues, oral endothelin antagonists, and phosphodiesterase 5 inhibitors.

The central healthcare initiative in the administration's $2.2 trillion budget proposal for fiscal year 2004 is to establish a Medicare prescription drug benefit. President George W Bush proposes to spend $6 billion as a "down payment" on a $400 billion/10-year Medicare drug benefit and "modernization" plan.

Ranked by net income in total enrollment as of January 1, 2002

Women are pivotal decision-makers who demand pertinent content and onlineconvenience

Washington, D.C. - Most disputes between patients and HMOs involve coverageof elective procedures and access to doctors and services outside a plan'snetwork, and not issues related to life-saving care, according to a newanalysis of health plan appeals decisions.

HHS Secretary Tommy G. Thompson says that managed care will remain on the changing healthcare menu.