Hydrocortisone Fights Severe Pneumonia

Ads

Treatment with infusions of the corticosteroid drug hydrocortisone brings significant improvement to patients with severe pneumonia, according to a study from Italy. It found that a seven-day course of low-dose hydrocortisone infusion sped patients' recovery from community-acquired pneumonia and prevented complications due to sepsis, a potentially fatal blood infection.

The findings appear in the February issue of the American Journal of Respiratory and Critical Care Medicine. According to the Centers for Disease Control and Prevention (CDC), pneumonia remains a major cause of illness and death in the United States, responsible for more than 1 million hospitalizations each year. The study, led by Dr. Marco Confalonieri of the University of Trieste, included 46 patients with severe community-acquired pneumonia. One group of 23 patients received 200 mg of infused hydrocortisone intravenously over seven days, while the other 23 received a sterile saline placebo in an equal volume.

"During the seven days of treatment, the clinical response of the two groups diverged," Confalonieri said in a prepared statement. In the group that did not receive hydrocortisone, one patient succumbed to fatal septic shock within three days of admission and nine more developed septic shock complicated by respiratory distress, the researchers report.

"In contrast, in the hydrocortisone group, the two patients who were admitted with septic shock were weaned off [treatment for sepsis] by Day 3 and 5, and no other patient developed sepsis-related complications. Hydrocortisone treatment appeared to be associated with a protective effect against delayed septic shock," Confalonieri concluded. Hydrocortisone may prove useful in fighting severe pneumonia, which is increasingly difficult to treat despite advances in antimicrobial therapy, the researchers say.

Diuretics' Benefits Outweigh Risk

Diuretics, pills used by millions of elderly people to lower high blood pressure, clearly reduce the long-term risk of death from heart attacks and strokes, according to 'a study that could ease fears that the medication's risks outweigh its benefits.

Diuretics, which work by removing fluid from the body, have been used for decades. But doctors have realized in the past few years that the drugs raise the risk of developing diabetes, which itself can lead to heart attacks and strokes.

As a result, some doctors were afraid that diuretics would do more harm than good. The first long-term study to examine the question found that while diuretics do raise the risk of diabetes, the rate of death from heart attacks or strokes was still nearly 15 percent lower in patients getting a diuretic compared with those who were given dummy pills.

"This is the most conclusive information we're likely to have, at least for some time," said Dr. Jeffrey Cutler, senior scientific adviser at the National Heart, Lung and Blood Institute, a sponsor of the study. "I think this will further reassure physicians." National guidelines list diuretics as a first-line treatment for high blood pressure. Nevertheless, some doctors have avoided prescribing diuretics since research linked them to diabetes.

The new study, published in the January issue of the American Journal of Cardiology, was partly funded by the National Institute on Aging and the Robert Wood Johnson Foundation of Plainsboro, N.J. Diuretics, medicine's oldest blood pressure drug, cost just pennies a day. Some of the newest drugs can cost much more.

Male Sexual Disorders

Prescribing Notes

Androgens are used as replacement therapy in castrated males and for treating established hypogonadic androgen deficiency. Their use in male infertility is empirical. Treatment should be initiated and supervised by specialist clinics.

Antiandrogens are used under hospital direction for male sexuality problems or female hirsutism.

Gonadotrophins are used to encourage testicular descent, or as a replacement in gonadotrophin deficiency.

Erectile Dsyfunction:

NB: Treatments for erectile dysfunction are available at NHS expense only for men treated for prostate cancer; men with kidney failure, spinal cord injury, diabetes, multiple sclerosis, single gene neurological disease, spina bifida, Parkinson' s disease, polio, severe pelvic injury or radical pelvic surgery or men who have had a prostatectomy; men who were already receiving drug treatment for impotence on 14 September 1998: through specialist services for men suffering severe distress because of impotence. Endorse FP10orGP10with"SLS" .

Alprostadil is a prostaglandin E1 given by intracavernous injection or intraurethral administration. It has vasoactive properties, which provide an artificial erection through inhibition of a1 adrenergic activity and relaxation of the blood vessels in the corpora cavernosa.

Sildenafil, tadalafii and vardenafit are phosphodiesterase type 5 inhibitors that are taken orally. They prevent the degradation of the smooth muscle relaxant cyclic guanosine monophosphate. increasing blood flow into the penis and so enhancing the erectile response to sexual stimulation.

Apomorphine is taken sublingually and produces an erection within 20 mins. It selectively stimulates central dopamine receptors that activate specific neural events in the paraventricular nucleus of the hypothalamus. Oxytocinergic pathways then relax the smooth muscle in the corpus cavernosum, leading to corporal engorgement and erection.

Similar of Hydrocortisone Fights Severe Pneumonia