Background. The incidence and severity of Clostridium difficile-associated diarrhea (CDAD) has been increasing, and there have been recent reports of metronidazole treatment failure. Metronidazole is still commonly used as first-line treatment for CDAD but has never been compared with vancomycin in a prospective, randomized, double-blind, placebo-controlled trial. We conducted such a trial, stratifying patients according to disease severity, to investigate whether one agent was superior for treating either mild or severe disease.Methods. From October 1994 through June 2002, patients with CDAD were stratified according to whether they had mild or severe disease based on clinical criteria and were randomly assigned to receive oral metronidazole (250 mg 4 times per day) or oral vancomycin (125 mg 4 times per day) for 10 days. Both groups received an oral placebo in addition to the study drug. Patients were followed up for 21 days to assess cure, treatment failure, relapse, or intolerance.Results. One hundred seventy-two patients were enrolled, and 150 of these patients successfully completed the trial. Among the patients with mild CDAD, treatment with metronidazole or vancomycin resulted in clinical cure in 90% and 98% of the patients, respectively ( ). Among the patients with severe CDAD, treatment P p .36 with metronidazole or vancomycin resulted in clinical cure in 76% and 97% of the patients, respectively (P p ). Clinical symptoms recurred in 15% of the patients treated with metronidazole and 14% of those treated with .02 vancomycin.Conclusions. Our findings suggest that metronidazole and vancomycin are equally effective for the treatment of mild CDAD, but vancomycin is superior for treating patients with severe CDAD.

Patients with type 1 and 2 diabetes and nephropathy frequently have a blunted fall in nighttime arterial blood pressure. This abnormality is already seen in subjects with type 1 diabetes who are in the microalbuminuric phase of the disease, and we have also shown that an increase in nighttime systolic blood pressure precedes the development of microalbuminuria. These studies suggest that nocturnal hypertension may be an important early predictor of diabetic nephropathy. Various drugs have different effects on nocturnal blood pressure, and chronotherapy may be key in determining clinical outcomes. There is a compelling need for studies showing that treating nocturnal hypertension in diabetes can prevent renal disease progression.

The levels of doxycycline in serum, bile and the gallbladder wall were determined in 25 patients during cholecystectomy, by means of bioassay after previous intravenous administration of doxycycline. The mean biliary level exceeded 20 microgram/ml, and the mean level in the gallbladder wall was greater than 2 microgram/g. With few exceptions all the levels found clearly exceeded the MIC of most relevant pathogens. This was confirmed by the levels found in bile drained via T-Tube. Thus, clinically important breakdown of doxycycline by the mainly alkaline bile acids should not be anticipated.

Background: The objective was to study about the drugs used in management of diabetic foot ulcer (DFU) and to grade the wounds using Wagner’s scale.Methods: An observational study was conducted at Department of Pharmacy, Rajah Muthiah Medical College Hospital over a period of six months from November 2018 to April 2019. The data was collected from 85 patients using data collection form. The patients were selected based on inclusion and exclusion criteria.Results: Overall 85 patients were enrolled in this study. The prevalence of DFU found to be 36% more in males 58 (68%) than in females 27 (32%). Considering the age group, higher prevalence was reported in patients among the age group of 60-70. This study shows, patients were found commonly to have habits of alcohol 18 (21%), smoking 11 (13%) and both 22 (26%). Overall, 23 classes of drugs were used in this study. Among these, mostly were antibiotics 12 (52%) then hypoglycemic drugs 5 (21%) and others are analgesics (9%), anti-ulcerant and vitamins. This study shows that the common antibiotics prescribed are metronidazole 39 (24%), cefotaxime 36 (22.7%), ciprofloxacin 25 (15.8%) and piperacillin 21 (13.2%). The common hypoglycemic drug used were of insulin 63 (74%), metformin 43 (77%), glimepiride 12 (14%) and metformin and glimepiride 12 (14%). By using Wagner’s scale, out of 85 patients, most of the ulcer were predominantly between grade IV and V.Conclusions: Targeting range of glycaemic levels and proper antibiotics is the best way of treating DFU. This study has provided the base line data regarding management of DFU which helps to improve therapeutic outcome.

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