A Moment Of Health

Clavulin

2009-11-19T22:22:00.000-08:00

CLAVULIN®

SmithKline Beecham

Amoxicillin - Clavulanate Potassium

Antibiotic - b-Lactamase Inhibitor

Action And Clinical Pharmacology:

Amoxicillin exerts a bactericidal action against sensitive organisms during the stage of active multiplication through the inhibition of the biosynthesis of bacterial cell wall mucopeptides. Clavulanic acid inhibits specific Beta-Lactamase of some microorganisms and allows amoxicillin to inhibit amoxicillin (ampicillin) resistant organisms which produce clavulanic acid sensitive b-lactamases.

Indications And Clinical Uses:

For the treatment of the following infections when caused by Clavulin-susceptible strains of the designated bacteria:

I:

Upper respiratory tract infections when caused by b-lactamase producing strains of S. aureus.

Sinusitis when caused by b-lactamase producing strains of H. influenzae or M. (B.) catarrhalis.

Otitis media when caused by b-lactamase producing strains of H. influenzae or M. (B.) catarrhalis.

II:

Lower respiratory tract infections when caused by b-lactamase producing strains of H. influenzae, K. pneumoniae, S. aureus or M. (B.) catarrhalis.

Skin and soft tissue infections when caused by b-lactamase producing strains of S. aureus.

Urinary tract infections when caused by b-lactamase producing strains of E. coli, P. mirabilis or Klebsiella species.

NB:

While Clavulin is indicated only for the conditions listed above, infections caused by ampicillin (amoxicillin) susceptible organisms are also amenable to Clavulin treatment due to its amoxicillin content.

Furthermore, mixed infections caused by organisms susceptible to ampicillin (amoxicillin) and b-lactamase producing organisms susceptible to Clavulin should not require the addition of another antibiotic.

Appropriate culture and susceptibility studies should be performed to identify the causative organism(s) and determine the susceptibility to Clavulin. However, when there is reason to believe an infection may involve any of the b-lactamase producing organisms listed above, therapy may be instituted prior to obtaining the results from bacteriological and susceptibility studies. Once these results are known, therapy should be adjusted if appropriate.

Contra-Indications:

In patients with a history of hypersensitivity to the penicillin, clavam, or cephalosporin group of b-lactams.

In patients where Infectious Mononucleosis is either suspected or confirmed.

In patients with a previous history of Clavulin-associated jaundice/hepatic dysfunction.

Manufacturers' Warnings In Clinical States:

Serious and occasionally fatal hypersensitivity reactions (anaphylaxis and angioedema) have been reported in patients on penicillin therapy. Although these reactions are more frequent following parenteral therapy, they have occurred in patients receiving penicillins orally. These reactions are most apt to occur in individuals with a history of sensitivity to multiple allergens. There have been reports of individuals with a history of cephalosporin hypersensitivity who have experienced severe reactions when treated with penicillins. Before initiating therapy with Clavulin, careful inquiry should be made concerning previous hypersensitivity reactions to penicillins, cephalosporins, clavams, or other allergens.

If an allergic reaction occurs the administration of Clavulin should be discontinued and appropriate therapy should be instituted. Serious anaphylactoid reactions require immediate emergency treatment with epinephrine. Oxygen, i.v. steroids, and airway management, including intubation, should also be used as indicated.

Clavulin should be used with caution in patients with evidence of hepatic dysfunction. Hepatic toxicity associated with the use of Clavulin is usually reversible. On rare occasions, deaths have been reported (less than 1 death reported per estimated 4 million prescriptions worldwide). These have generally been cases associated with serious underlying diseases or concomitant medications (see Contraindications and Adverse Effects, Liver).

Precautions:

Periodic assessment of renal, hepatic, and hematopoietic function should be made during prolonged therapy.

Clavulin is excreted mostly by the kidney. There is insufficient data to make specific dosage recommendations for patients with renal dysfunction. However, either a reduction in dose level or an extension in dose interval in proportion to the degree of loss of renal function will be needed.

The possibility of superinfections with mycotic or bacterial pathogens should be kept in mind during therapy. If superinfection should occur (usually involving Aerobacter, Pseudomonas, or Candida), the administration of Clavulin should be discontinued and appropriate therapy instituted.

The occurrence of a morbilliform rash following the use of ampicillin in patients with infectious mononucleosis is well documented. This reaction has also been reported following the use of amoxicillin. A similar reaction would also be expected with Clavulin.

In common with other broad-spectrum antibiotics, Clavulin may reduce the efficacy of oral contraceptives and patients should therfore be advised accordingly.

Pregnancy:

The safety of Clavulin in the treatment of infections during human pregnancy is unknown. As with all medicines, use should be avoided during pregnancy, especially during the first trimester, unless the anticipated benefit justifies the potential risk to the fetus.

Lactation:

Penicillins (including ampicillin) have been shown to be excreted in human breast milk. It is not known whether clavulanic acid is excreted in breast milk. Caution should be exercised if Clavulin is to be administered to a nursing mother.

Adverse Reactions:

Gastrointestinal:

Hypersensitivity:

Liver:

Hemic and Lymphatic Systems:

Other:

Symptoms And Treatment Of Overdose:

Dosage And Administration:

How do you know one suffers Retinoblastoma?

2009-11-12T23:00:00.000-08:00

One most reliable symptom is the presence of the Leukocoria. Leukocoria (also leukokoria) is an abnormal white reflection from the retina of the eye. Leukocoria resembles eyeshine, but leukocoria can occur in humans and other animals that lack eyeshine because their retina lacks a tapetum lucidum.

Tapetum lucidum is a layer of tissue in the eye of many vertebrate animals, that lies immediately behind or sometimes within the retina. It reflects visible light back through the retina, increasing the light available to the photoreceptors. This improves vision in low-light conditions, making the eyes of such animals glow at low light conditions.

Also note that Leukocoria is a medical sign for a number of conditions other than retinoblast, they include Coats disease, congenital cataracts, corneal scarring, melanoma of the ciliary body, Norrie disease, ocular toxocariasis, persistence of the tunica vasculosa lentis (PFV/PHPV), and retrolental fibroplasia.

Other less common and less specific signs and symptoms are:
• Deterioration of vision,
• a red and irritated eye,
• faltering growth or delayed development.
• Some children with retinoblastoma can develop a squint, commonly referred to as "cross-eyed" or "wall-eyed" (strabismus).

See the pictures below for some conditions related to this article:

A child with Leukocoria in retinoblastoma.

A child with squit or cross walled eyes.

A dog has a eyeshine and human do not.

In the next discussion, we will discuss as to why retinoblastoma should be timely diagnosed and be treated.

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Retinoblastoma - A treatable children cancer

2009-11-12T05:41:00.000-08:00

The introduction of the Retcam camera at the KNH is a stem towards combating one of the most treatable children cancer - retinoblastoma.

Retinoblastoma (Rb) is a rapidly developing cancer which develops in the cells of the retina, the light detecting tissue of the eye. In the developed world, Rb has one of the best cure rates of all childhood cancers (95-98%), with more than nine out of every ten sufferers surviving into adulthood. Retinoblastoma is a very treatable cancer.

Classification

There are two forms of the disease; a genetic heritable form and a non-genetic non-heritable form. Approximately 55% of children with Rb have the non-genetic form. If there is no history of the disease within the family, the disease is labelled "sporadic", but this does not necessarily indicate that it is the non-genetic form.

In about two thirds of cases, only one eye is affected (unilateral retinoblastoma); in the other third, tumours develop in both eyes (bilateral retinoblastoma). The number and size of tumours on each eye may vary. The position, size and quantity of tumours are considered when choosing the type of treatment for the disease.

Signs and Symptoms

The most common and obvious sign of retinoblastoma is an abnormal appearance of the pupil, leukocoria. Other less common and less specific signs and symptoms are: deterioration of vision, a red and irritated eye, faltering growth or delayed development. Some children with retinoblastoma can develop a squint, commonly referred to as "cross-eyed" or "wall-eyed" (strabismus). However, retinoblastoma presents with advanced disease in developing countries and eye enlargement is a common finding.

Depending on the position of the tumors, they may be visible during a simple eye exam using an ophthalmoscope to look through the pupil. A positive diagnosis is usually made only with an examination under anesthetic (EUA). A white eye reflection is not always a positive indication of retinoblastoma and can be caused by light being reflected badly or by other conditions such as Coats's Disease.

Frequency of retinoblastoma

Retinoblastoma is rare and affects approximately 1 in 15,000 live births. In the UK around 40 to 50 new cases are diagnosed each year.

Most children are diagnosed before the age of five years old. In the UK bilateral cases usually present within the first year with the average age at diagnosis being 9 months. Diagnosis of unilateral cases peaks between 24 and 30 months.
[edit] Cause of retinoblastoma

In children with the heritable genetic form of retinoblastoma there is a mutation on chromosome 13, called the RB1 gene. The genetic codes found in chromosomes control the way in which cells grow and develop within the body. If a portion of the code is missing or altered (mutation) a cancer may develop.

The defective RB1 gene can be inherited from either parent, however in some children, the mutation occurs in the early stages of fetal development. It is not known what causes the gene abnormality; it is most likely to be a random mistake during the copy process which occurs when a cell divides.

Treatment

Historical image showing Gordon Isaacs, the first patient treated with the linear accelerator (external beam radiation therapy) for retinoblastoma in 1957. Gordon's right eye was removed January 11, 1957 because the cancer had spread. His left eye, however, had only a localized tumor that prompted Henry Kaplan (doctor) to try to treat it with the electron beam.

Treatment of retinoblastoma varies from country to country. The first priority is to preserve the life of the child, then to preserve the vision and thirdly to minimize any complications or side effects of the treatment. The exact course of treatment will depend on the individual case and will be decided by the Ophthalmologist in discussion with the Paediatric Oncologist.

Options for treatment include: chemotherapy (which can be administered locally through a thin catheter that is threaded through the groin through the aorta and the neck into the optic vessels), cryotherapy, radioactive plaques, laser therapy, external beam radiotherapy and surgery. Any combinations of these treatments may be adopted.

In recent years, there has been an effort to find alternatives to enucleation and radiation therapy.