A randomised double-blind controlled trial compared three-day and 10-day courses of amoxycillin (25 mg/kg daily) in children with otitis media. Seventeen doctors from five centres admitted 84 children between the ages of 2 and 10 years. Symptoms and signs were measured on admission to the trial, on day 3, and on day 15. Mothers' observations were recorded daily for 10 days. Audiograms were performed at four and 12 weeks after the end of the trial. The treatment groups showed little difference in the speed of resolution of symptoms and signs, the numbers of primary treatment failures, or the frequency of recurrent ear infections. There were no complications in either group.Most children with otitis media can probably be successfully and safely treated with no more than a three-day course of amoxycillin providing their progress is reviewed about the fifth or sixth day after treatment started. This policy could save over £1 million annually in antibiotic costs.
The dose response curve for 25, 50, 75 and 100 mg doses of chlorthalidone was studied in double blind fashion over an 8 week period in patients who presented with untreated mild hypertension. One hundred and thirty four patients completed this multicentre, family practice study. After 2 week's medication, a decline in blood pressure was noted in all dosage groups and this was maximal by 4 weeks. At 8 weeks all doses of chlorthalidone induced a significant reduction in both systolic and diastolic blood pressure (mean -18 and -10 mmHg respectively). Amongst the 4 dosage groups, no differences in response were noted resulting in a flat dose response curve. During the study, mean blood urea and serum uric acid rose whilst serum potassium fell, the urea and potassium being least affected in the 25 mg dosage group. As the dosage of chlorthalidone increased, so the tendency for abnormal laboratory values increased. Unwanted effects sought during the study were relatively few in number. No clear dose response relationship was evident although the positive responses in the 25 mg dosage group were less than in the higher dosages. These results suggest that 25 mg chlorthalidone is the optimum dosage for initiation of therapy in patients with mild to moderate hypertension. This dosage is associated with less adverse biochemical changes and unwanted effects than the higher dosage studied.
Casual readings of blood pressure predict mortality and may reflect either the risk of sustained hypertension, additional components of 'white coat' hypertension or variable blood pressure. This study investigated mortality in 442 men and 360 women with a diastolic pressure (Phase IV) of 90 mmHg and over, unsustained on two subsequent monthly visits, followed for an average of 11 years and compared with a matched control cohort with an initial diastolic pressure (DBP) of less than 90 mmHg. Subjects were identified between 1975 and 1979 by screening 28,257 subjects aged 18-65 years on the lists of general practitioners in seven practices in the United Kingdom. Additionally, 912 men and 844 women with sustained hypertension (DBP > 90 mmHg on at least two out of three occasions) were identified and matched with normotensive controls. In men with sustained hypertension the relative risk (RR) for death from circulatory disease was 1.76, P < 0.01, 95% confidence interval 1.21, 2.58 and in women 1.85, P < 0.05, 95% confidence interval 1.06, 3.24 respectively, while in men with unsustained hypertension the RR = 1.52, P = 0.2, 95% confidence interval 0.81, 2.84. Few circulatory deaths occurred in women with transient hypertension or their controls (five and seven respectively). Despite the screening programme and further treatment, newly discovered subjects with sustained hypertension, both men and women, remain at high risk of cardiovascular mortality. The 95% confidence interval for men with transient hypertension does not exclude a similar adverse effect.
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