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Background: The gold standard for the treatment of hyperpigmentation is hydroquinone (HQ), which has been available as a skin lightener for more than 50 years. Numerous clinical studies have proven its efficacy in various topical formulations. In the United States, HQ is available as a nonprescription product in 2% formulations and as a 4% prescription product. Objective: This study compared the safety and efficacy of a 2% hydroquinone multi-ingredient foam with a standard 4% hydroquinone cream on photodamaged facial skin. Methods: A 12-week, investigator-blinded, randomized trial with a split-face design was conducted in women with moderate photodamaged facial skin. Results: Both products improved the appearance of photodamaged facial skin and were well-tolerated. No statistically significant changes were seen between treatments during the efficacy or tolerability evaluations. Conclusion: Both treatments (2% HQ Brighten and 4% HQ) improved the appearance of photodamaged facial skin and were well-tolerated and results well-perceived by subjects over the 12-week treatment period, compared with baseline grading scores.

Rejuvenation of aging hands is becoming increasingly important to physicians and their patients. While a variety of invasive treatments are available, topical products that improve manifestations of aging hands are needed. In this brief report, the efficacy of a topical product containing urea, lipids, sodium copper chlorophyllin complex, antioxidants, and humectants was assessed in subjects with moderate-to-severe photodamage of the hands.

John P McCook,1 Thomas J Stephens,2 Lily I Jiang,2 Robert M Law,3 Vincent Gotz4 1Discovery Partners LLC, Frisco, 2Thomas J. Stephens & Associates, Inc., Richardson, 3ProPath, Dallas, TX, 4MDRejuvena, Inc., San Diego, CA,USA Purpose: To examine the effect of sodium copper chlorophyllin complex on the expression of biomarkers of photoaged dermal extracellular matrix indicative of skin repair.Patients and methods: Following a previously published 12-day clinical assessment model, skin biopsy samples from the forearms of four healthy females with signs of photoaged skin were obtained and samples were analyzed by immunohistochemistry for key biomarkers of aging skin after each subject was treated with a test material consisting of a gel containing a liposomal dispersion of sodium copper chlorophyllin complex 0.05%, a positive control of tretinoin cream 0.025%, and an untreated negative control.Results: There was a statistically significantly greater amount of fibrillin/amyloid P and epidermal mucins found for skin treated with the test material containing 0.05% sodium copper chlorophyllin complex and the reference control tretinoin 0.025% cream compared to the negative control (untreated site). Expression of procollagen 1 and dermal mucin also showed a greater presence in the samples treated with the test material and the reference control compared to the negative control, though the differences were not statistically significant. No adverse events were observed or reported by the subjects during the course of the study.Conclusion: The results of this human biopsy study suggest that both retinoids and sodium copper chlorophyllin complex have beneficial effects on biomarkers of photoaged skin. Products containing both sodium copper chlorophyllin complex and retinols may provide a dual approach to reversing age-related decreases in hyaluronic acid (HA) in the skin: inhibition of the breakdown of HA via sodium copper chlorophyllin complex by inhibition of hyaluronidase, and stimulation of HA synthases by retinol. Keywords: hyaluronic acid, glycosaminoglycans, retinoid, hyaluronidase, mucins

Objectives This study compares the characteristics of treated and non-treated patients with Hepatitis C (HCV) infection. Methods Information on patient demographics, clinical data, and treatment regimens were collected from a retrospective medical record review of 998 patients diagnosed with HCV, representing a diverse geographic sample of 200 U.S. physicians including 130 gastroenterologists, 50 infectious disease physicians, and 20 hepatologists. A total of 551 patients were randomly selected and 447 were provided as an augmented sample in an intent-to-treat analysis based on treatment decisions. Pretreatment factors examined included age, gender, race, weight, HCV genotype, HCV viral load, serum ALT levels, liver biopsy results, cirrhosis, HIV co-infection, HBV co-infection, IV drug use, and insurance status. Univariate analyses were performed using Chi-squared or ANOVA tests. Factors that were significant in univariate analyses were entered into a multivariate logistic regression model with HCV treatment as the outcome variable. Results Of the 998 patients reviewed, 778 were treated for HCV and 220 were not treated. In univariate analyses, non-treated patients were more likely to be African American, HBV co-infected, HIV co-infected, IDUs, alcoholics, Medicaid insured, and were less likely to have had biopsies. The multivariate regression analysis demonstrated that performance of a liver biopsy, treatment with psychiatric medications (antidepressants and anxiolytics), and patient weight were independently associated with treatment, while Medicaid insurance and HIV co-infection were independently associated with a decreased likelihood of receiving HCV therapy. Conclusion This study suggests that it is not the clinical stage of HCV infection but the patient's demographic characteristics and co-morbid conditions that impact the decision to initiate HCV therapy. Copyright © 2005 John Wiley & Sons, Ltd.

The present study investigated the safety of induction therapy with daclizumab (compared with no induction treatment), in adult renal transplant patients reported to the Scientific Registry of Transplant Recipients (SRTR) database between January 1, 1998 and July 27, 2003. Patients who were discharged from the hospital on mycophenolate mofetil, azathioprine, or sirolimus were divided into two groups: induction treatment with daclizumab (n = 8203) and no induction treatment (n = 25,368). Patient survival, death due to infection and death due to malignancy were evaluated at 1 and 3 yr post-transplantation. Rejection and graft survival were also examined. Kaplan-Meier and Cox regression models were used to evaluate outcomes. No significant differences were found between patients treated with daclizumab compared with patients who received no induction therapy for death due to infection or malignancy at 1 and 3 yr post-transplantation. Patients treated with daclizumab (compared with no induction treatment) had statistically significantly better survival rates at 1 (96.9% vs. 96.2%, p = 0.003) and 3 yr (92.4% vs. 91.4%, p = 0.004) although absolute differences were minimal. This was confirmed in the multivariable Cox regression analysis for patient death at 1 (HR = 0.77, p < 0.001) and 3 yr (HR = 0.83, p = 0.001) post-transplantation. Patients treated with daclizumab compared to no induction had lower rejection rates at 1 (13.1% vs. 17.3%, p < 0.001) and 3 yr post-transplantation (16.7% vs. 21.3%, p < 0.001). Cox regression confirmed a decreased risk for rejection at 1 (HR = 0.74, p < 0.001) and 3 yr (HR = 0.75, p < 0.001). Treatment with daclizumab was associated with reduced risk for graft loss at 1 (HR = 0.82, p < 0.001) and 3 years (HR = 0.86, p < 0.001). In conclusion, daclizumab was associated with a significantly reduced risk for rejection and graft loss compared with no induction treatment, and improved patient survival. In addition, daclizumab was not associated with an increase in risk of death due to infection or malignancy, when compared with no induction therapy. These findings demonstrate the short and long-term safety and efficacy of daclizumab in patients transplanted between January 1998 and July 2003.

Patients with fungal infections who are treated with amphotericin B lipid complex (ABLC) often receive dosages less than that recommended in the product information (5 mg/kg.d). This occurs despite the described safety and increased efficacy in select patients treated with higher ABLC dosages.The purpose of this study was to compare the renal effects of high-dosage/long-duration (HDos/LDur) ABLC therapy (5 mg/kg.d for12 days) with those of low-dosage/short-duration (LDos/SDur) ABLC therapy (or=5 mg/kg.d foror=12 days).Male and female ABLC-treated patients of all ages were prospectively enrolled, and data were retrospectively collected for those who had receivedor=4 ABLC doses according to a large, multicenter patient database, the Collaborative Exchange of Antifungal Research (CLEAR) registry. The safety profile of each dosage was evaluated using serum creatinine concentration (S-Cr) and calculated creatinine clearance (CCcr).A total of 1726 patients were studied. The HDos/LDur group included 309 patients and theLDos/SDur group included 1417 patients. The median ages of the HDos/LDur and LDos/SDur groups were 42 and 48 years, respectively (ranges,1 to 83 and1 to 95 years; P0.001); females comprised 51% and 42% of the 2 populations (P = 0.004); and 6% and 12% had solid tumors (P = 0.002). The HDos/LDur group was more likely than the LDos/SDur group to have been treated for multiple systemic fungal pathogen infections (16% and 9%, respectively) and for mold infections (28% and 12%, respectively) (both, P0.001). The median change in S-Cr from baseline was 0.1 mg/dL in both groups (range, -4.9 to 5 mg/dL in the HDos/LDur group and -3.96 to 4.7 mg/dL in the LDos/SDur group). No increased risk for renal dysfunction, as reflected in the median change from baseline in CCcr, was observed in either cohort (-3 mL/min [range, -118.65 to 69.03 mL/min] in the HDos/LDur group; -2.17 mL/min [range, -107.48 to 104.45 mL/min] in the LDos/SDur group).These data suggest that higher ABLC dosages appear to be as well tolerated as lower dosages, warranting further study of ABLC dosages5 mg/kg.d for12 days in the treatment of systemic fungal infections.

There are numerous common skin disorders involving hyperpigmentation, including solar lentigines, postinflammatory hyperpigmentation, melasma, freckles, and dyschromia from photoaging. While these conditions are of an aesthetic nature, there is great interest in newer, safer, and more effective treatment modalities. Topical hydroquinone (HQ) has been the gold standard of skin lighteners for many years. However, regulatory authorities around the world are now questioning its safety. A randomized, double-blind, half-face study was conducted in females having moderate to severe facial hyperpigmentation to assess the efficacy and tolerability of 3 new skin brightener formulations containing SMA-432, a prostaglandin E2 inhibitor, compared with 4% HQ. Each subject was assigned 2 of the 4 test materials and was instructed to apply the product on the assigned side of the face twice daily for 12 weeks. Evaluation visits were conducted at baseline and at 4, 8, and 12 weeks. At each visit, subjects were evaluated by a blinded investigator for clinical efficacy and tolerability using grading scales. Standardized digital photography and Chroma Meter assessments were also taken. Self-assessment questionnaires were completed at weeks 4, 8, and 12. Sixty-eight Caucasian subjects (136 half faces) completed the study. All test materials significantly reduced overall hyperpigmentation and improved the Investigator's Global Hyperpigmentation Improvement rating at weeks 4, 8, and 12 compared with baseline. SMA-432 exhibited a dose-dependent improvement in hyperpigmentation. There were no major tolerability issues with any of the test materials. Self-assessments were generally favorable for all test materials. At the completion of the trial, subjects rated one of the tested multimodality brightener compositions as the most favorable product and 4% HQ as the least favorable. This study demonstrated that the new non-HQ-containing skin brightener formulations were as effective and equally well tolerated as the gold standard, 4% HQ, in females with facial hyperpigmentation.

Vitamin A and its derivatives (commonly termed retinoids) are widely used in topical anti-aging products. Certain retinoids such as retinol and its esters are available without a prescription, while others such as tretinoin are available only via prescription. A randomized, double-blind, controlled clinical study was conducted to compare the efficacy and tolerability of a tri-retinol 1.1% gradual release cream vs. tretinoin 0.025% cream in females with mild-to-moderate facial photodamage. Subjects applied the test product to the entire face in the evening after cleansing in a progressively increasing frequency starting twice weekly for the first week, followed by three times weekly during the second week and then daily as tolerated for the third week and beyond. Treatment was continued for a total of three months. Clinical evaluations and standardized digital photographs were performed at baseline and after four, eight, and 12 weeks of treatment. Self-assessment questionnaires were completed by the subjects at four, eight, and 12 weeks to assess perceived efficacy of the test products. Thirty-four subjects (16: tri-retinol and 18: tretinoin) completed the study. Both test products significantly improved signs of photodamage, including fine and coarse periocular wrinkles, skin firmness, skin tone, mottled pigmentation, tactile roughness, overall photodamage and global photodamage improvement. There were no significant differences in efficacy between the two products for these assessments. The adverse effects (which were graded as mild or less) were those typically seen with topical retinoids. Subjects reported93 percent overall satisfaction with both products at weeks 8 and 12.

The objective of this study was to evaluate patients' real-world experiences with desonide hydrogel for the treatment of mild to moderate atopic dermatitis (AD). Physicians who participated in this patient-experience program identified eligible participants (age range,3 months to 91 years) for treatment with desonide hydrogel 0.05%. The medication was prescribed by each participant's physician according to his/her practice guidelines and was provided to the participant at no charge. Patients (or their parents/guardians) voluntarily participated by providing consent and completing 2 surveys: one at baseline (pretreatment) and the other approximately 3 weeks after initiation of desonide hydrogel treatment (posttreatment). The pretreatment survey included questions about prior topical medication use for AD and satisfaction with prior treatments. The second survey assessed compliance with desonide hydrogel, satisfaction with treatment, characteristics of desonide hydrogel, intent to continue treatment, and willingness to recommend desonide hydrogel to others. A total of 1185 participants completed both the pretreatment and posttreatment surveys. Participant satisfaction with desonide hydrogel was 95% greater than satisfaction with prior topical medications for AD (P.01). Adherence to treatment with desonide hydrogel was more than 80% based on reports from participants. Eighty-nine percent of participants reported that they would continue to use the medication for their condition if needed and 85% would recommend desonide hydrogel to others. Prescribing physicians received individual summaries of survey responses reported by each of his/her participating patients, which provided valuable feedback regarding participants' perceptions of treatment. Participants reported favorable experiences after treatment with desonide hydrogel compared with prior topical therapies. Desonide is widely prescribed for the treatment of AD.

The stratum corneum typically is compromised in patients with atopic dermatitis (AD). Beneficial AD treatments should provide moisture to the skin as well as restore impaired barrier function. Traditional treatments involve ointments or creams. A clinical study was conducted to determine if desonide in a hydrogel vehicle (HGV) could improve the moisture content and barrier function of the stratum corneum in adults with mild to moderate AD. Participants applied desonide hydrogel 0.05% twice daily for 4 weeks to areas of both lesional and nonlesional skin. Corneometry and transepidermal water loss (TEWL) were measured at baseline and weeks 1, 2, and 4. Statistically significant improvements in corneometry and TEWL measurements on lesional skin were observed at all study visits compared with baseline (all Por = .002 and Por = .04, respectively).

The properties of vehicle formulations may influence drug delivery, efficacy, and tolerance profiles of topical medications. Patient preferences vary and the importance of certain aesthetic attributes depend on the disease state, the site of application, and the length and extent of treatment, among other factors. Formulations that offer aesthetic advantages over traditional vehicles may improve patients' willingness to apply therapy as directed and therefore may affect the outcome of treatment. A participant preference study was conducted to determine if an aqueous gel (hydrogel) formulation of desonide would appeal to patients with atopic dermatitis (AD). Before treatment adult participants with AD completed a questionnaire to assess their AD history and prior topical treatments and to rate the importance of topical vehicle attributes. Each participant then applied desonide hydrogel 0.05% to affected areas twice daily for 4 weeks. At the end of the treatment, participants were queried on the attributes of desonide hydrogel and how it compared with other vehicles previously used. Twenty-two participants with mild to moderate AD completed the study; 100% (22/22) of participants found desonide hydrogel to be easy to apply/use/spread, easy to use on hair-bearing skin, comfortable to use under makeup and/or cosmetics, suitable for use on multiple body areas, and stain free. Most participants reported that the product was soothing (82% [18/22]), did not dry the skin (96% [21/22]), disappeared quickly (82% [18/22]), was comfortable to wear under clothes (91% [20/22]), and was not greasy or shiny on skin (96% [21/22]).

Objective. To evaluate the efficacy and tolerance of a topical lip-care treatment. Step one of the two-step treatment is a lip-renewal formulation containing human growth factors, hyaluronic acid and marine filling spheres, emollients, and a tripeptide palmitoyl-glycyl-histidyl-lysine complex. Step two is a lip-plumper formulation containing niacin, emollients, and essential fatty acids. Design. Four-week, single-center, open-label, clinical study with clinical assessments at Baseline, Week 2, and Week 4. Treatment. Subjects wore the lip products at least eight hours every day with a minimum of three applications per day. Participants. Thirty-two women ages 22 to 40 years with mild-to-moderate lip dryness and average size lips completed the study. Measurements. Visual grading of the condition of the lips, rating of subjective irritation, corneometry, digital caliper measurements of lower lip, and digital photography. A self-assessment questionnaire was also employed to assess patient satisfaction. Results. Clinical assessments showed statistically significant improvements (P

A 3-month, open-label, single-center study was conducted to determine whether a uniquely formulated and physiologically balanced topical treatment serum containing multiple growth factors, cytokines, peptides, antioxidants and depigmenting agents could improve the visible signs of facial photodamage. Thirty-seven females, aged 32-55 years, with mild to severe, fine and coarse peri-ocular wrinkles were enrolled and completed the study. Subjects applied the treatment serum to the face twice daily for 3 months in conjunction with a basic skincare regimen. Clinical evaluations of photodamage were performed at baseline and months 1, 2 and 3. Cutometer measurements and subject self-assessment questionnaires were also conducted during the study. Clinical evaluations showed statistically significant reductions in fine wrinkles and coarse wrinkles and improvements in skin texture, tone and radiance starting at month 1 with continued improvements at months 2 and 3. Cutometer readings showed decreased skin extensibility and increased resiliency. Subject self-assessments confirmed that the beneficial effects of the treatment serum were readily observed by the users. The treatment serum was well-tolerated with no treatment-related adverse events reported during the 3-month study. Use of this novel treatment serum produced significant improvements in the visible signs of facial photodamage.

Wendy E Roberts,1 Lily I Jiang,2 James H Herndon Jr3 1Generational and Cosmetic Dermatology, Rancho Mirage, CA, 2Thomas J Stephens and Associates, Richardson, 3Dermatology Center of Dallas, Dallas, TX, USA Background: Photoaged skin results from various environmental factors, most importantly chronic sun exposure. Dyschromia and fine lines/wrinkles are common clinical manifestations of photodamaged skin. Purpose: This single-center clinical trial was conducted to assess the efficacy and tolerability of a new multifunctional facial primer (camouflage, broad-spectrum SPF 50, and a treatment for hyperpigmentation) when used by females with mild-to-moderate facial hyperpigmentation and fine lines due to photoaging over a course of 12 weeks. Patients and methods: Subjects were provided test material (Even Up-Clinical Pigment Perfector) and supporting products to use on their face and neck. Products were used according to specific application instructions. Clinical grading for efficacy and tolerability assessments were performed by an expert grader at baseline, baseline (post-application primer), week 4, week 8, week 12, and week 12 (post-application primer). Standardized digital photographs were taken, and self-assessment questionnaires were conducted. Results: Twenty-eight female subjects completed the 12-week trial. The facial primer improved scores for the appearance of hyperpigmentation and other photoaging parameters immediately after the first application. The treatment also showed a progressive improvement in the clinical assessment of hyperpigmentation and other photoaging parameters over the 12-week trial. These long-term benefits can be attributed to an improvement in the underlying skin condition. The facial primer was well tolerated. Subject questionnaires showed that the product was highly rated at all visits. Conclusion: The facial primer was shown to be effective and well tolerated for immediate and long-term improvement in the appearance of mild-to-moderate hyperpigmentation and fine lines associated with photodamage when used over a 12-week period. Keywords: photodamaged facial skin, medical makeup, dermocosmetic, cosmetic, SPF

Background:Hepatitis C virus (HCV) infection is the most common blood-borne virus in the United States. Several mono- and combination therapies have been approved by the US Food and Drug Administration for the treatment of HCV, but their routes of administration, dosing approaches, eras of introduction, and actual use in clinical practice and resulting effectiveness have not yet been reported.Objectives:The aim of this article was to characterize clinical use and virologic response (VR) of the HCV treatments interferon alfa-2b plus ribavirin (IFN + RBV) and peginterferon alfa-2b plus ribavirin (peg-IFN + RBV).Methods:This retrospective chart review of office-based practices in theUnited States was conducted at 200 physicians' offices across the United States. We collected data concerning dosing patterns, VR (HCV RNA load, ≤1000 IU/mL or “negative” on polymerase chain reaction qualitative analysis), and adverse events (AEs) from the medical records of a geographically diverse sample of patients receiving treatment for chronic HCV infection in the United States from July 2001 to June 2002. For efficacy assessment, factors that were statistically different at baseline were adjusted using logistic regression. Providers also reviewed the medical records for symptoms or signs consistent with HCV treatment-related AEs.Results:Data from the records of 675 patients (423 men, 252 women; mean [SD] age of 45.5 [8.2] years; mean [SD] body weight, 80.8 [19.4] kg) were analyzed. At baseline, the IFN + RBV treatment group (330 patients) had significantly higher percentages of black patients (22.1% vs 15.7%; P = 0.032) and patients with hepatic disease based on clinician-reported cirrhosis and liver dysfunction (18.8% vs 9.9%; P < 0.001), and a significantly lower percentage of white patients (60.3% vs 69.6%; P = 0.012) compared with the peg-IFN + RBV treatment group (345 patients). The difference in log-transformed baseline HCV RNA loads between the 2 treatment groups in this study was

Outcomes specifically in mycophenolate mofetil (MMF)-treated diabetic renal transplant patients have not been previously reported. This study compared acute rejection (AR), late acute rejection (LAR), patient survival [and specifically death from cardiovascular (CV), infectious and malignant causes], incidence of post-transplant malignancies, and graft loss in MMF- or azathioprine (AZA)-treated renal transplant patients with pre-transplant diabetes. Outcomes were compared between MMF- (n = 14 144) and AZA- (n = 3001) treated diabetic patients using the Scientific Registry of Transplant Recipients data on all U.S. adult renal transplants performed between 1995 and 2002. Statistical analyses included Kaplan-Meier survival analysis, Cox multivariable regression and chi-square tests. MMF patients had less AR compared with AZA-treated patients (23.5% vs. 28.3%, p < 0.001) and less risk for LAR over 4 yr [hazard ratio (HR): 0.64, 95% CI 0.44, 0.92; p = 0.02]. While time to any-cause death did not differ between the groups, MMF treatment was associated with a 20% decreased risk of CV death (HR: 0.80, 95% CI 0.67, 0.97; p = 0.020) compared with AZA treatment. MMF patients also had a lower incidence of malignancies than AZA patients (2.2% vs. 3.7%, p < 0.001). These results suggest treatment with MMF compared with treatment with AZA in diabetic transplant patients is associated with less AR, less risk of LAR, a decreased risk of CV death, and a lower incidence of malignancies.

Background. Mycophenolate mofetil (MMF) has been shown to decrease acute rejection episodes after kidney transplantation, and has been associated with better graft and patient survival vs azathioprine (AZA). Previous studies reported a higher risk of death due to infection in elderly recipients treated with MMFbased immunosuppression. Methods. We analysed 5069 elderly (>65 years of age) primary renal allograft recipients treated with either MMF or AZA reported to the Scientific Registry of Transplant Recipients between 1988 and 2000, and compared rates of acute rejection, late acute rejection, graft survival, death-censored graft survival, patient survival and death with a functioning graft. Results. In Cox proportional hazard models, MMF was associated with lower rates of late acute rejection with 12 (RR ¼ 0.72, P ¼ 0.11) and 24 months (RR ¼ 0.50, P ¼ 0.028) of continuous therapy. In univariate analysis (Kaplan–Meier), MMF was associated with improved patient (P ¼ 0.0003) and graft (P

Summary Objectives The safety and effectiveness of amphotericin B lipid complex (ABLC) treatment in elderly patients was investigated using a large multicenter database. Methods Data analysis was conducted on retrospectively collected patient data from 572 patients >65 years of age and 2930 patients ≤65 years of age treated for fungal infections at 160 North American hospitals. Results Patients were typically treated with ABLC for Candidiasis, multiple fungal pathogen infections and Aspergillosis, or were treated empirically. The median cumulative dose of ABLC in patients >65 years of age and those ⩽65 years of age was similar (3000 and 3258mg, respectively, P =0.127). Despite higher median pretreatment serum creatinine (S–Cr) among patients >65 years of age (1.7mg/dl vs. 1.4mg/dl, respectively), both groups showed only a 0.1mg/dl median S–Cr change from baseline by the end of therapy ( P =0.525). Clinical response was 56 and 51%, respectively, in patients >65 years of age and patients 65 years of age or younger ( P =0.049). Conclusions This study suggests that ABLC can be safely and effectively used in the treatment of invasive fungal disease in elderly patients.

A survey of selected drug labelers was conducted to generate a list of drug products that should not be refrigerated. Letters asking for information on products adversely affected by refrigeration were mailed to 109 drug product labelers. A second letter was sent to nonresponders and to labelers providing incomplete information. Responses were received from 97 labelers, 43 of whom stated that none of their products would be harmed by refrigeration. Eleven labelers were unable to provide conclusive data or a list of specific drug products that refrigeration would harm. Lists of drug products not to be refrigerated were provided by 43 labelers, some including explanations of the adverse effects of refrigeration. Pharmacists may find the survey's data useful in their patient education activities.

The efficacy of a lactobacillus preparation (Lactinex) in preventing ampicillin-associated diarrhea in adult inpatients was studied. In a double-blind procedure, 98 patients were assigned randomly to receive one packet of Lactinex (Lactobacillus acidophilus and L bulgaricus) or placebo four times daily for the first five days of ampicillin therapy. Cases of diarrhea were reviewed independently and classified according to etiology. Complete data were obtained for 79 patients--43 received placebo and 36 received Lactinex. Diarrhea occurred in nine (21%) patients receiving placebo and in three (8.3%) patients receiving Lactinex; the difference was not statistically significant (p = 0.21, Fisher's Exact Test). When the patients with diarrhea unrelated to ampicillin were excluded (50%), the incidence of ampicillin-induced diarrhea in the placebo group (14%) was significantly greater (p = 0.03, Fisher's Exact Test) than in the Lactinex group (0%). Prophylactic administration of lactobacillus preparations may be effective in preventing ampicillin-induced diarrhea; however, prophylactic administration appears to be justified, on a cost/benefit basis, only in patients with a history of antibiotic-induced diarrhea.

ple, Stewart and Cluff found that 25 to 59 percent of the patients in their study made errors in self-medication(1). Blackwell reported that 25 to 50 percent of outpatients studied completely failed to take prescribed medication(2). Other studies showed a significant percent of patients misuse medications in a manner that could be a serious threat to their health(3-7). Noncompliance should come as no surprise, when one considers conditions under which patients receive discharge instructions. On the morning of the patient's discharge, busy physicians or nurses supply a quantity of information that many times must seem overwhelming to. patients, whose thoughts about getting home and being with their families often preclude concentration. It then becomes obvious why discharged patients wonder what certain medications are for, how to take them, what precautions to take, and what side effects to report. The question is, How can hospitalized patients be educated effectively and economically about their medication regimens and assisted in their transition from hospital to home? Previous investigations have shown that verbal instructions alone do little to de