Antibiotics: Tips for Safe Use
A Primer on the Proper Use of Antibiotics
Aug. 8, 2007—
In the time since penicillin was discovered nearly 80 years ago, antibiotics have become one of the most important lifesaving weapons in doctors' arsenal against bacterial infection.
Now, the Lakeland, Fla.-based Publix grocery store chain is giving away seven of these drugs free of charge to those who have prescriptions for them.
Five of these -- amoxicillin, ampicillin, cephalexin, erythromycin and penicillin VK -- are commonly used by doctors to treat bacterial infections ranging from ear infections to gonorrhea.
But two of the drugs on the list -- ciprofloxacin and sulfamethoxazole/trimethoprim -- are high-grade antibiotics that doctors usually reserve for particularly serious infections.
While some hail the program as a godsend, others fear that the move could lead to overuse of the drugs.
This is because the use of antibiotics comes attached with important considerations. According to the American Academy of Family Physicians, there are certain situations in which antibiotics are helpful -- and many in which they can cause more harm than good.
Here are just a few tips that consumers can use to keep themselves safe when it comes to antibiotics:
Skip the antibiotics for the flu and the common cold. Antibiotics do not work against all infections. By their very nature, they are effective against only those caused by bacteria. This means that if you are suffering from a viral infection like the common cold or seasonal flu, they will likely do nothing to improve your health.
Never take antibiotics that have not been prescribed to you by a doctor. Taking these drugs inappropriately may not only bring no benefit but may also increase the chances that harmful bacteria present in your body could develop resistance to the drugs. The more resistant a bacteria is to treatment, the more dangerous it becomes.
Always finish the entire course of antibiotics you receive. Even if you start to feel better in the middle of the course of treatment, you must finish every pill that has been prescribed to you by a doctor. Failing to do so could increase the chances of developing bacterial resistance.
Keep careful track of any adverse reactions you experience when taking antibiotics. Many people experience adverse effects when taking certain antibiotics, whether they're allergic reactions or something else. It is important to make a note of these reactions so you can inform your doctor and lessen your chances of receiving the same drug again.
Thursday, August 14, 2008
Thursday, August 7, 2008
Vitamin B 6 deficiency
Vitamin B6 deficiency
Definition
Vitamin B6 is used by the body as a catalyst in reactions that involve amino acids. Vitamin B6 deficiency is rare, since most foods eaten contain the vitamin.
Description
Vitamin B6 is a water-soluble vitamin. The recommended dietary allowance (RDA) for vitamin B6 is 2.0 mg/day for the adult man and 1.6 mg/day for the adult woman. Vitamin B6 in the diet generally occurs as a form called pyridoxal phosphate. In this form, it cannot be absorbed by the body. During the process of digestion, the phosphate group is removed, and pyridoxal is produced. However, the body readily absorbs pyridoxal, and converts it back to the active form of the vitamin (pyridoxal phosphate).
Poultry, fish, liver, and eggs are good sources of vitamin B6, comprising about 3-4 mg vitamin/kg food; meat and milk contain lesser amounts of the vitamin. The vitamin also occurs, at about half this level, in a variety of plant foods, including beans, broccoli, cabbage, and peas. Vitamin B6 tends to be destroyed with prolonged cooking, with storage, or with exposure to light.
As mentioned, vitamin B6 takes various forms. One of these forms, called pyridoxine, is relatively stable. For this reason, pyridoxine is the form of vitamin B6 that is used in vitamin supplements, or when foods are fortified. Apples and other fruits are poor sources of the vitamin, containing only 0.2-0.6 mg vitamin/kg food.
Vitamin B6, used mainly in the body for the processing of amino acids, performs this task along with certain enzymes. The enzyme that participates in this type of complex is aminotransferase. Several types of aminotransferase exist. With vitamin B6 deficiency, while aminotransferase continues to occur in the various organs of the body, there is an abnormally low level of the active vitamin B6/aminotransferase complex present. Thus, this vitamin deficiency results in the impairment of a variety of activities in the body. With supplement correction of the vitamin B6 deficiency, the aminotransferase then readily forms the active complex, and normal metabolism is restored.
Vitamin B6 converts certain amino acids (glutamic acid, aspartic acid, glycine) to energy. This allows the body to process all dietary protein, even when the dietary protein is in excess of the body's needs. Vitamin B6 also allows the body to synthesize certain amino acids. For example, if the diet is deficient or low in certain amino acids, such as glycine or serine, vitamin B6 enables the body to make them from sugar. Vitamin B6 is used also for the synthesis of certain hormones, such as adrenaline.
Causes and symptoms
Vitamin B6 deficiency occurs rarely. When it does, it is usually associated with poor absorption of nutrients in the gastrointestinal tract (as in alcoholism, or with chronic diarrhea), the taking of certain drugs (as isoniazid, hydrolazine, penicillamine) that inactivate the vitamin, with genetic disorders that inhibit metabolism of the vitamin, or in cases of starvation.
The symptoms of vitamin B6 deficiency in adults are only vaguely defined. These include nervousness, irritability, insomnia, muscle weakness, and difficulty in walking. Vitamin B6 deficiency may produce fissures and cracking at the corners of the mouth. The deficiency occurred in infants fed early versions of commercial canned infant formula, when the vitamin had been inadvertently omitted from the formula. This error resulted in infants failing to grow, in irritability, and in seizures.
Diagnosis
Vitamin B6 status is measured by the transaminase stimulation test. This test requires extraction of red blood cells, and placement of the cells in two test tubes. Special chemicals (reagents) are added to both test tubes to allow for measurement of aminotransferase. This enzyme requires pyridoxal phosphate. A known quantity of pure pyridoxal phosphate is added to one of the test tubes. The activity level of the enzyme is measured, and compared, in both test tubes. If the added pyridoxal phosphate did not stimulate activity, the patient is considered not to be deficient in vitamin B6. Neither is the patient considered deficient if only slight stimulation occurred. But if a stimulation of four-fold or more occurred, a vitamin B6 deficiency is present.
Treatment
Vitamin B6 deficiency can be prevented or treated with consumption of the recommended dietary allowance, as supplied by food or by vitamin supplements.
Prognosis
The prognosis for correcting vitamin B6 deficiency is excellent.
Prevention
Vitamin B6 deficiency is not a major concern for most people. The deficiency can be prevented with consumption of a mixed diet that includes poultry, fish, eggs, meat, vegetables, and grains.
Key Terms
Amino acid
Amino acids are small molecules that are used as building blocks for all proteins. Some amino acids are also used in the body for the manufacture of hormones. There are about 20 nutritionally important amino acids, including glutamic acid, glycine, methionine, lysine, tryptophan, serine, and glycine.
Fat-soluble vitamins
Fat-soluble vitamins can be dissolved in oil or in melted fat.
Recommended Dietary Allowance (RDA)
The Recommended Dietary Allowances (RDAs) are quantities of nutrients in the diet that are required to maintain good health in people. RDAs are established by the Food and Nutrition Board of the National Academy of Sciences, and may be revised every few years. A separate RDA value exists for each nutrient. The RDA values refer to the amount of nutrient expected to maintain good health in people. The actual amounts of each nutrient required to maintain good health in specific individuals differ from person to person.
Water-soluble vitamins
Water-soluble vitamins can be dissolved in water or juice.
For Your Information
Resources
Books
Brody, T. Nutritional Biochemistry. San Diego: Academic Press, Inc., 1998.
Definition
Vitamin B6 is used by the body as a catalyst in reactions that involve amino acids. Vitamin B6 deficiency is rare, since most foods eaten contain the vitamin.
Description
Vitamin B6 is a water-soluble vitamin. The recommended dietary allowance (RDA) for vitamin B6 is 2.0 mg/day for the adult man and 1.6 mg/day for the adult woman. Vitamin B6 in the diet generally occurs as a form called pyridoxal phosphate. In this form, it cannot be absorbed by the body. During the process of digestion, the phosphate group is removed, and pyridoxal is produced. However, the body readily absorbs pyridoxal, and converts it back to the active form of the vitamin (pyridoxal phosphate).
Poultry, fish, liver, and eggs are good sources of vitamin B6, comprising about 3-4 mg vitamin/kg food; meat and milk contain lesser amounts of the vitamin. The vitamin also occurs, at about half this level, in a variety of plant foods, including beans, broccoli, cabbage, and peas. Vitamin B6 tends to be destroyed with prolonged cooking, with storage, or with exposure to light.
As mentioned, vitamin B6 takes various forms. One of these forms, called pyridoxine, is relatively stable. For this reason, pyridoxine is the form of vitamin B6 that is used in vitamin supplements, or when foods are fortified. Apples and other fruits are poor sources of the vitamin, containing only 0.2-0.6 mg vitamin/kg food.
Vitamin B6, used mainly in the body for the processing of amino acids, performs this task along with certain enzymes. The enzyme that participates in this type of complex is aminotransferase. Several types of aminotransferase exist. With vitamin B6 deficiency, while aminotransferase continues to occur in the various organs of the body, there is an abnormally low level of the active vitamin B6/aminotransferase complex present. Thus, this vitamin deficiency results in the impairment of a variety of activities in the body. With supplement correction of the vitamin B6 deficiency, the aminotransferase then readily forms the active complex, and normal metabolism is restored.
Vitamin B6 converts certain amino acids (glutamic acid, aspartic acid, glycine) to energy. This allows the body to process all dietary protein, even when the dietary protein is in excess of the body's needs. Vitamin B6 also allows the body to synthesize certain amino acids. For example, if the diet is deficient or low in certain amino acids, such as glycine or serine, vitamin B6 enables the body to make them from sugar. Vitamin B6 is used also for the synthesis of certain hormones, such as adrenaline.
Causes and symptoms
Vitamin B6 deficiency occurs rarely. When it does, it is usually associated with poor absorption of nutrients in the gastrointestinal tract (as in alcoholism, or with chronic diarrhea), the taking of certain drugs (as isoniazid, hydrolazine, penicillamine) that inactivate the vitamin, with genetic disorders that inhibit metabolism of the vitamin, or in cases of starvation.
The symptoms of vitamin B6 deficiency in adults are only vaguely defined. These include nervousness, irritability, insomnia, muscle weakness, and difficulty in walking. Vitamin B6 deficiency may produce fissures and cracking at the corners of the mouth. The deficiency occurred in infants fed early versions of commercial canned infant formula, when the vitamin had been inadvertently omitted from the formula. This error resulted in infants failing to grow, in irritability, and in seizures.
Diagnosis
Vitamin B6 status is measured by the transaminase stimulation test. This test requires extraction of red blood cells, and placement of the cells in two test tubes. Special chemicals (reagents) are added to both test tubes to allow for measurement of aminotransferase. This enzyme requires pyridoxal phosphate. A known quantity of pure pyridoxal phosphate is added to one of the test tubes. The activity level of the enzyme is measured, and compared, in both test tubes. If the added pyridoxal phosphate did not stimulate activity, the patient is considered not to be deficient in vitamin B6. Neither is the patient considered deficient if only slight stimulation occurred. But if a stimulation of four-fold or more occurred, a vitamin B6 deficiency is present.
Treatment
Vitamin B6 deficiency can be prevented or treated with consumption of the recommended dietary allowance, as supplied by food or by vitamin supplements.
Prognosis
The prognosis for correcting vitamin B6 deficiency is excellent.
Prevention
Vitamin B6 deficiency is not a major concern for most people. The deficiency can be prevented with consumption of a mixed diet that includes poultry, fish, eggs, meat, vegetables, and grains.
Key Terms
Amino acid
Amino acids are small molecules that are used as building blocks for all proteins. Some amino acids are also used in the body for the manufacture of hormones. There are about 20 nutritionally important amino acids, including glutamic acid, glycine, methionine, lysine, tryptophan, serine, and glycine.
Fat-soluble vitamins
Fat-soluble vitamins can be dissolved in oil or in melted fat.
Recommended Dietary Allowance (RDA)
The Recommended Dietary Allowances (RDAs) are quantities of nutrients in the diet that are required to maintain good health in people. RDAs are established by the Food and Nutrition Board of the National Academy of Sciences, and may be revised every few years. A separate RDA value exists for each nutrient. The RDA values refer to the amount of nutrient expected to maintain good health in people. The actual amounts of each nutrient required to maintain good health in specific individuals differ from person to person.
Water-soluble vitamins
Water-soluble vitamins can be dissolved in water or juice.
For Your Information
Resources
Books
Brody, T. Nutritional Biochemistry. San Diego: Academic Press, Inc., 1998.
Sunday, August 3, 2008
Comparison of Iron Supplements
Comparison of Oral Iron Supplements
A new iron supplement product in the U.S. called Ferralet 90 is adding to the confusion surrounding the numerous oral iron supplements on the market. Ferralet 90 is a combination product containing carbonyl iron, B12, vitamin C, folic acid, and docusate and it is marketed as a prescription product. No oral iron dietary supplements are approved by the FDA, but manufacturers can choose to market their products as prescription only.8 There are two main iron salts forms (ferric and ferrous irons) and numerous formulations (e.g., amino-acid chelates, carbonyl iron, polysaccharide-iron complex, combination products, extended-release products, etc) available in the U.S. and Canada. All dietary iron has to be reduced to the ferrous form to enter the mucosal cells; therefore ferrous iron is absorbed three times more readily than the ferric form. Anecdotal claims that sustained-release iron preparations cause fewer gastrointestinal side effects have not been well substantiated.1,2 There is some evidence that controlled-release iron preparation causes less nausea and epigastric pain than conventional ferrous sulfate, but the discontinuation rates are similar.3 Theoretically, once-daily dosing can improve compliance. However, extended-release or enteric-coated formulations have been found to transport iron past the duodenum and proximal jejunum, thereby reducing the absorption of iron.1,2 Vitamin C is added to some products to enhance iron absorption. About 200 mg is needed to increase absorption of 30 mg of elemental iron.1 However, doses of 500 mg to 1000 mg only increase iron absorption by about 10%.2 Most iron preparations containing vitamin C don't have a sufficient amount of vitamin C to substantially affect iron absorption.1,2 In general, iron supplements should be taken on an empty stomach since food can decrease absorption by 40% to 50%. GI side effects such as nausea and abdominal pain occur more frequently as the quantity of soluble elemental iron in contact with the stomach and duodenum increases. Higher iron doses also increase the occurrence of constipation.1,10 Therefore, there should be no difference in GI tolerance when an equal quantity of elemental iron is administered regardless of the form of iron salt.2 A chart summarizing the differences among the various iron formulations is included.
There's confusion about the different oral iron products.
Many are promoted as better tolerated or absorbed...but not all of these claims can be substantiated.
Ferrous sulfate, ferrous gluconate, and ferrous fumarate contain different percentages of elemental iron. Efficacy and tolerability are similar for equal doses of elemental iron.
Carbonyl iron (Ferralet 90, Feosol Carbonyl Iron caplets, etc) is pure elemental iron that's absorbed slowly to reduce toxicity.
Prescribe these if you're concerned about accidental ingestion. Iron is still the #1 cause of pediatric fatalities due to toxicity.
Polysaccharide-iron complex (Niferex-150, etc) is iron bound to carbohydrates. It's promoted to improve tolerability, but there's no proof that there's a significant difference.
Heme iron polypeptide (Proferrin ES, etc) is derived from hemoglobin in animal red blood cells. It's better absorbed than the inorganic iron salts, especially when taken with food.
Use the inexpensive ferrous sulfate first-line...or carbonyl iron if toxicity is a concern.
Tell patients that GI tolerability is linked to the iron DOSE...not the salt. Enteric-coated and controlled-release preps might reduce nausea...but at the expense of lower absorption.
Vitamin C increases iron absorption, but most combo products don't contain enough. Over 200 mg is needed to increase absorption of 30 mg elemental iron.
A new iron supplement product in the U.S. called Ferralet 90 is adding to the confusion surrounding the numerous oral iron supplements on the market. Ferralet 90 is a combination product containing carbonyl iron, B12, vitamin C, folic acid, and docusate and it is marketed as a prescription product. No oral iron dietary supplements are approved by the FDA, but manufacturers can choose to market their products as prescription only.8 There are two main iron salts forms (ferric and ferrous irons) and numerous formulations (e.g., amino-acid chelates, carbonyl iron, polysaccharide-iron complex, combination products, extended-release products, etc) available in the U.S. and Canada. All dietary iron has to be reduced to the ferrous form to enter the mucosal cells; therefore ferrous iron is absorbed three times more readily than the ferric form. Anecdotal claims that sustained-release iron preparations cause fewer gastrointestinal side effects have not been well substantiated.1,2 There is some evidence that controlled-release iron preparation causes less nausea and epigastric pain than conventional ferrous sulfate, but the discontinuation rates are similar.3 Theoretically, once-daily dosing can improve compliance. However, extended-release or enteric-coated formulations have been found to transport iron past the duodenum and proximal jejunum, thereby reducing the absorption of iron.1,2 Vitamin C is added to some products to enhance iron absorption. About 200 mg is needed to increase absorption of 30 mg of elemental iron.1 However, doses of 500 mg to 1000 mg only increase iron absorption by about 10%.2 Most iron preparations containing vitamin C don't have a sufficient amount of vitamin C to substantially affect iron absorption.1,2 In general, iron supplements should be taken on an empty stomach since food can decrease absorption by 40% to 50%. GI side effects such as nausea and abdominal pain occur more frequently as the quantity of soluble elemental iron in contact with the stomach and duodenum increases. Higher iron doses also increase the occurrence of constipation.1,10 Therefore, there should be no difference in GI tolerance when an equal quantity of elemental iron is administered regardless of the form of iron salt.2 A chart summarizing the differences among the various iron formulations is included.
There's confusion about the different oral iron products.
Many are promoted as better tolerated or absorbed...but not all of these claims can be substantiated.
Ferrous sulfate, ferrous gluconate, and ferrous fumarate contain different percentages of elemental iron. Efficacy and tolerability are similar for equal doses of elemental iron.
Carbonyl iron (Ferralet 90, Feosol Carbonyl Iron caplets, etc) is pure elemental iron that's absorbed slowly to reduce toxicity.
Prescribe these if you're concerned about accidental ingestion. Iron is still the #1 cause of pediatric fatalities due to toxicity.
Polysaccharide-iron complex (Niferex-150, etc) is iron bound to carbohydrates. It's promoted to improve tolerability, but there's no proof that there's a significant difference.
Heme iron polypeptide (Proferrin ES, etc) is derived from hemoglobin in animal red blood cells. It's better absorbed than the inorganic iron salts, especially when taken with food.
Use the inexpensive ferrous sulfate first-line...or carbonyl iron if toxicity is a concern.
Tell patients that GI tolerability is linked to the iron DOSE...not the salt. Enteric-coated and controlled-release preps might reduce nausea...but at the expense of lower absorption.
Vitamin C increases iron absorption, but most combo products don't contain enough. Over 200 mg is needed to increase absorption of 30 mg elemental iron.
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