trimethoprim--sulfamethoxazole-drug-combination and Pain

We evaluated the efficacy of the alpha1-adrenergic antagonist tamsulosin for conservative expulsive therapy in patients with ureteral colic due to juxtavesical stones.. A total of 60 consecutive symptomatic patients with stones located in the juxtavesical tract of the ureter were randomly divided into group 1--30 who received oral floroglucine-trimetossibenzene 3 times daily and group 2--30 who received 0.4 mg tamsulosin daily. The 2 groups received 30 mg deflazacort daily for 10 days plus cotrimoxazole 2 times daily for 8 days and 75 mg diclofenac injected intramuscularly on demand. Ultrasound followup and medical visits were performed weekly for 4 weeks. Stone passage rate and time, analgesic use, hospitalization and endoscopical intervention were evaluated. Statistical analysis was performed using the Student t test.. The stone expulsion rate was 70% for group 1 and 100% for group 2. Mean stone size was 5.8 and 6.7 mm, respectively (p = 0.001). Mean expulsion time was 111.1 hours for group 1 and 65.7 hours for group 2 (p = 0.020). The mean number of diclofenac injections was 2.83 for group 1 and 0.13 for group 2 (p <0.0001). Ten group 1 patients were hospitalized, of whom 9 underwent ureteroscopy, compared with none in group 2 (p <0.0001 and 0.001, respectively).. Tamsulosin used as a spasmolytic drug during renal colic due to juxtavesical calculi increased the stone expulsion rate and decreased expulsion time, the need for hospitalization and endoscopic procedures, and provided particularly good control of colic pain.

Topics: Administration, Oral; Adolescent; Adrenergic alpha-1 Receptor Antagonists; Adrenergic alpha-Antagonists; Adult; Aged; Anti-Infective Agents, Urinary; Anti-Inflammatory Agents; Diclofenac; Drug Therapy, Combination; Female; Hospitalization; Humans; Injections, Intramuscular; Male; Middle Aged; Pain; Pregnenediones; Sulfonamides; Tamsulosin; Trimethoprim, Sulfamethoxazole Drug Combination; Ureteral Calculi

Transurethral microwave thermotherapy (TUMT) can be painful. Pain sensation limits treatment tolerance and consequently also treatment efficacy. Of our population of patients treated with TUMT, 22% (63/288) needed intravenous analgesia and, nevertheless, 6% (17/288) needed definitive treatment interruption. The aim of this study was to identify the mechanism of pain sensation during TUMT and to verify whether the prophylactic use of a sedative drug would improve treatment tolerance. Eighty-three patients undergoing TUMT treatment for benign prostatic hyperplasia at our department entered a prospective, randomized, single-blinded study. Thirty minutes before treatment, 40 patients (group A) received 960 mg cotrimoxazole orally while 43 patients (group B) received 960 mg cotrimoxazole and 10 mg oxazepam, both orally. Statistically significant improvement in treatment tolerance in group B in comparison with group A was found. Pain sensation during TUMT seemed to be mostly due to anxiety. It is concluded that the prophylactic use of a sedative drug is advisable in patients undergoing TUMT in order to improve treatment tolerance.

Topics: Analgesia; Conscious Sedation; Diathermy; Fentanyl; Humans; Male; Microwaves; Oxazepam; Pain; Prospective Studies; Prostatic Hyperplasia; Single-Blind Method; Trimethoprim, Sulfamethoxazole Drug Combination

BACKGROUND Stevens Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are causes of rare but life-threatening emergencies characterized by desquamation of the skin and mucosa. As SJS most commonly presents with skin rash followed by mucosal involvement, we present a case of vulvovaginal lesions as the initial presentation with progression to SJS after re-exposure to the culprit drug. CASE REPORT A 27-year-old female with acute cystitis was given trimethoprim-sulfamethoxazole. After 2 days, she reported vaginal pain. Three days later, she was hospitalized with vulvovaginal ulcerations and restarted on trimethoprim-sulfamethoxazole, leading to worsening vaginal lesions with rapid desquamation of conjunctival and oropharyngeal involvement. Biopsies of arm lesions revealed SJS. CONCLUSIONS It is important to recognize SJS as a rare but life-threatening cause of vulvovaginal ulceration, as early diagnosis is vital for successful treatment.

Topics: Adult; Anti-Infective Agents, Urinary; Female; Humans; Pain; Skin Ulcer; Stevens-Johnson Syndrome; Trimethoprim, Sulfamethoxazole Drug Combination; Vulvar Diseases

Topics: Adult; Anti-Bacterial Agents; Antiretroviral Therapy, Highly Active; Combined Modality Therapy; Debridement; Drug Therapy, Combination; Female; Gingivitis; Gingivoplasty; Heroin Dependence; HIV Infections; Humans; Mandible; Methadone; Necrosis; Oral Ulcer; Pain; Stomatitis; Substance Abuse, Intravenous; Tooth Extraction; Tooth Loss; Treatment Refusal; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Asthma; Biopsy; Diagnosis, Differential; Erythema Nodosum; Exanthema; Female; Humans; Irritable Bowel Syndrome; Leg; Lymphatic Diseases; Mycobacterium tuberculosis; Pain; Radiography; Sarcoidosis; Skin; Trimethoprim, Sulfamethoxazole Drug Combination; Tuberculin Test; Tuberculosis, Pulmonary

The gene for sickle cell disease is carried by 8% of the African-American population in the United States. The primary care physician is often called upon to recognize and treat one of the major sequelae of sickle cell disease--vaso-occlusive pain crisis. An injectable nonsteroidal anti-inflammatory drug has recently become available and may offer some improvement in outcome of vaso-occlusive pain crises. We present five case reports reviewing various current therapeutic options, including newer pharmacologic agents, and comment on alternatives to impatient management of pain crises. The use of the emergency department short-term observation unit as an alternative to hospitalization is discussed.

Topics: Acetaminophen; Adolescent; Adult; Amitriptyline; Analgesics; Anemia, Sickle Cell; Anti-Inflammatory Agents, Non-Steroidal; Emergency Service, Hospital; Female; Humans; Ketorolac; Male; Meperidine; Oxycodone; Pain; Promethazine; Tolmetin; Trimethoprim, Sulfamethoxazole Drug Combination; Vascular Diseases

Topics: Acute Disease; Adult; Bacteriuria; Diagnosis, Differential; Drug Combinations; Enterobacteriaceae Infections; Humans; Lymphogranuloma Venereum; Male; Nitrofurantoin; Pain; Pain Management; Prostatectomy; Prostatic Diseases; Prostatitis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination