Clinical Briefs



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Am Fam Physician. 1998 May 1;57(9):2269-2270.

Vitamin A Supplementation During Pregnancy

Routine supplementation of vitamin A during pregnancy is not recommended by the American College of Obstetricians and Gynecologists (ACOG), according to an ACOG committee opinion (number 196, January 1998). ACOG believes that the dietary intake of vitamin A in the United States is enough to meet the needs of most pregnant women throughout gestation. If a physician believes the intake of vitamin A does not appear to be adequate, ACOG recommends that supplementation with 5,000 IU of vitamin A per day be considered. This amount is well below the probable minimum human teratogenic dose. ACOG suggests that physicians caution pregnant women or those planning to become pregnant about using high doses of vitamin A.

For more information about ACOG committee opinions, ACOG practice patterns and ACOG technical bulletins, contact ACOG, 409 12th St., S.W., P.O. Box 96920, Washington, D.C. 20090-6920; telephone: 800-762-2264.

In-Office Test for Influenza A and B

The U.S. Food and Drug Administration has approved a rapid, in-office test for influenza A and B. ZstatFlu is the only rapid point-of-care test available for influenza.

The testing process involves obtaining a throat swab. Sample preparation takes about one minute of hands-on time, and the results can be read in 60 minutes. According to the manufacturer, a positive test may appear sooner. ZstatFlu displays a visible blue dot that indicates the presence of influenza A or influenza B up to 24 hours before the appearance of symptoms. A white field indicates that no virus was detected.

The test is based on the reaction between a viral enzyme called neuraminidase and a color-generating substrate that binds only to neuraminidase of influenza A and B. Clinical studies have demonstrated a specificity of 99 percent and a sensitivity of 68 percent.

Fact Sheet on Injuries in Gymnastics

Current information on injuries associated with gymnastics and recommendations for safety are included in a new fact sheet published by the National Youth Sports Safety Foundation (NYSSF). The fact sheet has information on statistics, risks of participation, most common injuries and training. The information has been compiled from journal articles, national medical organizations, books, newsletters and experts in the field. The fact sheet is indicated for parents, health professionals and coaches to serve as a guideline on current recommendations. Copies of the publication may be purchased for $2 each by writing NYSSF, Dept. G, 333 Longwood Ave., Ste. 202, Boston, MA 02115-5711. The Internet address for the NYSSF is http://www.nyssf.org.

Routine Use of Rotavirus Vaccine

The Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention has voted to recommend the vaccine developed to prevent rotavirus gastroenteritis for routine use in all full-term infants. The official recommendation by ACIP awaits the approval of the vaccine by the U.S. Food and Drug Administration. The rotavirus vaccine will be marketed under the trade name RotaShield.

The vaccine is intended to be given in three oral doses at two, four and six months of age and is compatible with other routine childhood immunizations. Rotavirus gastroenteritis is highly contagious and infects nearly every child by the age of four years. It causes diarrhea, cramps and vomiting and results in dehydration and death in up to 1 million children worldwide every year. In the United States, up to 125 children die each year as a consequence of rotavirus infection.

Educational Publications on Hepatitis

The National Digestive Diseases Information Clearinghouse (NDDIC) has produced three new publications on hepatitis for patients. “What Do I Need to Know About Hepatitis A?” “What Do I Need to Know About Hepatitis B?” and “What Do I Need to Know About Hepatitis C?” provide basic information about the causes, risk factors, diagnosis, treatment and prevention of these common types of viral hepatitis.

Health care professionals can order a total of 25 copies of each publication free of charge from the NDDIC, attn: HEP, 2 Information Way, Bethesda, MD 20892-3570; telephone: 301-654-3810; fax: 301-907-8906; e-mail: nddic@info.niddk.nih.gov. The materials are also available on the Internet at http://www.niddk.nih.gov (then click on “Digestive Diseases”). The booklets are not copyrighted.

The NDDIC is an information dissemination service of the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health.

Treatment Option for Bacterial Vaginosis

A three-day treatment option for women with bacterial vaginosis who are not pregnant has been approved by the U.S. Food and Drug Administration (FDA). Clindamycin cream (Cleocin Vaginal Cream 2 percent) was first marketed as a seven-day course of therapy. Along with the approval of the three-day therapy option for nonpregnant women, the FDA has added pregnant women in their third trimester to the population who can be treated with the seven-day treatment option.

The clindamycin cream three-day treatment option is available in a 21-g tube with three disposable applicators. The recommended dosage for the three-day option is one applicator of cream administered intravaginally, at bedtime, for three days.

Clindamycin should not be used in individuals with a history of regional enteritis, ulcerative colitis or a history of antibiotic-associated colitis. The most common side effects are vaginitis and Candida albicans vaginal infections.

Arthritis Therapy with Gastrointestinal Protection

The U.S. Food and Drug Administration has approved a combination of diclofenac sodium and misoprostol (Arthrotec), an arthritis therapy that provides both a nonsteroidal anti-inflammatory drug (NSAID) and gastrointestinal mucosal protection against ulcers. The combination is indicated for patients with osteoarthritis and rheumatoid arthritis who are at high risk for NSAID-induced ulcers and their complications. In clinical trials, use of the combination therapy was associated with a 65 to 80 percent lower incidence of such ulcers when compared with diclofenac alone or with use of other common NSAID therapies.

The tablet consists of an enteric-coated core containing diclofenac (50 or 75 mg), surrounded by an outer coating containing misoprostol (200 μg). Misoprostol has been shown to prevent NSAID-induced stomach ulcers. The recommended dosage for patients with osteoarthritis is the 50-mg formulation three times daily and, for patients with rheumatoid arthritis, the recommended dosage is the 50-mg formulation three or four times daily. Arthrotec (containing 50 or 75 mg of diclofenac) can also be taken twice daily in patients who experience intolerance, but this dosage may not be as effective in preventing ulcers.

According to the manufacturer, the combination tablet of diclofenac-misoprostol was well tolerated by most patients in clinical trials. The most common side effects include abdominal pain, diarrhea and stomach upset. Because the formulation does contain an NSAID, there is a risk of ulcers and gastrointestinal bleeding. Arthrotec should not be used in women who are pregnant or who may become pregnant.



Copyright © 1998 by the American Academy of Family Physicians.
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