Doson Chua

Spironolactone use in heart failure patients with end-stage renal disease on hemodialysis: is it safe?

Spironolactone is used in the treatment of cardiovascular disease, but is contraindicated in renal dysfunction due to the risk of hyperkalemia. It is not known if patients with end‐stage renal disease (ESRD) on hemodialysis are at the same risk for hyperkalemia. The objective of this study was to systematically review the evidence evaluating the incidence of hyperkalemia with spironolactone use in ESRD patients on hemodialysis.

New antiplatelet agents for cardiovascular disease

Antiplatelet therapy is a key component in the management of many medical diseases to decrease the risk of cardiovascular events.[1][1] Acetylsalicyclic acid (ASA) is the most common antiplatelet agent used and is usually first-line therapy. Use of clopidogrel, especially in combination with ASA,

Not quite the full story on new antiplatelets

O’Sullivan and Tejani[1][1] provide an interesting perspective on our CMAJ review article.[2][2] Because of geographic differences in the efficacy of ticagrelor, the FDA delayed approval of the drug twice and requested further data and analysis.[3][3],[4][4] Although the FDA document does identify

Allergic Cross-Sensitivity between Penicillin and Carbapenem Antibiotics

Objective: To review the literature evaluating the cross-hypersensitivity between carbapenem and penicillin antibiotics. Data Sources: Primary literature was accessed through MEDLINE (1980–June 2004), EMBASE (1980–December 2004), International Pharmaceutical Abstracts, PubMed, and references of reviewed articles. Key search terms were carbapenem, imipenem, meropenem, ertapenem, drug hypersensitivity, and penicillin allergy. Study Selection and Data Extraction: All articles describing clinical studies involving the use of carbapenem antibiotics in patients allergic to penicillin were reviewed. Data Synthesis: Four studies assessed carbapenem hypersensitivity in penicillin-allergic patients. Original estimates deemed the cross-reactivity to be 50% based on skin testing in a small number of patients; however, 3 more recent retrospective analyses indicate the overall incidence to be approximately 10%. The retrospective nature and presence of confounding factors in the more recent studies make it difficult to apply the lower estimates of carbapenem cross-sensitivity to a general patient population. The majority of cross-reactivity reactions reported was the development of a rash or hives. Conclusions: With minimal data available, the incidence of allergic reaction to carbapenem antibiotics in patients with self-reported penicillin allergy is likely less than the original skin test–determined estimates of 50%. However, caution should be used in patients with previously reported anaphylactic reactions to penicillin. A detailed allergy history is important in determining the clinical consequences of the potential cross-reactivity of carbapenem antibiotics in penicillin-allergic patients.