PBMC were obtained from four HIV-negative donors. Two of them KV and KS ; had been on SMX without adverse effects, whereas donor UNO experienced symptoms of drug allergy for the first time 10 years ago. He developed an erythematous exanthem after therapy with co-trimoxazole SMX plus trimethoprim ; . Two years later, he suffered a generalized exanthem within 1 day of re-exposure to co-trimoxazole that persisted for several days. No specific IgE and IgG Abs against SMX or trimethoprim were detected, but the lymphocyte transformation test demonstrated strong T cell proliferation to SMX 6, 11 ; . The second allergic donor KG ; was a young pharmacist who developed allergic symptoms exanthem ; after being treated for a urinary tract infection with an unknown sulfonamide. Five years later, she developed a macular exanthem and dyspnea after working with sulfamethoxazole in the laboratory. The HLA type of the donor UNO is A2 26, B44 60, DRB1 * 01 10, and of the donor KG is A2 68, B50 65, DRB1 * 07 13. The HLA types of the nonallergic donors are A1 2, B8 37, DRB1 * 03 10 for KV and A28 32, B17 44, DRB1 * 07 11 for KS.
Haemophilus influenzae: Severe: cefotaxime 500 mg i.v. 6 hourly child: 30 -50 mg kg i.v. 6-8 hourly ; , chloramphenicol as for Other Anaerobes Less Severe: amoxycillin-clavulanate 40 10 mg kg d to maximum 1.5 0.375 g in 3 divided doses Aeromonas hydrophila, Edwardsiella tarda: ciprofloxacin, aminoglycoside, third generation cephalosporin Vibrio: doxycycline 100 mg orally or i. v. twice daily + ceftazidime 2 g i.v. 3 times a day or ciprofloxacin 400 mg twice a day for 3 d or gentamicin Mycoplasma hominis: doxycycline Stenotrophomonas maltophilia: resection + cotrimoxazole + ticarcillin -clavulanate + aztreonam Other Aerobic Gram Negatives: ticarcillin + gentamicin Erysipelothrix rhusiopathiae: penicillin Fungi: amphotericin B 0.75mg kg d Prophylaxis Recurrent Streptococcus pyogenes Cellulitis ; : phenoxymethylpenicillin 250 mg orally twice daily for up to 6 NECROTISING FASCIITIS: incidence in adults 0.4 100 000, in children 0.08 100 000; mortality rates up to 73%; diabetes mellitus, immunosuppressive medications and AIDS predispose TYPE I PROGRESSIVE SYNERGISTIC BACTERIAL GANGRENE ; Agents: classically microaerophilic streptococci + Staphylococcus aureus Meleney' synergistic gangrene ; but also applied s to situations involving other streptococci 30% of isolates ; , Staphylococcus aureus gives a chronic condition ; , Gram negative bacilli especially Escherichia coli, Pseudomonas, Shigella, Enterobacter, Proteus, Serratia ; , Enterococcus faecalis and various anaerobes particularly Bacteroides, Peptostreptococcus, Clostr idium, Peptococcus may develop as a complication of foot and leg sores in diabetics, occasionally in other situations; Fournier' gangrene is necrotising fasciitis of scrotum rapidly s progressing to penis and is caused by Peptostreptococcus in association with Proteus, Escherichia coli, Staphylococcus aureus, ? -haemolytic streptococci rarely Streptococcus agalactiae associated with diabetes ; and various anaerobes; may follow use of nonsteroidal antiinflammatory drugs in treating inflammatory cutaneous les ions TYPE II Haemolytic Streptococcal Gangrene ; : prior injury penetrating injuries, cuts, burns, blunt trauma, muscle strain, surgical incisions, irradiation, cancer, diabetes, infection on trunk, alcoholism, HIV infection, cardiovascular and pulmonary disease, puerperium predisposing factors; also associated with use of nonsteroidal antiinflammatory drugs in varicella; 74% mortality Agents: Streptococcus pyogenes , occasionally in combination with Staphylococcus aureus Diagnosis: localised pain swelling, tenderness or erythema in 87%, gastrointestinal complaints nausea, vomiting, diarrhoea ; in 53%, influenza-like symptoms aches, chills, fever ; in 47%; culture of swab or biopsy from deep in wound; blood cultures; C reactive protein ? 16 mg dL positive predictive value 44%, negative predictive value 99% ; , creatine kinase ? 600 U L positive predictive value 58%, negative predictive value 95% MRI 94% accuracy ; or CT scan exudates extending along fascial planes frozen section; 'finger test' pathogno monic Treatment: operative removal of devitalised tissue; meropenem 25 mg kg to 1 g i.v. 8 hourly + clindamycin 15 mg kg to 600 mg i.v. 8 hourly or lincomycin 15 mg kg to 600 mg i.v. 8 hourly ; supportive care in ICU critical Streptococcus pyogenes: benzylpenicillin 45 mg kg to 1.8 g i.v. 4 hourly + clindamycin 15 mg kg to 600 mg i.v. 8 hourly or lincomycin 15 mg kg to 600 mg i.v. 8 hourly + normal immunoglobulin 0.4 -2 g kg i.v. for 1 or 2 doses during first 72 h; debridement; hyperbaric oxygen Penicillin Hypersensitive: substitute cephalothin 50 mg kg to 2 g i.v. 6 hourly or cephazolin 50 mg kg to 2 g i.v. 8 hourly for benzylpenicillin Pseudomonas aeruginosa: extensive debridement and resection; combination antipseudomonas antimicrobial therapy; leucocyte transfusions or colony-stimulating factors Polymicrobial: meropenem 25 mg kg to 1 g i.v. 8 hourly LYMPHOCUTANEOUS SYNDROME Agents: Sporothrix schenckii most common ; , Nocardia brasiliensis very common ; , Mycobacterium marinum very common ; , Leishmania brasiliensis very common in endemic areas ; , Leishmania tropica common in endemic areas ; , Coccidioides immitis common ; , Francisella tularensis common ; , Mycobacterium chelonei common ; , less frequent Blastomyces dermatitidis, Cryptococcus neoformans, Fusarium, Histoplasma capsulatum, Scedosporium apiospermum, Scopulariopsis, Nocardia asteroides, Nocardia otitidis-caviarum, Nocardia transvalensis, Staphylococcus aureus, Streptococcus pyogenes, Mycobacterium avium intracellulare, Mycobacterium flavescens, Mycobacterium fortuitum emerging pathogen in AIDS ; , Mycobacterium kansasii, Mycobacterium tuberculosis, Leishmania major, cowpox virus, herpes simplex virus Diagnosis: biopsy and culture of skin lesion, lymph node Treatment: Scedosporium apiospermum: ketoconazole, fluconazole, flucytosine Sporothrix schenckii: itraconazole.
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Boys aged 3 with no VUR Long-term treatment with trimethoprim may be regarded as cost-effective, and the probability that it is cost-effective at the threshold of 30, 000 per QALY is 0.77. In this case, nitrofurantoin and cotrimoxazole may not be regarded as costeffective incremental cost per QALY gained of 51, 428 and 86, 000, respectively ; . The probability that they will be cost-effective at a threshold of 30, 000 per QALY is 0.16 and 0.05, respectively. Boys aged 3 with VUR Long-term treatment with cotrimoxazole is more cost-effective than in boys aged 3 with no VUR incremental cost per QALY gained of 20, 476 ; . However, this choice is very uncertain, and the probability that it is cost-effective at the threshold of 30, 000 per QALY is only 0.29.
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Silver suph flamazine ; topical antibacterial septran bactrim , co-trimoxazole , septra , cotrim ; co-trimoxazole is a combination of trimethoprim and sulfamethoxazole, a sulfa drug and triphasil.
From the Department of Medicine, Drexel University College of Medicine, Philadelphia, Pa M.D.E. and Section of Cardiology, Boston University School of Medicine, Boston, Mass R.H.F. ; . Drs Ezekowitz and Falk have been consultants for AstraZeneca, manufacturer of Exanta ximelagatran ; . Address reprint requests and correspondence to Michael D. Ezekowitz, MD, PhD, Department of Medicine, Drexel University College of Medicine, 245 N 15th St, Room 6104, NCB, Philadelphia, PA 19102 e-mail: mde22 drexel ; . 2004 Mayo Foundation for Medical Education and Research.
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Concomitant therapy with potentially nephrotoxic or myelosuppressive medicines such as dapsone, systemic pentamidine, pyrimethamine, co-trimoxazole, amphotericin, flucytosine, ganciclovir, interferon, vincristine, vinblastine and doxorubicin may also increase risk of toxicity with sonke-lamivudine + zidovudine!
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Fungal Meningitis: CSF white cell count 5000 L, lymphocytes increased, red blood cells absent, glucose normal or slightly decreased, protein 60 mg dL, Gram stain and bacterial culture negative Tuberculous Meningitis: CSF white cell count 1000 L, polymorphs increased, red blood cells absent, glucose 45 mg dL, acid-fast stain positive in 80% if 10 mL of CSF centrifuged and sediment examined for 30-90 minutes, acid-fast bacilli culture positive in 85% Carcinomatous Meningitis: CSF white cell count 0-500 L, 0-95% polymorphs, red blood cells variable, glucose decreased or normal, protein usually increased, Gram stain and bacterial culture negative Brain Abscess: CSF white cell count 10-500 ? L, red blood cells variable, glucose decreased in 25%, protein increased in 75%, Gram stain positive in 10%, culture positive in 16% Endocarditis: CSF white cell count 50 ? L, polymorphs increased in 28%, lymphocytes increased in 25%, red blood cells occasionally raised, glucose normal or decreased, protein normal or increased, bacterial culture positive in 16% Traumatic Tap: leucocytes: erythrocytes ? 1: 500 Note that contaminating bacteria may be obtained from slides on which smears are made, tubes in which CSF is collected, needles and syringes in which CSF taken, stains used for staining smear Treatment: see categories below; if bacterial meningitis is suspected, immediately administer benzylpenicillin 1 y: 300 mg; 1-9 y: 600 mg; ? 10 y: 1200 mg ; or ceftriaxone 50 mg kg to 2 g i.v. if penicillin hypersensitive or likely delay of 6 h further therapy and transfer to hospital; in hospital, dexamethasone 0.15 mg kg to 10 mg i.v. + Community Acquired: ceftriaxone 100 mg kg to 4 g i.v. daily or 50 mg kg to 2 g i.v. 12 hourly for 7-10 d or cefotaxime 50 mg kg to 2 g i.v. 6 hourly for 7-10 d + benzylpenicillin 60 mg kg to 1.8-2.4 g i.v. 4 hourly for 7-10 d or amoxy ampicillin 50 mg kg to 2 g i.v. 4 hourly for 7-10 d if Listeria monocytogenes Suspected or Immunosuppressed ; Gram Positive Cocci Seen, Pneumococcal Antigen Assay Positive, Neutrophils But No Organisms Seen: add vancomycin 12.5 mg kg to 500 mg child 12 y: 15 mg kg to 500 mg ; i.v. 6 hourly by slow infusion monitor blood levels and adjust dose accordingly ; Immediate Penicillin or Cepahlosporin Hypersensitivity: vancomycin 12.5 mg kg to 500 mg child 12 y: 15 mg kg to 500 mg ; i.v. 6 hourly by slow infusion monitor blood levels and adjust dose accordingly ; + ciprofloxacin 10 mg kg to 400 mg i.v. 12 hourly or moxifloxacin 10 mg kg to 400 mg i.v. daily Neisseria meningitidis: benzylpenicillin 45 mg kg to 1.8 g i.v. 4 hourly for 3-5 d, then ceftriaxone 250 mg child 125 mg ; i.m. as single dose or ciprofloxacin 500 mg orally as single dose 12 y ; or rifampicin 10 mg kg to 600 mg 1 mo: 5 mg kg ; orally 12 hourly for 2 d and or immunisation Penicillin Hypersensitive Not Immediate ; : ceftriaxone 100 mg kg to 4 g i.v. daily for 3-5 d or 50 mg kg to 2 g i.v. 12 hourly for 3-5 d or cefotaxime 50 mg kg to 2 g i.v. 6 hourly for 3-5 d Immediate Penicillin or Cephalosporin Hypersensitive: ciprofloxacin 10 mg kg to 400 mg i.v. 12 hourly for 3-5 d Streptococcus pneumoniae: Penicillin MIC 0.125 mg L: benzylpenicillin 45 mg kg to 1.8 g i.v. 4 hourly for 1014 d Penicillin MIC 0.125 mg L: vancomycin 15 mg kg to 500 mg i.v. 6 hourly + cefotaxime 50 mg kg to 2 g i.v. 6 hourly or ceftriaxone 50 mg kg to 2 g i.v. 12 hourly Haemophilus influenzae type b: Penicillin Susceptible: benzylpenicillin 60 mg kg to 2.4 g i.v. 4 hourly for 7 d or amoxy ampicillin 50 mg kg to 2 g i.v. 4 hourly for 7 d Penicillin Resistant: ceftriaxone 100 mg kg to 4 g i.v. daily for 7 d or mg kg to 2 g i.v. 12 hourly for 7 d or cefotaxime 50 mg kg to 2 g i.v. 6 hourly for 7 d Immediate Penicillin or Cephalosporin Hypersensitive: chloramphenicol 20-25 mg kg to a g i.v. 6 hourly for 7 d or ciprofloxacin 10 mg kg to 400 mg i.v. 12 hourly for 7 d Listeria monocytogenes: benzylpenicillin 60 mg kg to 2.4 g i.v. 4 hourly or amoxy ampicillin 50 mg kg to 2 g i.v. 4 hourly Penicillin Hypersensitive: cotrimoxazole 4 20 mg kg to 160 800 mg i.v. 6 hourly and vasotec.
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485 Recommendation In choosing an analgesic for the field, desirable properties should be: safety, efficacy, ease of administration, rapid onset, short duration, low abuse potential for patients and staff, and reversibility.3 There is insufficient published evidence to decide which is the best agent for prehospital analgesia. The medical director of each EMS system must evaluate different alternatives available on the market and decide which agent or agents are most suitable for the system's local needs and capabilities. This decision should be made in consultation with the medical staffs of the system's receiving hospitals. The EMS system must be aware of local and regional regulations pertaining to the use of controlled medications. Prehospital providers must be educated in the appropriate use of these medications as well as the management of adverse effects and complications of each agent selected.
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To promote the most appropriate utilization of selected high risk or higher cost medications, PTI will use one of or a combination of the following to enforce Formulary compliance. 1 ; NDC lock and block at the point of sale, 2 ; Formulary filling fee incentives for pharmacists, 3 ; copay differentials for members, 4 ; on-line Formulary messaging, 5 ; prior authorization, 6 ; dollar limits per claim before prior authorization and 7 ; quantity limitations. The P&T Committee has established Formulary criteria with input from participating physicians and consideration of current medical literature, for example, amox.
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The target enzyme of TMP is dihydrofolate reductase DHFR ; , which catalyses the reduction of 7, 8-dihydrofolate to 5, 6, 7, and depends on the reduced form of nicotinamide adenine dinucleotide phosphate. In Streptococcus pneumoniae, Staphylococcus aureus, Escherichia coli, Enterococcus faecalis and Plasmodium falciparum, mutations in the DHFR genes were found to confer resistance to DHFR inhibitors including TMP and pyrimethamine [610]. Ma et al. [11] have reported the cloning and sequencing of the DHFR gene in human-derived P. carinii. The DHFR nucleotide sequences were identical in 37 clinical isolates except one with a synonymous substitution. This report describes the DHFR nucleotide and amino acid sequence patterns of P. carinii isolates from immunosuppressed patients in Japan. The linkage of amino acid substitutions in DHFR to those in DHPS for each isolate of P. carinii and the relationship between the substitutions in DHFR and the results of co-trimoxazole treatment in patients with PCP are also discussed.
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Table D1.9. Indices of abundance and CVs for the trawl CPUE data. Debra is a 45-year-old woman with a known diagnosis of type 2 diabetes for 3 years. She has not had a medical check-up for 2 years. She returns at this time with a primary complaint of chronic fatigue. Her laboratory test results show the following: HbA1c 8.3%; serum cholesterol 214 mg dl; triglycerides 275 mg dl. Her current weight is 175 lb., and her height is 64 in. BMI 30 ; . She states she hasn't returned for any follow-up visits because the only advice she gets is to lose weight and not to eat sugar, neither of which she is able to do. 1. What advice will you offer to improve Debra's metabolic parameters and, in particular, to improve her blood glucose control? 2. What guidelines for carbohydrate intake can help Debra improve her glycemia? 3. What suggestions will you have about fat intake? 4. What information will you share about exercise? 5. What meal-planning method do you suggest for her? 6. What will you recommend regarding her sugar intake? and warfarin.
Chi-square test or Fisher's Exact test as appropriate. For estimates of multiresistance, co-trimoxazole and trimethoprim resistance was counted as one resistance.
Madan Lal Faculty Member, Indian Institute of Foreign Trade, New Delhi-110016. from international competition. Against this backdrop, standards and regulations in general, and sanitary and phytosanitary measures in particular, involve a mix of protection and protectionist objectives which is very complex to disentangle. This generates a very demanding challenge for an economist used to trade-off costs and benefits in order to evaluate different policy options. Among the agreements of the World Trade Organisation WTO ; , the Application of the Agreement on Sanitary and Phytosanitary SPS ; Measures is to protect the legitimate rights of importing countries with respect to national health and safety without providing a and wellbutrin and trimox, for instance, penicillin.
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Two interesting studies regarding Pneumocystis carinii pneumonia PCP ; may help refine treatment for that infection. Researchers from Canada and France found that oral corticosteroids prednisone ; were helpful to persons being treated for mild episodes of PCP. 23 Corticosteroids are already well-established as an important adjunct for treating moderate to severe bouts of PCP. In a Canadian U.S. study, trimethoprim-sulfamethoxazole TMP-SMX, also known as cotrimoxazole, Septra, and Bactrim ; was compared to an experimental antiprotozoal drug, atovaquone, in the treatment of PCP.24 Atovaquone was found to be less effective overall than TMP-SMX, but also less toxic. Susequently, atovaquone has been approved as salvage option for treating PCP. It has also been under study for the treatment of toxoplasmosis and cryptosporidiosis. ; Italian physicians reported five cases of pneumonia caused not by Pneumocystis but by Rhodococcus equi.25 They caution that the relative infrequency of this infection may contribute to its misdiagnosis, even while its severity possibly qualifies it as an AIDS "index" diagnosis. A U.S. study of new potential agents to treat toxoplasmosis found that azithromycin, clarithromycin, and atovaquone each had synergistic activity in combinations with the older drugs-- pyrimethamine, sulfadiazine or dapsone.26 All six of these drugs were known to have.
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ANAEROBES Carbencillin, Cefoxitin, Clindamycin, Chloramphenicol, Erythromycin, Metronidazole, Ampicillin, Tetracycline. ENTEROBACTERIA Amikacin, Aztreonam, Carbencillin, Chloramphenicol, Fosfomycin, Netilmycin, Cefotaxime, Rifampicin. ENTEROBACTERIA URINE Nalidixic acid, Ampicillin, Cefuroxime, Cefrazidime, Co-trimoxazole, Gentamicin, Nitrofurantoin, Norfloxacin. ENTEROBACTERIA FROM URINE AND OTHER SAMPLES Pipemidic acid, Cefoxitin, Cefoperazone, Cefuroxime, Sisomycin, Netilmicin, Piperacillin, Tobramycin. ENTEROCOCCI Amoxicillin, Ampicillin, Erythromycin, Nitrofurantoin, Tetracycline, Vancomycin, Gentamicin, Ciprofloxacin. PSEUDOMONAS ACINETOBACTER Amikacin, Carbencillin, Cefoperazone, Cefrazidime, Gentamicin, Netilmycin, Pipemidic acid, Tobramycin. STAPHILOCOCCHI STREPTOCOCCHI Cefhalothin, Cefuroxime, Netilmicin, Co-trimoxazole, Erytromycin, Gentamicin, Rifampicin, Oxacillin. 71L9542 50 test 71L9539 50 test 71L9540 50 test 71L9544 50 test 71L9543 50 test 71L9538 50 test.
These drugs are various combinations of dihydrofolate-reductase inhibitors proguanil, chlorproguanil, pyrimethamine, and trimethoprim ; and sulfa drugs dapsone, sulfalene, sulfamethoxazole, sulfadoxine, and others ; . Although these drugs have antimalarial activity when used alone, parasitological resistance can develop rapidly. When used in combination, they produce a synergistic effect on the parasite and can be effective even in the presence of resistance to the individual components. Typical combinations include sulfadoxine pyrimethamine SP or Fansidar 1 ; , sulfalenepyrimethamine metakelfin ; , and sulfamethoxazole-trimethoprim co-trimoxazole ; . A new antifolate combination drug is currently being tested in Africa. This drug, a combination of chlorproguanil and dapsone, also known as LapDap, has a much more potent synergistic effect on malaria than existing drugs such as SP. Benefits of this combination include 1 ; a greater cure rate, even in areas currently experiencing some level of SP resistance, 2 ; a lower likelihood of resistance developing because of a more advantageous pharmacokinetic and pharmacodynamic profile, and 3 ; probable low cost currently estimated at less than US$ 1 per adult treatment course ; 29.
6 h ; . the case of seizure, anti-seizure drugs must be added, taking into account that all except valproic acid interact with protease inhibitors and non-nucleoside reverse transcriptase inhibitors96. For patients who cannot tolerate sulfadiazine due to hypersensitivity reactions or other adverse effects, the alternative is the combination of clindamycin 600 mg 6 h ; and pyrimethamine also with folinic acid ; 96-98. The efficacy of this regimen is similar, although in the maintenance phase it has proven to be inferior to sulfadiazine-pyrimethamine98. Another alternative for patients who cannot tolerate clindamycin is the use of clarithromycin 1 g 12 azithromycin 1, 200-1, 500 mg day ; , combined if possible with pyrimethamine99, 100. Atovaquone is an antiparasitic drug that has also been used to treat TE101, 102 at a dose of 750 mg 3 tid Its efficacy seems to be correlate well with plasma levels and it synergizes with pyramethamine. There is some experience with IV cotrimoxazole, which is the drug of choice for primary prophylaxis of this opportunistic infection103. It may also be useful for the treatment of rare cases of the simultaneous appearance of P. carinii pneumonia and T. gondii encephalitis. Protozoa which cause intestinal infection: Cryptosporidium parvum, Isospora belli, Microsporidia spp., Cyclospora, Giardia lamblia, and others Despite the fact that the clinical manifestations of the infections caused by some of these pathogens are similar chronic diarrhea and gradual weight loss ; , treatment and outcome are different. The response of I. belli is generally good even spectacular ; with COT administration one double strength tablet [160 800 mg] every 6-8 h for 10 days, followed by twice a day for 3 weeks ; 104, 105. A less intensive COT regimen has also proven effective106. Pyrimethamine has been proposed as an alternative at a dose of 75 mg d plus folic acid 10 mg day, for two weeks, and ciprofloxacin 500 mg 12 h for 7 days, although it is less effective than cotrimoxazole106. Some success has been reported diclazuril 300 mg 12 h, albendazole plus ornidazole, and nitazoxanide. For Microsporidia, favorable parasitological and clinical responses have been reported with albendazole, even in extraintestinal forms of the disease107. Other useful drugs and triphasil.
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Table 4. Relative Risk of Death Cox Analysis.
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We excluded 4 patients from analysis--2 CYP2C9 * 1 * 1 carriers who started amiodarone and benzbromarone, 1 CYP2C9 * 1 * 2 carrier who started amiodarone, and 1 CYP2C9 * 1 * 3 carrier who started cotrimoxazole. All aforementioned drugs are CYP2C9 inhibitors and were started before stability was achieved.17, 31, 32 Adjusted for age, sex, target INR therapeutic range of anticoagulation, and use of antibiotics before stability was achieved. Statistically significant difference P .05.
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Clients on ART Human Resource NACO Human Resource SACS Human Resource ART Clinic Human Resource Hospital staff Available from Monthly Reports that ART centres prepare and send to respective SACS Estimated proportion of time spent by the NACO staff on the ART programme was arrived at based on discussions. Actual proportion of time is listed in the annex. Estimated proportion of time spent by the SACS staff on the ART programme was arrived at based on discussions. Actual proportion of time is listed elsewhere. NACO ART guideline specifies the details of staff to be appointed at the ART clinic. It was verified at respective sites, and actual `in place' staff was taken into account. Additionally, details of dedicated ART clinic staff - other than NACO sponsored were also accounted for. In addition to the ART clinic staff, hospital physicians, especially from Medicine and Microbiology departments were actively involved in the ART programme. The Medicine department physicians' time was apportioned to ART programme based on discussions around their perceptions about involvement in the programme at respective sites. For the Microbiology department, 25 percent of the time of one faculty was accounted for based on various discussion at all the sites Available from Monthly reports that ART centres prepare and send to respective SACS ARV drugs supply and consumption figures are available from monthly reports. The unit prices of different drug molecules for the years 2004-05 and 2005-06 were obtained from NACO. Since the drug prices during two years and volume of drug supplied to different sites were different, a sitespecific weighted average unit cost was calculated. Finally, the total consumption figures were multiplied with the weighted average unit prices to get the total expenditure on ARV. For the cases of state level purchasing of ARVs, a ratio of NACO and state supply was calculated, and accordingly, the expenditure based on two different unit costs - was calculated. Unit cost of CD4 test kit was collected from respective SACS. The unit cost of sheath fluid was calculated based on Delhi SACS data and applied to all other sites. Total expenditure was calculated based on unit cost and total consumption. Monthly data on CD4 testing, control and failed tests were available from Microbiology lab. Sum of these yielded total consumption of CD4 tests. A container of 20 liters of sheath fluid was assumed to be required for 150 CD4 tests. All centres provide Co-trimoxazole - one tablet a day - to all clients having CD4 count less than 200 cells till it improves beyond 200 cells. Only Imphal could provide actual consumption data for the study period. CD4 count profile of ART clients was only available from Ahmedabad and thus, this proportion 73% of clients would take Septran for six months and 11% for a year ; was applied to sites where actual estimated proportion was not available. Only RIMS and Trichur could give data on actual consumption of OI drugs. For other centers, consumption of OI drugs had to be calculated based on the profile of OI infections among clients and prescribed dosage, which was available only for Ahmedabad; the proportion of clients with major OIs was calculated for Ahmedabad and used for other sites.
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