Chemotherapy versus best supportive care for extensive small cell lung cancer

BACKGROUND

Combination chemotherapy has been the mainstay of treatment for extensive stage small cell lung cancer (SCLC) over the last 25 years even though it only gives a short prolongation in median survival time. The main goal for these patients, if their survival prognosis is limited, should be adequate palliation with the aim of improving their quality of life.

OBJECTIVES

To evaluate the effectiveness of chemotherapy in extensive SCLC compared with best supportive care (BSC) or placebo treatment.

SEARCH STRATEGY

Medline (1966-Jan 2003), Embase (1974-Jan 2003), Cancerlit (1993-Jan 2003) and the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 4, 2002) were searched. In addition experts in the field were contacted to identify further studies not found by electronic searches.

SELECTION CRITERIA

Randomised controlled trials in which any chemotherapy treatment was compared with a placebo group or best supportive care in patients with extensive stage SCLC.

DATA COLLECTION AND ANALYSIS

Data extraction and quality assessment were undertaken independently by two reviewers and disagreements were resolved by a third author. Additional information on the included studies was obtained from the author of the original studies.

MAIN RESULTS

Only two studies (the first published in 1977 and the second in 1982) met the inclusion criteria of the review. A total of 65 patients with extensive disease (33 in the first study and 32 in the second) were randomised to received either placebo treatment or ifosfamide. In the second study a third arm of comparison included ifosfamide plus CCNU. Ifosfamide gave an extra 78.5 days survival (mean survival time) compared with the placebo group. Partial tumour response was greater with the active treatment. Toxicity was only seen in the chemotherapy group. Pooled analysis was not possible because only mean survival time was reported in both studies for patients with extensive disease.

REVIEWER'S CONCLUSIONS

Chemotherapeutic treatment prolongs survival in comparison with placebo in patients with advanced SCLC. Nevertheless the impact of chemotherapy on quality of life and in patients with poor prognosis is unknown. Well-designed, controlled trials are needed to further evaluate the risks and benefits of different chemotherapeutic schedules in patients with advanced small cell lung cancer.

An organizational model for a primary care program of home health care in Spain: a description of the program

The National Institute of Health (INSALUD) in Spain has successfully used a model of home care that has two major components, each using the physician as part of the team that provides care at home. The first component is home health care that is provided to chronically ill, terminally ill and homebound patients, whereby professionals of primary care provide care for the patient at home, along with other professionals who provide specialized care as support elements. The second component is hospitalization at home, whereby care is provided to acutely ill patients or patients with a precocious medical or surgical discharge from the hospital. The professionals from the hospital provide the basis of care. and the primary health care professionals are the support elements. Both components incorporate a team of support.

Twenty-four-month oral carcinogenicity study of ebrotidine in rats

Three groups of Sprague-Dawley CD rats (males and females) were initially administered p.o. with ebrotidine, a novel H2-receptor antagonist, mixed with the diet, at 50, 200, and 500 mg/kg/d, respectively. Two concurrent control groups of animals were used. After 13 months, initial 200 mg/kg was lowered to 150 mg/kg, and a new group was administered with 300 mg/kg, due to the body weight reduction observed in the top dose group. After 24 months, survivors were killed and necropsied, and a histopathological study was performed. The frequencies of the different tumour types that were found were not raised due to the treatment. Lower frequencies of some types of pituitary and mammary gland tumours, in the groups treated with the higher doses, were the only statistically significant changes. Among the non-neoplastic effects, a lower body weight increment and food consumption (500 and 300 mg/kg, both sexes), lower survival (500 mg/kg, males), presence of lipoid pneumonia (500 mg/kg, only in males, and 300 mg/kg, both sexes), and lithiasis in urinary system (500 mg/kg) were observed. No changes in gastric mucosa (the main target organ) were attributable to ebrotidine. Regarding the non-neoplastic effects, 150 mg/kg was the no observed adverse effect level. According to the previous results of the carcinogenicity study in mice, conjointly with those of the study in rats reported here, there is no evidence of carcinogenic risk either in males or in females in these species.

[Respiratory function in pediatric survivors of malignant neoplasms]

AIM

To evaluate post-treatment pulmonary function in patients with malignant extrapulmonary neoplasia and its relationship with age, type of neoplasty and treatment received.

METHODS

Cohort study of 95 pediatric patients after chemotherapy with or without surgery or extrapulmonary thoracic radiotherapy. The patients were in remission without treatment and able to undergo pulmonary function testing. Personal history and exposure to risk factors or toxic habits were evaluated. Clinical examination, chest radiographs, pulmonary gammography, basal and stress pulmometry, forced spirometry, whole body phletismography and carbonmonoxide transfer test were performed.

RESULTS

Mean age at diagnosis was 5 +/- 3.3 years. Treatment duration was 2.4 +/- 1.3 years and time without treatment 4.3 +/- 3. 3 years. Thirty-six patients were reviewed two and a half years after the first control. Thirty-nine patients had acute lymphoblastic leukemia and 57 had solid tumors. Sixty percent showed functional restriction due to chest deformity after undergoing chest surgery. The association between functional restriction and radiotherapy (6 patients) did not produce poorer functional results. Forty-three percent showed initial change in TLCO. Nineteen percent showed basal hemoglobin saturation under 93% which in 16% fell after physical exercise. These alterations improved with time. However, restrictive change initially present in 11.5% persisted at the second evaluation. Thoracic surgery was the main cause of thoracic deformity and therefore of restrictive change. The children under 8 years old and those who received longer treatments tended to show the worst TLCO values. The patients with neuroblastoma showed greater restrictive change while the change in TLCO was more frequent in patients with Burkitt s lymphoma and in those treated with cyclophosphamide.

CONCLUSIONS

Neither personal or family history of respiratory disease nor the presence of symptoms such as cough served to identify risk of functional change. Restrictive change in pulmonary function was greater in patients who had undergone thoracic surgery. Functional values were worse in patients with neuroblastoma. Pulmonary function should be followed up in pediatric survivors of malignant neoplasia in order to prevent restrictive alterations.

7-[3-(1-piperidinyl)propoxy]chromenones as potential atypical antipsychotics. 2. Pharmacological profile of 7-[3-[4-(6-fluoro-1, 2-benzisoxazol-3-yl)-piperidin-1-yl]propoxy]-3-(hydroxymeth yl)chromen -4-one (abaperidone, FI-8602)

A series of novel 7-[3-(1-piperidinyl)propoxy]chromenones was synthesized and tested as potential antipsychotics in several in vitro and in vivo assays. The compounds possessed good affinity for D2 receptors, together with a greater affinity for 5-HT2 receptors, a profile which has been proposed as a model for atypical antipsychotics. Several agents also displayed a high potency in the climbing mice assay on oral administration, suggesting a potent antipsychotic effect as compared to reference standards. Compound 23 was selected for further pharmacological evaluation. Induction of catalepsy and inhibition of stereotypies weaker than standards, along with a lower increase in serum prolactin levels, were indicative of a potential atypical profile for this compound. From these results, 7-[3-[4-(6-fluoro-1, 2-benzisoxazol-3-yl)piperidin-1-yl]propoxy]-3-(hydroxymethyl )chromen- 4-one (23, abaperidone) has been proposed for clinical evaluation in humans as a potential atypical antipsychotic.

Efficacy of senna versus lactulose in terminal cancer patients treated with opioids

The best laxative for terminal cancer patients treated with opioids still remains to be determined. This comparative study was conducted with the objective of determining treatment and cost efficiency for senna and lactulose in terminal cancer patients treated with opioids. The methodology used a randomized, open, parallel group design. The study was conducted in the Palliative Care Unit in one Madrid Health Care District. Ninety-one terminal cancer patients were randomized into two groups: A = treated with senna (starting with 0.4 mL daily), and B = treated with lactulose (starting with 15 mL daily) for a 27-day period. The main outcome measures were defecation-free intervals of 72 hr, days with defecation, general health status, and treatment cost. Laxative efficacy was analyzed through t test and analysis of variance. No difference was found between the laxatives in defecation-free intervals or in days with defecation. The final scores for general health status were similar in both groups. Given that the two treatments have similar efficacy and adverse effects, a recommendation is made for the use of senna because its cost is lower than lactulose.

Carcinogenicity studies on ebrotidine

The results from two carcinogenicity studies on ebrotidine (N-[2-(E)-[[2-[[[2-[(diaminomethylene)amino]-4-thiazolyl] methyl]thio]ethyl]amino]methylene]-4-bromo-benzenesulfonamide, CAS 100981-43-9, FI-3542) conducted in mice and rats are reported. Oral doses of 50, 200 and 500 mg/kg were administered to mice for 18 months and 50, 200 (150), 300 and 500 mg/kg were administered to rats for 24 months. The study design was prepared according to EEC guidelines, and the recommendations by the International Agency for Research on Cancer were used for the statistical analysis of data. Weekly palpations were made along the course of studies and general parameters were monitored. The only effects attributed to ebrotidine administration were a slight decrease in the survival rate of female mice given the 500 mg/kg dose and a lower weight gain in rats of both sexes. The histopathological data revealed that lipoid pneumonia and kidney calculi are more frequent in rats treated with doses of 500 and 300 mg/kg. No increment in the spontaneous occurrence of tumours or significant presence of tumours in treated animals differing from that in control animals was observed, and a decrease in the time required for their onset that could be related to ebrotidine was not observed either. There were no differences in hyperplastic and/or dysplastic changes between treated and control animals. Therefore, it is deduced that ebrotidine does not induce neoplastic or preneoplastic effects in rats or mice even at doses of 500 mg/kg, at which some general toxicity effects are seen.

Subacute toxicity of ebrotidine in rats and dogs

Subacute toxicity studies of ebrotidine (N-[(E)-[[2-[[[2-[(diaminomethylene)amino]-4-thiazolyl]methyl] thio]ethyl]amino]methylene]-4-bromo-benzenesulfonamide, CAS 100981-43-9, FI-3542) were performed in Spragu-Dawley rats and Beagle dogs. Both animal species were administered with the same dose levels (50, 200 and 500 mg/kg) for 4 and 7 weeks, respectively. In a previous 4-week subacute toxicity study in the rat, ranitidine and cimetidine at 500 mg/kg were used as reference drugs. The results indicated that ebrotidine was well tolerated at 50 mg/kg, while there were dose-related effects at 200 and 500 mg/kg. Probably due to its pharmacokinetics, ebrotidine was more toxic in dogs than in rats, since the most severe effects were the death or sacrifice in extremis of two dogs from the high dose group which had undergone rectal prolapse, while no deaths occurred in the rats. The changes that were very likely related to treatment (500 mg/kg) were a lower weight in both species, a slight decrease of hematocrit and red blood cells in rats, single increments of transaminases, alkaline phosphatase and lactate dehydrogenase in dogs (some animals of the 200 mg/kg dose group were also affected) and a higher liver weight. These effects with a few exceptions were found to be common to cimetidine and ranitidine.

Comparative study of plasma gastrin levels in rats after two months of ebrotidine administration

Four groups of male rats were orally administered for 60 days with daily doses of ebrotidine (N-[(E)-[[2-[[[2-[(diaminoethylene) amino]-4-thiazolyl]methyl]thio]ethyl]amino]methylene]-4-bromo- benzenesulfonamide, CAS 100981-43-9, FI-3542) (500 mg/kg), ranitidine (500 mg/kg), cimetidine (500 mg/kg) and omeprazole (43.5 mg/kg). A fifth group received no treatment and was used as control. The curve of gastrinemia was obtained on days 1, 15 and 60 of administration. On each of these days gastrinemia was assessed at 0, 1, 5, 8, and 24 h on day 1, and 1, 5, 8, 10 and 24 h on days 15 and 60. The purpose of this study was to compare the plasma gastrin level profile in association with the administration of test drugs on days 1, 15 and 60 of treatment. The results showed a significant difference in the duration of hypergastrinemia of H2-receptor antagonists as compared to proton pump blockers. Although peak plasma gastrin levels were attained for all products between 5 and 8 h after day 1 of administration, H2-receptor antagonists, unlike omeprazole, achieved recovery of gastrin baseline levels within 24 h. On days 15 and 60 of ebrotidine, treatment, plasma gastrin levels returned to normal range at 5 and 8 h after administration, respectively. After ranitidine and cimetidine, hypergastrinemia was still present at this time, but normal levels were attained before 24 h. With omeprazole plasma gastrin levels did not return to normal range within 24 h after each administration, and a cumulative effect occurred during treatment. The omeprazole treated group showed the highest and more sustained plasma gastrin levels. It was concluded that ebrotidine was the antisecretory agent with the lowest hypergastrinemic effect during long-term treatment. With ebrotidine daily baseline gastrin levels were more rapidly recovered after each administration.

Synthesis and assessment of formamidines as new histamine H2-receptor antagonists

Four series of compounds whose substructure contains a formamidine functionalized as a novel group in the chemistry of histamine H2-receptors have been synthesized. Series design, synthesis and pharmacological data including inhibition of histamine-stimulated acid secretion, inhibition of acid secretion p.o. and pA2 are reported. N-[(E)-[[2-[[[2](Diaminomethylene)amino]-4-thiazolyl] methyl]thio]ethyl]amino]methylene]-4-bromo-benzenesulfonamide (ebrotidine, CAS 100981-43-9, FI-3542) was selected for further research.

Involvement of endogenous nitric oxide and sulfhydryl compounds in ebrotidine-induced gastroprotection

The role of endogenous nitric oxide and sulfhydryl compounds in the prevention by ebrotidine (N-[(E)- [[2-[[[2-[(diaminomethylene)amino]-4-thiazolyl]methyl]thio]ethyl]amino] methylene]-4-bromo-benzenesulfonamide, CAS 100981-43-9, FI-3542) (100 mg/kg i.g.) of ethanol-induced gastric damage in rats was demonstrated. When the animals were pretreated with N-nitro-L-arginine methyl ester, an inhibitor of nitric oxide synthase, at the dose of 10 mg/kg i.v., the mucosal lesions were aggravated and the gastroprotective action of ebrotidine decreased from 85% to 24%. This decrease in ebrotidine protection was antagonized by L-arginine (200 mg/kg i.v.), the lesion inhibition rate being 69%. D-arginine (200 mg/kg i.v.) was ineffective and the inhibition afforded by ebrotidine was only 14%. Pretreatment with N-ethylmaleimide, a sulfhydryl blocker, at the dose of 50 mg/kg s.c., increased the mucosal lesion induced by ethanol, and the gastroprotective action of ebrotidine decreased from 75% to 9%. These results suggest that endogenous nitric oxide and sulfhydryl compounds play a crucial role in the gastroprotective activity of ebrotidine.

In vitro anti-Helicobacter pylori activity of ebrotidine

The in vitro anti-Helicobacter pylori (H. pylori) activity of ebrotidine (N-[(E)-[[2-[[[2-[(diaminomethylene) amino]-4-thiazolyl]methyl]thio]ethyl]amino]methylene]-4-bromo- benzenesulfonamide, CAS 100981-43-9, FI-3542) versus ranitidine, and their effect on the susceptibility to the antimicrobial agents used in H. pylori eradication were investigated. Assessment was performed by determining the minimum inhibitory concentrations (MIC) against 9 strains of H. pylori, 8 from clinical source and 1 from the American Type Culture Collection (ATCC 43504), in Mueller-Hinton solid media plus 7% blood. The concentration of inocula was 10(7) CFU/ml, incubation was performed at 37 degrees C in microaerophilic atmosphere, and results were read after 5 days of growth. Ebrotidine gave a mean MIC value of 75 micrograms/ml, while that for ranitidine was > 1000 micrograms/ml. Ebrotidine at 100 micrograms/ml enhanced the activity of the antimicrobials studied as follows: erythromycin 3 times, tetracycline 1.1 times, amoxicillin 3 times, metronidazole-sensitive strains 9 times and clarithromycin 5 times. Ranitidine had no effect on the MIC of the antibiotics even at 500 micrograms/ml.

Pharmacokinetics of ebrotidine in rats and dogs

The pharmacokinetics of ebrotidine (N-[(E)-[[[2-[(diaminomethylene)amino] -4-thiazolyl]methyl]thio]ethyl] amino]methylene]-4-bromo-benzenesulfonamide, CAS 100981-43-9, FI-3542) was studied in the rat and dog. After oral (agar suspension) and intravenous administration at 10 mg/kg to rats, ebrotidine was rapidly absorbed. Cmax values averaged 0.498 microgram/ml attained at tmax = 30 min. Distribution was fitted to a two-compartmental model with t1/2 beta = 1 h (i.v.). Clearance (Cl) was 29 ml/min.kg and volume of distribution (Vdss) was 1852 ml/kg. Absolute bioavailability was 22% of the dose administered. After oral (the same tablet formulation as that used for clinical trials) and intravenous administration at 150 mg and 25 mg, respectively, to dogs, absorption of ebrotidine was relatively rapid. Cmax values averaged 2,170 micrograms/ml attained at tmax = 2 h. Distribution was fitted to a two-compartmental model with t1/2 beta = 2.8 h (i.v.). Clearance (Cl) was 600 ml/h.kg and volume of distribution (Vdss) was 1000 ml/kg. Absolute bioavailability, which is variable in this type of drugs, ranges from 29% to 64% of the dose administered.

Toxicity of ebrotidine on reproduction. Toxicity on fertility and general reproductive performance, embryo-fetal toxicity and peri- and postnatal toxicity

Reproduction toxicity studies of ebrotidine (N-[(E)-[[2-[[[2-[(diaminomethylene)amino]-4-thiazolyl]methyl] thio]ethyl]amino]methylene]-4-bromo-benzenesulfonamide, CAS 100981-43-9, FI-3542) are presented in this paper. Rats dosed with 50, 200 and 500 mg/kg p.o. of ebrotidine were used for the fertility and peri- and postnatal toxicity studies, and rabbits dosed with 25, 100 and 250 mg/kg and rats dosed with 50, 200 and 500 mg/kg of ebrotidine were used for the embryotoxicity study. The fertility study was designed in accordance with a 2-generation study protocol. The results showed that ebrotidine did not interfere with male and female gametogenesis, fertility, organogenesis, postnatal development and lactation in F0 or F1 animals. Only general or non-specific effects were attributed to treatment, such as a lower weight gain in parents or fetuses in rats, or a somewhat slower bone calcification in rats, which was shown to be recoverable and had no peri- or postnatal repercussions. Neither did the fertility study reveal a possible longer duration of gestation nor did the peri- and postnatal study show a lower weight of the F1 offspring. There was only an increase in rabbit embryonic mortality, probably related to some cases of abortion at the high dose. No potential antiandrogenic effect on the reproductive function has been found. Among the different doses used in both animal species, the maximum toxic effect-free dose was that of 25 mg/kg.

Action of ebrotidine, ranitidine and cimetidine on the specific binding to histamine H1- and H2-receptors

Ebrotidine (N-[(E)-[[2-[[[2-[(diaminomethylene)-4-thiazolyl]methyl]thio] ethyl]amino]methylene]-4-bromo-benzenesulfonamide, CAS 100981-43-9, FI-3542), a selective H2-receptor antagonist, has proved to competitively inhibit the positive chronotropism induced by histamine in isolated guinea pig atrium. The affinity of ebrotidine to histamine H1- and H2-receptors through the displacement of 3H-pyrilamine and 3H-thiotidine binding to guinea pig cerebellum and brain cortex membranes was investigated. Ebrotidine displaced 3H-thiotidine specific binding to histamine H2-receptors (Ki: 127.5 nmol/l), showing a higher affinity (p < 0.05) than ranitidine (Ki: 190.0 nmol/l) and cimetidine (Ki: 246.1 nmol/l). None of the three substances displaced 3H-pyrilamine binding to H1-receptors (Ki: > 5000 nmol/l). The results showed that ebrotidine is a drug with a high affinity for H2 receptors, higher than cimetidine and ranitidine.

Histamine H2-receptor antagonist action of ebrotidine. Effects on gastric acid secretion, gastrin levels and NSAID-induced gastrotoxicity in the rat

The antagonism of histamine H2-receptors by ebrotidine (N-[(E)-[[2-[[[2-[(diaminomethylene)amino]-4-thiazolyl]methyl]thio]ethyl ] amino]methylene]-4-bromo-benzenesulfonamide, CAS 100981-43-9, FI-3542) was assessed on isolated guinea-pig right atrium. The dose-response curves obtained by histamine on the positive chronotropic effect in guinea-pig atrium were displaced to the right in parallel depending on the concentration of ebrotidine and ranitidine without change in the maximum response with pA2 values of 7.12 and 7.26, respectively. The slope of the regression line of log (DR-1) against log ebrotidine concentration was not significantly different from unity: 0.96 (95% confidence limits: 0.89-1.03). These results indicate that ebrotidine is a competitive H2-receptor antagonist. Following intravenous administration to rats, ebrotidine inhibited histamine- and pentagastrin-stimulated acid secretion in a dose-dependent manner, ED50 being 0.21 and 0.44 mg/kg, respectively. After oral administration to fasting rats 3 h before their sacrifice, ebrotidine decreased the total acid contents of the stomach in a dose-dependent manner, ED50 being 7.5 mg/kg. After a single dose of 100 mg/kg in fasting rats, ebrotidine increased significantly serum gastrin levels within 2 and 5 h after administration, but 8 h after administration serum gastrin levels returned to normal values. In contrast, ranitidine at a single oral dose of 100 mg/kg increased serum gastrin levels more markedly within 2 and 5 h after administration, while after 8 h, this increase still persisted although without significant differences with respect to control, and after 24 h levels returned to normal values. Both ebrotidine and ranitidine were administered orally at a dose of 100 mg/kg for 26 days showing significant increments in plasma gastrin levels 5 h after administration. Such increments were not so marked after ebrotidine and normal values were attained at 24 h after administration. The results obtained after repeated oral administration for 15 days of ebrotidine and ranitidine at the doses of 15 and 50 mg/kg demonstrated that ebrotidine did not increase significantly serum gastrin levels with respect to control 2 h after administration, and no dose-related effect was observed. In contrast, ranitidine increased serum gastrin levels significantly and in a dose-dependent manner with respect to control group. ED50 values of ebrotidine obtained in the experiments on the prevention of NSAID-induced gastrotoxicity in the rat were 12.2, 12.5, 11.5 and 9.8 mg/kg against diclofenac, ketoprofen, indometacin and naproxen, respectively. ED50 values of ranitidine were of the same order: 20.6, 13.9, > 50 and 15.1 mg/kg.

Study of the population of antral G-cells and enterochromaffin-like cells in the rat and mouse gastric mucosa after long-term treatment with ebrotidine

The potential effect of ebrotidine (N-[(E)-[[2-[[[2-[(diaminomethylene]amino]-4-thiazolyl]methyl]thio]ethyl ] amino)methylene]-4-bromo-benzenesulfonamide, CAS 100981-43-9, FI-3542) on two types of enteroendocrine cell populations in the gastric mucosa, antral G-cells and enterochromaffin-like cells, was investigated. The study of the population of antral G-cells was performed in a group of male rats treated with ebrotidine 500 mg/kg p.o. for 60 days; a control group receiving 10 ml/kg of an aqueous agar solution was used. A PAP (peroxidase-antiperoxidase) system-associated antigastrin immunohistochemical method was used for cell identification. The population of enterochromaffin-like cells was assessed by quantifying the density of argyrophilic cells in mouse gastric mucosa after an 18-month treatment with ebrotidine 500 mg/kg. Grimelius silver staining method was used for cell identification. In both studies, cell count was performed using a light microscope at 400 x magnification and cell density was calculated by computer-assisted image analysis. Compared to control, ebrotidine did not cause any significant differences in the cell density of the populations studied.

Physicochemical properties, analytical determinations and stability of ebrotidine

Ebrotidine (N-[(E)-[[2-[[[2-[(diaminomethylene)amino]-4-thiazolyl]methyl] thio]ethyl]amino]methylene]-4-bromo-benzenesulfonamide, CAS 100981-43-9, FI-3542) is a new H2-receptor antagonist with a potent antisecretory activity and evidenced gastroprotection. This paper describes its physicochemical properties, spectroscopy for its structural identification, detection methods for its organic and inorganic impurities, purity quantitation and stressed degradation and stability tests in solid and solution forms in order to know the behaviour of the test substance against certain experimental conditions. The results obtained indicate that ebrotidine is stable for over 3 years normal storage conditions (25 degrees C/75% RH). As ebrotidine was not found to be hygroscopic or particularly photosensitive, no special storage precautions are required.

Study on the increment of the amount of gastric mucus in rats after repeated-dose administration of ebrotidine

Ebrotidine (N-[(E)-[[2-[[[2-[(diaminomethylene)amino]-4-thiazolyl]methyl]thio]ethyl ] amino]methylene]-4-bromo-benzenesulfonamide, CAS 100981-43-9, FI-3542) is a novel H2-receptor antagonist that also exhibits a potent gastroprotective action against ethanol damage. This study was designed to ascertain under physiological conditions the effect of ebrotidine on the secretion of gastric mucus, probably the main component of the mucosal barrier. Two groups of 20 rats each were given a daily oral dose of 10 or 35 mg/kg ebrotidine, respectively, for 17 days. A third group of 20 rats was used as a control. Once the administration period had concluded, the animals were killed and their stomachs were removed and processed by the periodic acid-Schiff (PAS) histochemical method, selective for mucopolysaccharides. PAS-positive areas exhibited a characteristic carmine colour, allowing morphometric study by computerized image analysis. All the histological sections studied were from the same region of the stomach. A significant increase in the PAS-positive area corresponding to glandular mucus was found in all treated groups. This action is consistent with an increased secretion of mucopolysaccharides and represents one of the main mechanisms of the cytoprotective action of ebrotidine.

Chronic toxicity of ebrotidine in rats and dogs

The results obtained in the chronic toxicity studies of ebrotidine (N-[(E)-[[2-[[[2-[(diaminomethylene)amino]-4-thiazolyl] methyl]thio]ethyl]amino]methylene]-4-bromo-benzenesulfonamide, CAS 100981-43-9, FI-3542) by oral route in rats and in Beagle dogs are reported. Rats were administered for 6 months and dogs for 12 months. The doses were 50, 200 and 500 mg/kg in rats and 50, 200 and 400 mg/kg in dogs. The dose of 400 mg/kg was reduced to 350 mg/kg after 3 months of treatment, due to its toxicity. The effects probably related to the administration of ebrotidine were as follows: three dogs from the high dose group died after 3, 4.5 and 8 months of treatment (in rat there was no mortality); occult blood in faeces; lower weight gain in the high dose group (in rats only females were affected); lower food consumption in rats from the high dose group (and also females from the middle dose group); reduction of erythrocyte count and packed cell volume, only in rats and at the end of the study; alkaline phosphatases increment in rats and dogs; proteinemia decrease in rats; and a tendency to decrease in the testicular weight, which was not statistically significant (p > 0.05). The only histopathological changes observed were moderate erosions or ulcerations in the intestinal mucosa of some dogs from the high dose group. These effects coincide with those published for other competitive H2-receptor inhibitors. The maximum toxic effect-free level was 50 mg/kg for both rats and dogs, which provides a wide safety margin with respect to the therapeutic dose.

Effect of ebrotidine on ethanol-induced gastric mucosal damage in the rat. Comparative study with other H2-receptor antagonists

Ebrotidine (N-[(E)-[[2-[[[2-[(diaminomethylene)amino]-4-thiazolyl]methyl]thio]ethyl ] amino]methylene]-4-bromo-benzenesulfonamide, CAS 100981-43-9, FI-3542) is a novel H2-receptor antagonist with additional gastroprotective effect. The gastroprotective effect of oral doses of ebrotidine against ethanol-induced mucosal damage in female rats was compared with the effect of cimetidine, ranitidine and famotidine. Macroscopically, ebrotidine showed dose-dependent inhibition of the lesion, with significant differences from that of controls at doses of > or = 12.50 mg/kg (ED50 was 26.54 mg/kg). None of the other drugs tested showed gastroprotective effect under the same conditions. The histopathological study revealed significant reduction in the number of deep and superficial ulcers in ebrotidine-treated animals. The gastroprotective effect of ebrotidine is patent even in the presence of indometacin suggesting that prostaglandins play a rather negligible role in gastroprotective action. These results suggest that ebrotidine may be more useful than the classically known H2-antagonists in the treatment of peptic ulcers.

Acute toxicity studies of ebrotidine

The acute toxicity of two formulations of ebrotidine (N-[N-[(E)-[[2-[[[2-[(diaminomethylene)amino]-4-thiazolyl] methyl]thio]ethyl]amino]methylene]-4-bromo-benzenesulfonamide, CAS 100981-43-9, FI-3542) was studied in rats and mice by different routes of dosing: oral and intraperitoneal routes in rats and mice (suspension), intravenous and oral routes in mice and intravenous route in rats (injectable solution). LD50 values for the oral route were indeterminable in all cases. For the intraperitoneal route. LD50 values were 316 mg/kg (rat) and 366 mg/kg (mouse), and for the intravenous route LD50 values were 100 mg/kg (rat) and 107 mg/kg (mouse).

Metabolism of ebrotidine. A review

A hypothetical metabolic pathway for ebrotidine (N-[(E)-[[(2-[[[2-[(diaminomethylene]amino]-4-thiazolyl] methyl]thio]ethyl]amino]methylene-4-bromo-benzenesulfonamide, CAS 100981-43-9, FI-3542) has been proposed on the basis of previous data on the metabolism of other H2-receptor antagonists as well as on in vitro degradation assays of ebrotidine. Its potential metabolites have been synthesized and characterized, and their presence in human urine has been investigated by high-performance liquid chromatography (HPLC). Analytical-scale HPLC allowed the identification of metabolites by means of their retention time and UV spectrum, while semipreparative-scale HPLC allowed their identification through FT-IR and 1H-NMR. Mass spectrometry using atmospheric pressure chemical ionization (APCI) and electrospray ionization (ESI) for HPLC-MS coupling allowed the identification of all metabolites in human urine. The quantitative determination of ebrotidine and its derivatives has been performed according to a newly designed method which consisted of a liquid-liquid extraction in a basic medium followed by reversed-phase HPLC with ion-pair formation. This method was sensitive, precise and no chromatographic interferences with other drugs which might be administered in combination with ebrotidine were observed. In order to elucidate the excretion of ebrotidine, the analytical method was applied to the analysis of the urine collected from 2 healthy volunteers 96 h after receiving 400 mg of ebrotidine.

7-[3-(1-piperidinyl)propoxy]chromenones as potential atypical antipsychotics

Compound 1 (1-benzyl-3-methyl-4-[4-(4-fluorophenyl)-4-oxobutyl]piperazine), a synthetic intermediate identified as a potential atypical antipsychotic, was selected as the starting point for pharmacological improvement. From 1, sequential structural variations were conducted in order to improve its potency and oral bioavailability. These variations included a series of piperazine, ethanediamine, and piperidine derivatives. The piperidine series afforded some orally potent compounds in the inhibition of apomorphine-induced climbing and hyperactivity in mice, which are regarded as behavioral models predictive of antipsychotic efficacy. Further optimization of these structures led to the highly potent 7-[3-(1-piperidinyl)propoxy]chromenones. Inhibition of stereotypies and induction of catalepsy in rats at doses substantially higher than required for inhibition of climbing suggest an atypical antipsychotic profile, which is assumed to predict a reduced induction of extrapyramidal side effects in humans.

[A comparative study of the marginal non-Gypsy pediatric population]

OBJECTIVE

To identify a population group at social risk and its principal features compared with the general population of Medina del Campo.

DESIGN

A crossover observation study.

SETTING

Primary care. Health district.

PATIENTS AND OTHER PARTICIPANTS

Children under 8 belonging to the marginalized non-gypsy population and children of the same age from the general population.

MEASUREMENTS AND RESULTS

Less weight and height, deficient compliance with healthy child monitoring, an acceptable level of vaccination (over 80%), excess of acute dermatological and neurological pathology (7.6% against 0% in the general population). 45% of pregnancies were unwanted, with a higher average of siblings and other people living in ordinary or poor-quality housing, which belonged to the grandparents in 50% of cases. Young parents with little training and serious problems of unemployment (60%), drug dependency (33%), alcoholism (23.3%) and delinquency (18.5%). The mother looked after the children by herself in 48% of cases.

CONCLUSIONS

There is little healthy child monitoring and light undernourishment, but the vaccination coverage is acceptable. High prevalence of unwanted pregnancies. Young parents, with little education, unemployed, with high prevalence of drug dependency, alcoholism and delinquency. High prevalence of single-parent families.

Antiinflammatory activity of topically applied sertaconazole nitrate

The antiinflammatory activity of topically applied sertaconazole nitrate was investigated. The dermal administration of 2% sertaconazole to rats, in which edema was induced by application of croton oil in the external ear, induced a 39.8% reduction of edema. The results show that sertaconazole applied by topical route at the concentration at which it is used in clinic, has antiinflammatory action in this experimental model.

Study of the population of enterochromaffin-like cells in mouse gastric mucosa after long-term treatment with ebrotidine

The possible hyperplastic effect on the mouse gastric mucosa following administration of 500 mg/kg of ebrotidine for 18 mo was investigated. The animals were taken from the study of carcinogenesis in mouse carried out with this product. Two different aspects were considered to assess such a possible hyperplastic effect. The height of the fundic and antral mucosa was microscopically measured in several points. Histologic sections obtained from standardized levels of the stomach were used. The density of argyrophil cells in the gastric mucosa has been also quantified, in order to identify enterochromaffin-like (ECL) cells, the most abundant among the cells that have this property. Grimelius' silver staining method was used to identify ECL cells. The cell count was performed under x400 magnification, and the length of mucosa examined was determined by computer-assisted image analysis. This study complements the mouse carcinogenesis study, in which no differences in tumor incidence were found between treated and control animals. The results show that administration of 500 mg/kg/day of ebrotidine for 18 mo to mice did not induce any hyperplastic effect on the gastric mucosa comprising its various cell types or any specific, diffuse, or focal hyperplasia of ECL cells.

Ocular tolerance of sertaconazole gel

The in vitro and in vivo tolerance of sertaconazole gel, a new topical azole antifungal, was studied. Ketoconazole gel (Panfungol) was used as a reference substance. The methods applied for tolerance assessment were the bovine corneal opacity and permeability test for the in vitro assay and a modified Draize test for the in vivo assay. The results obtained show that both substances can be classified as slightly irritant and with acceptable tolerance. However, unlike ketoconazole gel, sertaconazole gel did not cause a positive lesion index in vivo. Ketoconazole was 5.25 times more irritant in vitro than sertaconazole gel, whose effect was similar to that of saline solution. Consequently, the negligible irritant effect of sertaconazole gel on a type of epithelium that is extremely sensitive, i.e. the cornea, confirms the good tolerance of this new antifungal gel on other structures such as the skin and mucous membranes.

Effect of ebrotidine on the density of antral G-cells in the gastric mucosa in the rat

Two groups of male rats were treated orally for 60 days with ebrotidine and cimetidine, used as reference standard, respectively. The dose used of both drugs was 500 mg/kg. A third group, used as control, received 10 ml/kg of an aqueous agar suspension. After receiving the last dose, the animals were killed by inhalation of CO2 in a sealed chamber and the stomachs were removed for histological preparation. The purpose of this study was to count antral G-cells throughout the gastric mucosa by light microscope. A PAP system-associated antigastrin immunohistochemical method was used for cell identification. Cell density, with respect to their location in the gastric mucosa and the treatments given, was calculated using image analysis techniques. The results showed that ebrotidine did not cause any significant differences in the density of the population of these cells compared with the control group, while cimetidine induced a significant proliferation of antral G-cells.

Effects of dotarizine on peripheral and pulmonary circulation and cardiac dynamics in dogs

The cardiovascular effects of dotarizine in 10-min intravenous infusions were studied in thiopental-anesthetized dogs. The effects of dotarizine 0.024 mg/kg/min almost paralleled those of saline controls; 0.079 mg/kg/min dotarizine significantly raised the stroke index and ejection fraction, and, at a rate of 0.25 mg/kg/min, further effects appeared and were dose-dependent. Dotarizine produced arterial dilation in both systemic and pulmonary circulation: the total peripheral resistance dropped, and femoral artery flow rose; aortic and pulmonary artery mean and diastolic pressures declined, and systolic pressures remained almost stable. A trend of bradycardia and pulmonary artery pressure reduction persisted for 30 min. As compared with the reduced total peripheral resistance, aortic pressure fell only moderately because of rising cardiac output due to a higher ejection fraction and stroke volume. Cardiac preload tended to decline; contractility tended to increase. Cardiac performance remained stable while myocardial oxygen consumption tended to fall, as did the pressure-rate product and the tension time index. Dotarizine exerted direct cardiovascular effects similar to those of the 5-HT2-receptor antagonist ketanserin and, more generally, to calcium channel blockers rather than to alpha-adrenoceptor blockers.

A standardized format for handling data on plasmids, viruses and transposons: The PVT database format

The PVT format described here has been designed to store and retrieve genetic data on plasmids, viruses or transposons with special focus on their applications. Both naturally-occurring and engineered elements can be included in it. A variety of data can be accommodated in fields that are grouped in blocks: name and type of element, database administration, element administration, history, propagation, selection and host, biological properties, cloned insert and applications. The number of fields, now 157, can be expanded as required. Most properties can be described in simple logical fields. The format is organized to permit rapid searches and to facilitate communication between database and user; connection with culture and/or DNA collections is also envisaged and adequate fields for these tasks have been provided. The format allows cross-reference with that originated by the Microbial Information Network Europe (MINE) for computer storage and handling of bacterial or fungal strain data.

Relationship between fetal weight and litter size in rats: application to reproductive toxicology studies

The inverse relationship between mammalian fetal weight and litter size has been discussed by many authors, but their opinions reveal no agreement at all. As in toxicity studies of reproduction, both parameters must be correctly evaluated. We investigated the existence of such a relationship in 2466 fetuses from 203 litters of Sprague-Dawley CD control rats. The frequency distribution of fetal weights had a normal adjustment. From the mean weight of fetuses in each litter, the mean fetal weights in each litter size and correlation coefficient were calculated and the regression line was plotted; the correlation coefficient (r = 0.677) was highly significant (P = 0.002), which made evident that there was an inverse relationship between fetal weight and litter size. If fetal weight/litter size inverse relationship is not taken into account when toxicity on the fetal weight is analyzed, wrong conclusions may be reached if the test substance reduces the litter size, provoking embryofoetal mortality. The iatrogenic decrement in fetal weight can be masked by an increment due to the litter size reduction. We suggest that in all three segments of reproductive toxicity studies, litter size must be considered as a covariate to the effect of the test substance on the fetal weight, in order to perform a correct analysis of covariance (ANCOVA), in addition to the dose factor commonly used in common ANOVA.

Chronic toxicity studies of sertaconazole after oral administration to rats and ferrets

Six-month chronic oral toxicity studies of 7-chloro-3-[1-(2, 4-dichlorophenyl)-2-(1H-imidazol-1-yl)ethoxy-methyl] benzo[b]thiophene (sertaconazole, FI-7045, CAS 99592-32-2) were carried out in rats and ferrets. The dose levels used were 50, 150 and 300 mg/kg in rats and 50, 150 and 250 mg/kg in ferrets. There was no mortality associated with the drug in either of the two species. The results obtained show that the toxic effects may be summarized as a smaller body weight increase in rats at 150 and 300 mg/kg and in male ferrets at 250 mg/kg. Food consumption decreased significantly in rats at 300 mg/kg, and was not proportional to the doses of 150 and 50 mg/kg. In serum biochemistry, increases in alkaline phosphatase in rats, ALT in male ferrets at 150 and 250 mg/kg and AST only at 250 mg/kg were observed. BUN increased at 150 and 250 mg/kg in ferrets.

Pharmacokinetic evaluation of labelled sertaconazole after dermal application

14C-labelled 7-chloro-3-[1-(2,4-dichlorophenyl)-2-(1H-imidazol-1-yl)ethoxy-methyl] benzo[b]thiophene (sertaconazole, FI-7045, CAS 99592-32-2) was administered systemically (i.v. route) and topically (dermal route) in different formulations at doses of 10 mg/kg to hairless Sprague-Dawley rats. Determination of plasma and liver levels of radioactivity demonstrated that the dermal application of sertaconazole induced very low systemic absorption with all the formulations used: 1.47% for sertaconazole cream, 1.97% for sertaconazole solution, 0.665% for sertaconazole powder and 0.885% for sertaconazole gel. Calculations were made from the areas under plasma levels curves of each topical administration in comparison with intravenous administration. Significant radioactivity levels were found in the liver, which was consistent with a high hepatic metabolization and faecal excretion of the substance. However, the liver levels after topical application were virtually insignificant in comparison with the levels in the same organ obtained after intravenous administration.

Acute toxicity studies of sertaconazole

The acute toxicity of 7-chloro-3-[1-(2,4-dichlorophenyl)-2-(1H-imidazol-1-yl)ethoxy- methyl]benzo[b]thiophene (sertaconazole, FI-7045, CAS 99592-32-2) was evaluated in mice and rats after single administration by oral, subcutaneous and intraperitoneal routes. The latter intended to ensure maximum blood levels, since intravenous route was unfeasible due to drug insolubility in water. LD50 was indeterminable (greater than 8000 mg/kg) in all routes of dosing. According to these results, and having furthermore proved the absorption of the test substance after oral administration, sertaconazole was concluded to be very safe in the event of overdose or accidental ingestion.

Reproduction toxicity of sertaconazole. Segment II (teratology) and Segment III (peri-postnatal toxicity)

The reproduction toxicity of 7-chloro-3-[1-(2,4-dichlorophenyl)-2- (1H-imidazol-1-yl)ethoxy-methyl]benzo[b]thiophene (sertaconazole, FI-7045, CAS 99592-32-2) (50, 100 and 150 mg/kg by oral route) has been investigated by performing two studies: the embryotoxicity or teratology study in rats and rabbits, and the peri-postnatal toxicity study in rats. According to the results obtained from the embryotoxicity studies, there was no maternal toxicity in either of the two species studied. The only embryofoetal abnormalities with statistical and toxicological significance were observed at the dose of 150 mg/kg in the teratology study on rabbits: hepatomegalia, pericardial oedema and peritoneal and hepatic haemorrhages. The results of the peri-postnatal study showed that the only maternal effect relating to the drug was an increase, proportional to the dose, in the weight of the ovaries, which was significant at the dose of 150 mg/kg. With reference to the offspring, only a reduction in the viability index at 150 mg/kg was observed. The non observed effects level (NOEL) for all three studies can be estimated at 100 mg/kg.

Genotoxicity studies on sertaconazole

A series of 6 studies has been performed to evaluate the potential genotoxic effect of 7-chloro-3-[1-(2,4-dichlorophenyl)-2-(1H- imidazol-1-yl)ethoxy-methyl]benzo[b]thiophene (sertaconazole, FI 7045, CAS 99592-32-2). From these studies, the reverse mutation assay on Salmonella typhimurium, sex-linked recessive lethal mutations on Drosophila and genetic mutations in cultured mammal cells allowed to study the genetic mutations in prokaryotes and eukaryotes. In vitro and in vivo chromosomal aberrations were studied using human lymphocytes cytogenetic test, micronucleus test and sister chromatid exchange test. The results obtained in these studies, which are complemented one another, demonstrated that sertaconazole did not induce any signs of promutagenic, mutagenic or clastogenic activity or interference with the chromosomal segregation process.

Inhibition of ergosterol synthesis by sertaconazole in Candida albicans

7-Chloro-3-[1-(2,4-dichlorophenyl)-2-(1H-imidazol-1-yl) ethoxy-methyl] benzo [b] thiophene (sertaconazole, FI-7045, CAS 99592-32-2), a new topical antifungal agent, has shown activity against a broad range of clinically relevant yeasts and fungi. In the present study, the molecular basis of the pharmacological action of sertaconazole was examined by investigating the inhibition of ergosterol synthesis in cultures of Candida albicans, ATCC E-10.231, at 6 x 10(5) cells/ml grown aerobically at 37 degrees C, using various concentrations of sertaconazole. Sertaconazole inhibited the ergosterol synthesis with IC50 = 115 nmol/l. The results show that one of the mechanisms of action of sertaconazole consists in the inhibition of ergosterol synthesis.

Dermal tolerance and phototoxicity studies of sertaconazole

The local dermal tolerance of 7-chloro-3-[1-(2,4-dichlorophenyl)-2-(1H- imidazol-1-yl)ethoxy-methyl]benzo[b] thiophene (sertaconazole, FI 7045, CAS 99592-32-2) was evaluated in hairless rats and albino rabbits. Test substance was applied in 2% powder (0.5 g), gel (0.5 ml) and solution (0.5 ml) formulations to rats (this is the concentration intended for the pharmaceutical preparation) and in 6% cream (0.5 ml) to rabbits (this concentration was used to estimate an overdose maximal effect). After 3- and 24-h exposure of the test substance to animals, they were observed for erythema and oedema. Sertaconazole may be considered as non irritant, since its primary irritation index was less than 0.5 in all the tests. A phototoxicity study was also carried out on guinea pigs with 1 ml 2% cream per animal, compared with psoralene as a positive control. Sertaconazole did not present any risk, since the phototoxicity level reached was null, with 2 being the minimum value considered as having toxic significance.

In vitro activity of sertaconazole

The activity of 7-chloro-3-[1-(2,4-dichlorophenyl)-2-(1H-imidazol-1-yl) ethoxy-methyl]benzo[b]thiophene (sertaconazole, FI 7045, CAS 99592-32-2), a new topical antifungal, was studied in vitro against several infecting organisms. The results obtained show that sertaconazole is a broad-spectrum antifungal against yeasts (C. albicans, C. tropicalis, C. pseudotropicalis, C. krusei, Trichosporon and Cryptococcus), dermatophytes (Microsporum, Trichophyton and Epidermophyton), opportunistic filamentous fungi (Aspergillus) and Gram-positive bacteria. The MIC (minimum inhibitory concentration) values for the fungistatic activity were between 0.35 and 5.04 micrograms/ml for yeasts and between 0.24 and 2 micrograms/ml for dermatophytes; even partial activities (IC25) against these organisms were obtained at concentrations 10 times lower than those mentioned. At concentrations superior to MIC (MFC between 0.5 and 16 micrograms/ml), sertaconazole exhibited fungicidal activity.

In vitro comparative study of the fungistatic and fungicidal activity of sertaconazole and other antifungals against Candida albicans

The fungistatic and fungicidal activity of 7-chloro-3-[1-(2, 4-dichlorophenyl)-2-(1H-imidazol-1-yl)ethoxy-methyl]benzo[b]thiophene (sertaconazole, FI-7045, CAS 99592-32-2) against Candida albicans was determined and compared with that obtained for other antifungals. The fungistatic activity of sertaconazole, evaluated through the MIC obtained in Sabouraud and YNB media, gave results comparable to those obtained with miconazole and clotrimazole, and superior to those presented by bifonazole and ketoconazole. The fungicidal activity, evaluated by means of the 90% reduction in viable cells, took place at a concentration of 8 micrograms/ml for sertaconazole and at higher concentrations for the other drugs studied.

Physico-chemical properties, analytical determinations and stability of sertaconazole nitrate

Sertaconazole nitrate, the nitrate salt of 7-chloro-3-[1-(2,4-dichlorophenyl)-2-(1H-imidazol-1-yl)ethoxy-methyl] benzo[b]thiophene (sertaconazole, FI-7045, CAS 99592-32-2), is a new azole antifungal, which has proved to have a wide spectrum and high activity. This paper describes its physico-chemical properties, structural identification including polymorphism, detection of impurities, determination of related compounds, separation, quantification and purity assays using high-performance liquid chromatography (HPLC) and quantitative assays specially elemental and functional analysis. Stability of sertaconazole nitrate in solid form under accelerated (light, humidity and temperature) and real time conditions and in suspension form at different pH values (acid and basic) was also studied. The results show that sertaconazole nitrate is extremely stable under all the conditions tested, both in solid and in suspension form. Sertaconazole nitrate in solid form packaged in tight sealed amber glass bottles was stable for over 5 years under normal storage conditions.

Subacute toxicity and maximum tolerable dose of sertaconazole in repeated administration studies

28-Day oral and dermal subacute toxicity studies of 7-chloro-3-[1-(2,4-dichlorophenyl)-2-(1H-imidazol-1-yl) ethoxy-methyl] benzo [b] thiophene (sertaconazole, FI-7045, CAS 99592-32-2), were carried out. The oral studies included the evaluation of subacute toxicity in rat (dose levels of 50, 150 and 300 mg/kg) and maximum tolerable dose in repeated administration in ferrets (consecutive dose levels in accordance with a geometric progression of 50, 75, 112.5, 168 and 250 mg/kg), which were the animal species intended for chronic toxicity studies. The dermal studies included the evaluation of subacute toxicity in rats and rabbits (1 ml/kg of a 2% cream). The results, in general, have shown low toxic effects, which can be summarized as a slight non-significant hepatomegalia in the rat with increased gamma-GTP and alkaline phosphatase values and a high urinary pH value; no histopathological changes were observed. These effects are characteristic of azole derivatives and are therefore common to other antifungals with this chemical group.

Direct membrane-damaging effect of sertaconazole on Candida albicans as a mechanism of its fungicidal activity

The direct action of 7-chloro-3-[1-(2,4-dichlorophenyl)-2-(1H-imidazol-1-yl)ethoxy- methyl]benzo[b]thiophene (sertaconazole, FI-7045, CAS 99592-32-2) on the membrane integrity of C. albicans is studied by quantifying the leakage of intracellular adenosine triphosphate (ATP) into the medium as an index of the changes in membrane permeability and integrity and cell viability of the culture used. Sertaconazole caused a dose-dependent decrease in intracellular ATP after only 10-min exposure and a concomitant significant increase in extracellular ATP. This behaviour is characteristic of antifungals which are fungicidal as a result of a direct membrane damage. Thus sertaconazole, in addition to the mechanism of action responsible for its fungistatic activity (inhibition of ergosterol synthesis), has a second mechanism of action providing a significant fungicidal activity due to direct cell membrane damage.