Combined intranasal ipratropium bromide and oxymetazoline in experimental rhinovirus infection

The topical anticholinergic ipratropium bromide and topical decongestant oxymetazoline were tested to determine whether oxymetazoline alone and the combination were well tolerated and reduced rhinorrhea and middle ear pressure abnormalities during experimental rhinovirus infection. The study was double-bind, placebo-controlled, and double dummy in design. Healthy volunteers (n = 109) with low serum neutralizing antibody titer (< or = 1:2) were. Treatments inoculated with rhinovirus (type 39 or Hank's strain) and randomized to treatment with ipra-tropium bromide 0.06% two sprays per nostril (84 micrograms per treatment) and oxymetazoline 0.05% two sprays per nostril, oxymetazoline alone, or placebo. Treatments were self administered twice daily for 5 days beginning 1 day after rhinovirus inoculation. The overall infection rate was 83% and of those infected, 88% felt that they had a cold. During the 3-hour period after dosing, the increase in nasal discharge was significantly lower in the combined ipratropium and oxymetazoline (0.13 +/- 0.17 gm/3 hr, mean +/- SE) than after oxymetazoline alone (0.60 +/- 0.18 gm/3 hr) or vehicle (0.73 +/- 0.18 gm/3 hr). Over the 5-day observation period, total daily nasal discharge also tended to be lower in the ipratropium plus oxymetazoline group (3.67 +/- 0.70 gm/24 hr, mean +/- SE) compared to oxymetazoline (5.61 +/- 0.73: 35% reduction) or the vehicle (5.04 +/- 0.73; 27% reduction) recipients, but the differences were not statistically significant. Subjective assessments of rhinorrhea indicated that the severity of rhinorrhea was significantly better among patients receiving oxymetazoline alone or with ipratropium compared to the vehicle. No significant difference in the cumulative frequencies of middle ear pressure abnormalities (27-31%) were found among the treatment groups. Oxymetazoline does not consistently stimulate or decrease nasal mucus production, and ipratropium added to oxymetazoline is well tolerated and reduces rhinorrhea during experimental rhinovirus infection.

Effectiveness and safety of intranasal ipratropium bromide in common colds. A randomized, double-blind, placebo-controlled trial

OBJECTIVE

To determine the tolerability and clinical effectiveness of intranasal ipratropium bromide for the treatment of symptoms of common colds.

DESIGN

Multicenter, double-blind, randomized trial.

SETTING

3 university student health services.

PATIENTS

411 previously healthy persons 14 to 56 years of age who had cold symptoms that had lasted for no more than 36 hours, rhinorrhea subjectively judged to be of at least moderate severity, and documented nasal discharge of at least 1.5 g over a 1-hour observation period.

INTERVENTION

Either 1) ipratropium bromide nasal spray 0.06% in buffered salt solution, two 42-micrograms sprays per nostril administered by metered pump spray; 2) control nasal spray, which consisted of buffered salt solution; or 3) no treatment. Treatments were self-administered three or four times daily during waking hours for 4 days. After receiving their morning dose, patients stayed at the study center for 6 hours on study day 1 and 3 hours on study day 2; symptom severity was recorded and nasal mucus discharges were collected and weighed hourly during these periods.

RESULTS

Ipratropium recipients had 26% less nasal discharge than controls (P = 0.0024) and 34% less nasal discharge than untreated patients (P = 0.0001). Severity of rhinorrhea as judged subjectively was reduced in ipratropium recipients by 31% compared with controls and by 78% compared with untreated patients (P = 0.0001 for both comparisons). In addition to being associated with reductions in daily assessments of the severity of rhinorrhea (P < or = 0.003), ipratropium was associated with reduced sneezing on study days 2 (20% difference; P = 0.03) and 4 (30% difference; P = 0.02) but not with reduced nasal congestion compared with the control spray. Ipratropium was generally well tolerated but was associated with higher rates of blood-tinged mucus (16.8% in the ipratropium group compared with 3.6% in the control group; P = 0.01) and nasal dryness (11.7% in the ipratropium group compared with 3.6% in the control group; P = 0.021) than the control spray. Patient assessments of the overall effectiveness of treatment were more favorable for ipratropium than for the control spray (P < or = 0.026) or for no treatment (P < or = 0.002) on each day of inquiry (study days 1, 2, and 5).

CONCLUSIONS

Intranasal ipratropium bromide provides specific relief of rhinorrhea and sneezing associated with common colds.

Opiate v CNS depressant therapy in neonatal drug abstinence syndrome

Paregoric and phenobarbital, administered randomly in 153 passively addicted neonates, initially appeared to control neonatal abstinence signs equally well. However, seven of the 62 phenobarbital-treated newborns had abstinence-associated seizures within the first month of life, while none of 49 paregoric-treated neonates had seizures. Forty-two neonates initially requiring no specific pharmacotherapy for abstinence signs were born to mothers taking less methadone hydrochloride just before delivery. Five of those 42 neonates, however, had seizures within the first 14 days of life. Seizure occurrence could not be predicted from analysis of early abstinence patterns. We consider paregoric to be the treatment of choice for the neonatal abstinence syndrome. Phenobarbital use should be monitored with serum drug levels and modification of recommended dosage regimens considered.

Evaluation of a combination of self-administered fluoride procedures for the control of dental caries in a nonfluoride area: findings after four years

Nearly all children who attend elementary school (grades K through 6) in a rural community have participated since 1972 in a school-based caries preventive program consisting of daily ingestion of a 1-mg fluoride tablet and weekly rinsing with a 0.2% sodium fluoride solution. 3they also regularly receive toothbrushes and a fluoride dentifrice for use at home. Examinations conducted after four years showed that the prevalence of dental caries among continuous participants, 7 through 12 years of age, was reduced by 35% compared with baseline findings; mean DMFS scores in 1972 and 1976 were 5.39 and 3.49, respectively. The preventive program inhibited decay in all three types of surfaces: approximal surfaces received about twice the relative protection against decay (70%) as buccolingual surfaces (34%) and more than three times as much as occlusal surfaces (22%). A comparison of estimates of four-year increments of decay taken from cross-sectional data at the baseline and actual increments from the 1972 and 1976 examinations showed that, for children ages 6 through 15, the incremental DMFS score was 41% lower during the period of the program than before its initiation. Findings in older children (ages 13 through 15) in 1976 who had stopped participation when they left elementary school at about age 12 showed evidence of strong posttreatment effects--as great as 31% fewer DMFS for 14-year-old children.

Effect of chewable fluoride tablets on dental caries in schoolchildren: results after six years of use

Two groups of children, initially in the first and second grades, chewed, rinsed with, and swallowed an acidulated phosphate-fluoride tablet containing 1 mg of fluoride either once or twice a day in school. A control group of children followed the procedure once a day using a placebo tablet. An evaluation after six years of treatments showed that both the once-a-day and the twice-a-day procedures with fluoride tablets effectively reduced the incidence of dental caries.

An evaluation of Knutson's formula for estimating age-specific DMF teeth

The present study evaluated a formula suggested by Knutson for obtaining an age-specific estimate of mean DMFT in a population on the basis of the age-specific percentage of individuals with 1 or more DMFT. A total of 149 previously collected age-specific data sets from low-flouride areas in the U.S.A. were used, and the two parameters K and B were estimated using the method of weighted least squares. The analysis showed that the formula could be used with good accuracy for certain restrictions of age (5--11 years) and percentage of individuals with 1 or more DMFT (less than or equal to 70%).

Analysis of caries clinical trial data in the presence of study group imbalance

Imbalance of any important factor in caries clinical trials can bias group means, and make decisions based on such means of questionable value. Six hypothetical trials are presented which have varying degrees of imbalance in baseline DMFS. The crude group means for these trials vary radically, from one extreme in which the treated group has significantly less decay than the control group, to the opposite extreme in which the control group has significantly less decay than the treated group. Two methods for adjustment to correct for the imbalances, the analyses of covariance and blocking analysis, are discussed and applied to each trial. For these data sets the blocking analysis appears superior to the analysis of covariance in terms of maintaining the essential character of the data. An appendix explaining in detail how the blocking analysis is performed can be obtained on request to the author.

Enamel biopsy results of children receiving fluoride tablets

This study measured the fluoride in tooth enamel of 338 schoolchildren after daily use of acidulated phosphate-fluoride (APF) tablets, and investigated the relationship between observed amounts of enamel fluoride and incidence of caries. Randomly selected study groups received under supervision either one placebo tablet, one APF tablet containing 1 mg fluoride, or 2 APF tablets (3 hours apart) each school day. An abrasive enamel-type biopsy of a maxillary central incisor was taken 30 months after the start of fluoride tablet treatments at the time of the follow-up examinations. Mean fluoride levels in the biopsied enamel from each of the three groups were similar despite a significant restriction in caries in the group receiving two APF tablets per day. These findings suggest that fluoride can restrict dental caries by some mechanism other than fluoride uptake in the enamel.

Comparative recovery of Streptococcus mutans on ten isolation media

The ability of Streptococcus mutans (Bratthall serotypes a through e) to grow on 10 isolation media was examined. The number and morphology of the colonies were observed to vary on different media. The use of blood-sucrose media consistently produced the highest recoveries. Mitis salivarius agar (MS) and higher recovery values than modified medium 10 (MM10SB), Trypticase-yeast extract-cystine medium (TYC), or MS with 1% tellurite (MST). MST with 40% sucrose (MS40S), MST with 20% sucrose and 0.2 U of bacitracin per ml (MSB), and Carlsson medium with 1% sulfasoxazole (MC), media formulated for the selection of S. mutans, were the most inhibitory for all serotypes. The morphology of several S. mutans strains was atypical on MC and MS40S, making positive identification difficult. Absence of growth of serotype a strains on MSB and serotype d strains on MC were the two major differences observed among the serotypes. Results are discussed in terms of the difficulties in making quantitative determinations from cultural data.

Effect of acidulated phosphate-fluoride chewable tablets in schoolchildren: results after 55 months

Two groups of children initially in the first and second grades chewed, rinsed with, and swallowed an acidulated phosphate-fluoride tablet containing 1 mg of fluoride either once or twice a day in school. A control group of children followed the procedure once a day using a placebo tablet. An interim evaluation after 55 months showed that the children receiving two fluoride tablets daily had a significant reduction in incremental caries on early erupting teeth, which received primarily topical exposure to the fluoride, as well as on late erupting teeth, which received mainly preeruptive, systemic exposure. The findings also suggested that the use of a single fluoride table daily may reduce dental caries, although the presence of a benefit was less definitive than it was for the two-tablet procedure.

The effect of professional toothcleansing on gingivitis and dental caries in children after 1 year

The purpose of this study was to determine the effects of professional mechanical toothcleansing on plaque, gingivitis, and dental caries in young children with a high caries experience. Seventy-eight children, 7 years of age, were stratified according to presence or absence of smooth surface lesions on the permanent teeth and subsequently randomly assigned to an experimental group and a control group. The experimental group was given a thorough mechanical toothcleansing every 2 weeks. After 12 months a statistically significant difference in plaque accumulation and a minor difference in level of gingival inflammation could be demonstrated between the two groups. The incidence of dental caries in permanent teeth present at both examinations was 70% lower in the experimental group. The effect on permanent teeth erupting during the study and on primary teeth present at both examinations was not statistically significant.

Prevalence of dental caries in white and black children in Nelson County, Virginia, a rural southern community

Until a few years ago, the results of most surveys of the prevalence of dental caries among school-age children in the United States, particularly those done in the south, showed that black children had a lower prevalence of dental caries than did white children who lived in the same community.4-6,11,16,19,20-23,25 However, in several recent surveys, the formerly observed race-caries relation has not been detected.2,8,17,18,26 In connection with a study initiated in 1972 in Nelson County, Virginia to determine the effectiveness of a combination of self-applied procedures for the administration of fluoride, baseline data on dental caries experience were collected for 1,374 white and 761 black children attending the County's public schools. The availability of data for large numbers of white and black children prompted a cross-racial comparison of prevalence of dental caries. Findings of the comparative analysis are contained in this report.