VELOSEF 250 CAPSULES VELOSEF 500 CAPSULES Cephradkie Capsuies VELOSEF 125 FOR ORAL SUSPENSION VELOSEF 250 FOR ORAL SUSPENSION Cephradine for Oral Suspension VELOSEF FOR INJECTION, 500 mg and 1 g Cephradlne for InjectIon ACTION: Cephradine is a semi-synthetic, cephalosporin antibiotic exhibiting bactericidal activity through inhibition of cell-wall synthesis. INDICATIONS: Infections in the respiratory and genitourinary tracts, and in the akin and soft tissues, due to susceptible organiams. Senaitivity tests should be performed: therapy may be instituted before receiving the results. CONTRAINDICATIONS: Hypersensitivity to the cephalosporin group of antibiotics. WARNINGS: There is evidence ot partial cross-allergenicity between the penicillins and the cephalosporins. Therefore, cephradine should be used with caution in patients with known hypersensitivity to penicillins. Antibiotics, including cephradine, should be used cautiously and only when abeolutely necessary in patients with a history of allergies, perticularly to drugs. Usage during pregnancy and lactation: Safety for use ot this product during pregnancy has not been established. Cephradine is secreted in bresat milk. PRECAUTIONS: Patients should be obeerved carefully during therapy. Allergic reactions require discontinuation of VELOSEF and appropriate treatment. Prolonged use of VELOSEF may result in overgrowth ot nonsusceptible organisms: appropriate measures should be instituted. During long-term therapy, hematological, renal and hepatic functions should be monitored periodically. Patients with known or suspected renal impairment should be obeerved carefully since cephradine may accumulate in the serum and tissues unless dosage is suitably reduced. See DOSAGE AND ADMINISTRATION section. Indicated surgical procedures should be performed in conjunction with antibiotic therapy; e.g., the incision and drainage of abscesses. After treatment with cephalosporins, a false-positive reaction for glucosa in the urine may occur, but not with enzymebased tests. A false-positive Coombe test has also been reported. VELOSEF for Injection is not compatible with Lactated Ringers Solution or other calcium-containing infusion fluids. ADVERSE REACTIONS: Usually limited to gastrointestinal disturbances and occasional hypersensitivity, but may include hematological and hepetobiliary disturbances, as well as elevated BUN, LDH or serum creatinine; superinfection; vaginitis and joint pains. Thrombophlebitis following IV. injection and sterile abscesses after tM. injection have occurred. Only occasionally severe enough to warrant cessation 01 therapy DOSAGE AND ADMINISTRATION: The presence of tood in the gastrointestinal tract delays the absorption and reduces the peak level but does not affect the total amount of cephradine absorbed. VELOSEF Capsules and VELOSEF for Oral Suspension Adults: Respiratory tract infections: 250 mg, q6h. Pneumococcal lobar pneumonia: 500 mg, q6H. Genitourinary tract infections: 500 mg, q6h. Prolonged therapy is advisable for the treatment of prostatitis and epididymitis. Children: 25 to 50 mg/kg/day, divided into tour equally spaced doses, e.g.: VELOSEF for Oral Suspension Child's Weight 125 mg/S ml 250 mg/5 ml lOkg(221be) /2toltsp.q6h 20kg(.lbs) 1 to2tsp.q6h Atol tsp. q6h 4Okg(881bs) 2to4tsp.q6h lto2tsp.q6h Smaller doses than those indicated above should not be used. For otitis media due to H. influenzae, doses from 75 to 100 mg/kg/day are recommended. VELOSEF for Injection: For use in serious and life-threatening infections or where oral therapy is not possible. Average adult daily dose is 2 - 4 g, depending on the Infection. In children, a daily dose of 50- 100 mg/kg is recommended. All patients; all formulations: Larger doses (up to 1 g q6h in adults or up to 25 mg/kg q6h in children) may be given for severe or chronic infections: maximum daily dose should not exceed 4 g. Therapy should be continued for a minimum ot 48 to 72 hours after the patient becomes asymptomatic or evidence of bacterial eradication has been obtained. In infections caused by hemolytic streptococci, a minimum 10-daytreatment period is recommended. Stubborn intections may require treatment for several weeks with frequent bacteriological and clinical appraisal. A modified dosage schedule in patients with decreased renal function is necessary. Each patient should be considered individually: the following schedule is recommended sa a guideline. Initial loading dose: 750 mg. Maintenance dose: 500 mg at the time intervals listed below: Crestinine Clearance Time Interval (mI/mm/i .73m2) > 20 mI/mm 6- 12 hours 15-19m1/min 12-24hours 10-14 mI/mm 24-40 hours 5-9 mI/mm 40- 50 hours < 5m1/min 50-7ohours DOSAGE FORMS: Capsules of 250 mg and 500 mg in bottles of 50, and bottles of VELOSEF 125 and 250 for Oral Suspension which, after reconstitution, provide 100 ml of pleasantly flavoured suspension containing 25 mg/mI and 50 mg/mI respectively. VELOSEF for Injection is provided as a sterile powder for reconstitution in vials containing 500 mg or 1 g. Consult Product Monograph for reconstitution procedure. Product Monograph available to physicians and pharmacists on request.
E R.SQUIBB& SONS LTD. EED 2365 COTE DE LIESSE, MONTREAL, QUE. H4N 2M7
these were payments scattered over the past few months and not one single lot from one envelope - that is, we could not blame it on the postal services the only intelligible response at the other end of the phone was "I am sorry." Now that isn't good enough there's got to be some kind of explanation. Maybe my other colleagues in the province have come across such an incident. If not, then either they are more fortunate than I or they have not been checking on payments not received from OHIP; if the latter, they may be in for a rude shock. M.S. AHLUWALIA, MB Bothwell Medical Centre Bothwell, ON
Northern health care To the editor: Dr. Tom Wood states (Can Med Assoc J 114: 947, 1976) "Many communities in the far Canadian North have never had regular medical care; because of the isolation and difficult conditions, few doctors have been induced to work there." Since 1966 a coordinated medical care system has operated north of the 60th parallel. Currently 38 physicians are employed full-time, permanently, in the Northwest Territories. They are supported by a further seven full-time physicians who spend much time in the Northwest Territories, together with a number of visiting specialists on shortterm contracts arranged through universities. The population of the Northwest Territories is around 40 000; it is evident that availability of medical care differs little from the average in many parts of southern Canada and is indubitably better than in some. FJ. CovILL, MB Chief medical and health officer Northwest Territories 14th Floor Baker Centre 10025 - 106 St. Edmonton, AB
Student selection and internship: fear oft accompanies shaking of traditional beliefs To the editor: The fear about the trend the CMA Council on Medical Education is taking expressed by Dr. J. Slater in his letter to the editor "Student selection and internship" (Can Med Assoc 1 114: 995, 1976) is most unfortunate, and 1 am writing to assure him that research such as that being done by the CMA council should not be feared but lauded. It is true that the council is investigating many traditions within medical education, and research that shakes traditional beliefs is often feared and censured. Experimentation sometimes
produces less than satisfactory results; however, it often provides a basis for rational change. And just the fact that there are "private laboratory kickback type" scandals indicates that some changes may be needed. Dr. Slater's comments are intriguing. J.L. CHOUINARD Coordinator Council on Medical Education Canadian Medical Association
The Canadian abortion law To the editor: The main thrust of the letter by Drs. Cohen, Rapson and Watters (Can Med Assoc J 114: 593, 1976) is that abortion is good medicine and should not be denied to certain groups of citizens. I think, on the other hand, that liberalized abortion is bad medicine and should be curtailed rather than encouraged. Removing abortion from the Criminal Code - in other words, leaving the decision just to the doctor and the patient - would mean that more and more abortions would be done for unsound, nonmedical reasons and there would be an abortion-on-demand situation, as in Japan and other countries. There are powerful medical reasons for not having abortion on demand and for stating that liberal abortion is bad medicine because the decision to perform the operation tends to be in the hands of the patient rather than the doctor. It is becoming increasingly clear that abortion is a hazardous operation with far-reaching effects. The reason the medical profession in Israel recently decided not to support legalized abortion in their country was the medical dangers and complications. Early complications of abortion were well described in a CMAJ editorial in February 1972 (Can Med Assoc J 106: 295, 1972) and in many other articles. These include death, hemorrhage, shock, cervical injury, infection and others. Scandinavian data indicate that the maternal mortality for legalized abortion is 0.3 to 0.8/1000. This is twice as great as the maternal mortality for childbirth in most countries.1 Later complications are not so well known. More and more reports from Scandinavia, Japan, Eastern Europe, Switzerland and other countries that have had legalized abortion for many years point to the dangers to the future reproductive ability of women who have had an abortion, especially young primigravidas. These dangers form the basis for the. Wynn report,2 which referred to 80 or more papers from different parts of the world and was summarized in an editorial in the British Medical Journal of March 1973.. Prematurity and spontaneous abortion in subsequent pregnancies are the commonest hazards and, according to the
CMA JOURNAL/AUGUST 7, 1976/VOL. 115 211
Garamycin
ophthalmic solution/ointment
(Gentamicin Sulfate U.S.P.) INDICATIONS: For the treatment of superficial bacterial infections of the conjunctiva, cornea, eyelids, tear ducts, and skin adjacent to the eye. Such infections include conjunctivitis, blepharitis, blepharoconjunctivitis, keratitis, keratoconjunctivitis, episcleritis, dacrocyst'tis, corneal ulcers, and infected eye sockets. Also for the prevention of ocular infection if injury makes the eye or adjacent area vulnerable to infections; after removal of foreign bodies, after burns or laceration of the lids or conjunctivae; or after damage from chemical or physical agents, and before and after eye surgery. CONTRAINDICATIONS: Sensitivity to any of the components in the preparations. PRECAUTIONS: Use of topical antibiotics occasionally allows overgrowth of nonsusceptible microorganisms such as fungi. If this occurs, or if irritation or sensitization to any of the components of this preparation develops, treatment with it should be discontinued and appropriate therapy initiated. To avoid possible contamination of the solution or ointment, do not permit the solution dropper tip or ointment tube tip to come in contact with any surface. ADVERSE EFFECTS: Eye medications may sting briefly on application, and gentamicin eye preparations are no exception. Irritation, but not sensitization, has been reported. DOSAGE: Ophthalmic Ointment: Apply to the affected areas in or near the eye 3or4timesaday. If the ophthalmic solution is used during theday, the ointment can be used at bedtime to continue treatment during the night. Ophthalmic Solution: Instill 2 drops into the conjunctival sac of the affected eye 3 or 4 times daily. Dosage may be increased in severe infections and reduced at the end of treatment. In the infections that may develop intermittently in the immature tear ducts of children (dacrocystitis), hot compresses and massage of the area over the tear duct may be useful as adjuncts to the ophthalmic solution. SUPPLIED: Ophthalmic Ointment: Each g of ointment contains: 5mg gentamicin sulfate (equivalent to 3 mg gentamicin base), and methylparaben and propylparaben as preservatives in a bland base of clear petrolatum. Available in 3,5 g tubes with applicator tip. OPHThALMIC SOLUTION: Each ml of sterile aqueous solution buffered to approximately pH 6,7 contains 5 mg gentamicin sulfate (equivalent to 3mg gentamicin base); disodium phosphate; monosodium phosphate; sodium chloride; and benzalkonium chloride as preservatives. Available in 5 ml plastic dropper bottles.
Metimyd
ophthalmic suspension (Prednisolone acetate LISP. and Sodium sulfacetamide U.S.P.) INDICATIONS: Suspension: Inflammatory and allergic disease of the eye, ear and nose, especially when anti-bacterial effect is desired. CONTRAINDICATIONS: Tuberculosis, fungal and most viral lesions of the eye (herpes simplex/dendritic keratitis): vaccinia; varicella; acute purulent conjunctivitis and acute purulent blepharitis and in those persons who have shown hypersensitivity to any of its components. PRECAUTIONS: Extendecluse of topical steroid therapy may cause increased intraocular pressure in certain individuals. It is advisable that intraocular pressure be checked frequently. In those diseases causing thinningof thecornea, perforation has been known to occur with the use of topical steroids. Prolonged use may result in overgrowth of nonsusceptible organisms, including fungi. Appropriate measures should be taken if superinfection occurs. A few individuals may be sensitive to one or more components of this product. If any reactions indicating sensitivity are observed, discontinue use. Store in a cool place. DOSAGE: Administration should be adjusted to the specific needs of the individual. 2 or 3 drops should be instilled into the conjunctival sac every nour or two during the day and less often at night until response is favorable. The dosage should be reduced thereafter; SUPPLIED: Each ml contains: microcrystalline prednisolone acetate US.P. 5 mg (0,5%) suspended in an isotonic buffered and preserved solution of sodium sulfacetamide liSP. 100 mg (10%). Available in 5 ml dropper bottles. Detailed information available in the Compendium of Pharmaceuticals and Specialties and also on request from Schering Corporation Limited. *Registered Trade Mark 1. Gordon, D.M.: Amer. J. Ophthal. 69:300 (Feb.) 1970 tDue to susceptible organisms.
Schering Corporation Limited
Pointe Claire, Que. H9R 1B4
report, there may be a 40% increase in incidence of premature birth. The incidence of ectopic pregnancy is increased two- or threefold after a previOLlS abortion, the report noted. But the 1969 survey of the Office of the Prime Minister of Japan reported a 400% increase in incidence of tubal pregnancies. The Wynn report stated that the incidence of' pelvic inflammation increased fourfold after abortion and that sterility occurred subsequently in 2 to 5%; the Japanese data indicated that sterility occurred subsequently in 9%. The British perinatal mortality survey of 1963 found that a previous abortion increased the chances. of a subsequent perinatal death by 50%. Psychological after effects have been described. Jeffcoate1 stated that 10% of those who had an abortion had permanent remorse and regret, and if the indications for the operation were flimsy the proportion was 25 to 50%. Adverse sociologic effects of abortion on demand are not to be ignored. After some years abortion tends to be used as a birth control measure. Many women have more than one abortion. Legalizing abortion may not reduce greatly the illegal practice of it and some reports have shown that it has increased this practice. There tends to be a heavy strain on hospital services when many abortions are performed. Easy access to abortion may have ill effects on the moral standards and sexual mores of a community. The population of a country may be reduced to an alarming extent; for example, Romania had to reverse its liberal abortion laws in 1966 because the country was facing depopulation. Thus, I seriously question the wisdom of liberalizing abortion in Canada further by removing this matter from the Criminal Code and I do not hold with the view that easy access to abortion is a boon. We may find in time that the reverse is true. P. G. COFFEY, MD Kemptville, ON
References 1. JEFFCOATE TNA: Principles of Gynaecology,
3rd ed, New York, Appleton, 1967, pp 807, 813
2. WYNN M, WYNN A: Some consequences of induced abortion to children born subsequently, London, England, Fdundation for Education and Research in Childbearing, 1972 3. Latent morbidity after abortion (E). Br Med J 1: 506, 1973
To the editor: On the issue of complications following legal abortion, Dr. Coffey quotes Jeffcoate, whose antiabortion views are widely known, and the Wynn report, a document compiled by two crusaders for "compulsory pregnancy's who used data inappropriately in an attempt to substantiate their personal beliefs. As an example, in this
document they attempted to bolster their antiabortion position by quoting from the British perinatal mortality survey of 1963 as follows: "Any patient who has a previous history of an abortion should be regarded as a high risk patient and be invariably booked for hospital delivery under consultant care". That statement was written years before induced abortions became legal in Great Britain, and referred to willingly pregnant women with a history of spontaneous abortion. Most of the other consequences of abortion "documented" by the Wynns were examined by a World Health Organization scientific group in 1970. Their report1 concluded that "an increased tendency to ectopic pregnancy, placenta previa and premature separation of the placenta has been postulated but not established". The same report stated that "several large studies have failed to show whether secondary sterility occurs more frequently after legal abortion than after delivery". Using data supplied from Hungary and Japan during the 1960s, the WHO group did suggest that premature births tended to occur more frequently in women who had had prior induced abortions. Since premature infants are at greater risk than term infants, such a possibility could not be dismissed lightly and many investigators have studied the question since 1970. Hogue2 has demonstrated that retrospective studies of the 1960s, on whose data the WHO opinion was based, contained a number of methodologic loopholes. Using a refined study design she was able to demonstrate "no connection" between an induced abortion and premature birth in a subsequent wanted pregnancy. Similarly, the data of Roht and Aoyama,3 who studied close to 4000 Japanese women, suggested that "the rates of prematurity and/or spontaneous abortion were not increased in pregnancy subsequent to an induced abortion". The "evidence" for the gloomy predictions of the Wynn report has vanished in the light of new knowledge. Dr. Coffey's comments - again quoting Jeffcoate about the psychological after effects of abortion do not square with the data from the literature. Results of studies in Aberdeen,4 England5 and Sweden6'7 suggested that women denied a safe legal abortion - that is, the victims of compulsory pregnancy - were more likely to experience emotional distress than women who were allowed to exercise reproductive responsibility by the use of the option of legal abortion.8 In other words, compulsory pregnancy is bad medicine. Dr. Coffey makes another statement that is contradicted by modern evidence. The notion that abor-
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