The American journal of the medical sciences
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Metronidazole is a treatment of choice for several types of infections, but coexisting conditions or concomitant medications may preclude its use. Although tinidazole, a newer nitroimidazole, may be an option in cases where drug interactions make the use of metronidazole inadvisable, similar absolute contraindications exist. In situations where nitroimidazole use is contraindicated or inadvisable, clinicians may have difficulty deciding on efficacious treatment options. ⋯ For giardiasis, alternative options include paromomycin, nitazoxanide or the antihelminthic benzimidazoles. Alternatives for Clostridium difficile are varied, including oral vancomycin, nitazoxanide and rifaximin. Although options are limited, alternative therapies for treatment of patients with absolute contraindications to the nitroimidazole antibiotics are available.
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Hyperglycemia is common in nondiabetic patients with acute myocardial infarction (AMI). Elevated blood glucose level may reflect a response to stress, an underlying abnormal glucometabolic state or both. Regardless of mechanism, hyperglycemia complicating AMI is associated with an inflammatory and prothrombotic state, depressed myocardial contractility and increased short- and long-term mortality. Studies are needed to define optimal monitoring and management of hyperglycemia in nondiabetic patients with AMI.