LETTERS.

A Single Dose of Reality

The position of Dr. Sebastian Faro reflects that of a physician out of touch with the realities of patient behavior ("Single-Dose Tx for Gonorrhea Galled Insufficient," April 15, 1999, p. 64).

Dr. Faro apparently completely missed the point of single-dose therapy in this and many other conditions.

One would be hard pressed to prove that, under laboratory conditions, multidose therapy is not more effective than single dose. He apparently failed to realize, however, that we are not practicing in a laboratory but with patients who, had they been willing and able to follow medical prescriptions/proscriptions, would not have contracted gonorrhea in the first place.

Perhaps Dr. Faro needs to get out a little more frequently.

Dwight E. Hooper, M.D.

Columbus Regional Healthcare Phenix City, Ala.

Dr. Faro replies:

Dr. Hooper has missed the point.

First, I do not practice in a laboratory, although I use data generated in the laboratory when deciding on whether to institute treatments.

Second, my concern is simply this: gonococcal and chlamydial infections of the cervix are mostly asymptomatic; therefore, when the diagnosis is made it is usually well after acquisition of the infecting organism.

Not knowing the duration of the infection, there is no way of knowing whether or not the infection has advanced to the upper genital tract.

Since there are no data to determine whether a one-time dose of antibiotic can produce adequate tissue levels for a long enough period of time, we should be careful not to adopt treatment regimens that may place the patient in harm's way.

Dr. Hooper may feel better by giving a single dose to the patients he sees, but he does not know if his treatment is truly benefiting the patient. I suggest that he investigate the question he is raising. Perhaps reading the literature may enlighten him as to the difficulty of treating STDs, especially of the cervix, uterus, and fallopian tubes.

Food Bar Prompts Question

I read Dr. Andrew J. Maxwell's comments in the article "Food Bar May Eat Away at Peripheral Artery Disease" (May 15, 1999, P. 11).

I have one question: What will all that nitric oxide do to arthritic joints and inflammatory bowel diseases?

Gerard K. Nash, DO.

solo practice

Amarillo, Tex.

Dr. Maxwell replies:

Dr. Nash raises a legitimate concern that augmentation of nitric oxide (NO) production in disease states characterized by NO overproduction may be detrimental. These states include sepsis and inflammatory diseases such as arthritis, inflammatory bowel disease, and transplant vasculopathy.

Issues such as these are why we chose to categorize our food bar in the regulatory class of medical foods, to be used under the supervision of a physician.

No study that I'm aware of has shown that use of L-arginine in the inflammatory or septic states increases NO activity with a detrimental effect. Animal studies suggest that the use of L-arginine in the presence of these diseases is not harmful. Conversely inhibition of NO activity with anti-inflammatory agents may have unintended adverse effects on vascular function.

We have not determined the effect of long-term use of our medical food bar in patients with these diseases. But we have had patients with arthritis as a comorbidity in our clinical studies (one study has had participants on the bar for over 2 years); they have not experienced an increase in symptoms with bar use.

Furthermore, there has not been a single self-report of increased symptoms of any inflammatory disease during the 6-month postmarketing period.

The food bar has been shown, at least on a short-term basis, to be safe and efficacious in patients with atherosclerotic vascular diseases. Nonetheless, until these questions can be answered, the bar should be used under the supervision of a health care professional so that these issues can be closely monitored.

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Publication:	Family Practice News
Date:	Sep 1, 1999
Words:	633
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