Diprolene
Prescription of high-potency corticosteroid agents and clotrimazole-betamethasone dipropionate by pediatricians.

Fleischer AB Jr, Feldman SR.

Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1071, USA.

Family physicians, internists, and pediatricians are more likely to prescribe combination topical antifungal-topical corticosteroid preparations than are dermatologists. One such preparation, clotrimazole-betamethasone dipropionate, can cause atrophy because it has a high-potency corticosteroid component. We analyzed data from the National Ambulatory Medical Care Survey for visits to pediatricians from 1990 to 1994 and isolated visits at which a topical corticosteroid agent or clotrimazole-betamethasone dipropionate was prescribed. Pediatricians rarely prescribed single-agent, high-potency topical corticosteroid agents in managing patients with skin disorders. High-potency corticosteroid agents accounted for 5.0% of topical corticosteroid prescriptions, whereas 56.3% were low-potency and 38.7% were medium-potency agents. Of the 696,285 mentions of clotrimazole-betamethasone dipropionate, 56.4% (389,920) were for children aged newborn to 4 years; diagnoses were erythematodesquamatous dermatoses, diaper rash, tinea, well-baby visit, and candidiasis. In contrast, for dermatologists nationwide, no drug mention existed for this combination agent for children aged newborn to 4 years over the 5-year study period. Our results show that clotrimazole-betamethasone dipropionate is prescribed inappropriately by pediatricians, especially in the treatment of young children. Pediatricians rarely use high-potency topical corticosteroid agents, but most of their use of clotrimazole-betamethasone dipropionate is in the youngest children, in whom such corticosteroid use is least appropriate. This prescription pattern suggests that some pediatricians may be unaware that clotrimazole-betamethasone dipropionate has a high-potency cortico steroid component.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10566568&dopt=Abstract betamethasone Diprolene AF



Diprolene
[Prenatal induction of lung maturation in the fetus. Betamethasone versus betamethasone+thyrotropin-releasing hormone]

[Article in Czech]

Roztocil A, Svojanovska K, Matuskova D, Borek I, Juren T, Unzeitig V, Ventruba P.

Gynek.-porod. klinika LF MU, Brno.

During the period from May 1, 1994 till December 31, 1997 at the First and Second Departments of Gynaecology and Obstetrics Masaryk University Brno 311 neonates with birthweights from 500 to 2000 g were born. A retrospective study was made comparing neonatal results of three methods of prenatal induction of maturing of surfactant in premature neonates. The first group was without treatment, in the second group only betamethasone was administered and in the third group betamethasone and thyrotropin releasing hormone (TRH). The neonates were divided into three body weight groups: 500-999 g, 1000-1499 g and 1500 g and more. The most favourable results with administration of betamethasone and TRH were obtained in the group weighing 500-999 g. This pertained to the smaller number of post-partum administration of surfactant, reduction of the oxygenation index and period of artificial pulmonary ventilation. IVth grade RDS and other complications in the child. In the group of neonates weighing 1000-1499 g administration of betamethasone and TRH had a positive effect only on the oxygenation index and grade of RDS. In the group of neonates with weights above 1500 there were no statistically significant differences between the described three groups. It may be concluded that the greatest effectiveness was achieved by a combination of betamethasone and TRH in neonates weighing 500-999 g, this combination was less effective in the group weighing 1000-1499 g and without effect in those weighing 1500 g or more.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10568043&dopt=Abstract betamethasone Diprolene AF



Diprolene
The effect of antenatal steroid administration on the fetal response to vibroacoustic stimulation.

Rotmensch S, Celentano C, Liberati M, Sadan O, Glezerman M.

Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Holon, Israel.

BACKGROUND: Betamethasone transiently suppresses multiple fetal biophysical activities, including breathing movements, limb and trunk movements, heart rate variability, and heart rate accelerations. Unnecessary iatrogenic delivery of preterm fetuses due to the false diagnosis of fetal compromise has been described in this setting. The sonographically observed startle response of the fetus to vibroacoustic stimulation has been described as another modality to provide reassurance about fetal well-being. It is unknown, however, whether the startle response is also suppressed by betamethasone. The purpose of this study was to examine the effect of betamethasone on this biophysical parameter. METHODS: A prospective cohort study. Vibroacoustic stimulation was applied to the maternal abdomen and fetal movement responses were sonographically observed prior to (0 hours), 48 hours after, and 96 hours after betamethasone administration. We recorded the presence or absence of the fetal startle response, and, if a response was present, graded semi-quantitatively the intensity of the movements (vigorous versus sluggish). RESULTS: Twenty-two of 26 fetuses (84.6%) displayed a vigorous vibroacoustic startle response prior to betamethasone administration, in comparison to three of 26 fetuses (11.5%) at 48 hours after exposure (p<0.0001). Eleven fetuses and eight fetuses displayed no startle response at all (p<0.0005), or a sluggish response only (p<0.0005) at 48 hours, respectively. At 96 hours after betamethasone exposure, no differences in the number of fetuses with a vigorous, sluggish, or absent response were observed in comparison to 0 hours. Stratification of cases by gestational age groups of 28-30 weeks versus 31-34 weeks showed similar response patterns. CONCLUSION: Antenatal betamethasone exposure transiently suppresses the sonographically observed fetal startle response to vibroacoustic stimulation. Accordingly, this modality cannot be used for the ascertainment of fetal well-being of steroid exposed fetuses. Betamethasone seems to suppress central nervous system dependent biophysical activities. including the brain-stem dependent vibroacoustic startle reflex.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10577612&dopt=Abstract betamethasone Diprolene AF



Diprolene
Developmental and glucocorticoid regulation of surfactant protein mRNAs in preterm lambs.

Tan RC, Ikegami M, Jobe AH, Yao LY, Possmayer F, Ballard PL.

Department of Pediatrics, University of Pennsylvania School of Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA.

Glucocorticoid treatment increases content of surfactant protein (SP) A and SP-B in lung tissue and lavage fluid of preterm lambs. To investigate this process, we determined the ontogeny and glucocorticoid induction of SP mRNAs. In separate treatment protocols, each with its own controls, sheep were injected with betamethasone 15 h, 48 h, or weekly for 1-4 doses before preterm delivery. Using ovine SP cDNAs, we found an increase equal to or more than threefold in basal levels of all three SP mRNAs between 125 days and term. After betamethasone treatment, SP-B and SP-C mRNA levels increased by 15 h and all SP mRNAs were elevated after 24 h (>/=2-fold); mRNA levels in fetuses delivered 1-3 wk after betamethasone were not different from control. We conclude that in vivo betamethasone rapidly induces a coordinated increase in SP mRNAs, which is fully reversible within 7 days despite repetitive doses of betamethasone. Similar increases in mRNA and protein contents for SP-A and SP-B suggest that glucocorticoid regulation of these SPs in vivo is primarily pretranslational.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10600884&dopt=Abstract betamethasone Diprolene AF



Diprolene
The effect of six weeks topical nasal betamethasone drops on the hypothalamo-pituitary-adrenal axis and bone turnover in patients with nasal polyposis.

Gazis AG, Homer JJ, Henson DB, Page SR, Jones NS.

Department of Diabetes, University Hospital, Nottingham, UK.

Betamethasone topical nasal drops may have systemic corticosteroid activity and cause suppression of the hypothalamo-pituitary-adrenal (HPA) axis and impairment of bone turnover. The aim of this study was to assess the effect of a standard 6-week regime of betamethasone topical nasal drops on the HPA axis (using a physiological dose (1 microg) ACTH test) and on bone turnover (using markers of bone turnover, urinary deoxypyridinoline and serum bone specific alkaline phosphatase). Eleven patients with nasal polyposis were included in a prospective cohort study. Plasma cortisol was lower after betamethasone treatment at all time intervals (P < 0. 0001). There was no change in urinary deoxypyridinoline corrected for creatinine or bone specific alkaline phosphatase. Six weeks' treatment with recommended doses of betamethasone suppresses the HPA axis, but has no significant effect upon markers of bone turnover. Topical betamethasone in subjects with nasal polyps should be viewed as systemic corticosteroid administration and the long and short-term sequelae should be borne in mind.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10606995&dopt=Abstract betamethasone Diprolene AF