Gantanol Roche Successful sulfonamide therapy in: cystitis prostatitis pyelitis urethritis and prevention of secondary infections following urologic instrumentation 'Gantanol' 'Roche' (sulfamethoxazole) Rx Summary Indications: Bacterial infections due to the sulfonamide sensitive organisms; prevention of infection following urologic instrumentation. Contraindications: In premature and newborn infants, general sulfonamide intolerance and severe liver damage. In pregnant women, the week before term. Adverse reactions: Headache, nausea, vomiting, urticaria, blood dyscrasias, drug fever, skin rash and hematuria. If one or more of these reactions occur, drug should be withdrawn. Precautions: The usual precautions in sulfonamide therapy should be observed. In prolonged therapy blood counts should be performed. Dosage: Adults - 4 tablets or 4 teaspoonfuls of suspension initially, then 2 tablets or two teaspoonfuls of suspension b.i.d. Children (up to 40 kg) 1 tablet or 1 teaspoonful of suspension per 10 kg/body weight, then 1/2 tablet or 1/2 teaspoonful of suspension per 10 kg/body weight b.i.d. Supply: Tablets, 500 mg; 100, 500. Duplex pack, containing 28 'Gantanol' Tablets and 12 Uro Gantanol® Tablets. Suspension, 500 mg/tsp. (5 ml); 100, 400 ml. Information on request ®FReg. Trade Mark /jj\ Hoffmann-La Roche Limited is no reason why a group of physicians who are determined to deal directly with their patients should not take advantage of Chargex, Master Charge, American Express, etc. I should be interested to hear from those physicians who support the concept of the use of a medical charge card, or favor entering into some form of association with established credit card organizations in Canada. A. G. Dawrant, MD Edmonton, Alta. New Association Formed A seminar on correctional medicine was held in Calgary in June during the annual meeting of the Canadian Medical Association. This meeting was well attended by physicians working in penitentiaries and jails across the country. During this meeting numerous papers were presented which were of great interest to the members present and during the business portion of the meeting a permanent executive was elected to continue defining and promoting the aim of high quality medical care in such institutions. The executive consists of the following persons: Dr. C. Roy, Abbotsford, B.C., president; Dr. G. S. L. Wilson, Drumheller, Alta., vice-president; Dr. D. G. Workman, Amherstview, Ont., secretary; Dr. R. M. MacMillan, Peterborough, Ont., treasurer; Drs. J. G. Harris, Laval, Que., and R. Sivasankar, Prince Albert, Sask., as members at large. D. G. Workman, MD, Amherstview, Ont. Data Bank on Stress We wish to announce the unrestricted availability of our documentation service on all subjects relating to stress in medicine or daily life. Since the first description of biologic stress and the General Adaptation Syndrome (GAS) in 1936, we have collected approximately 110,000 original articles (among them several hundred books) all of which are indexed in depth according to the Symbolic Shorthand System (SSS) for rapid information retrieval. Scientists from all parts of the world regularly visit our Institute to make use of this collection, and any competent investigator is welcome to consult the original publications. An appointment should, however, be arranged in advance by writing to the CANADIAN FAMILY PHYSICIAN/SEPTEMBER undersigned in order to be assured of suitable office space and assistance. No charge is made for this service, but original articles cannot be removed from the library. A complete list of references including title (with English translation if published in another language), journal, year and inclusive page numbers is available at $0.25 per reference upon request to the undersigned. Photocopies of articles may be obtained at an additional charge of $0.15 a page. These prices include handling charges and postage by surface mail. This offer is made on a cost basis in order to facilitate stress research throughout the world since although in the past we have received many requests for documentation of this type, it has come to our attention that many scientists are reluctant to ask for such information gratis. Actually, we feel it is wasteful to limit access to our data bank on stress, and so we shall attempt to satisfy all requests. However, we must warn the scientific community that this service may have to be restricted or terminated if requests should exceed our facilities. Antonio Rodriguez, Chief Documentalist, Institut de mldecine et de chirurgie experimentales, University of Montreal, Montreal, Que. Wheelchair Power! On May 22 and 23, a conference was held at York University on the subject of housing and supportive services for the physically disabled. Present at this conference were 120 delegates from all over Ontario as well as resource personnel. During the conference, it was repeatedly brought to my attention that very few doctors' offices or clinics have access for wheelchairs. I know this from personal experience, but I am in a fortunate position, having more contact with members of the medical fraternity, so that I can shop around for accessible facilities. I have repeatedly checked new architectural designs for clinics which are published in the medical magazines. Seldom are these accessible for wheelchairs and if there is front entrance accessibility, there are nearly always architectural barriers inside the building. It was a strong recommendation of the recent conference that every public building should have mandatory 21 PVF* SUSPENSION (benzathine phenoxymethyl penicillin suspension, Frosst Std.) PVF* K TABLETS (potassium phenoxymethyl penicillin tablets, U.S.P.) INDICATIONS: The treatment of mild to moderately severe infections due to penicillin G susceptible organisms including streptococcal pharyngitis, staphylococcal infection without bacteremia and pneumococcal infections, which usually respond to oral therapy; to prevent recurrences following rheumatic fever and/or chorea. To prevent bacterial endocarditis in patients with congenital and/or rheumatic heart lesions, prior to undergoing dental procedures or minor upper respiratory tract surgery or instrumentation; for the prevention of bacteremia following tooth extraction. CONTRAINDICATIONS: Patients with a history of penicillin or cephalosporin allergy; oral therapy not recommended in the active treatment of syphilis, subacute bacterial endocarditis, diphtheria, gas gangrene or other severe infections due to penicillin- susceptible organisms. WARNINGS: Serious and occasionally fatal hypersensitivity reactions, more likely in individuals with a history of sensitivity to multiple allergens, reported with penicillin therapy. Individuals with a history of penicillin hypersensitivity have experienced severe reactions when treated with cephalosporin. Anaphylaxis, though more frequent following parenteral therapy, has occurred with oral penicillin, and must be treated promptly by cessation of drug therapy and with epinephrine. Milder reactions of the hypersensitivity types may be relieved with antihistamines. PRECAUTIONS: Should not be administered un- less enquiry has been made to ensure that the patient has had no previous allergic reactions to penicillin; should be used with caution in individuals with histories of significant allergies and/or asthma. As with any antibiotic, prolonged use and treatment with high doses may result in overgrowth of nonsusceptible organisms, including fungi. The opal route of administration should not be relied upon in patients with severe illness or with nausea, vomiting, gastric dilatation, cardiospasms or intestinal hypermotility. In streptococcal infections therapy must be sufficient (a minimum of ten days) to eliminate the organism, as shown by culture; otherwise the sequelae of streptococcal disease may occur. Occasional patients will not absorb orally therapeutic amounts. ADVERSE REACTIONS: Although much less frequently after oral than after parenteral penicillin therapy, all degrees of hypersensitivity including fatal anaphylaxis have been observed with oral penicillin. The most common reactions are nausea, vomiting, epigastric distress, diarrhea and black, hairy tongue. The hypersensitivity reactions noted are skin eruptions (ranging from maculopapular to exfoliative dermatitis), urticaria; reactions resembling serum sickness, including chills, fever, edema; and anaphylaxis. Fever and eosinophilia may frequently be the only reactions observed. Hemolytic anemia, leukopenia, thrombocytopenia, neuropathy and nephropathy are infrequent reactions and are usually associated with high doses of parenteral penicillin. DOSAGE SUM MARY: Dosage should be individualized according to the sensitivity of the causative microorganisms and severity of the infection and adjusted to the clinical response of the patient. The usual dosage range for adults and children 12 years and over is 250,000 up to 500,000 I.U. three to four times a day. Therapy for children under twelve years of age is calculated on the basis of body weight. For infants and small children, the suggested daily dose is 25,000 to 90,000 I.U. (15 to 50 mg) per kg in three to six divided doses. DETAILED INFORMATION AVAILABLE ON REQUEST HOW SUPPLIED No. 994- PVF * 500 Suspension. Each 5 ml teaspoonful, fruityflavoured, orange colour, contains 500,000 I.U. (300 mg) of Phenoxymethyl Penicillin as Benzathine salt, and is supplied in bottles of 100 ml and 450 ml (16 fI. oz.). No. 993- PVF * 250 Suspeosion. Each 5 ml teaspoonful, fruity flavoured, canary yellow colour, contains 250,000 l.U. (150 mg) of Phenoxymethyl Penicillin as Benzathine salt, is supplied in bottles of 100 ml and 450 ml (16 fl. oz.). No. 860- PVF * K 500 Tablets, 500,000 I.U. (300 mg) each, of Phenoxymethyl Penicillin as Potassium salt, are white, round, 7/16" diameter, upper surface engraved PVF with score line, are '500 supplied in bottles of 20 and 500. (MC-301 ) *Trademark . ' °-, accessibility for wheelchairs, and such mandatory architectural construction may very well become legal in the near future. Nevertheless, many older buildings will continue to exist for some time to come. Surely the medical profession could be setting an example for the architects and designers of the future. J. S. Whittaker, MD Clinical Director, Outpatients 'Dept. Ontario Crippled Children's Centre, Toronto. Ont. Should Milk Formulae Be on Prescription Only? In view of the recent comments on the advantages of breastfeeding (editorial, Can. Med. Assoc. J. 112: 1281, 1975 and Myres, CFP 21:4:73, 1975) attributing to bottlefeeding such diverse and occasionally life-threatening conditions as obesity, colonization of the gastrointestinal tract by E.coli, recurrent rhinorrhea, bronchiolitis, bronchopneumonia, necrotizing enterocolitis and sudden infant death syndrome, the time has come to call a halt to the sale of milk formulae except on prescription, until such time as their safety can be established. Surely any ° CANADIAN FAMILY PHYSICIAN/SEPTEMBER other drug suspected of causing such morbidity and mortality would be banned? I am not suggesting that formula foods be totally unavailable, as they obviously are of great yalue and importance when used properly and under the guidance of a physician who has decided, in the words of the drug companies, "That the expected benefits outweigh the possible risks". I have no doubt that it will be argued by the companies marketing these products that it is not the product itself which is dangerous, but the manner in which it is used. However, the same argument could as well be applied. to heroin! It is up to the company to anticipate that use of the product by the general public will be less than perfect. There is also bound to be much protesting from mothers who are so overwhelmed by advertising that they are unable to see the convenience of breastfeeding, and its numerous benefits. Thus a policy change would have to be accompanied by a massive educational campaign to appraise them of the dangers of bottlefeeding and the advantages of breastfeeding. T. Hancock. MB, BS, Chipman, N.B. II ' 0~~~~~~~~~ C\JI Tower 23