EXPERT
Dwight Cochran
Allergist and Immunologist
Dr. Dwight Cochran is a top Infectious Disease Specialist in Wendell, . With a passion for the field and an unwavering commitment to their specialty, Dr. Dwight Cochran is an expert in changing the lives of their patients for the better. Through their designated cause and expertise in the field, Dr. Dwight Cochran is a prime example of a true leader in healthcare. As a leader and expert in their field, Dr. Dwight Cochran is passionate about enhancing patient quality of life. They embody the values of communication, safety, and trust when dealing directly with patients. In Wendell, NC , Dr. Dwight Cochran is a true asset to their field and dedicated to the profession of medicine.
51 years
Experience
Dwight Cochran
- Wendell, NC
- Purdue University
- Accepting new patients
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Does a cold sore mean herpes?
Herpes simplex is the cause of the common cold sore. Keep in mind that the presence of one can be a sign that lack of sleep, poor nutrition, or contact with someone who has an READ MORE
Herpes simplex is the cause of the common cold sore. Keep in mind that the presence of one can be a sign that lack of sleep, poor nutrition, or contact with someone who has an active viral ulcer/cold sore is the common mode of transmission.
Is herpes cold sores an infectious disease?
Yes, *herpes simplex* is a virus that causes common "cold sores" and unrestricted contact with open sores is how it is easily spread. There are some antiviral over-the-counter READ MORE
Yes, *herpes simplex* is a virus that causes common "cold sores" and unrestricted contact with open sores is how it is easily spread. There are some antiviral over-the-counter ointments which can be applied 3-4 times a day to reduce the chances of spread to others and to other areas of the infected individual, like the eyes or genitals. Touching the sores is discouraged and after applying the ointments, thorough hand washing is advised. If you have trouble locating the ointments, just ask the pharmacist at your pharmacy and they can assist you.
Dwight E. Cochran, D.V.M., MS
Dwight E. Cochran, D.V.M., MS
How is H.pylori infection treated?
Triple therapy Triple therapy for H pylori infection remains an option for first-line therapy in areas of low (< 15%) clarithromycin resistance [4] and consists of the following: Proton READ MORE
Triple therapy
Triple therapy for H pylori infection remains an option for first-line therapy in areas of low (< 15%) clarithromycin resistance [4] and consists of the following:
Proton pump inhibitor (PPI) (eg, omeprazole 20 mg BID, lansoprazole 30 mg BID, esomeprazole 40 mg QD, pantoprazole 40 mg QD, rabeprazole 20 mg BID) [5, 6] plus
Clarithromycin 500 mg BID [5] (first-line and continues to be recommended in areas where H pylori clarithromycin resistance is less than 15% and in patients without previous macrolide exposure [2] ) or metronidazole 500 mg BID [5] (when clarithromycin resistance is increasing) [7, 8] plus
Amoxicillin 1000 mg BID [5] or metronidazole 500 mg BID [9] (if not already selected)
Duration
A Cochrane meta-analysis of 55 studies concluded that 14 days is the optimal duration of triple therapy, achieving an H pylori eradication rate of 81.9%, whereas 7 days attains an eradication rate of only 72.9%. [10] In more recent studies, however, the eradication rate with 14-day triple therapy is not significantly different from that with 10-day sequential therapy (amoxicillin and a PPI for 5 days followed by a PPI, clarithromycin and metronidazole for another 5 days) [11] or 10-day concomitant nonbismuth quadruple therapy. [12]
Nonbismuth quadruple therapy
Nonbismuth quadruple therapy may be given sequentially or concomitantly. [3]
Sequential therapy
Sequential therapy (a suggested first-line option [2] ) is superior to standard triple therapy, according to two systematic reviews, [13, 14] and consists of the following:
PPI plus amoxicillin for 5-7 days (eg, pantoprazole 40 mg BID and amoxicillin 1 g BID for 7 days [15] ), then
PPI plus 2 other antibiotics for the next 5-7 days; clarithromycin and metronidazole are the antibiotics usually chosen, but levofloxacin-based regimens (see below) [13, 16, 17] and tetracycline-based regimens (eg, pantoprazole 40 mg BID, tetracycline 500 mg QID, and metronidazole 500 mg BID) [15] are superior to 14-day triple therapy, based on a meta-analysis of 21 trials [13]
Eradication rates with different durations of sequential therapy are as follows:
14 days: 90.7-92.5% eradication rates [18, 19]
10 days: 87% eradication rate [6, 5, 18]
Concomitant therapy
Concomitant therapy (an alternative first-line option [2] ) consists of the following (using dosages similar to those in triple therapy; or all drugs BID in one study):
PPI plus
Amoxicillin plus
Clarithromycin (1 g modified-release tablet QD in one study) plus
Metronidazole (500 mg TID in one study)
Duration of concomitant therapy is 10-14 days. [20, 21, 6]
Concomitant therapy is better for clarithromycin-resistant strains, [20, 4] and 14 days of concomitant therapy is superior to 14-day triple therapy, with cure rates of ≥90%. [22, 23, 24, 25]
Triple therapy for H pylori infection remains an option for first-line therapy in areas of low (< 15%) clarithromycin resistance [4] and consists of the following:
Proton pump inhibitor (PPI) (eg, omeprazole 20 mg BID, lansoprazole 30 mg BID, esomeprazole 40 mg QD, pantoprazole 40 mg QD, rabeprazole 20 mg BID) [5, 6] plus
Clarithromycin 500 mg BID [5] (first-line and continues to be recommended in areas where H pylori clarithromycin resistance is less than 15% and in patients without previous macrolide exposure [2] ) or metronidazole 500 mg BID [5] (when clarithromycin resistance is increasing) [7, 8] plus
Amoxicillin 1000 mg BID [5] or metronidazole 500 mg BID [9] (if not already selected)
Duration
A Cochrane meta-analysis of 55 studies concluded that 14 days is the optimal duration of triple therapy, achieving an H pylori eradication rate of 81.9%, whereas 7 days attains an eradication rate of only 72.9%. [10] In more recent studies, however, the eradication rate with 14-day triple therapy is not significantly different from that with 10-day sequential therapy (amoxicillin and a PPI for 5 days followed by a PPI, clarithromycin and metronidazole for another 5 days) [11] or 10-day concomitant nonbismuth quadruple therapy. [12]
Nonbismuth quadruple therapy
Nonbismuth quadruple therapy may be given sequentially or concomitantly. [3]
Sequential therapy
Sequential therapy (a suggested first-line option [2] ) is superior to standard triple therapy, according to two systematic reviews, [13, 14] and consists of the following:
PPI plus amoxicillin for 5-7 days (eg, pantoprazole 40 mg BID and amoxicillin 1 g BID for 7 days [15] ), then
PPI plus 2 other antibiotics for the next 5-7 days; clarithromycin and metronidazole are the antibiotics usually chosen, but levofloxacin-based regimens (see below) [13, 16, 17] and tetracycline-based regimens (eg, pantoprazole 40 mg BID, tetracycline 500 mg QID, and metronidazole 500 mg BID) [15] are superior to 14-day triple therapy, based on a meta-analysis of 21 trials [13]
Eradication rates with different durations of sequential therapy are as follows:
14 days: 90.7-92.5% eradication rates [18, 19]
10 days: 87% eradication rate [6, 5, 18]
Concomitant therapy
Concomitant therapy (an alternative first-line option [2] ) consists of the following (using dosages similar to those in triple therapy; or all drugs BID in one study):
PPI plus
Amoxicillin plus
Clarithromycin (1 g modified-release tablet QD in one study) plus
Metronidazole (500 mg TID in one study)
Duration of concomitant therapy is 10-14 days. [20, 21, 6]
Concomitant therapy is better for clarithromycin-resistant strains, [20, 4] and 14 days of concomitant therapy is superior to 14-day triple therapy, with cure rates of ≥90%. [22, 23, 24, 25]
Can ringworm infection be treated?
The usual case of ringworm can be treated. It's a fungus and therefore keeping the affected areas dry makes the "environment" of the skin areas not conducive to growth. There are READ MORE
The usual case of ringworm can be treated. It's a fungus and therefore keeping the affected areas dry makes the "environment" of the skin areas not conducive to growth. There are both topical (e.g., clotrimazole, econazole, miconazole, terbinafine, fluconazole, ketoconazole, etc.) and oral medications that can be prescribed. I'd suggest getting a dermatologist to look at the affected areas and then convince him/her to be aggressive in therapy. Remember, yeast/fungi have to have heat and moisture to grow. Eliminate those and dry out the areas regularly and you'll go a long way towards control. When I was an athletic trainer, we did everything humanly possible to "air out" areas that are warm and moist. Cornstarch in the groins before and after workouts and bedtime, and now with better anti-fungals, you can be more effective, BUT the key is keeping the affected areas DRY so the fungus can't live! Sometimes the areas itch so much that an anti-inflammatory drug is needed to control the redness, swelling, heat and pain.
Good luck, and don't self-medicate if you can help it. Get a pro to shut it down ASAP! I sympathize!
Good luck, and don't self-medicate if you can help it. Get a pro to shut it down ASAP! I sympathize!
