Since the last Medical Letter review of generic drugs (Volume 28, page 1, 1986), the prediction that generic drugs newly approved in the USA under more relaxed federal regulations will probably be as reliable as brand-name drugs has generally been accurate. Few well-documented generic product failures have been reported. Recently, however, the equivalence of generic topical corticosteroids has been questioned.

Methylphenidate (Ritalin and others), a Schedule II controlled substance in the USA, is a short-acting central-nervous-system stimulant widely used for treatment of children with school performance or behavior problems, or what is now called Attention Deficit-Hyperactivity Disorder, or AD-HD (American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, third ed., revised [DSM-III R], Washington, DC:authors, 1987, p 50). Some studies have estimated that more than 3% of elementary school students are taking methylphenidate, and one parents' group has brought a...

(Kodak) perform clinical chemistry tests using desk-top instruments, microliter samples and postage-stamp-sized analytical slides containing dry reagents layered on clear polyester and mounted in plastic. The system requires no wet reagents, except for electrolyte determinations, and is designed to require a minimum amount of training to operate. A single analysis takes about five minutes.

Trimetrexate glucuronate (Parke-Davis), an investigational drug, is now available in the USA from the National Institute of Allergy and Infectious Diseases (NIAID) for treatment of selected AIDS patients with Pneumocystis carinii pneumonia (PCP). For this indication, trimetrexate is always used concurrently with leucovorin (Wellcovorin; and others).

Photoplex (Herbert), a new sunscreen formulation containing 7% padimate O and 3% Parsol 1789, is being advertised as the first and only chemical sunscreen with proven absorption throughout the UVB and UVA spectrum.

The Reflotron (Boehringer Mannheim), a desk-top colorimetric reflectance analyzer that weighs 12 pounds, can do clinical chemistry tests on 30 l of whole blood, plasma or serum, using multilayered strips containing dry chemicals. A single test takes two to three minutes.

The gram-positive bacillus Clostridium difficile is the most common identifiable cause of antibiotic-associated diarrhea and pseudomembranous colitis (R Fekety in GL Mandell et al, eds, Principles and Practice of Infectious Diseases, 3rd ed, New York:Churchill Livingstone, 1990, page 863). C. difficile colitis usually develops during or soon after antibiotic treatment. Virtually any antimicrobial agent can cause the disorder, but clindamycin, ampicillin and the cephalosporins have been implicated most frequently. Pseudomembranous colitis was recently reported in five patients who had ...

Ifosfamide (Ifex - Mead Johnson), a synthetic analog of cyclophosphamide (Cytoxan; and others), has been approved by the US Food and Drug Administration (FDA) for concurrent use with other drugs in third-line chemotherapy of metastatic germ-cell testicular cancer. Given concomitantly, a synthetic sulfhydryl compound known as mesna (Mesnex - Asta) acts in the urine to detoxify metabolites of ifosfamide that cause hemorrhagic cystitis (H Burkert, Cancer Treat Rev, 10 suppl A:175, 1983). Ifosfamide and mesna are available together from Bristol-Myers Oncology Division.

Endoscopic injection of sclerosing agents is now widely accepted as a primary treatment for bleeding esophageal varices (J Terblanche et al, N Engl J Med, 320:1393, 1469, May 25 and June 1, 1989). Ethanolamine oleate 5% (Ethamolin - Glaxo), a sclerosing agent that has been available in Canada and abroad for many years, was recently approved for this indication by the US Food and Drug Administration (FDA).

Recombinant alpha interferon has been marketed in the USA for treatment of hairy-cell leukemia, genital warts, and AIDS-related Kaposi's sarcoma (Medical Letter, 28:78, 1986; 30:70, 1988). Recent reports indicate it may also be useful for treatment of chronic viral hepatitis. Recombinant alpha interferon is available as alfa-2a (Roferon-A - Roche) or alfa-2b (Intron A - Schering), which are identical except for one amino acid.