Safety of Picolax (sodium picosulphate-magnesium citrate) in inflammatory bowel disease.

Comment Cusum plotting is clinically useful when a fever is swinging wildly and the overall trend is hidden, when other antimicrobial agents are given that are therapeutically unnecessary, and in patients in whom temperature remains raised but generally static. It indicates worsening of the fever despite antimicrobial treatment and thus discloses ineffective treatment. In this study the overall trend of fever was more easily seen with cusum plotting and timing of empirical antifungal treatment was easier. In neutropenic patients who fail to respond to treatment with broad spectrum antibiotics empirical antifungal treatment is started on the fifth or sixth day of fever. This study also showed that when patients remain febrile (that is, the gradient of the cusum plot does not change appreciably) defervescence was achieved within 24-48 hours after addition of antifungal agents. Prospective cusum plotting of temperature indicates almost immediately failure of empirical antibacterial agents or the need for empirical antifungal treatment and thus has a place in day to day management of fever in neutropenic patients.