A major focus of research for my laboratory is to identify and determine the significance of drug interactions with popular botanical (herbal) products. Presently I am part of a collaborative effort to study the potential adverse interactions involving cranberry extracts and beta lactam antibiotics. Concurrent use of cranberry and antibiotics is common in women with urinary tract infections. I am also a participant in a project to evaluate the sleep effects in humans of valerian extract and to correlate effects with the pharmacokinetics of the valerian constituent, valerenic acid.

Another focus of research has been to define the impact of antibiotics on the gut flora and to identify ways of minimizing the adverse effects of the perturbations (diarrhea and colitis). Our approach has been to replace the normal bacteria eliminated by antibiotics with innocuous microorganisms that have inhibitory activities against pathogens. We have successfully used the yeast, Saccharomyces boulardii, in human clinical trials to prevent antibiotic-associated diarrhea and to treat pseudomembranous colitis.

Recent Publications

Journal Articles:

R. Fekety, L.V. McFarland, C.M. Surawicz, R.N. Greenberg, G.W. Elmer, and M. E. Mulligan, "Recurrent Clostridium difficile Diarrhea: Characteristics of and risk factors for patients enrolled in a prospective, randomized, double-blinded trial" Clin. Infec. Dis. 24, 324-333 (1997).

L. V. McFarland and G. W. Elmer, "Pharmaceutical Probiotics for the Treatment of Anaerobic and Other Infections" Anaerobe 3,73-78 (1997).

G. W. Elmer and L. V. McFarland, Comment on "The Lack of Therapeutic Effect of Saccharomyces boulardii in the Prevention of Antibiotic-related Diarrhoea in Elderly Patients" [letter] J. Infection 37,307-308 (1998)

L. V. McFarland, C. M. Surawicz, M. Rubin, R. Fekety, G. W. Elmer and R. N. Greenberg. "Recurrent Clostridium difficile disease: epidemiology and clinical characteristics" Infection Control and Hospital Epidemiology 20:43-50 (1999).

G. W. Elmer, S. W. Martin, K. L. Horner, L. V. McFarland and R. H. Levy. "Survival of Saccharomyces boulardii in the Rat Gastrointestinal Tract and Effects of Dietary Fiber" Microbial Ecology in Health and Disease 11:29-34 (1999)

G. W. Elmer, R. Vega, M. A. Mohutsky and L. V. McFarland. "Variable Time of Onset of Clostridium difficile Disease Initiated by Antimicrobial Treatment in Hamsters" Microbial Ecology in Health and Disease 11:163-168 (1999).

G.W. Elmer, L.V. McFarland, C.M. Surawicz, L. Danko and R.N. Greenberg. "Behavior of Saccharomyces boulardii in recurrent Clostridium difficile disease patients" Aliment. Pharmacol. Ther. 13: 1663-1668 (1999).

D. Levy, A. Stergachis, J. Clouse, K. Van Vorst, E. Johnson, D. Graham, B-J Park, D. Shatin, L. V. McFarland, and G. W. Elmer. "Antibiotics and Clostridium difficile Diarrhea in the Ambulatory Setting" Clinical Therapeutics 22:91-102 (2000).

K. L. Horner, R. C. Le Boeuf, L. V. McFarland and G. W. Elmer "Dietary Fiber Effects on Clostridium difficile Disease in Hamsters" Nutrition Res. 20:1105-14 (2000).

C. M. Surawicz, L. V. McFarland, R. N. Greenberg, M. Rubin, R. Fekety, M.E. Mulligan, R. J. Garcia, S. Brandmarker, K. Bowen, D. Borjal and G. W. Elmer. "The Search for a Better Treatment for Recurent C. difficile disease: The Use of High Dose Vancomycin Combined with Saccharomyces boulardii" Clinical Infectious Diseases 31:1012-1017 (2000).

G. W. Elmer. "Probiotics: "Living Drugs" Am J Health-Systems Pharmacy. 2001; 58: 1101-1107.

A. Y. Lam, M. A. Mohutsky and G. W. Elmer. "Probable Herbal/Drug interaction between warfarin and a common Chinese Herb, Lycium barbarum" Ann Pharmacother., 35: 1199­1201 (2001).

C. A. Krone, G. W. Elmer, J. T. A. Ely, H. H. Fudenberg and J. Thoreson. "Does Gastrointestinal Candida albicans prevent ubiquinone absorption?" Medical Hypotheses 57:570-572 (2001).

L.V. McFarland, C. M. Surawicz and G. W. Elmer. "Breaking the cycle: Treatment Strategies for 163 Cases of Recurrent C. difficile Disease" Am J Gastroenterology. 97:1769-1775 (2002).

G. N. Scott and G. W. Elmer. "Update on Drug and Natural Product Interactions" Am J Health-Sys Pharm 59:339-347 (2002).

G. W. Elmer. Commentary: "Probiotics: Using Live Microbes to Decrease Antimicrobial Use" Alliance for the Prudent use of Antibiotics Newsletter 20:1-5 (2002).

G. D. Anderson, G. Rosito, M. A. Mohustsy and G. W. Elmer "Drug Interaction Potential of Soy Extract and Panax ginseng" Clin Pharmacol Ther 43:643-648 (2003).

M. A. Mohutsky, G. D. Anderson, J. W. Miller and G. W. Elmer "Ginkgo biloba Inhibits Cytochrome P450 2C9 In Vitro but not In Vivo" J Pharm Sci submitted 2003

S. W. Martin, R. Vega, K. Horner, L. V. McFarland and G. W. Elmer "A Physiologically Based Pharmacokinetic Medel to Describe the Disposition of Saccharomyces boulsrdii in the Intestinal Tract of Rats" Pharmaceutical Res submitted 2003.

Anderson GD, Elmer GW, Kantor ED, Templeton IE, Vitiello MV. Pharmacokinetics of valerenic acid after administration of valerian in healthy subjects. Phytother Res. Sep 2005;19(9):801-803.

Taibi DM, Vitiello MV, Barsness S, Anderson GD, Elmer GW, Landis CA. A randomized clinical trial of valerian fails to improve subjective and objecctive sleep quality of older women with sleep distrubance. Sleep Med. in press.

Book Chapters:

S. W. Martin, A. C. Heatherington and G. W. Elmer, "Pharmacokinetics of Probiotics" In: Biotherapeutic Agents and Infectious Diseases (G. W. Elmer, L. V. McFarland, and C. M. Surawicz, eds.) Humana Press pp. 106-120 (1999).

G. W. Elmer and L. V. McFarland, "Biotherapeutic Agents in the Treatment of Infectious Diseases" In: Gastroenterology Clinics of North America (C. M. Surawicz, ed.) W. B. Saunders, Philadelphia. vol. 30, pp. 837-854 (2001)

G. W. Elmer and L. V. McFarland, "Biological Properties of Evidenced-based Probiotics" In: Probiotics in Food Safety and Human Health (I. Goktepe and V. Juneja, eds.) Marcel Dekker, New York. in press (2004)

Books:

H. M. Silverman, J. A. Romano, and G. W. Elmer, "The Vitamin Book", Bantam Press, 1999.

G. W. Elmer, L. V. McFarland, and C. M. Surawicz, editors. "Biotherapeutic Agents and Infectious Diseases" Humana Press, 1999.

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