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Biomedical subjects

A M Geddes

Publications and source records attributed to A M Geddes.

At least 37 records · Page 2Linked to original sources
PubMed1988

The impact of a policy of collaborative management on mortality and morbidity from infective endocarditis.

The present study represents a comprehensive retrospective review of endocarditis in a large district general hospital since the inception of a formalized policy involving collaborative management a decade ago. The principle was to involve a recognised team of cardiologists, specialists in infectious disease and microbiologists in the treatment of the disease from the moment of its diagnosis. The pattern of infection has not altered in terms of prevalent organisms and valves infected since the change in management policy. There has, however, been a significant decline in the mortality, from 34 to 24% for all patients with endocarditis. Amongst those referred for collaborative management, the mortality has fallen to 6%. The single greatest improvement is a reduction in the number of patients dying of heart failure, the number of patients developing systemic emboli or requiring prosthetic valve replacement remaining unchanged. The results indicate that early referral to, and treatment by, a multidisciplinary team can significantly reduce the mortality from bacterial endocarditis.

Adolescent↗
PubMed1988

A clinical, microbiological and pharmacokinetic study of ciprofloxacin plus vancomycin as initial therapy of febrile episodes in neutropenic patients.

Forty-six episodes of fever in 34 patients with neutropenia and haematological malignancy were treated empirically with a combination of ciprofloxacin and vancomycin. Improvement or temporary improvement was seen in 86% of evaluable episodes, and 75% of bacteraemias improved. There was no difference in the response rate between infections due to Gram-negative and those due to Gram-positive organisms, despite the fact that MICs for ciprofloxacin for Gram-negative organisms were generally much lower. Pharmacokinetic data were obtained from five patients while receiving iv ciprofloxacin and after conversion to the oral form of the drug. The mean plasma half life on 200 mg iv was 5.7 +/- 1.7 h and mean plasma clearance 389 ml/min. The peak serum level after 750 mg orally was 3.6 +/- 2.2 mg/l and occurred between 1 and 3 h.

Adolescent↗
PubMed1987

Antiviral therapy.

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Adjuvants, Immunologic↗
PubMed1987

Cerebral toxoplasmosis in a patient with Hodgkin's disease.

A case is described of a patient presenting with enlarged lymph nodes and in whom a diagnosis of acute toxoplasmosis was made. The patient later developed Hodgkin's disease for which chemotherapy was started. Reactivation of the quiescent toxoplasma infection took place with devastating results. Prophylactic treatment in such cases is discussed.

Brain Diseases↗
PubMed1987

The clinical and echocardiographic diagnosis of infective endocarditis.

We report the results of a series of 75 patients admitted to the East Birmingham Hospital between 1976 and 1984. Rheumatic heart disease is now an uncommon predisposing factor. The viridans streptococci are a decreasing cause of infection while staphylococcal infections are increasing and often occur on previously normal heart valves. The presenting symptoms of the disease are usually non-specific and the classical physical signs of endocarditis are uncommon. Blood culture and echocardiography are the most useful investigations in establishing the diagnosis. The diagnosis of endocarditis should be considered in all febrile patients, especially if they are ill, who have a cardiac murmur or persistent bacteraemia.

Aged↗
PubMed1987

Cephalosporins in gram-positive infections.

Infections caused by Gram-positive bacteria are an important and common cause of morbidity and mortality. Staphylococci and streptococci are the most frequent infecting organisms in skin and soft tissue infections, pneumonia, bone and joint infections, and endocarditis. Anaerobic Gram-positive bacteria such as Clostridia spp. cause infections that can rapidly produce tissue necrosis and death. The cephalosporins are indicated for the treatment of infections caused by Gram-positive bacteria in certain circumstances. These include selected patients with endocarditis, osteomyelitis, septic arthritis and cellulitis. They are also used as alternatives to the penicillins in penicillin-allergic patients and for 'mixed' infections caused by Gram-positive and Gram-negative organisms. This article discusses the indications for the cephalosporin group of antibiotics in patients suffering from infections caused by Gram-positive bacteria.

Animals↗
PubMed1986

Trimethoprim in enteric fever.

Seventy-one patients suffering from typhoid or paratyphoid fever were treated with trimethoprim. Sixty-three were cured. Only three patients continued to excrete Salmonella typhi in stools at the time of discharge from hospital. Trimethoprim alone is a suitable agent for the treatment of enteric fever.

Adolescent↗
PubMed1986

Preliminary evaluation of ciprofloxacin, a new 4-quinolone antibiotic, in the treatment of febrile neutropenic patients.

Twenty-four episodes of fever in neutropenic patients with haematological malignancy were treated with ciprofloxacin. In 13 episodes ciprofloxacin was used after failure of first-line antibiotic therapy, and in 11 episodes because of a history of allergy to the proposed first line antibiotics. Improvement or temporary improvement was seen in 64% of patients with evaluable infection. Fifty per cent of patients with bacteraemia improved. Resistance to ciprofloxacin developed in strains of staphylococci and streptococci, but Gram-negative organisms were generally extremely sensitive to the antibiotic. One patient developed a severe photosensitivity rash but there were no other adverse reactions. Preliminary pharmacokinetic data were obtained following intravenous infusion of 400 mg of ciprofloxacin in five patients. The mean plasma half-life was 3.6 +/- 1.0 h and the mean plasma clearance was 8.42 +/- 2.5 ml/min/kg.

Adult↗
PubMed1986

Alteration of the body flora by antibiotics--can it be avoided?

It is not possible to avoid completely the undesirable consequences of antibiotics on the microflora of the human body, but their occurrence can be reduced significantly and to some degree controlled by a number of measures. These include: Rational antibiotic prescribing by individual clinicians. The construction and implementation of hospital antibiotic policies for the treatment and prophylaxis of infection. Good hospital hygiene. Isolation of patients colonized or infected by organisms resistant to certain antibiotics. National and international control of antibiotic use in humans and in animals.

Animals↗
PubMed1985

The activity of imipenem on Legionella pneumophila, with a note on the treatment of two cases.

An in-vitro assessment of the activity of imipenem, a new carbapenem beta-lactam antibiotic, was undertaken on isolates of Legionella pneumophila. The minimum inhibitory concentrations of imipenem were in the range 0.03 to 0.25 mg/l and turbidimetric studies showed that imipenem had a marked bactericidal effect which was more pronounced than that seen with either rifampicin or erythromycin. Two patients with legionella pneumonia were successfully treated with imipenem as part of a clinical trial of the drug.

Dose-Response Relationship, Drug↗
PubMed1985

Sulbactam/ampicillin: effects on glucose metabolism in diabetics with soft tissue infection.

Rats and dogs chronically treated with high doses of sulbactam are known to sequester protein-bound glycogen in their hepatocytes. As a result, previous UK studies of sulbactam/ampicillin excluded patients suffering from diabetes mellitus. This study examined the effects of sulbactam/ampicillin compared to flucloxacillin/ampicillin on diabetic control, the ability to mobilize glycogen and the pancreatic beta cell response to glucagon, in diabetic patients suffering from soft tissue infection. There was no significant effect between treatment groups on any of these parameters. Sulbactam/ampicillin is unlikely to have an adverse effect on diabetic control in clinical practice when used short term in the doses employed in this study.

Ampicillin↗