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Biomedical subjects

A M Ristuccia

Publications and source records attributed to A M Ristuccia.

15 recordsLinked to original sources
PubMed1992

Teicoplanin in the treatment of bone and joint infections. Teicoplanin Bone and Joint Cooperative Study Group, USA.

Teicoplanin is a new glycopeptide antibiotic with activity against Gram-positive bacteria, including methicillin-resistant organisms. Teicoplanin is administered once daily, either intravenously or intramuscularly. Teicoplanin was given once daily, intravenously or intramuscularly, in the treatment of hospitalized or ambulatory patients with Gram-positive bone or joint infections. A total of 90/98 patients were evaluated for efficacy; 41 had acute osteomyelitis, 41 had chronic osteomyelitis, and 8 had septic arthritis. At the end of therapy, 37 acute osteomyelitis patients were cured/improved with a 90% cure rate at 6-month follow-up; 2 relapsed and 1 failed. At the end of therapy 30 chronic osteomyelitis patients were cured/improved with an 88% cure rate at 6-month follow-up; 2 relapsed and 1 failed. 100% of the septic arthritis patients were cured at the end of therapy and at 1-month follow-up. The most common bacterial isolates cultured from bone were S. aureus (39 isolates), S. epidermidis (11 isolates), other coagulase-negative staphylococci (20 isolates), enterococci (6 isolates), and other streptococcal species (20 isolates). The most common bacterial isolates cultured from joint fluid were S. aureus (6 isolates) and S. epidermidis (2 isolates). All patients tolerated the intramuscular or intravenous routes of administration well. Adverse reactions were mild and most cases did not require discontinuation of therapy. The majority of therapy was administered on an outpatient basis. Teicoplanin was safe, effective, convenient and relatively well tolerated in patients with acute or chronic osteomyelitis or septic arthritis.

Acute Disease↗
PubMed1990

Pseudomonas aeruginosa infections in the podiatric patient.

Pseudomonal infections of the skin, soft tissue, bone, and toe web may often be very difficult to treat. This article reviews the microbiology, pathogenesis, and treatment of pseudomonal infections that are related to podiatric medicine and surgery.

Anti-Bacterial Agents↗
PubMed1985

An overview of amikacin.

Amikacin, a semisynthetic analog of kanamycin, is very active against most gram-negative bacteria including gentamicin- and tobramycin-resistant strains. The effectiveness of amikacin in the treatment of serious gram-negative bacillary infections is well documented. Due to its resistance to inactivating enzymes, it is the aminoglycoside of choice for the treatment of known or suspected serious gram-negative infections caused by organisms resistant to gentamicin or tobramycin. Amikacin should be part of an empiric antibiotic regimen for the therapy of suspected sepsis in febrile, leukopenic immunocompromised hosts since it exhibits enhanced activity against the organisms most frequently encountered in this patient population. High response rates have been reported with the use of amikacin combined with beta-lactam antibiotics in immunocompromised or granulocytopenic patients. It exhibits impressive in vitro synergy against aminoglycoside-sensitive and -resistant organisms when used in combination with the new acylureidopenicillins and third-generation cephalosporins. Amikacin has the advantage of being the aminoglycoside least inactivated by the semisynthetic penicillins. Amikacin achieves high and predictable serum concentrations and has a favorable therapeutic index. Its potential for nephrotoxicity and ototoxicity is not significantly different than that encountered with gentamicin or tobramycin. Amikacin appears to be the preferred aminoglycoside for use at the present time because of its activity against gentamicin- and tobramycin-resistant organisms, its low resistance potential, its relative low degree of inactivation by the semisynthetic penicillins, and its superior pharmacokinetic profile.

Amikacin↗
PubMed1985

Symposium on infections in the compromised host. Hematologic effects of cancer chemotherapy.

Use of the antineoplastic agents frequently causes myelosuppression and neutropenia. Neutropenic patients often fail to manifest the usual signs and symptoms of infection; they are unable to mount an adequate inflammatory response and infection disseminates rapidly. There is a direct correlation between the degree of granulocytopenia and the incidence and severity of infections. During the period of granulocytopenia (the vulnerable period) the risk of infection is high. While safeguarding the patient throughout the entire period of hospitalization, nurses should be more vigilant during this time. They must be alert to subtle signs of infection and the patient should be monitored closely for increased temperature (greater than or equal to 101 degrees F), mouth sores, sore throat, cough, congestion, or dysuria. The patient undergoing chemotherapy faces many threats to survival. This patient also offers an extraordinary challenge to nursing practitioners because good care may significantly improve the patient's quality and length of life.

Antineoplastic Agents↗
PubMed1984

Comparison of bioassay, high-performance liquid chromatography, and fluorescence polarization immunoassay for quantitative determination of vancomycin in serum.

This investigation was designed to compare three assay techniques, the traditional bioassay (agar diffusion), and two more recent techniques, high-performance liquid chromatography (HPLC) and fluorescence polarization immunoassay (FPIA), for the determination of vancomycin concentrations in serum. One hundred clinical samples obtained from patients receiving vancomycin were assayed by each method. The results from each assay were compared using linear regression analysis. The resultant correlation coefficients were as follows: 0.9996 for the HPLC versus FPIA, 0.7773 for the FPIA versus bioassay, and 0.7779 for HPLC versus bioassay. The FPIA technique was the easiest and fastest of the three methods; FPIA and HPLC were the most accurate.

Biological Assay↗
PubMed1982

Current concepts in antimicrobial therapy of prostatitis.

Acute prostatitis usually is caused by aerobic gram-negative organisms or, to a lesser extent, the enterococci. The treatment of acute prostatitis requires the use of an antimicrobial with the appropriate spectrum for ten to fourteen days. However, treatment of chronic prostatitis is a more difficult therapeutic problem because of the relative impermeability of the noninflamed prostate to the majority of antimicrobial agents. The organisms most commonly responsible for chronic prostatitis include the aerobic gram-negative organisms, as well as chlamydia. Chlamydia may be the sole pathogens, or may be found as a copathogen with gram-negative organisms. Relatively few antibiotics have the appropriate physiochemical characteristics to penetrate the subacutely inflamed prostate. The most important determinant of tissue penetration in chronic prostatitis is the lipid solubility of the antibiotic, to a lesser extent its pKa (ionization potential), and the molecular size of the antibiotic. In general, penicillins, cephalosporins, and aminoglycosides do not penetrate well into the chronically inflammed prostate tissue. At the present time, the preferred agents in treating chronic prostatitis are trimethoprim or doxycycline. Doxycycline has the advantage of being active against chlamydia as well as the usual organisms that are responsible for chronic prostatitis. Therapy should be continued for two to three months.

Anti-Bacterial Agents↗
PubMed1982

The aminoglycosides.

Aminoglycosides remain the cornerstone of prophylaxis and therapy against the majority of aerobic gram-negative organisms responsible for serious sepsis in the hospital. Gentamicin, tobramycin, amikacin are all equally efficacious against susceptible organisms and differ only in their patterns of resistance and pharmacokinetic profiles. The ototoxic and nephrotoxic potential of gentamicin, tobramycin, and amikacin is comparable. Amikacin appears to be preferred for general use at present because of its low resistance potential and superior pharmacokinetic profile (high and predictable serum peaks, wide toxic-therapeutic ratio, high "kill ratio," and q 12 h dosing). In spite of the introduction of the third generation cephalosporins, which are highly active against a variety of aerobic gram-negative organisms, the aminoglycosides will continue to play an important role in the treatment of gram-negative infections. Indeed, the expected usefulness of aminoglycosides may be prolonged by the introduction of the third generation cephalosporins since these drugs will probably be used in combination with aminoglycosides to extend spectrum and to take advantage of possible synergy.

Aminoglycosides↗
PubMed1982

Penetration of gentamicin into burn wounds.

This study was originated in recognition that little data have been accumulated in the literature regarding concentrations of gentamicin in various infected tissues. The study was undertaken to determine if systemically administered gentamicin penetrates burn wound eschar and to determine if there is a relationship between gentamicin serum levels attained and concentration of gentamicin reaching the eschar. Five hospitalized adult patients requiring parenteral gentamicin for sepsis secondary to third-degree burns were studied prospectively. For the purpose of determining the amount of gentamicin reaching the eschar, biopsy of the burn wound eschar was performed on each patient. Venous blood samples were also obtained to examine the relationship of serial serum samples to eschar levels. Calculated pharmacokinetic parameters include elimination rate constants, apparent volume of distribution, beta, and gentamicin half-life. The data indicate that systemically administered gentamicin does penetrate burn eschar in measurable quantities. Deeper layers of eschar tissue contained significantly greater quantities of gentamicin. Analysis of variance resulted in statistically significant (p less than 0.05) rise is eschar concentration with time. A positive correlation between the peak serum gentamicin concentration and the concentration of gentamicin reaching the burn tissue was found. The quantity of gentamicin attained was sufficient to prevent proliferation of organisms cultured from the eschar of patients. Accumulation of gentamicin in the eschar occurred in every patient studied. This study suggests the eradication of organisms in eschar samples is due to the achievable concentration of gentamicin at this site.

Adult↗
PubMed1982

Doxycycline.

The chemistry, mode of action, antimicrobial activity, pharmacokinetics, and therapeutic efficacy of doxycycline are reviewed. Doxycycline displays excellent activity against gram-positive and gram-negative aerobic and anaerobic pathogens. The oral absorption of doxycycline is rapid and virtually complete and is not significantly decreased by food. Moreover, serum concentrations of doxycycline following oral and intravenous (i.v.) administration are comparable. Because of the prolonged half-life of doxycycline, once daily administration is possible. Tissue penetration of doxycycline is excellent. Levels within the therapeutic range have been found in most organs and tissues, including kidney, lung, gallbladder, prostate, intestinal tract, myocardium, sinus secretions, tonsil, aqueous humor, and female reproductive tissue. Doxycycline does not accumulate in patients with renal insufficiency and is not removed from the blood to any great extent during hemodialysis. Extensive clinical investigation has shown doxycycline to be highly effective in infections of the respiratory tract, including atypical pneumonias; skin and soft tissue; genitourinary infection including gonorrhea, syphilis, nonspecific urethritis, and prostatitis; intraabdominal infection due to trauma, sepsis, or surgery; and cholera. Evidence also suggests that doxycycline will prove effective in the treatment of Legionnaires' disease. In addition, placebo-controlled clinical trials suggest doxycycline is effective in the prevention of traveler's diarrhea.

Abdomen↗
PubMedDate not supplied

Clinical usefulness of vancomycin.

The antibacterial spectrum, pharmacokinetics, and clinical uses of vancomycin are reviewed. Vancomycin interferes with peptidoglycan biosynthesis in multiplying organisms and is bactericidal. It is supplied as the hydrochloride salt and is available in 500-mg ampuls. Vancomycin is usually administered intravenously or orally. I.V. vancomycin should be administered slowly (over 30--60 min) and in an adequate volume (100--250 ml) of 5% dextrose injection. Usual adult dose is 500 mg every six hours or 1 g every 12 hours. Serum vancomycin kinetics are best explained on the basis of a two- or three-compartment open model. Vancomycin is almost completely eliminated through the kidneys. Mean vancomycin concentrations in the presence of inflamed meninges, pleural fluid, pericardial fluid, ascitic fluid, synovial fluid, and bile are approximately 15% of the serum concentrations. Vancomycin is used prophylactically to prevent infections caused by gram-positive cocci. Vancomycin is an ideal drug for prophylaxis in prosthetic implant surgery because of its long serum half-life and activity against Staphylococcus epidermidis and Staph. aureus. Vancomycin has been used in the prevention and treatment of shunt infection in hemodialysis patients. It can be used adjunctly with a number of antibiotics to treat a variety of bacterial infections. Vancomycin is recognized as one of the most potent antistaphylococcal drugs available. It is the drug-of-choice in the treatment of serious methicillin-resistant Staph. aureus infections. It is the preferred therapy for Clostridium difficile (antibiotic-associated) colitis.(ABSTRACT TRUNCATED AT 250 WORDS)

Bacteria↗