An open-label, nonrandomized, multicenter study was designed to evaluate the efficacy and safety of intravenous (i.v.) ciprofloxacin, followed by oral ciprofloxacin and/or some other antimicrobial, as presumptive (empiric) therapy in hospitalized patients with clinical and bacteriologic evidence of infection. Out of a total of 149 patients recruited by 31 physician investigators, 148 were assessable for the determination of clinical efficacy and 102 patients were assessable for bacteriologic efficacy. All 149 patients were included in the evaluation of the safety of i.v. ciprofloxacin. The mean duration of IV ciprofloxacin therapy was 6 days, and 111 patients were subsequently switched to oral treatment with ciprofloxacin and/or some other antimicrobial. A clinically favorable response was achieved using i.v. ciprofloxacin in 48 (75%) of 64 patients with pneumonia; 4 (80%) of 5 patients with other lower respiratory tract infection (LRTI); 21 (88%) of 24 patients with pyelonephritis; all 7 (100%) patients with complicated cystitis; 16 (94%) of 17 patients with other complicated urinary tract infection (UTI); all 8 (100%) patients with cellulitis; both (100%) patients with infected ulcer; 4 (80%) of 5 patients with other skin or skin structure infection; 5 (83%) of 6 patients with bone infections; all 8 (100%) patients with septicemia; the 1 (100%) patient with acute cholecystitis; and the 1 (100%) patient with liver abscess. Of the 88 patients from these infection categories who were switched to oral ciprofloxacin, only 2 patients (2.3%) were classified as a clinical failure at the end of all therapy. Eradication of the causative pathogen was demonstrated with i.v. ciprofloxacin in 18 (55%) of 33 assessable patients with pneumonia; 1 (25%) of 4 patients with other LRTI; 17 (81%) of 21 patients with pyelonephritis; 3 (43%) of 7 patients with complicated cystitis; 9 (69%) of 13 patients with other complicated UTI; 3 (60%) of 5 patients with cellulitis; neither (0%) of the 2 patients with infected ulcer; 3 (50%) of 6 patients with other skin or skin structure infection; 2 (33%) of 6 patients with bone infections; and 4 (80%) of 5 patients with septicemia. A causative pathogen was not isolated in the 1 patient with liver abscess; initial bacteriologic culture was not available for the patient with acute cholecystitis. Of the 56 bacteriologically assessable patients from these infection categories who were switched to oral ciprofloxacin, there were only 3 patients (5.4%) in whom the causative bacterial pathogens were not successfully eradicated at the end of all therapy. There were no unexpected adverse events with the use of i.v. ciprofloxacin.(ABSTRACT TRUNCATED AT 400 WORDS)

Administration, Oral↗

PubMedDate not supplied

Failure of intrapartum antibiotics to prevent culture-proved neonatal group B streptococcal sepsis.

Early-onset group B streptococci (GBS-EOS) sepsis may be prevented by intrapartum antibiotics administered for GBS maternal colonization, premature labor, or prolonged rupture of membranes. We sought to identify cases of neonatal GBS sepsis after apparent failure of intrapartum chemotherapy and to determine the factors associated with failure of intrapartum antibiotics in these cases. We identified 96 GBS blood culture-positive infants at five military medical centers from 1987 to 1990. Eighteen (18.7%) of these infants had mothers who had received intrapartum antibiotics; 16 of 18 cases were early-onset disease, 15 of which initially had symptoms at less than 1 hour of age. Two infants had late-onset disease develop at 3 weeks of age. At least one perinatal risk factor (prematurity, prolonged rupture of membranes > 12 hours, maternal fever) was present in each of the 16 cases. Indications for intrapartum antibiotics were suspected chorioamnionitis (13 cases), GBS colonization and prolonged rupture of membranes or prematurity (3), and GBS colonization alone (2). Maternal antibiotics included ampicillin (14 cases), cephadyl (1), vancomycin (1), clindamycin (1), and gentamicin alone (1). The median number of doses of ampicillin before delivery was 1 (range, 1 to 21), which was administered at a median of 4 hours (range, 1 to 84) before birth. The mean dose of ampicillin was 1.8 gm/dose (range, 1 to 2 gm/dose). Two of 16 (12.5%) infants with GBS-EOS died as a result of GBS sepsis. In our population of neonates with GBS-EOS, 18.4% (16 of 87) of the infants had positive blood cultures despite intrapartum antibiotics. Intrapartum antibiotics may fail to prevent GBS sepsis in a number of infants born to mothers colonized with GBS or to those with acute chorioamnionitis.

Ampicillin↗

PubMedDate not supplied

Audit of nutrition screening in patients with acute illness.

This paper describes a nine-month comparative audit project looking at the assessment and management of patients' nutritional status. The findings show a significant improvement in nutritional management following a staff training programme.

Acute Disease↗

PubMedDate not supplied

Managing terminal illness.

Explore the source record for details and available documents.

Health Personnel↗