Influence of furosemide diuresis on antimicrobial treatment of pyelonephritis due to Escherichia coli.
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Biomedical subjects
Publications and source records attributed to D Kaye.
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Cefazolin sodium, a cephalosporin for parenteral use, was evaluated in vitro and in 26 patients. Cefazolin had activity equivalent to cephalothin against Streptococcus pneumoniae, Staphylococcus aureus, group A streptococci, and Proteus mirabilis. Cefazolin was four- to eightfold more active against Escherichia coli and slightly more active against Klebsiella pneumoniae, whereas cephalothin was slightly more active against indole-positive Proteus species. After a 500-mg dose of cefazolin intramuscularly, peak concentrations in the serum were high enough to inhibit all strains of S. pneumoniae, S. aureus, group A streptococci, E. coli, K. pneumoniae, and P. mirabilis, as well as 60% of strains of Proteus species other than P. mirabilis. All of 26 patients (18 with pneumonia, 6 with urinary tract infection, and 2 with skin infections) responded clinically and bacteriologically to cefazolin therapy. There were no major side effects of therapy, and no patient complained of pain at the site of intramuscular injection. Cefazolin is an effective cephalosporin which can be used intramuscularly for therapy of serious bacterial infections. Its major advantages over other cephalosporins are higher, more sustained concentrations in the blood and apparent lack of pain on intramuscular injection.
In a double-blind study with each patient as his own control cephapirin and cephalothin were administered to 20 patients in opposite arms for a period of 48 hr each. Neither the incidence of phlebitis nor the degree of phlebitis was significantly different with the two drugs, and there was no difference in the time of onset of pain or phlebitis.
Ten chronic enteric typhoid carriers treated with oral ampicillin have been followed for 4 to 9 years and no relapses have occurred. Patients are probably cured if relapse does not occur within 2 years.
Against more than 90% of 200 bacterial strains tested in vitro, the inhibitory concentration of gentamicin and tobramycin was 3.1 mug/ml and that of BB-K 8, a new semisynthetic aminoglycoside derivative of kanamycin, was 6.3 mug/ml.
Carbenicillin indanyl sodium, ampicillin, or cephalexin was administered orally to 61 patients with urinary tract infections. Assignment of drug was made by a computer-generated, randomized plan in a double-blind fashion. The rates of cure 4 weeks after therapy were 50, 42, and 50% for patients treated with carbenicillin, ampicillin, and cephalexin, respectively. Failure of therapy was correlated with chronicity of infection and sensitivity of the microorganism to the antibiotic used. Thirty-nine percent of the patients developed side effects, but there were no significant differences in side effects among the three antibiotics. This double-blind study demonstrates that carbenicillin indanyl sodium is as effective as ampicillin and cephalexin in treatment of urinary tract infections.
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Cephapirin sodium, a cephalosporin for parenteral use, was evaluated in vitro and in 27 patients. Cephapirin had activity equivalent to cephalothin against 25 strains each of Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, and Staphylococcus aureus; 10 strains each of Diplococcus pneumoniae, Pseudomonas species, and Enterobacter species; and 8 strains of Proteus species other than P. mirabilis. All strains of S. aureus and D. pneumoniae and most strains of E. coli, K. pneumoniae, and Proteus species were inhibited by concentrations of cephapirin achieved in the serum. Of 27 patients (20 with pneumonia, 2 with S. aureus empyema, and 5 with miscellaneous infections), 25 responded to cephapirin therapy. The only major toxicity thought to be drug-related occurred in a patient who developed reversible bone marrow depression with leukopenia, neutropenia, and anemia. Although cephapirin was painful on intramuscular injection, phlebitis and pain were absent in patients treated intravenously. In a controlled comparison of intravenously administered cephalothin and cephapirin in four additional patients, the latter caused much less pain than the former and caused no phlebitis.
A case of neutropenia associated with cephapirin therapy is described. After discontinuation of cephapirin therapy, the neutrophil count returned to normal. Bone marrow examination revealed a marked reduction of polymorphonuclear leukocytes beyond the metamyelocyte stage and eosinophilia.
The incidence of isolation of Staphylococcus aureus strains resistant to methicillin is increasing in England and other European countries, whereas there have been only isolated reports of resistance in the United States. We thought this contrast might be related to the use of special sensitive screening techniques (i.e., incubation at 30 C, prolonged incubation, use of 5% sodium chloride-agar medium, and use of a large inoculum) in these other countries. A survey was undertaken in a hospital in Philadelphia to detect methicillin-resistant S. aureus. In spite of using large inocula, 5% sodium chloride-agar medium, and prolonged incubation at 30 C, no strains of S. aureus resistant to methicillin were found.
One hundred fifty-two strains of Escherichia coli, Klebsiella-Enterobacter, Pseudomonas aeruginosa, Proteus species, and Staphylococcus aureus were inhibited by 3.1 mug of tobramycin/ml in a broth-dilution method and showed zones of inhibition of 16 mm or more around a 10-mug tobramycin disc in the Kirby-Bauer method. Tobramycin was most active against S. aureus, 100% of strains being inhibited by 0.1 mug/ml. All strains of E. coli, K. pneumoniae, P. aeruginosa, and indole-positive Proteus species, and 80% of Enterobacter species were inhibited by 0.8 mug of tobramycin/ml, whereas only 48% of P. mirabilis strains were inhibited by this concentration. Tobramycin was approximately twice as active as gentamicin against S. aureus, four times as active against P. aeruginosa, slightly more active against E. coli and Enterobacter species, equally active against P. mirabilis, and slightly less active against K. pneumoniae. The minimal bactericidal concentrations of tobramycin and gentamicin were the same as or twice the minimal inhibitory concentrations for all strains except those of P. aeruginosa, against which greater concentrations of both gentamicin and tobramycin were required for bactericidal activity. Tobramycin sterilized cultures of S. aureus, E. coli, and P. aeruginosa, but the rate of bactericidal action was faster with a combination of tobramycin and carbenicillin than with either antibiotic alone in the same concentrations. Tobramycin retained potency in the presence of 200 to 600 mug of carbenicillin/ml for at least 6 hr of incubation at 37 C, but lost potency in the presence of 600 mug of carbenicillin/ml by 24 hr of incubation and in the presence of 800 mug/ml by 2 hr of incubation.
In the present studies, the effect of ampicillin (40 mg intramuscularly twice a day) in combination with water diuresis, produced by the ingestion of 5% dextrose in water, was determined on renal titers of enterococci after intravenous inoculation of 4 x 10(8)-2 x 10(9) enterococci into rats. Ampicillin injections with or without diuresis were started 4 or 21 days after initiation of infection and continued for 7 or 14 days. In comparison to controls (saline injections in rats drinking tap water), diuresis plus saline injections did not lower renal titers of enterococci. Injection of ampicillin in nondiuresing rats had little effect on renal titers of enterococci after 7 days of treatment started 4 or 21 days after initiation of infection. However, 2 wk of ampicillin therapy resulted in a significant decrease in renal titers. The addition of water diuresis to ampicillin treatment markedly potentiated the effect of ampicillin alone in decreasing renal titers of enterococci after 1 or 2 wk of therapy.These studies demonstrate that diuresis resulting from administration of dextrose in water plus ampicillin starting 4 or 21 days after intravenous injection of enterococci reduces renal titers more than ampicillin or diuresis alone.