[Chronic urinary tract infections in childhood].
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Biomedical subjects
Publications and source records attributed to F Daschner.
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The pharmacokinetic properties of ceftizoxime, a new beta-lactamase-resistant cephalosporin, were investigated in 27 patients following perioperative antimicrobial prophylaxis. 2 g of ceftizoxime were injected before surgery and the concentrations measured in serum, muscle and renal tissue over a period of 30 min to 7 h. The pharmacokinetic data indicated high and long-lasting concentrations of ceftizoxime, especially in the renal tissue; this makes the drug ideal for the treatment of complicated urinary tract infections with obstruction and involvement of the renal tissue, provided the bacteria present are sensitive. The administration of 2 g i. v. every 12 h should be sufficient. In view of the high and long-lasting concentrations, it should be possible to treat uncomplicated urinary tract infections with a single dose of 2 g every 24 h. However, Enterococci, Bacteroides and Pseudomonas aeruginosa are not sufficiently sensitive to ceftizoxime and a combination with an aminoglycoside is thus indicated in the treatment of high-risk patients in the absence of bacteriological tests.
Thirty-six patients received an intravenous bolus injection of 2 g cefoxitin over 5 min at various times before abdominal or vaginal hysterectomy. Cefoxitin levels in myometrium and salpinges were substantially higher than those in endometrium and almost as high as those in serum during the first two hours following the i. v. administration of the drug. Tissue concentrations of 8 micrograms/g could be maintained for two hours. The cefoxitin tissue concentrations attained in myometrium, endometrium and salpinges justify controlled prospective clinical studies on the prevention of postoperative wound infections with this antibiotic.
4 g mezlocillin as a five-minute intravenous bolus were given preoperatively to 31 adult patients undergoing open-heart surgery. Mezlocillin serum levels declined from 42.8 mg/l at 1-2 h after injection to less than 1 mg/l at 6-8 h after application. Concentrations in muscle and subcutaneous tissue varied between 18 micrograms/g and less than 1 microgram/g. Mezlocillin levels in heart valves were higher than those in muscle and subcutaneous tissue, thus suggesting rapid diffusion of mezlocillin.
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The correlation between aminoglycoside consumption patterns and the occurrence of aminoglycoside-resistant bacteria from 12 different countries was analyzed. Regional and national data were collected retrospectively and compared. There was evidence of a wide variation of the national aminoglycoside consumption patterns in the different countries. There was a striking correlation of gentamicin resistance and the total national aminoglycoside and national gentamicin consumption. In addition, there was a clear correlation between bacterial resistance inside and outside the hospital to the total amount of aminoglycoside, particularly gentamicin, consumption in hospitals. In a number of countries, an increase in the frequency of gentamicin-resistant bacterial strains could be noticed. For amikacin, only a correlation of staphylococcal resistance in hospitalized patients to the total amount of national aminoglycoside and amikacin consumption could be found.