Quinolones in general practice.
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4-Quinolones↗
Biomedical subjects
G Lindsay
Publications and source records attributed to G Lindsay.
Post-marketing surveillance of quinolones 1988-1990.
It has been much easier to obtain original data on adverse drug reactions (ADR) of quinolones from the pharmaceutical industry than it was two years ago. This is to be welcomed and, as anticipated, the new data continue to suggest that the new 4-quinolones have an ADR profile which is very similar to that of other antimicrobials. Visual disturbance is not a prominent feature, in contrast to the ADR profile of nalidixic acid. Better definition of quinolone ADRs requires prospective study, and the results of a newly completed prescription event monitoring study are awaited with interest. The potential use of computerised databases and record linkage is examined, but at present the number of quinolone prescriptions is too small to assess documentation of serious but rare events such as convulsions. Physicians need to be aware of the limitations of current data on suspected ADRs. Further investment in computerised databases is required to satisfy the requirements for attributing causality of an event to a drug.
4-Quinolones↗
Taste disturbance with acetazolamide.
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Acetazolamide↗
Gonococcal infection within Scotland: antigenic heterogeneity and antibiotic susceptibility of infecting strains.
Two panels of monoclonal antibody reagents were used to serotype all strains of Neisseria gonorrhoeae isolated from four separate geographical areas serving two million of the five million Scottish population. Serotype 1B isolates accounted for 60% of the 869 strains examined and were more prevalent than 1A isolates in each geographical area. A total of 11 1A serovars and 47 1B serovars were recognised. Only two of the 11 1A serovars (Aedgkih/Arost and Aedih/Arst) were found in every centre but these accounted for over 90% of the 1A isolates. Although there was a total of 47 different 1B serovars over 80% of the isolates were accounted for by the ten most commonly encountered serovars. There were, however, marked geographical differences within both major and minor serovars. There was a highly significant difference (P less than 0.001) between protein 1A and 1B serovars with respect to their susceptibility to penicillin. Within each protein 1 type there were also differences in antibiotic susceptibility. Penicillinase-producing N. gonorrhoeae (PPNG) were found in all centres and accounted for 24 (2.8%) of the 869 isolates. The majority of the PPNG (71%) were serotype 1A and with one exception were serovar Aedih/Arst. PPNG strains accounted for 37% (16) of the 43 Aedih/Arst isolates. Epidemiological, diagnostic and therapeutic implications arising from the distinct geographical differences in the pool of circulating gonococci are discussed.
Antibodies, Monoclonal↗
A bacteriological assessment of ampicillin with sulbactam as antibiotic prophylaxis in patients undergoing biliary tract operations. The West of Scotland Surgical Infection Study Group.
A prospective audit of 644 patients undergoing biliary tract operations has been conducted in ten district general hospitals. All patients received a single dose of ampicillin 2 g and sulbactam 1 g as antibiotic prophylaxis. Bacteria were cultured from the bile of 121 patients. In patients with sterile bile the incidence of postoperative infection was 2.5%, while in those with colonized bile it was 22% (P less than 0.0001). The 35 patients from whose bile bacteria of two or more species were isolated, had a higher incidence of wound infection (34%) than those whose bile yielded only one species of bacterium (17%; P less than 0.05). Seventeen of the 27 patients with colonized bile who developed postoperative infection were shown to be infected by the same organisms that had been isolated from their bile. The patients whose bile yielded organisms resistant to the prophylactic antibiotic combination did not have a significantly higher rate of infection than those from whose bile only sensitive organisms were obtained. A marked difference in sensitivity patterns between the participating hospitals was observed.
Adolescent↗
Penetration of ciprofloxacin into the aqueous humour of the uninflamed human eye after oral administration.
One hundred and one patients received oral ciprofloxacin prior to elective cataract removal. The quinolone content of the aqueous humour ranged from 2.7% to 15.4% of the corresponding serum level. The mean aqueous peak exceeded 0.4 mg/l between 2 and 3.5 h after administration. The highest aqueous concentration was achieved with a 1 g dose. In uninflamed eyes oral ciprofloxacin achieved intraocular concentrations that are bactericidal for Gram-negative bacteria including Pseudomonas aeruginosa. It may prove useful in the treatment of established intraocular infection and in prophylaxis prior to silastic implants.
Administration, Oral↗
Relationship between bile colonization, high-risk factors and postoperative sepsis in patients undergoing biliary tract operations while receiving a prophylactic antibiotic. West of Scotland Surgical Infection Study Group.
A prospective audit of 644 patients undergoing biliary tract operations has been conducted to assess the incidence of bile colonization and its association with the incidence of postoperative sepsis when all patients received the same prophylactic antibiotic. The accuracy of the determination of high-risk factors has been assessed as has the correlation between bile colonization and patients assessed as 'high risk'. Organisms were cultured from the bile of 121 (19 per cent) patients and among these the incidence of wound or intra-abdominal sepsis was 22 per cent whereas among patients with sterile bile the incidence was only 2 per cent (P less than 0.0001). Although the incidence of bile colonization within the high-risk group (32 per cent) was more than twice that in the low-risk group (14 per cent), more than half (54 per cent) of the patients with positive bile cultures were in the low-risk group. It is concluded that, despite prophylactic antibiotics, bile colonization remains the major factor associated with postoperative sepsis, but that this cannot be predicted accurately by preoperative assessment of high-risk factors. Furthermore, we believe that a policy of selective administration of prophylactic antibiotics solely to high-risk patients cannot be justified.
Adult↗
A multicenter study to compare cefotetan alone with cefotetan and metronidazole as prophylaxis against infection in elective colorectal operations.
The role of antibiotic prophylaxis in operations upon the colon and rectum is now well recognized. In this study, the efficacy of cefotetan, a broad spectrum cephamycin antibiotic, given alone (n = 315), is compared with that of the combination of cefotetan and metronidazole (n = 300). The groups were well matched for age, sex, pathologic features and operations performed. There was no statistical difference in the incidence of operation-related infection between the two groups. We conclude that cefotetan given alone is as effective as the combination of cefotetan and metronidazole for prophylaxis against operation-related infection in elective colorectal operations.
Adult↗
A multicentre study to compare piperacillin with the combination of netilmicin and metronidazole for prophylaxis in elective colorectal surgery undertaken in district general hospitals.
We have conducted a multicentre randomized study to compare piperacillin with the combination of netilmicin and metronidazole in patients undergoing elective colorectal surgery. There was no significant difference in the incidence of operation-related infection, chest or urinary tract infection. Major life-threatening sepsis occurred in 6% and the overall incidence of operation-related infection was 24%. Organisms which normally inhabit the bowel lumen were cultured from most of the postoperative infections; however, Staphylococcus aureus was isolated as a causative organism in nine patients in the piperacillin group compared with none in the netilmicin and metronidazole group. We are concerned at the high incidence of infection in both groups, and we believe that other factors in addition to prophylactic antibiotics need to be evaluated if the incidence of infection is to be reduced further.
Adult↗
Antibiotic prophylaxis in transurethral resection of the prostate with reference to the influence of preoperative catheterization.
The value of prophylactic antibiotics in transurethral resection of the prostate (TURP) remains controversial. We have conducted a prospective study in which 308 patients undergoing TURP have been randomized to receive no antibiotic cover (n = 150) or 36 h perioperative cover with temocillin. In 62 patients the urine was found to be infected at the time of operation. In these patients the incidence of postoperative urinary-tract infection (UTI) was 33% in the group who received temocillin, and 87% in the control group (P less than 0.001). In patients with sterile urine at operation (n = 235), the incidence of postoperative UTI was 13% in the temocillin group compared with 24% in the control group (P less than 0.05). Gram-positive organisms were mainly responsible for infection which occurred in patients who had received temocillin. A high incidence of postoperative UTI occurred in patients who had required preoperative catheterization despite the fact that their preoperative urine specimen was sterile. We conclude, (i) prophylactic antibiotics are of benefit in patients undergoing TURP, (ii) the antibiotic administered should be active against both gram-positive and gram-negative organisms, (iii) patients with an indwelling catheter should be considered at a higher risk of infection whether or not organisms are cultured from their preoperative urine specimen.
Adult↗
Susceptibility of 89,517 gram-negative isolates to aztreonam and other antibiotics.
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Anti-Bacterial Agents↗
A comparative study of cefotetan and metronidazole against metronidazole alone to prevent infection after appendectomy.
The role of metronidazole in reducing the incidence of infectious complications after appendectomy has been established, but the value of an additional antibiotic to act against aerobic pathogens remains controversial. Patients who received 2 grams of cefotetan intravenously at the time of appendectomy and those who did not were compared for the incidence of infection. All patients received 1 gram of metronidazole per rectum preoperatively and every 12 hours for five days postoperatively. Infection occurred in three patients who received cefotetan and 16 of those who did not (p less than 0.01). We conclude that a single dose of cefotetan, an antibiotic which is effective against aerobic and anaerobic organisms, produces a significant reduction in the incidence of infection when added to metronidazole in the management of patients after appendectomy.
Adolescent↗
Timentin in the treatment of post-operative infections.
In an open study 50 patients were treated for a variety of infections with 3.2 g Timentin 6, 8- or 12-hourly for a mean period of six days. Timentin was clinically successful in 87% of patients assessed at the end of treatment of whom 95% remained cured or improved at a later follow-up. Bacteriologically Timentin was successful against 92% of organisms, including all 11 which were ticarcillin or ampicillin resistant. Side effects were reported in seven patients, the majority of which were minor local reactions at the site of infusion. This open study shows Timentin to be a safe and effective antibiotic for the treatment of infection.
Adolescent↗
Penetration of ciprofloxacin into aqueous humor.
Ciprofloxacin is a potentially useful antibiotic in eye infection. A pilot study was performed on 25 patients undergoing routine cataract surgery to assess the penetration of the drug into aqueous humor after oral administration. The mean peak level of 0.56 mg/l achieved in aqueous is above the MIC for most gram negative organisms, including Pseudomonas aeruginosa.
Administration, Oral↗
Smokeless tobacco--an overview for physicians.
This is one of a series of articles from western state public health departments.
Adolescent↗
A possible increase in the incidence of congenital heart defects among the offspring of affected parents.
The incidence of congenital heart disease in the children of 219 probands was determined. Each of these probands had one of four selected defects: atrial septal defect, coarctation of the aorta, aortic valve stenosis or complex dextrocardia. Of their children, 8.8% had substantial congenital cardiac defects. This is a much higher incidence than that reported in most comparable studies. The difference is highly significant statistically and therefore is likely to be genuine. The cause of the high recurrence is probably environmental.
Adolescent↗
Comparison of several control standard endotoxins to the National Reference Standard Endotoxin--an HIMA collaborative study.
A collaborative study, initiated under the auspices of the Health Industry Manufacturers Association (HIMA), was designed to establish the relationship of Escherichia coli O55:B5 endotoxin (the control standard endotoxin of HIMA and the Food and Drug Administration's Office of Medical Devices) to the U.S. National Reference Standard Endotoxin and to two internationally used control standard endotoxins. By using two Limulus amoebocyte lysate test systems, it was established that the E. coli O55:B5 endotoxin lot originally used by HIMA and the Office of Medical Devices to establish Limulus amoebocyte lysate release test criteria for pyrogen testing of medical devices contains approximately 4.5 endotoxin units (EU) per ng. Thus, the 1.0-ng/kg endotoxin dose limit currently established for medical devices is approximately the same as the 5.0-EU/kg endotoxin limit (on an activity basis) established by several other Food and Drug Administration agencies for human and animal parenteral drugs and biological products.
Endotoxins↗