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Biomedical subjects

H Portier

Publications and source records attributed to H Portier.

At least 91 records · Page 5Linked to original sources
PubMed1990

A multicentre, open, clinical trial of a new intravenous formulation of fusidic acid in severe staphylococcal infections.

A new intravenous formulation of fusidic acid, containing sodium fusidate, was used to treat 54 seriously ill patients. Forty-nine patients were infected with fusidic acid sensitive staphylococci. Fusidic acid was given with another antibiotic in 46 cases and alone in three instances. Thirty-three (70.2%) of the 47 cases analysed were cured. Five patients failed to respond and five patients died whilst receiving therapy. Superinfection was recorded in four cases. Adverse events, mainly comprising local intolerance at the infusion site or abnormal liver function tests, were recorded in 22 (40.7%) patients. Therapy was withdrawn because of side effects in only four (7.4%) cases.

Adolescent↗
PubMed1990

Five day treatment of pharyngotonsillitis with cefpodoxime proxetil.

A ten day course of oral penicillin is still recommended for pharyngotonsillitis with the aim of eradicating Streptococcus pyogenes and preventing rheumatic fever. However there is some evidence that penicillin V therapy is less satisfactory than in former years. Several explanations have been suggested, including inadequate pharmacokinetic properties, poor patient compliance, penicillin tolerance, re-infection and carrier state, and indirect pathogenicity. In this context we evaluated the efficacy of third generation cephalosporins. We have shown that a short course of five days treatment with cefpodoxime is as effective as the ten days of conventional treatment with penicillin in terms of both clinical and bacteriological efficacy. Moreover the possibility of reducing the duration of therapy and the twice daily administration of these new cephalosporins results in better patient compliance with treatment.

Adolescent↗
PubMed1990

A double-blind randomized placebo trial on very high doses of acyclovir in weakly symptomatic HIV-patients.

Herpesvirus infections are thought to be cofactors of the human immunodeficiency virus (HIV) disease, and high concentrations of acyclovir (ACV) are active on all herpesviruses. Because ACV was shown to delay the cytopathic effect of HIV in vitro, we evaluated the effect of intermittent high doses of ACV in mildly symptomatic HIV-patients in a randomized double-blind placebo-controlled trial with a 4-month treatment period. A total of 30 CDC II and III patients were enrolled; 24 (80%) completed the study. Placebo and ACV were given once a week in a 3-h infusion with 1 g oral probenecid. Each dose of ACV was 50 mg/kg. Pharmacokinetic data were obtained from patients of the preliminary open study. The obtained concentrations were effective against both herpesviruses and HIV: peak concentrations were 197 and 11 mumol/l in serum and CSF, respectively; the CSF:serum ratio of the areas under the curve was 82%. Two patients with placebo acquired hairy leukoplakia and detectable antigenemia vs. none in the ACV group (p = 0.23). T-helper cell count over the 4-month period decreased in the placebo group while it increased in the ACV-treated group (mean of change = -105 c/microliters vs. +68 c/microliters; p = 0.06). beta 2-microglobulin increased with placebo and did not with ACV (mean of change = +0.63 mg/l vs. -0.27 mg/l, p less than 0.025). Only one patient had, at one time, transient elevation of creatinemia related to ACV. We concluded that weekly high doses of ACV were able to delay the progression of some significant markers of HIV disease. Thus, preventive/prophylactic treatment of herpesvirus infections could be useful in mildly symptomatic HIV patients. Further larger trials using a more feasible treatment are warranted.

Acyclovir↗
PubMed1990

Acyclovir pharmacokinetics in plasmapheresis.

During experimental treatment of human immunodeficiency virus (HIV-1) infection using high doses of acyclovir (ACV) (600 mg IV every 8 h), cyclosporin, and several courses of plasmapheresis (PE) (60 ml/kg), ACV pharmacokinetics in three patients have been measured. The results with or without PE were not significantly different: half-time of elimination 3 vs. 2.3 h, volume of distribution 1.8 vs. 1.14 liter/kg, and total clearance 404 vs. 314 ml/min. The clearance and the fraction of elimination due to PE were 5.27 ml/min and 2.5%, respectively. These findings suggest that supplemental doses of ACV are not needed when plasmapheresis is performed.

Acyclovir↗
PubMed1990

[Nosocomial Staphylococcus epidermidis and Staphylococcus aureus septicemias in neonates].

Sixteen neonates developed staphylococcal septicemia (S. epidermidis in 10 cases and S. aureus in six). Two infections were due to maternofetal contamination and four to contaminated foreign material. Clinical symptoms included non-specific evidence of neonatal bacterial infection and, in S. aureus infections, suggestive skin or bone localizations. Fifteen patients recovered without sequelae and one died as a result of S. aureus septicopyemia. In view of the patterns of resistance to antimicrobial agents exhibited by S. aureus and S. epidermidis, the vancomycin-amikacin combination seems the most appropriate treatment in neonatal staphylococcal septicemias. However, the fosfomycin-cefotaxim combination can be proposed for the treatment of staphylococcal infections with osteoarticular or meningeal involvement.

Anti-Bacterial Agents↗
PubMed1989

[A simplified method of vaccination against rabies after exposure].

Vaccination against rabies after exposure to the risk of contamination is currently performed according to the WHO recommendations: 6 injections in 6 visits. We have studied the serological effectiveness of a simplified method using the human diploid-cell rabies vaccine: the vaccine is injected subcutaneously at the rate of 2 doses on day 0, then one dose on day 7 and one dose on day 21. Fifty subjects were vaccinated, and antiglycoprotein antibodies were assayed in serum by the immunoenzymatic technique (EU/ml). Seroconversion with titres above 0.5 EU/ml was observed in all subjects. The antibody titres were 0.127 +/- 1.57, 11.31 +/- 8.87, 10.2 +/- 7.55, and the numbers of subjects with protective titres were 0/50, 11/50, 46/47 and 36/37 on days 0, 7, 21 and 90 respectively. No undesirable side-effect was recorded. The good results obtained with this 2+1+1 vaccination schedule (4 injections in 3 visits) suggest that the recommended method of post-exposure vaccination could be replaced by this simplified method.

Antibodies, Viral↗
PubMed1989

Infraclinical neuropathies related to immunodeficiency virus infection associated with higher T-helper cell count.

To assess subclinical involvement of the peripheral nervous system and its relationship to the immunological status of human immunodeficiency virus (HIV)-infected patients, we prospectively studied the peripheral nerve conductions and the subsets of peripheral blood lymphocytes of HIV patients. Fifty-seven patients, aged 20-54 years, 28 homosexuals and 29 heterosexuals, classified as CDC II-III (40 patients) and CDC IV (17 patients) were studied. No neurological symptoms or signs were present on bedside examination or questioning for all of the CDC II-III patients. For each conduction measured (H-reflex, sural and sciatic velocities, sural amplitude), the geometric mean was below normal values (p less than 0.05). Among the 57 HIV-infected patients, 20 (35%) had a significant decrease of at least one electrophysiologic measurement: 10/17 CDC IV patients vs. 10/40 CDC II-III patients (p less than 0.05). Two or more simultaneous abnormalities were more often observed in the CDC IV than in the CDC II-III group (9/10 vs. 4/10) (p less than 0.01). In the CDC II-III group, patients with subclinical neuropathies had higher T-helper and lower T-suppressor cell counts and higher T-helper/T-suppressor ratios than random patients without any neurologic abnormalities (1,057 vs. 657 cells/microliters, p less than 0.05, and 757 vs. 1,304 cells/microliters, p less than 0.01, 1.55 vs. 0.68, p less than 0.01, respectively). We conclude that (a) the peripheral nervous system is precociously and subclinically involved in the HIV disease; (b) the patients with infraclinical neuropathies have a significantly higher T-helper cell count than those without any neurologic involvement. The mechanism and the prognostic value of these two findings remain to be more precisely examined, and further studies are required.

Acquired Immunodeficiency Syndrome↗
PubMed1989

[Meningeal diffusion of cefpirome in adults].

Cefpirome is a new aminothiazolyl cephalosporin with a low protein binding, a long half-life of elimination and a wide antibacterial spectrum including pseudomonas and staphylococcus. We studied its diffusion into the cerebrospinal fluid (CSF). Cefpirome, 2 g, was administered intravenously over 3 min. Nineteen patients, aged 12-75 y (mean +/- SD = 40 +/- 20) were studied: 13 had meningitis (septic = 6; chronic = 2; viral = 4). Seric and CSF samples were assayed by the high pressure liquid chromatography (HPLC) procedure. Results at 1, 3, 6, 9 and 12 hours after the infusion were (mean +/- SD) 62.44 +/- 19.8 mg/l, 26.51 +/- 3.7 mg/l, 10.19 +/- 3.3 mg/l, 3.99 +/- 2.3 mg/l, 2 +/- 1.72 mg/l in the serum and 1.1 +/- 1 mg/l, 2.6 +/- 1.8 mg/l, 2.83 +/- 1.7 mg/l, 1.92 +/- 1 mg/l, 1.83 +/- 0.36 mg/l in CSF of bacterial meningitidis respectively. The half-life of elimination were 2.45 h and 9.8 h in the blood and CSF respectively. The area under the curve CSF/serum ratio was 28%. We conclude that cefpirome concentrations in the CSF were above the minimal inhibitory concentrations of almost all the bacteria causing meningitis.

Adolescent↗
PubMed1988

[Evaluation of ceftazidime treatment in septicemia expert systems].

The septicaemia expert-system (SES) consists of 18 departments of infectious diseases and microbiology in different French university hospitals. In this context, and compared with the totality of cases analyzed, ceftazidime was used by preference in worrying infections, i.e. often older patients, higher frequency of hospital-acquired infections and of multibacterial infections, greater number of pathogens regarded as difficult to eradicate. The results of ceftazidime treatment in these patients were not different from those obtained in the totality of cases.

Adolescent↗
PubMed1988

Altered peripheral nerve conduction in HIV-patients.

An electrophysiological study on peripheral nerves conduction was performed on HIV-seropositive patients without neurological signs on clinical examination. Eight of the 28 patients (28%) had an infraclinical neuropathy, which was myelinic or axonal and rather distal than proximal. The mechanism of these involvements is not known, but their early existence could justify an early treatment even for asymptomatic patients.

AIDS-Related Complex↗
PubMed1987

[Treatment with a cefotaxime-fosfomycin combination of staphylococcal or enterobacterial meningitis in adults].

Thirty-two patients were included in this trial: 22 with staphylococcal meningitis (including 5 methicillin-resistant) and 10 with enterobacterial meningitis. Mean duration of treatment was 14.5 and 15.9 days respectively. The combination was synergistic in vitro against 10 of the 12 strains of Staphylococcus and 5 of the 6 strains of Enterobacteriaceae studied. Bacteriological sterilization occurred in all cases which could be evaluated, and clinical recovery was obtained in 95.2% of patients with staphylococcal meningitis (4 unrelated deaths) and 100% of patients with enterobacterial meningitis (2 deaths). Bactericidal power of the cerebro-spinal fluid, often less than 1/8, was not correlated with effectiveness against Staphylococci. Mean CSF concentrations of cefotaxime, desacetylcefotaxime and fosfomycin on the 2nd and 15th days of treatment were 4, 3.5 and 39.8 mg/l and 2.2, 2.1 and 28.0 mg/l, respectively. Clinical and biological acceptability was satisfactory. There were three cases of superinfection or colonization, by Pseudomonas and Enterobacter.

Adolescent↗
PubMed1987

[Combination of a 3d-generation cephalosporin (cefotaxime or ceftazidime) and a new quinolone (pefloxacine) in the treatment of febrile episodes in neutropenic diseases (37 cases)].

The combination of beta-lactam antibiotics and new quinolones is a form of broad spectrum antibiotic therapy rapidly bactericidal in vitro which could be an alternative to the classical combination of beta-lactam antibiotics and aminoglycosides in the first line treatment of febrile episodes in patients with neutropenia. The treatment of 37 initial febrile episodes (12 cases of septicemia, 7 infectious sites and 38 cases of fever of unknown origin) in 33 neutropenic patients (PMN leucocytes less than 500/mm3) using the combination of a third generation cephalosporin (cefotaxime or ceftazidime) and a new quinolone (pefloxacin) resulted in an 86% immediate success rate (32 cases/37). Results and course during treatment were similar in both groups (cefotaxime or ceftazidime). A second febrile episode occurred in 11 cases (4 superinfections, 2 chest infections, 5 fevers of unknown origin). Clinical acceptability was satisfactory in both groups. Minimal and transient changes in liver function tests were observed in 19% of the successfully treated patients. Study of quantitative aerobic stool cultures revealed the emergence of resistant bacterial strains, essentially Pseudomonas sp. (6 cases). More extensive trials should provide a better view of the role of this new combination in the first line treatment of febrile episodes in the neutropenic patient.

Agranulocytosis↗