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Biomedical subjects

J E Conte

Publications and source records attributed to J E Conte.

At least 55 records · Page 3Linked to original sources
PubMed1983

Antibiotic prophylaxis in surgical procedures. A critical analysis of the literature.

The use of prophylactic antibiotics in surgery is widespread and often inappropriate. The lack of well-designed clinical studies partially explains the present confusion regarding the subject. We reviewed the literature in English on antibiotic prophylaxis through June 1982. Antibiotic prophylaxis reduces the incidence of wound infection after colorectal surgery, vaginal hysterectomy, and laryngeal and oropharyngeal resection for carcinoma, and in high-risk patients undergoing gastroduodenal or biliary surgery. In clean operations such as cardiac surgery, vascular procedures, and orthopedic surgery with placement of prostheses, the high morbidity associated with an infection justifies the use of antibiotics even though the risk of infection is small. There are conflicting data on the usefulness of prophylaxis in abdominal hysterectomy, cesarean section, noncardiac thoracic procedures, and urologic surgery. The effectiveness of prophylaxis in neurosurgery cannot be evaluated at the present time.

Administration, Oral↗
PubMed1982

Utilization of antibiotics: analysis of appropriateness of use.

An antibiotic utilization review was performed for the purpose of determining the frequency and types of infectious diseases presenting to a large, teaching hospital emergency department, and the appropriateness of the use of antibiotics in this setting. In 27% of the visits a diagnosis of an infectious disease was made or an antibiotic was prescribed. The most common presenting diagnoses (comprising more than 75% of cases) were infections of the respiratory tract, skin, urogenital system, and gastrointestinal tract. Penicillins and sulfonamides were frequently prescribed in nearly two-thirds of cases. Antibiotic prescribing was determined to be appropriate in 78% of cases. Inappropriate use most often involved the use of prophylactic antibiotics in clean lacerations and the use of prophylactic antibiotic combination products following trauma to the eye.

Adolescent↗
PubMed1982

Herpetic proctitis and meningitis: recovery of two strains of herpes simplex virus type 1 from cerebrospinal fluid.

A patient with simultaneous proctitis and meningitis due to herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) was extensively investigated. In both disease locations the infection was clinically evident and culture-proven. Analysis by sodium dodecylsulfate-polyacrylamide gel electrophoresis of rectal isolates revealed both HSV-1 and HSV-2. The cerebrospinal fluid harbored two apparently different strains of HSV-1, one of which was shown by restriction endonuclease analysis to be identical with the rectal isolate of HSV-1.

Adult↗
PubMed1982

Multiple-dose pharmacokinetics of amdinocillin in healthy volunteers.

The pharmacokinetics of amdinocillin (mecillinam) after multiple intravenous doses to healthy subjects are described. Assay of plasma and urine samples was carried out with a sensitive and specific high-pressure liquid chromatographic technique. A dose of 10 mg/kg of body weight was administered every 4 h for six doses. No accumulation was noted. Mean peak plasma concentrations were approximately 50 micrograms/ml, and the plasma half-life was approximately 53 min. Total plasma clearance was 4.6 ml/min per kg after the first dose, which declined slightly to 4.1 ml/min per kg after the last dose. Renal clearance remained fairly constant at approximately 2.9 ml/min per kg, or twice the creatinine clearance. The fraction excreted unchanged totaled 63% during the 4-h interval after the first dose and was nearly 70% overall. The steady-state volume of distribution was calculated to be 0.26 liter/kg. Urinary concentrations of amdinocillin were far in excess of the usual inhibitory concentrations for susceptible pathogens and were as high as 3,000 micrograms/ml. Dose of amdinocillin every 4 h provide plasma and urine concentrations which should be effective for the treatment of infections.

Adult↗
PubMed1982

Pharmacokinetics of cefonicid, a new broad-spectrum cephalosporin.

This study determined the pharmacokinetic disposition of cefonicid. A single dose of 7.5 mg/kg of body weight was administered to five healthy volunteers as a 5-min intravenous infusion. Multiple plasma and urine samples were collected for 48 h. Peak plasma concentrations ranged from 95 to 156 micrograms/ml and fell slowly (mean plasma half-life, 4.4 +/- 0.8 h), so that levels after 12 h were in the range of 6 to 12 micrograms/ml. Urinary concentrations were high but variable and ranged from 100 to 1,000 micrograms/ml for the first 12 h after the dose and averaged 84 micrograms/ml between 12 and 24 h. Plasma and renal clearances were 0.32 +/- 0.06 and 0.29 +/- 0.05 ml/min per kg, respectively. An average of 88 +/- 6% of the dose was excreted unchanged in the urine over 48 h. The mean steady-state volume of distribution was found to be 0.11 +/- 0.01 liters/kg.

Biological Assay↗
PubMed1980

Mammalian bite wounds.

Clinical data were collected prospectively from a series of 160 patients presenting with mammalian bite wounds. Anaerobic and aerobic cultures were prepared from sterile swabs placed in 65 bite wounds prior to cleansing. Infection was noted in 11 of 22 cat bites, six of 37 human bites, three of 80 dog bites, and in none of the 21 bites caused by other mammals. Pasteurella multocida was recovered from six infected cat and dog bites, all of which developed infection within 24 hours of injury. Staphylococcus aureus and Streptococcus viridans were the principal pathogens isolated from the remaining infected cat, dog, and human bites. Infection most commonly followed puncture wounds caused by cats (10/19) and lacerations into subcutaneous tissue of the hand caused by humans (4/17). None of the 10 sutured wounds became infected. All infected bite wounds responded to antibiotic therapy. No conclusions regarding the value of prophylactic antibiotics could be made.

Animals↗
PubMed1980

Pharmacokinetics of mecillinam in health subjects.

Mecillinam is an amidino penicillinate derivative with a broad spectrum of activity against many gram-negative bacilli. Moreover, marked in vitro synergy against these organisms occurs when mecillinam is combined with other beta-lactam antibiotics. The purpose of this study was to determine the pharmacokinetic disposition of this antibiotic. A single dose of 10 mg/kg was administered to 12 healthy volunteers as a 15-min intravenous infusion. Multiple plasma and urine samples were collected at frequent intervals for 8 and 24 h, respectively. Plasma samples were assayed for mecillinam by using a specific high-pressure liquid chromatographic assay developed in our laboratory. Peak plasma levels ranged from 34 to 80 micrograms/ml, and after 4 h, plasma levels were 0.7 to 1.9 microgram/ml. The mean terminal plasma half-life was 51.1 +/- 8.6 min. The mean steady-state volume of distribution was calculated to be 0.23 +/- 0.04 liter/kg. The mean plasma and renal clearances were 3.5 +/- 0.4 and 2.5 +/- 0.4 ml/min per kg, respectively. The mean percentage of the dose excreted unchanged in the urine at 4 h was 67 +/- 5%; 71 +/- 6% was recovered in 24 h. Urine concentrations at 4 h were far above the minimum inhibitory concentration for susceptible gram-negative organisms.

Adult↗
PubMed1980

Absence of nafcillin-associated nephritis. A prospective analysis of 210 patients.

In a prospective study of 210 consecutively seen patients receiving nafcillin, no patient's therapy was discontinued because of clinically manifested or suspected nephritis. Administration of nafcillin was discontinued because of an adverse reaction in only two patients, one with a rash and one with neutropenia. In seven of the ten patients in whom renal dysfunction developed during treatment, renal function improved while the patients continued to receive nafcillin. In the remaining three patients, renal failure was attributed to other factors including rhabdomyolysis and myoglobinuria, gastrointestinal hemorrhage and hypotension, and what appeared to be aminoglycoside toxicity. No renal biopsy studies were done because none were clinically indicated. Although the results of this study do not rule out the possibility that nafcillin may induce nephritis, if it does occur it appears in such a mild form-manifested solely as urinary sediment abnormalities-or so infrequently that it was not detected in this group of patients. In four patients, leukopenia could not be explained on any basis other than nafcillin administration.

Adolescent↗
PubMed1979

Cardiopulmonary resuscitation in a university hospital. An analysis of survival and cost.

A cost analysis and study were done of patient survival after inhospital cardiopulmonary resuscitation during one year at a university hospital. The immediate survival rate in 128 patients was 52 percent. Survival to discharge and six-month survival rates were 19 percent and 15.6 percent, respectively. In all, 23 patients (18 percent) had multiple arrests (two to four per patient) during the same hospital stay. Immediate and six-month survival rates in this group were 52 percent (12 patients) and 9 percent (two patients), respectively. Gender or location where cardiopulmonary arrests occurred in the hospital did not influence survival. The cost of a Code Blue (direct expenses only) was $366. We conclude that the outcome following resuscitation at this university hospital compares favorably with the experience of others, and that the direct cost is modest in relation to the results obtained.

Adolescent↗
PubMed1979

Aminoglycoside use monitored by clinical pharmaceutical services.

A pharmacy-infectious diseases program designed to promote the rational use of, and decrease the adverse reactions attributed to, amikacin and tobramycin is described. Requests for amikacin and tobramycin were screened initially by a pharmacist and later reviewed by an infectious disease physician. When the appropriateness of amikacin or tobramycin use was questionable, the drug was released pending review of the order by the chief of infectious diseases. Pharmacists, in consultation with the infectious diseases service, made recommendations for alternative antibiotic therapy or dosage regimens, provided drug education to prescribing physicians and nurses, and aided in monitoring efficacy and toxicity of therapy. During a two-year period, 12 patients received tobramycin and 42 patients received amikacin. The drugs were discontinued as recommended in the 12 patients for whom culture results were negative or indicated sensitivity to other antibiotics. Two initial requests for the drugs were denied. No incidents of renal impairment were definitely associated with tobramycin or amikacin use. During an 18-month portion of the study, the two drugs accounted for approximately 2% of the hospital's total aminoglycoside costs and 4% of the total number of aminoglycoside therapy courses. Monitoring of antibiotic use may promote safe, rational antibiotic use and potentially reduces hospital costs.

Amikacin↗
PubMed1978

Urinary tract infection/vaginitis protocol. Use in a walk-in clinic.

A process, outcome and salary-cost analysis was made of the use of a urinary tract infection/vaginitis protocol. Three nurse practitioners, in a university-based, walk-in clinic, cared for 128 women presenting with complaints of dysuria or vaginal discharge, or both. There were no significant differences among the nurse practitioners in data collection, diagnostic accuracy or patient outcome. The diagnoses were correct in 92 percent, incorrect in 6 percent and indeterminate in 2 percent of the patients. Incorrect diagnoses were due to presumption of urinary tract infection in patients with the urethral syndrome or vaginitis. Of the patients, 78 percent were actually sent home without seeing a physician. Concordance with the nurse practitioners' physical examination was 100 percent in those patients examined by a physician. In 82 percent of the patients there was alleviation of symptoms. Patient satisfaction with this method of care was extraordinary, with 98 percent of the patients giving favorable reports. True physician extension was achieved with a reduction in physician time per patient from 20 minutes to 6 minutes. In contrast to previously reported data, only a modest reduction in salary cost savings (10 percent) could be shown. The author concludes that nurse practitioners working in an acute care clinic or emergency department can see the patients defined in the study and provide high-quality care at a reasonable cost.

Adolescent↗
PubMed1975

Are chlamydial infections the most prevalent venereal disease?

We studied two population groups (more than 1,600 patients) to determine the prevalence and clinical associations of genital tract infections with chlamydiae and herpesviruses. Base-line isolation rates for asymptomatic women having routine pelvic examinations were much lower than rates for symptomatic women. In both groups, chlamydiae were more prevalent than herpesviruses. Chlamydial infection was associated much more commonly with cervicitis (36.6%) than with vaginitis only (4.1%). Among 282 symptomatic men, the cultures of 19.9% yielded chlamydiae, and 4.3%, herpesviruses. Chlamydiae were recovered from 35.5% (27 of 76) of specimens from men with nongonococcal urethritis, and from an even larger proportion, 57% (24 of 42), of the specimens from men with frank discharge.

Adult↗
PubMed1970

The clinical spectrum of meningococcal disease.

These discussions are selected from the weekly staff conferences in the Department of Medicine, University of California, San Francisco. Taken from transcriptions, they are prepared by Drs. Sydney E. Salmon and Robert W. Schrier, Assistant Professors of Medicine, under the direction of Dr. Lloyd H. Smith, Jr., Professor of Medicine and Chairman of the Department of Medicine.

Adolescent↗