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Biomedical subjects

J Garau

Publications and source records attributed to J Garau.

At least 37 records · Page 2Linked to original sources
PubMed2001

Efficacy and safety of gemifloxacin in the treatment of community-acquired pneumonia: a randomized, double-blind comparison with trovafloxacin.

This multicentre, randomized, double blind, parallel group study compared the efficacy and safety of gemifloxacin (320 mg once daily) with trovafloxacin (200 mg once daily) in 571 patients with community-acquired pneumonia (CAP). Although treatment was given routinely for 7 days it could be extended to 14 days; two-thirds of patients were treated for 7 days. High clinical success rates were noted at follow-up in the per-protocol population in both the gemifloxacin group (95.8%) and the trovafloxacin group (93.6%), non-inferiority with 95% CI. In the intent-to-treat population, the clinical success rate at follow-up was significantly superior for gemifloxacin (87.6%) compared with trovafloxacin (81.1%; 95% CI 0.5, 12.4). The pathogens identified most commonly at presentation were Mycoplasma pneumoniae and Streptococcus pneumoniae. Gemifloxacin eradicated 100% of S. pneumoniae. One bacteraemic isolate of S. pneumoniae was associated with clinical failure in the trovafloxacin group (MIC of trovafloxacin 8 mg/L). Gemifloxacin was well tolerated and the incidence of transient liver function abnormalities was very low. Gemifloxacin is an effective and well-tolerated treatment for patients with CAP.

Adolescent↗
PubMed2000

Bacteraemia caused by non-glucose-fermenting gram-negative bacilli and Aeromonas species in patients with haematological malignancies and solid tumours.

The clinical characteristics and outcome of bacteraemia caused by non-glucose-fermenting gram-negative bacilli and Aeromonas spp. were examined in 115 adults with haematological malignancies or solid tumours. The most aggressive pathogens were Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Aeromonas spp., Acinetobacter spp. and Burkholderia cepacia, all of which caused either septic syndrome or pneumonia in more than 40% of cases. Pseudomonas aeruginosa was involved less often in catheter-related bacteraemia than other species. Polymicrobial bacteraemia (n=28) was more often catheter-related than monomicrobial bacteraemia and more often required catheter removal for definitive cure. The most important predictors of catheter-related bacteraemia and its outcome were polymicrobial infection, the presence of pneumonia or septic syndrome and the species involved.

Adolescent↗
PubMed2000

Spontaneous spleen rupture during typhoid fever.

Typhoid fever currently is an uncommon disease in western countries, and cases usually are imported from endemic areas.1 The most common complications are intestinal bleeding or perforation and necrotizing cholecystitis, although hepatitis, myocarditis, nephritis, and meningitis may occur. Spontaneous spleen rupture during typhoid fever is a known but rare complication. This report describes a new case and reviews the literature.

Adolescent↗
PubMed2000

Gemifloxacin versus amoxicillin/clavulanate in the treatment of acute exacerbations of chronic bronchitis. The 070 Clinical Study group.

Six hundred patients were evaluated in this randomized, double-blind, double-dummy, multicenter, parallel-group study comparing the efficacy and safety of gemifloxacin (320 mg once-daily for 5 days) and amoxicillin/clavulanate (500/125 mg three-times daily for 7 days) for the treatment of acute exacerbations of chronic bronchitis (AECB). Of note, more than 90% of study participants had stage 2 disease at study entry. The two drugs were found to be equally effective, with clinical success rates of 93.6% for gemifloxacin and 93.2% on amoxicillin/clavulanate (95% CI -3.9 to 4.6). Bacteriological success rates favored gemifloxacin (90.9% compared with 79.5% for amoxicillin/clavulanate; 95% CI -3.3 to 26.0); however, this difference was not statistically significant. Gemifloxacin and amoxicillin/clavulanate were both well tolerated. In summary, gemifloxacin was found to be well tolerated and effective for the treatment of AECB, suggesting it is well suited for empirical treatment of this common respiratory condition in the current clinical environment.

Acute-Phase Reaction↗
PubMed1999

Carbapenems in clinical practice: a guide to their use in serious infection.

Meropenem and imipenem/cilastatin, currently the only available carbapenem agents in Europe and the United States, are characterised by a broad spectrum of antimicrobial activity and stability to beta-lactamase-mediated resistance mechanisms. A guide to the use of carbapenems in clinical practice is presented; the role of carbapenems in the treatment of several types of serious bacterial infection and an up-to-date account of their clinical efficacy and safety profiles are discussed. The good clinical efficacy and favourable safety profiles of the carbapenems make them valuable as initial empirical therapy in the treatment of ventilator-associated pneumonia, sepsis of unknown origin, post-operative peritonitis, paediatric meningitis, and febrile neutropenia. However, to maintain superior efficacy, the carbapenems should be used appropriately for definitive therapy.

Bacterial Infections↗
PubMed1999

The role of glycopeptide antibiotics in the treatment of infective endocarditis.

There are several sets of guidelines for the treatment of infective endocarditis, reflecting the need for differing treatment in various countries and times. This review considers the need for differing treatment modalities and in particular the utility of the glycopeptide antibiotics vancomycin and teicoplanin. Specific recommendations are offered as to when to consider the use of glycopeptides, appropriate dosage, length of treatment course and whether to use monotherapy or combined therapy. Used judiciously, the glycopeptides give results as good as can be achieved with other antimicrobial agents without exceptional toxicity. The potential of teicoplanin for use in the outpatient treatment of infective endocarditis is considered.

Anti-Bacterial Agents↗
PubMed1999

Emergence and dissemination of quinolone-resistant Escherichia coli in the community.

We studied the evolution of resistance to quinolones in Escherichia coli from 1992 to 1997 in Barcelona, Spain. An increasing proportion of quinolone-resistant E. coli (QREC) infections was observed. QREC strains were more common in patients with nosocomial infections but also increased in patients with community-acquired infections (9% in 1992 to 17% in 1996). Seventy (12%) of 572 episodes of E. coli bacteremia were due to QREC. Factors significantly associated with QREC bacteremia were the presence of underlying disease, recent exposure to antibiotics, and bacteremia of unknown origin. In the multivariate analysis, only prior exposure to antimicrobial agents (P < 0.001; odds ratio [OR] = 2), specifically, to quinolones (P < 0. 001; OR = 14), and the presence of a urinary catheter (P < 0.001; OR = 2) were significantly associated with QREC bacteremia. Among 16 QREC isolates from cultures of blood of community origin selected at random, 13 different pulsed-field gel electrophoresis patterns were recognized, showing the genetic diversity of these isolates and in turn indicating the independent emergence of QREC in the community. The prevalence of QREC in the feces of healthy people was unexpectedly high (24% in adults and 26% in children). A survey of the prevalence of QREC of avian and porcine origin revealed a very high proportion of QREC in animal feces (up to 90% of chickens harbored QREC). The high prevalence of QREC in the stools of healthy humans in our area could be linked to the high prevalence of resistant isolates in poultry and pork.

Aged↗
PubMed1999

Influence of comorbidity and severity on the clinical outcome of bacteremic pneumococcal pneumonia treated with beta-lactam monotherapy.

The influence of the severity of pneumonia and comorbidity factors, as predictors of clinical outcome, was assessed in patients with microbiologically documented pneumococcal bacteremic pneumonia treated with penicillin or third generation cephalosporin monotherapy in a 5-year retrospective study. Among 288 patients admitted to three Spanish hospitals with bacteremic pneumococcal pneumonia, 65 (23%) were included. Twenty-four were treated with penicillins and 41 with a third-generation cephalosporin. Twenty-seven patients (42%) had severe pneumonia and 41 (63%) had a comorbidity index >1. Twenty-one patients (32%) were infected with penicillin-resistant strains. Four cases (2 with penicillin-resistant strains; 3 treated with cephalosporins) were clinical failures. Four cases (3 with penicillin-resistant strains; 2 treated with cephalosporins) died, i.e. 6% mortality rate. The only factor that influenced empirical treatment election was HIV-positive condition. Clinical outcome was not influenced by treatment election, penicillin susceptibility of the infecting pneumococci, patient basal conditions or severity of pneumonia, but the latter was associated with mortality and length of hospitalization.

Adolescent↗
PubMed1999

Basing empiric treatment choices for respiratory tract infection on the results of the Alexander Project.

For respiratory tract infection (RTI), antibiotics should have proven clinical efficacy against the major pathogens involved-Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis. As the pattern of resistance to antimicrobials changes, the clinical effectiveness of these agents should be reviewed. However, clinical trials are time consuming and costly, and alternative ways of predicting clinical efficacy using susceptibility data have been investigated. Pharmacodynamic breakpoints have been suggested as providing the link between susceptibility data and clinical effectiveness and this is supported by emerging clinical evidence. Thus, using the data collected in the Alexander Project, guidelines for the treatment of RTI can be developed which reflect the local resistance profile and maximize the chances of clinical success.

Anti-Bacterial Agents↗
PubMed1998

Clinical strategies for serious infection: a European perspective.

Antimicrobial resistance in nosocomial isolates is of increasing concern to the clinician, particularly in intensive care units. With more expensive drugs and prolonged periods of hospitalization required, resistance can result in increased healthcare costs. For the patient, infection with multiply resistant strains of bacteria is associated with high mortality rates. This review focuses on the prevalence of nosocomial infections throughout Europe, with particular emphasis on the prevalence of resistance to common antimicrobial agents. The beta-lactams are the most frequently prescribed antimicrobials, and the growing importance of extended spectrum beta-lactamases and the hyperproduction of chromosomal beta-lactamase by stably derepressed mutants in the development of microbial resistance are discussed. Given that the most common reason for modification of an initial empiric antibiotic treatment is the isolation of microorganisms not susceptible to the initial choice of treatment, the results from two European multicenter trials comparing the efficacy of the carbapenems, meropenem, and imipenem/cilastatin, for the treatment of serious nosocomial infections, are appraised. In light of these results, it can be concluded that the carbapenems are effective as initial empiric monotherapy for nosocomial infections because of their broad spectrum of efficacy and stability to beta-lactamases.

Bacterial Infections↗