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Biomedical subjects

J Klastersky

Publications and source records attributed to J Klastersky.

At least 325 records · Page 18Linked to original sources
PubMed1976

Clinical and bacteriological evaluation of amikacin in severe gram-negative infections.

Amikacin was administered to 51 patients with serious Gram-negative infections. A favorable clinical outcome was observed in 32 patients (62 per cent). No major untoward effects were noted. The severity of the underlying disease and the site of the infection were important for the outcome. Urinary tract infections responded in 21 (78 per cent) out of 27 patients, but bronchopulmonary infections responded in only 3 out of 10 patients (30 per cent). The degree of antibacterial activity of the serum of the patients receiving amikacin was found to be related to the outcome. An activity greater than or equal to 1/8 was associated with 78 per cent of favorable responses and was found more often in patients receiving 1500 mg daily.

Adult↗
PubMed1976

Synergism between amikacin and cefazolin against Klebsiella: in vitro studies and effect on the bactericidal activity of serum.

Synergism between amikacin and cefazolin was studied in vitro in 20 strains of Klebsiella isolated from clinical material. Several techniques for the demonstration of synergism in vitro were employed. The checkerboard technique with use of bactericidal end points and the killing curves method showed synergism between amikacin and cefazolin for 13 and 15 strains, respectively. The two techniques were in accordance in 12 instances. The data obtained in vitro were correlated with the bactericidal activity in sera from 10 subjects who had received the usual doses of amikacin and cefazolin, alone or in combination. The sera of subjects who received amikacin plus cefazolin were bactericidal at significantly higher dilutions than sera of patients who received cefazolin alone. The increased serum bactericidal activity in subjects receiving amikacin plus cefazolin was observed only for strains against which these antibiotics were synergistic in vitro.

Aged↗
PubMed1976

Comparative effectiveness of combinations of amikacin with penicillin G and amikacin with carbenicillin in gram-negative septicemia: double-blind clinical trial.

Preliminary results are presented for an ongoing, double-blind, clinical trial, in which the efficacy of amikacin plus penicillin G (Amik-Pen) and amikacin plus carbenicillin (Amik-Carb) is compared in treatment of severe gram-negative infections superimposed on serious underlying disease. All clinical isolates were sensitive to amikacin in vitro (minimal inhibitory concentration, less than 12 mug/ml). Results in 50 patients with cancer and documented gram-negative infection, 29 of which involved septicemia, were analyzed. In the Amik-Pen group, 40% of 15 cases of septicemia responded favorable to therapy, as compared with 86% of 14 cases of septicemia in the Amik-Carb group; this difference is statistically significant (P less than 0.02). When all patients were considered together, the outcome appeared more favorable (1) in infections caused by pathogens sensitive to both antibiotics used then in those caused by organisms sensitive to amikacin only (83% vs. 43%); (2) when the combined antibiotics demonstrated synergy in virto against the offending pathogen than when the combination was nonsynergistic (83% vs. 38%); and (3) when the peak serum antimicrobial dilution titer was larger than or equal to 1:8 than when titers were lower. The results of this study suggest that routine use of an antibiotic combination that has demonstrable in vitro synergy against the offending pathogen should be considered for the treatment of proven or suspected severe infections due to gram-negative bacilli.

Amikacin↗
PubMed1976

Pharmacological study of cefazolin during intermittent and continuous infusion: a crossover investigation in humans.

Levels of cefazolin were determined in plasma, urine, bile, and cerebrospinal fluid in humans after a bolus intravenous injection and during a controlled, continuous intravenous infusion. All the patients were studied in a steady-state and crossover fashion. In plasma, the mean peak level after bolus injection (1.5 g) studied in 12 patients was 206.5 mug/ml; during continuous infusion (6 g daily), the mean level remained stable at 52.6 mug/ml. With bolus injection and continuous infusion, respectively, 89.7 and 86.3% of the administered dose of cefazolin were excreted in the urine of nine patients over the 6-h period considered. The levels of cefazolin in common bile duct bile were studied in six cholecystectomized patients. In bile collected during the two 3-h periods of the experiment, the mean concentration of the drug in the bile after bolus injection was 66.9 and 22.0 mug/ml, respectively; during continuous infusion, the corresponding biliary levels were 50.7 and 51.3 mug/ml, respectively. In four neurosurgical patients with an intraventricular catheter, neither bolus injection nor continuous infusion resulted in a demonstrable concentration of cefazolin in the cerebrospinal fluid. The continuous intravenous administration of cefazolin might have some advantage over the intravenous bolus intermittent injections. In plasma, the area under the curve is greater with continuous infusion than with bolus injection. In bile, the levels of cefazolin are more sustained with continuous infusion than with bolus injection. This approach to intravenous administration of cefazolin deserves more pharmacological and clinical trials.

Bile↗
PubMed1976

Antimicrobial prophylaxis in patients with rhinorrhea or otorrhea: a double-blind study.

A controlled double-blind study was performed on patients with injury to the head and face which had caused rhinorrhea or otorrhea. The patients were treated, at the time of the admission to the hospital, with penicillin (20 mega-units daily) or a placebo. A total of 52 patients was studied, 26 in each treatment group. Meningitis developed in one patient in the placebo group. Staphylococcus epidermidis (sensitive to penicillin) was the causative pathogen in this patient who also had a retained intraventricular foreign body. The frequency of extra-neurological infections and of asymptomatic pulmonary bacterial colonization was similar in both groups, but frequency of asymptomatic bacteriuria was higher in the placebo-treated patients.

Adolescent↗
PubMed1976

[Comparative study of ticarcillin and of carbenicillin as prophylactic treatment in the oncologic surgery of head and neck (author's transl)].

The frequency of postoperative infections in oncologic head and neck surgery can be reduced by the prophylactic use of antibiotics. In order to assess such preventive treatments as to their advantages and disadvantages, a controlled clinical trial was undertaken. The prophylactic use of antibiotics was used in 107 patients, operated for tumors of the upper airway-digestive tract. According to a previous randomisation, the patients received either carbenicillin either ticarcillin. The efficiency of carbenicillin and ticarcillin proved similar. The results obtained with these antibiotics turned out to be superior to those previously obtained with combined ampicillin and cloxacillin; the number of wound infections, primary and secondary, was lessened. The most frequent complications were thrombophlebitis at the site of intravenous perfusion of the antibiotics and hypokaliemia.

Carbenicillin↗
PubMed1975

Comparison of amikacin and gentamicin.

The sensitivity to gentamicin (G) and to amikacin (A) of 25 strains of Escherichia coli (EC), 25 Klebsiella sp. (K), 25 Proteus and Providence sp. (PP), and 25 Ps. aeruginosa (PA) were tested in vitro by the disc method, by the inocula-replicating method, and by a tube dilution technique using 10-5 microorganisms/ml. Bactericidal concentrations active on 50% and 90% of the strains were 1.5 and 4.5 mug/ml for EC, 3 and mug/ml for K, 1.5 and 3 mug/ml for PP, and 3 and 3 mug/ml for PA. Resistance to killing by 12 mug/ml of G was found for 16 strains (1 EC, 9 K, 4 PP, and 2 PA) but only 5 strains were also resistant to 12 mug/ml of A. Conversely, 4 strains (1 EC, 1 PP, and 2 PA) were resistant to 12 mug/ml of A but were killed by 6 mug/ml of G or even less. G (1.5 MG/KG) AND A (5 mg/kg) were administered to 5 bolunteers in a crossover fashion. The mean bactericidal activity of the sera obtained at 1 hr after the injection of G and A was, respectively, 1/4 and 1/4 for ED, 1/4 and 1/8 for K, 1/2 and 1/2 for PP, and 1/2 and 1/2 for PA. Sera obtained in A-treated patients killed at a dilution of 1/8, 8 strains of ED, 17 K, 1 PP, and O PA; at that dilution sera from G-treated patients killed 5 ED, 9 K, O P, and O PA. The main advantage of A over G might be the absence of cross-resistance between A and G for particular pathogens.

Aminobutyrates↗
PubMed1975

Sisomicin: Bacteriological and clinical evaluation.

A preliminary study was conducted with sisomicin, a new aminoglycoside antibiotic. The drug was administered to 40 patients in doses varying from 1.5 to 3.75 mg/kg/day. Sisomicin proved to be an effective therapy in urinary tract infections and to a lesser extent in wound infections caused by gram-negative rods; favorable results have been observed in 91.6% and in 66.6% of the patients presenting these infections. Toxic reactions involving the hearing function, renal function, and general tolerance were infrequent: they occurred in less than 5% of the patients in this series. (However in approximately 22% of the patients, there was a transient appearance of granular casts in the urine.

Anti-Bacterial Agents↗
PubMed1975

Concentrations of gentamicin in bronchial secretions after intramuscular and endotracheal administration.

A crossover study was performed in five adult tracheotomized patients without respiratory tract disease to investigate the tracheobronchial kinetics of intramuscularly and endotracheally administered gentamicin in the absence of infection. Although intramuscular injection of 2 mg/kg of gentamicin yielded adequate levels in the serum, the concentrations in the bronchial secretions of noninfected patients were not adequate to inhibit strains of Pseudomonas aeruginosa isolated from other patients with clinical infections. Conversely, endotracheally administered gentamicin resulted in high and sustained concentrations in the bronchial secretions that were many times superior to the minimum bactericidal concentration of gentamicin against Pseudomonas aeruginosa. Gentamicin administered by aerosols resulted in concentrations within the bronchial secretions and sputum that were adequate to kill more than 90 per cent of the strains of Pseudomonas aeruginosa isolated in this hosopital. These studies suggest that endotracheally administered gentamicin might prove to be an adequate adjunct for the treatment of severe Pseudomonas infection of the tracheobronchial tract, particularly in the absence of foreight bodies and abnormalities of structure or function.

Aerosols↗
PubMed1975

Multiple tuberculomas of the brain. Report of a case.

A case of multiple tuberculomas of the brain in a pregnant patient is reported. The symptoms and signs suggested a lesion of the cerebellum which was found to be only congested and oedematous at craniotomy. The correct diagnosis was made at autopsy.

Adult↗