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Biomedical subjects

M Breteau

Publications and source records attributed to M Breteau.

At least 37 records · Page 2Linked to original sources

[Comparison of plasma levels of amoxicillin administered by oral and intravenous routes in neonatal bacterial colonization].

Twenty-one full-term neonates who had a diagnosis of bacterial colonization were randomly assigned to receive amoxicillin 40 mg.kg-1 every 12 hours by either IV or oral route. Plasma levels of amoxicillin were assayed by HPLC at 0.5 (H0.5), 2 (H2), 6 (H6), 9 (H9) hours after the amoxicillin dose for both administration routes and also at the end of the infusion for the IV route. Average levels of plasma amoxicillin with IV and oral routes were not different except at H0.5 where they were higher with the IV route. With oral route Cmax was measured at H2 (6 times) or H6 (4 times). At the end of the infusion, plasma levels were between 55 and 154 mg.l-1 (81 +/- 32 mg.l-1). They decreased quickly so half life of amoxicillin by IV route was between 1.79 and 8.9 hs (4.28 +/- 2.4 hs). They were always above MIC for germs encountered in neonates except at H9 twice with IV and once with oral route. Pharmacokinetic data of this study allow to use oral route for amoxicillin for bacterial colonization in neonates: this administration route could also be proposed in infections following IV route as soon as hemodynamic and gastrointestinal conditions permit. The efficacy of such an attitude could be evaluated by a clinical trial.

Administration, Oral↗

[A new molecule in antiparasitic therapy: alpha-difluoromethylornithine].

Alpha-difluoromethylornithine (DFMO) is a specific irreversible inhibitor of ornithine-decarboxylase (ODC), key enzyme in the biosynthesis of polyamines, physiological compounds involved in cell multiplication. Pharmacokinetic studies of the drug revealed good oral absorption, low metabolisation and mainly urinary excretion. Short half-life (3 hrs to 3 hrs 30) implicates daily repeated administrations. DFMO is well tolerated, side effects being reversible on discontinuing drug therapy. They chiefly include diarrheas, hematological perturbations (thrombocytopenia) and hear losses (high dosages). Experimental studies show best results on trypanosomes: curative action in mice infected with Trypanosoma brucei brucei. DFMO is effective too against infection with sporozoïtes of Plasmodium berghei. Early clinical observations in African patients with Trypanosoma brucei gambiense sleeping sickness show favorable results: efficacy in both stages of the disease, without significant toxicity. Further trials are required to define optimal therapeutic applications. By the way, DFMO already seems to be a promising alternative to conventional therapy of African trypanosomiasis, expecting other indications in the field of antiparasitic chemotherapy.

Animals↗

[Hepatitis due to nonsteroidal anti-inflammatory agents].

The extended prescription of non-steroidal anti-inflammatory drugs in medical practice involve numerous adverse effects. Among them, hepatic injuries, rather uncommon, are very diverse with regard to clinical type and evolution scheme, according to the derivatives used. Salicylates, when taken at high doses, increase serum transaminases, mostly without overt clinical symptoms. Phenylbutazone is obviously hepatotoxic: it induces cytolytic hepatitis, in some cases with fatal issue. Among the indole derivatives, indometacine was involved, especially in children; mixed hepatitis have been noted during sulindac therapy, mostly with favourable outcome. In the group of propionic acid derivatives, ibuprofen, pirprofen and naproxen have been implicated in hepatitis of various types; ibufenac and benoxaprofen were quickly retired after occasioning several deaths. Concerning others non-steroidal anti-inflammatory drugs, some cases have been reported with piroxicam and diclofenac. Hepatotoxicity mechanisms are often unknown; they appear different according to each drug. Besides, the rheumatic disease under treatment and pharmacokinetic particularities (sulindac, diclofenac) might be important in this view. Monitoring of serum hepatic-enzyme concentrations seems recommended for patients receiving non-steroidal anti-inflammatory for long time therapy.

Adult↗

Pharmacokinetics of amikacin in cystic fibrosis: a study of bronchial diffusion.

36 pharmacokinetic studies of amikacin were performed to evaluate the bronchial diffusion of amikacin in 9 children with cystic fibrosis, 3 to 15 years old. Amikacin was administered i.v. according to a variable dosage regimen. Four children without cystic fibrosis were enrolled as controls. The mean half life was 1.1, the volume of distribution averaged 0.26 l/kg, and the mean plasma clearance was 131 ml/min/1.73 m2, which no differed from that of the controls. The mean peak plasma concentration was always above the MIC but its level depended on the unit dose: 18.5 mg/l, 25,95 mg/l and 31,46 mg/l for doses of 5, 7.5 and 12.5 mg/kg, respectively. Between consecutive amikacin infusions, the plasma level was above the MIC for 21% and 46% of the time after the 5 and 7.5 mg/kg doses. The maximum concentration in sputum between H1 and H2 was always below the MIC, except after 15 mg/kg. The ratio AUC sputum/AUC plasma was between 0.028 and 0.61, and it increased from the beginning to the end of the course of treatment. No side effects were observed on hearing, or vestibular and renal function. The results are used to suggest more appropriate dosing regimens.

Adolescent↗

[Use of anti-digoxin antibodies in digitalis poisoning in an infant].

Digitalis poisoning is rare, always iatrogenic and potentially lethal in infants. We report one case of severe poisoning in which treatment with digoxin Fab antibody fragments was successful. Evolution of plasma digitoxin levels showed an initial rapid decrease (T 1/2:1 hour), then a slower decline (T 1/2:5.5 days). No undesirable side-effects were observed.

Antibodies↗

[Acute overdosage with benzodiazepine derivatives (author's transl)].

The study of 210 cases of voluntary intoxications by benzodiazepines alone, out of a total of 2080 intoxicated patients admitted at the Hospital of Tours, shows that when no other drugs is associated the prognosis is good, both for children and for adults. The association with ethanol does not change the prognosis. The clinical symptoms alone cannot prove the nature of the gravity of the intoxications. After having analysed the drugs present in the gastric juice, and after having checked that only benzodiazepines are implied, the patient can usually be taken care of on a non specialized ward.

Adolescent↗

[Value of the intravenous route for the use of phenobarbital in asphyxiated full term newborn infants].

Phenobarbital (20 mg/kg) was given intravenously to asphyxiated full term neonates who were less than 48 hours old. Further doses were given for 4 days (5 mgs/kg/d). Plasma levels were within the therapeutic range from 5 to 36 hours after the first injection but the maintenance dose always resulted in overdose by 5th day. The exact maintenance dose needs to be determined.

Asphyxia Neonatorum↗

[Bromide encephalopathies (author's transl)].

Bromide encephalopathies are frequently reported in Northern America and Great Britain. There is no characteristic clinical pattern, the neurological symptoms are multiple, this is readily explained by the diffusion of bromide ions to all regions in the central nervous system. An accurate history (bromide intake, followed by the slow onset of digestive and neuropsychiatric symptoms) as well as an apparent hyperchloremia are of the greatest aid in suggesting the diagnosis. The incidence of this type of intoxication is greater in women over 50. The association of a salt free diet to bromide therapy favors the onset of clinical symptoms because of the competition between bromide and chloride at the choroid plexus and at the renal tubule.

Brain Diseases↗