Concentrations of cephalexin (an orally absorbed derivative of cephalosporin C) in serum and urine were determined in normal volunteers and patients. The in vitro antibacterial activity was also studied. All strains of group A beta-hemolytic streptococci and Diplococcus pneumoniae were inhibited by 3.1 mug/ml. Of the Staphylococcus aureus strains, 88% were inhibited by 6.3 mug/ml, and 12.5 mug/ml was inhibitory for all S. aureus, 80% of Escherichia coli, 72% of Klebsiella-Aerobacter, and 56% of Proteus mirabilis strains. About 90 to 96% of E. coli, Klebsiella Aerobacter, and P. mirabilis strains were inhibited by 25 mug of cephalexin per ml. Pseudomonas and indole-positive Proteus strains proved to be quite resistant to cephalexin. Cephalexin was well absorbed after oral administration. A peak serum concentration of cephalexin of at least 5 mug/ml was achieved in each volunteer with 250 and 500-mg doses. A mean peak serum concentration of 7.7 mug/ml was achieved with 250-mg doses; 12.3mug/ml was achieved with 500-mg doses of antibiotic. Food did not interfere with absorption. Probenecid enhanced both the peak serum concentration and the duration of antibiotic activity in the serum. Over 90% of the administered dose was excreted in the urine within 6 hr. The mean peak serum concentration of cephalexin after an oral dose of 500 mg was adequate to inhibit all group A streptococci, D. pneumoniae, and S. aureus, 85% of E. coli, and about 40 to 75% of Klebsiella-Aerobacter and P. mirabilis strains. Levels of cephalexin in urine were adequate to inhibit over 90% of E. coli, and P. mirabilis and 80 to 96% of Klebsiella-Aerobacter strains.

Cephalosporins↗

PubMedDate not supplied

Single-dose regimen of cefonicid for the treatment of uncomplicated infections of the lower urinary tract.

Fifty-three women with symptoms of lower urinary tract infection were randomly assigned to treatment with cefonicid administered intramuscularly in a single 1-g dose or to treatment with 500 mg of amoxicillin administered orally three times a day for five to seven days. Urine cultures were obtained before therapy and again at five to 18 days and six to seven weeks after termination of therapy. Forty-one patients had greater than or equal to 2 X 10(4) colony-forming units (cfu)/ml of catheterized urine or greater than or equal to 10(5) cfu/ml of midstream urine. In the cefonicid-treated group, 19 (90%) of 21 patients demonstrated bacteriologic cure at early follow-up. Of the 18 patients seen at late follow-up, 15 were cured and three were reinfected. One patient was lost to late follow-up. In the amoxicillin-treated group, 16 (80%) of 20 patients demonstrated bacteriologic cure at early follow-up. Of the 15 patients available at late follow-up, 14 were cured and one was reinfected. One patient was lost to late follow-up. Cefonicid is an effective single-dose agent in uncomplicated lower urinary tract infection.

Adult↗

PubMedDate not supplied

Multicenter study of the clinical efficacy of imipenem/cilastatin for treatment of serious infections.

The efficacy and safety of imipenem/cilastatin was evaluated in a multicenter study. For 49 of the 78 patients with 79 infections entered into the study, the clinical and bacteriologic efficacy of therapy could be evaluated. Toxicity data were analyzed for all 79 infections. Overall, 35 of 49 infections were cured or improved: 10 of 11 cases of pneumonia; 8 of 15 cases of pyelonephritis; 4 of 5 cases of osteomyelitis; 3 of 4 intravascular infections; 6 of 9 soft tissue infections; and 4 of 5 miscellaneous infections. There were 13 bacteriologic failures; superinfections with resistant organisms (i.e., Candida albicans, methicillin-resistant Staphylococcus epidermidis, and Pseudomonas maltophilia) occurred in three patients; reinfection with sensitive pathogens complicated one urinary tract infection; relapses developed of five urinary tract infections and of one case of endarteritis; and bacteriologic persistence occurred in three soft tissue infections. Infections with Pseudomonas aeruginosa were the most difficult to treat. In only six of 11 P. aeruginosa infections was both bacteriologic and clinical cure achieved. Adverse effects were minimal; no serious hematologic or hepatic toxicity and no adverse renal effects were noted.

Adult↗

PubMedDate not supplied

Pneumonia caused by gram-negative bacilli: an overview.

Colonization of the oropharynx by Pseudomonas aeruginosa and enteric gram-negative bacilli in acutely ill or debilitated patients, alcoholics, diabetics, and persons with chronic bronchitis may lead to pneumonia. Although gram staining of sputum may provide immediate etiologic clues, the diagnosis is proven only by isolation of the pathogen from blood or pleural fluid or by various invasive techniques since expectorated specimens from highly susceptible patients are often contaminated with aerobic gram-negative bacilli colonizing the oropharynx. However, restricting the definition of cases to those involving empyema or bacteremia results in an underestimation of incidence. Combination therapy with a beta-lactam antibiotic plus an aminoglycoside is commonly recommended for gram-negative bacillary pneumonia because (1) the patients involved are usually debilitated and immunocompromised; (2) mortality is high; and (3) the spectrum of antibacterial activity is increased, emergence of resistance may be retarded, and synergistic activity may result. For example, a third-generation cephem antibiotic plus an aminoglycoside can be used for initial treatment of community-acquired gram-negative bacillary pneumonia, and piperacillin or azlocillin plus amikacin can be used for initial treatment of nosocomial infection in which P. aeruginosa or some other antibiotic-resistant gram-negative bacillus is more likely to be involved.

Acinetobacter Infections↗

PubMedDate not supplied

In vitro inhibition of growth of neisseria gonorrhoeae by genital microorganisms.

The ability of microorganisms present in titers of over 10(5)/ml in the vaginal or cervical secretions to inhibit growth of N. gonorrhoeae in vitro was tested. Study of a strain of N. gonorrhoeae against 77 microorganisms demonstrated that most strans of S. epidermidis, S. aureus and the one "Gaffkya anaerobia" interfered with the growth of the N. gonorrhoeae. A minority of strains of S. viridans, Neisseria, Candida and Bifidobacterium demonstrated interference. No strains of enterococcus, diptheroids, aerobic Lactobacillus, Peptostreptococcus, Peptococcus, anaerobic Lactobacillus or Veillonella demonstrated interference.

Bacteria↗

PubMedDate not supplied

Ciprofloxacin for the treatment of osteomyelitis: a review.

The authors review the use of ciprofloxacin, a new oral quinolone antibiotic, for the treatment of bone infections. The article discusses the spectrum of activity, pharmacokinetics, and toxicity of the quinolone agents. The authors also provide a detailed discussion of the efficacy of ciprofloxacin for osteomyelitis in animal studies and human trials.

Animals↗