Infectious diseases complicating renal transplantation: a survey and recommendations for prevention, recognition, and management.
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Biomedical subjects
Publications and source records attributed to M J Raff.
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This study in dogs using tissue-implanted capsules indicates that cephalothin, cefazolin, ampicillin and tetracycline are excreted in the bile, appearing in this fluid at concentrations greater than the concomitant serum levels. Hepatic interstitial fluid concentrations of these agents differed little from levels achieved in soft tissues elsewhere in the body, indicating that compounds which are concentrated in bile do not necessarily achieve high levels in the hepatic parenchyma. The selection of an antimicrobial agent for the therapy of hepatic parenchymal infection or obstructive cholecystitis should, therefore, be based on susceptibilities of the suspected organism rather than on the relative tendencies of various agents to be concentrated in bile.
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Fifteen patients who had severe Staphylococcus aureus infections were treated with minocycline for 6 to 24 days; all responded satisfactorily. Where possible, posttherapy cultures were taken, and in all instances, the pathogen was eradicated. There was no adverse reactions. Minocycline proved to be an acceptable and effective alternative for staphylococcal soft-tissue infections. It has the following advantages: (1) it is administered orally on a twice-daily dosage schedule, which facilitates patient compliance; (2) its toxicity is well defined and is not troublesome during short-term therapy; and (3) it penetrates tissues in therapeutic amounts and yields serum levels that are well above the minimum inhibitory concentrations of most staphylococci.
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The time rates of binding of three antibiotics of similar chemical structure, each with differing degrees of protein binding, were determined. Cephaloridine, which is 10% bound by serum proteins, was bound at a more rapid rate than cephalothin, which is 40% bound by serum protein. Cefazolin, bound 80%, required for longest time period for maximum binding to occur. The rate of protein binding appears directly related to the total percentage bound. The data from this study indicate that prolonged rates of binding of highly protein-bound drugs may influence pharmacological studies.
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