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Biomedical subjects

M Westenfelder

Publications and source records attributed to M Westenfelder.

28 records · Page 2Linked to original sources
PubMed1980

[Efficacy and tolerance of trimethoprim/sulfamethoxazole administered intramuscularly in patients with urinary tract infections (author's transl)].

The antimicrobial efficacy, general and local tolerance of a new intramuscular application form of trimethoprim/sulfamethoxazole was evaluated in a French-German clinical study. Fifty-five urological patients with urinary tract infections were treated with two i. m. injections (3 ml) daily over three to five days followed by oral medication. The study revealed excellent antimicrobial efficacy of the drug. In general TMP/SMZ was tolerated well after i. m. administration. Elevation of creatinine phosphokinase was observed in only three patients treated i. m. for five days. The high viscosity of the solution renders i. m. injection technically difficult, leading to a high proportion of local complications. The indications for use of i. m. administered TMP/SMZ in the hospital are limited, however it should be suitable for private practitioners in that an effective antimicrobial treatment can be started which can be continued by oral or intravenous medication.

Adult↗
PubMed1979

[Lipoid A, a factor in the pathogenesis of chronic pyelonephritis. Experimental and clinical studies of a lipoid A dependent pathological immune reaction].

Lipid A injected into the temporarily occluded renal pelvis of adult dogs, persisted in the kidney tissue and induced an abacterial interstitial nephritis with positive anti-lipid A titers. This reaction was increased by a single dose of lipid A vaccine, reduced by four consecutive immunisations prior to the lipid A injection and absent in puppies. The presence of IgG, IgM and complement complexes in the kidney was demonstrated by immunofluoroscopy. Lipid A antibody titers were measured by the passive hemolysis test in 349 humans. In two out of 20 healthy adults and 16 out of 18 children with recurrent urinary tract infection anti-lipid A antibodies were present. In contrast, no titers were found in 23 newborn babies. In a group of 156 patients with acute urinary tract infection, 28% revealed positive titers, whereas in a group of 132 patients with recurrent urinary tract infection titers occurred in 81%. Selected from this group of 132 patients 61 suffered from an acute infection of the upper tract. 59 oft these (96%) showed definite titers. There was no difference in the development of anti-lipid A antibodies between men and women and the height of the titers did not correlate with the clinical picture of the disease (acute or chronic). The combination of proteinuria and anti-lipid A antibodies indicates the pressure of reccurrent urinary tract infection or chronic pyelonephritis with about 90% accuracy. The titers are caused by immunogenically active lipid A in the body. Since lipid A has the ability to remain in the renal tissue for a long period of time and thereby to maintain the inflammatory response, long-term antimicrobial prophylaxis (six months) should be given to patients with a high risk of recurrent urinary tract infection.

Animals↗
PubMed1977

[Occurence, significance and clinical consequences of lipid A antibody titers in patients with urinary tract infection (author's transl)].

Lipid A antibody titers were measured by the passive hemolysis test in 349 humans. In two out of 20 healthy adults and 16 out of 18 children with recurrent urinary tract infection (UTI) in the presence of anomalies anti-lipid A antibodies were present. In contrast, no titers were found in 23 newborn babies. In a group of 156 patients with acute UTI, 28% revealed positive titers, whereas in a group of 132 patients with recurrent UTI titers occurred in 81%. In a selected group of 132 patients with recurrent infections of the upper tract 59 (=96%) showed definite titers. There was no difference in the development of anti-lipid A antibodies between men and women and the height of the titers did not correlate with the clinical picture of the disease (acute or chronic). The combination of proteinuria and anti-lipid A antibodies indicates the presence of recurrent UTI or chronic pyelonephritis with about 90% accuracy. The titers are caused by immunogenically active lipid A in the body. Since lipid A has the ability to remain in the renal tissue for a long period of time and thereby to maintain the inflamatory response, long-term antimicrobial prophylaxis (six months) should be given to patients with a high risk of recurrent UTI.

Adolescent↗
PubMed1975

Experimental lipid A-induced nephritis in the dog.

The effect of radioactive lipid A, obtained from Escherichia coli, on the kidney of adult dogs and puppies was investigated. Injection of lipid A into the temporarily occluded renal pelvis of adult dogs caused abacterial interstitial nephritis in all animals tested. The intensity and duration of the kidney response coorelated well with the lipid A dose administered. Lipid A was demonstrated autoradiographically in the renal cortex, extra- and intracellularly. Radioactivity was still present after 10 weeks in 16 of 20 examined dogs. In the remaining four dogs the interstitial nephritis had subsided. Thirteen of 14 puppies in which the immunologic defense mechanisms had not yet developed showed no histologic reaction in the kidney after the same procedure as in the adult dogs. Lipid A appeared in the renal parenchyma through the blood stream rather than through the retrograde route. Lipid A antibody titers could be detected only in adult dogs, never in puppies. Lipid A apparently provoked an immunologic process in the kidney damaged by the operative manipulations, thus resulting in an abacterial interstitial nephritis. The possibility that chronic abacterial pyelonephritis can be induced clinically through lipid A and thus may have a pathogenesis similar to abacterial interstitial nephritis is discussed.

Animals↗
PubMedDate not supplied

[Ceftizoxime concentration in blood, muscle, and kidney tissue].

The pharmacokinetic properties of ceftizoxime, a new beta-lactamase-resistant cephalosporin, were investigated in 27 patients following perioperative antimicrobial prophylaxis. 2 g of ceftizoxime were injected before surgery and the concentrations measured in serum, muscle and renal tissue over a period of 30 min to 7 h. The pharmacokinetic data indicated high and long-lasting concentrations of ceftizoxime, especially in the renal tissue; this makes the drug ideal for the treatment of complicated urinary tract infections with obstruction and involvement of the renal tissue, provided the bacteria present are sensitive. The administration of 2 g i. v. every 12 h should be sufficient. In view of the high and long-lasting concentrations, it should be possible to treat uncomplicated urinary tract infections with a single dose of 2 g every 24 h. However, Enterococci, Bacteroides and Pseudomonas aeruginosa are not sufficiently sensitive to ceftizoxime and a combination with an aminoglycoside is thus indicated in the treatment of high-risk patients in the absence of bacteriological tests.

Cefotaxime↗
PubMedDate not supplied

[Clinical studies of the efficacy and tolerance of cefotaxime, ceftizoxime and ceftriaxone in patients with complicated urinary tract infections].

An open randomised clinical study was performed in three groups of 20 patients each with well-defined complicated urinary tract infections to compare the efficacy and tolerance of cefotaxime (1-2 g b.i.d.), ceftizoxime (2 g b.i.d.) and ceftriaxone (2 g u.i.d.). Treatment was administered intravenously over seven days. 63% of the patients were free of infection three to five days after the treatment. There was no significant difference in the efficacy of the three antibiotics with respect to the elimination rate of the sensitive bacteria. There were differences, however, with respect to the development of resistance and the occurrence of superinfections during therapy. No resistance developed during therapy in the ceftizoxime group. Resistance developed twice in the cefotaxime group and three times in the ceftriaxone group. Superinfections with resistant bacteria occurred significantly more frequently in the cefotaxime group (n = 8) than in the ceftriaxone group (n = 2). Six superinfections were observed in the ceftizoxime group. These differences, which could not be explained by the presence of complicating clinical factors, were considered to be due to the pharmacokinetic properties of the substances.

Adult↗
PubMedDate not supplied

[Clinical study of the effectiveness and tolerance of norfloxacin in the therapy of complicated urinary tract infections and in long-term prevention of recurrent urinary tract infections].

The efficacy and tolerance of norfloxacin in the treatment of complicated urinary tract infections and in low dose long-term prophylaxis over six months for recurrent UTI were investigated in 60 and 27 patients, respectively. In the prophylaxis group, compliance with medication was controlled weekly using Mecur BT. Five to nine days after treatment, the urine was sterile in 50 out of the 60 patients treated (83.3%); relapse occurred in six patients and was associated with development of resistance in two. Four patients suffered re-infection within the study period. Failure of treatment was closely related to persisting complicating factors in the urinary tract. The overall tolerance of norfloxacin was satisfactory. However, there was one severe allergic reaction. During the total 391 weeks of low dose long-term prophylaxis given to 27 patients, only one break-through infection occurred. Yet compliance studies proved that antimicrobial activity was present in the urines of less than 50% of the patients. During prophylaxis, the rate of infection was reduced from three to four to 0.13 to 0.05 infections/patient/year. There was no development of resistance in the isolates from these patients. Only two adverse reactions were observed.

Administration, Oral↗