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Biomedical subjects

R Frei

Publications and source records attributed to R Frei.

106 records · Page 6Linked to original sources
PubMed1986

Use of ciprofloxacin in the treatment of Pseudomonas aeruginosa infections.

The therapeutic efficacy and safety of ciprofloxacin was studied in 30 patients with Pseudomonas aeruginosa infections. In 20 patients ciprofloxacin was given alone and in 10 patients (including 8 compromised hosts) in combination with an aminoglycoside (9) or azlocillin (1). Ciprofloxacin was given in doses of 500 mg orally or 200-300 mg i.v. every 12 h. In patients receiving only ciprofloxacin clinical cure with eradication of bacteria was obtained in 15 patients (75%) with infections of bone and joint (6), skin and soft tissue (4), lung (2), middle ear (2) and CSF (1). Two patients with lymphoma and Pseudomonas aeruginosa pneumonia died. In patients receiving combination therapy a definite therapeutic success was achieved in four (40%). Three patients with Pseudomonas aeruginosa septicemia died. In seven patients nine bacterial strains with decreasing susceptibility of ciprofloxacin (increase in MIC from less than or equal to 0.5 micrograms/ml to 2-16 micrograms/ml) were selected (6 Pseudomonas aeruginosa, 1 Enterobacter cloacae, 1 Serratia marcescens, 1 Staphylococcus aureus). Ciprofloxacin was well tolerated. This new quinolone seems to be suitable for single drug treatment of Pseudomonas aeruginosa infections in patients with normal host defense mechanisms, while its therapeutic potential in compromised hosts requires further evaluation.

Administration, Oral↗
PubMedDate not supplied

Fatal Legionella pneumophila pneumonia: treatment failure despite early sequential oral-parenteral amoxicillin-clavulanic acid therapy.

A 68-year-old male, having just returned from a two-week holiday on the Island of Ischia, developed unilateral pneumonia for which he was treated with oral amoxicillin-clavulanic acid and hospitalized within three days when the disease worsened and spread to both lungs. Despite parenteral amoxicillin-clavulanic acid (up to 2.2 g i.v. t.i.d.) the pneumonia spread rapidly over the next three days. Sputum cultures returned post mortem yielded Legionella pneumophila serogroup 1 and urine tests revealed the presence of Legionella antigen. Disk diffusion susceptibility testing on BCYE of the causative pathogen revealed zone diameters of inhibition of the clinical isolate exceeding 50 mm, indicating high susceptibility to this antibiotic combination. The therapeutic failure of amoxicillin-clavulanic acid should stimulate further reports and studies on the efficacy against legionellosis of this drug and similar beta-lactam inhibitor combinations as well as other beta-lactamase-stable beta-lactams.

Administration, Oral↗
PubMedDate not supplied

In vitro susceptibility of 33 clinical case isolates of Xanthomonas maltophilia. Inconsistent correlation of agar dilution and of disk diffusion test results.

Xanthomonas maltophilia is an emerging nosocomial pathogen, possibly selected by a changing antimicrobial usage and patient population. In the present study, we tested the susceptibility of 33 recent clinical case isolates to 12 commonly employed antimicrobials. Trimethoprim-sulfamethoxazole (1:19 ratio) and doxycycline were uniformly the most active agents; ciprofloxacin and fleroxacin were slightly less active and, along with tetracycline and ceftazidime, more variable in their potency. Interestingly, the disk diffusion method routinely overstated the activity of ciprofloxacin (12% very major errors, 58% minor errors). The present in vitro data and the hitherto accumulated clinical experience suggest that in the absence of unequivocal clinical efficacy of ciprofloxacin against this increasingly recognized nosocomial pathogen, the decision to use ciprofloxacin or any other fluoroquinolone against these pathogens should rely preferentially on the dilution susceptibility test method results. In contrast, the present study confirms the excellent predictive value of trimethoprim-sulfamethoxazole, tetracycline, and fleroxacin disks as well as the higher (9% minor errors) inhibitory activity of these drugs. Hence, pending the elaboration of clinical efficacy data of alternative antimicrobial agents against X. maltophilia infections, trimethoprim-sulfamethoxazole remains a sound therapeutic choice.

4-Quinolones↗
PubMedDate not supplied

In vitro activity of three carbapenem antibiotics. Comparative studies with biapenem (L-627), imipenem, and meropenem against aerobic pathogens isolated worldwide.

The in vitro activity of biapenem (formerly L-627 or LJC10, 627), a new carbapenem, was compared with that of imipenem and meropenem against > 6000 clinically significant pathogens isolated in six countries worldwide. Biapenem was active against members of the family Enterobacteriaceae with a 90% minimum inhibitory concentration (MIC90) ranging from < or = 0.06 to 2 micrograms/ml. Only Serratia spp. and Providencia spp. were less susceptible (MIC90, 8 micrograms/ml). Pseudomonas aeruginosa and Xanthomonas maltophilia displayed an MIC90 of > or = 8 micrograms/ml biapenem/ml whereas Acinetobacter spp. were susceptible at < or = 1 micrograms/ml. Oxacillin-resistant staphylococci were resistant to biapenem at > 8 micrograms/ml whereas oxacillin-sensitive staphylococci were susceptible at < or = 1 micrograms/ml. Biapenem, imipenem, and meropenem displayed poor activity against Ent. faecium (MIC90, > or = 8 micrograms/ml), and only imipenem displayed slightly better activity against Ent. faecalis (MIC90, 4 micrograms/ml). The rank order of activity against groups of isolates was Enterobacteriaceae (meropenem > biapenem > or = imipenem), Ps. aeruginosa (biapenem = meropenem = imipenem), oxacillin-sensitive staphylococci (imipenem > or = biapenem = meropenem), oxacillin-resistant staphylococci (biapenem = meropenem = imipenem), and Enterococcus spp. (biapenem = meropenem = imipenem). These in vitro suggest that further developmental work on biapenem is warranted.

Enterobacteriaceae↗
PubMedDate not supplied

Outer membrane permeability and beta-lactamase content in Pseudomonas maltophilia clinical isolates and laboratory mutants.

Low outer-membrane permeability appears to be responsible for the generally high degree of antibiotic resistance of Pseudomonas maltophilia. Constitutive overproduction of beta-lactamases affects the sensitivity of these bacteria only to those beta-lactam antibiotics that are hydrolyzed by strain-specific beta-lactamases and that do not efficiently induce these enzymes in inducible strains.

Anti-Bacterial Agents↗
PubMedDate not supplied

Antibacterial activity of oral antibiotics against anaerobic bacteria.

The spectrum and the antibacterial susceptibility of anaerobic bacteria to oral antibiotics isolated from clinical specimens was assessed in two different centres, the first receiving specimens from University departments and the second from general practitioners and small hospitals. Susceptibility was studied with a microtiter ready-to-use panel system, using the manufacturer's modified Wilkins-Chalgren's broth as the test medium for the following antibiotics: ampicillin, ampicillin+sulbactam, amoxicillin+clavulanic acid, cephalexin, cefaclor, cefuroxime, cefetamet, clindamycin, doxycycline and erythromycin. Anaerobic bacteria frequently encountered in clinical specimens from the University departments were mainly resistant Bacteroides spp., especially Bacteroides fragilis, Propionibacterium spp. and Peptostreptococcus spp., whereas in the outpatient center, Peptostreptococcus spp, Actinomyces spp. and Veillonella parvula (usually considered as colonizing flora) represented 90% of the cultured bacteria. The study shows that the members of most Bacteroides spp. encountered in a hospital environment are resistant to most of these agents (except clindamycin, amoxicillin+clavulanic acid, and ampicillin+sulbactam), whereas the gram-positive pathogens are widely covered by most of the orally available agents studied including cefetamet.

Administration, Oral↗
PubMedDate not supplied

[Intestinal microecology of the adult population of Mongolia, Switzerland, and Russia].

The study of intestinal microflora was made in clinically healthy young adults living in rural areas of Mongolia, in Russia (Moscow) and in Switzerland, as well as in Swiss citizens of elderly age groups (55-68 and 87-94 years). Essential differences in the quantitative and qualitative characteristics of intestinal microflora both in the inhabitants of different countries as well as in people belonging to different age groups in the same country were established. The results of the study demonstrated the expediency of working out the criteria of the norm for intestinal microflora both for the population of different countries and for people living in the same country, but belonging to different age groups.

Adult↗
PubMedDate not supplied

[Qualitative composition of the normal intestinal microflora in individuals from the various age groups].

The study of the microflora of the large intestine in healthy adult volunteers of different age groups (25-36, 55-68 and 88-94 years old), living in Switzerland, has been carried out. As revealed by the analysis of the result obtained in this study, normal intestinal microflora in adults has different qualitative and quantitative characteristics at different periods of their life. The greatest diversity of intestinal microflora is observed at a mature age (55-68 years old), while the poorest microflora is observed in people more advanced in age. The amount of microorganisms inhabiting the intestine reaches its maximum in people of mature age and is low in elderly people. Changes in normal intestinal microflora are probaly linked with morpho-functional transformations in the host body at different periods of life. It is expedient to work out the criteria of norm for the microflora of different age groups with a view to use these criteria for the evaluation of the microbial status of the intestine in persons of different age.

Adult↗
PubMedDate not supplied

[Intestinal microflora in children from Mongolia, Russia, and Switzerland].

Intestinal microflora was studied in 3 groups of children; 55--living in Mongolia, 18--in Switzerland and 28--in Russia. Age of children of both sexual groups was 1.5-3 years. This study revealed that in none of these groups of clinically healthy children living in different regions and having different diet normal intestinal microflora corresponded to the standard considered to be the norm. The revision of norm criteria for normal intestinal microflora in children is recommended.

Child, Preschool↗
PubMedDate not supplied

[Effect of the lavage of the digestive tract on microflora in patients with polyps in the large intestine].

The microbial status of the intestine and the influence of lavage with polyethylene glycol and balanced electrolyte solution (PEG + E), used in the process of the preparation of patients to polypectomy, on this status were evaluated. The study of microflora was made before oral lavage after, and 48-72 hours later its completion. For control, a group of healthy volunteers, also subjected to oral lavage with PEG + E, was used. The lavage of the digestive tract with PEG + E led to a sharp change in the microbial status in both groups. Some microorganisms, previously absent in the intestine, were found after lavage. The processes of the restoration of intestinal microflora after lavage in healthy volunteers and in patients with polyps had certain differences. In healthy volunteers intestinal microflora was completely restored, and even improved, 48-72 hours after lavage with PEG + E, while at the expiration of this time intestinal microflora in the patients with polyps could be characterized as dysbiotic.

Administration, Oral↗