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Biomedical subjects

R Gleckman

Publications and source records attributed to R Gleckman.

At least 19 recordsLinked to original sources
PubMed2001

What do the new antimicrobials offer? Weighing the advantages and disadvantages compared with traditional agents.

The newest antimicrobial drugs have broader spectrums of activity than their predecessors. But are they better than traditional antimicrobial agents? Several drugs recently approved by the US Food and Drug Administration (FDA) may be more effective against uncommon and antimicrobial-resistant pathogens, but their superior efficacy in treating common infections has yet to be proved. Dr Gleckman discusses the advantages and disadvantages of these new drugs and how they can best be used to avoid fostering the emergence of drug-resistant pathogens.

Acetamides↗
PubMed1998

How do the newer oral antimicrobials stack up against traditional agents?

As the antibiotic arsenal expands with the development of new oral agents, selecting appropriate therapy is becoming more difficult. What are the therapeutic indications for the newer antimicrobials, and what advantages do they have over traditional agents? Drs Gleckman and De La Rosa discuss current issues related to antibiotic treatment and offer specific recommendations for the best use of the newer agents.

Administration, Oral↗
PubMed1997

Principles of antibiotic prescribing in the elderly.

Clinicians providing care to elderly patients must appreciate the subtle clinical manifestations that herald the onset of life-threatening infectious disease. Aged patients with an infection may have neither fever nor leucocytosis, making diagnosis challenging. Often, the early features of infectious disease are nonspecific and may resemble inflammatory or neoplastic processes, or there may be insufficient time to await definitive laboratory confirmation, and empirical antimicrobial treatment must be initiated. Aging involves inevitable deleterious alterations in biological processes and, in many elderly patients, this is most strongly characterised by diminished renal functional capacity. This has a major influence on antimicrobial prescribing in the elderly, because therapeutic efficacy must be achieved while minimising the risk of drug-related toxicity. Before prescribing an antibiotic to an aged patient with an infection, the clinician must be cognisant of the patient's drug allergy history and the other drugs that the patient is taking. Ignorance of potential drug-drug interactions can result in ineffective treatment or enhanced toxicity. The therapy of elderly patients with infections is being expanded. To reduce costs and enhance the efficiency of care, systems have been developed to provide antimicrobial care in the home and in long term care facilities. Home healthcare has burgeoned, and drugs that are well tolerated, have a broad spectrum of activity and are simple to administer (e.g. ceftriaxone and fluoroquinolones) appear to be eminently suitable for this therapeutic role. Physicians must also be informed of the factors responsible for the emergence of resistant bacteria that are contributing to infections in institutional and community settings. Clinicians should strive to curb inappropriate antibiotic use to stem the tide of infections that are caused by multidrug-resistant bacteria.

Aged↗
PubMed1996

Assessment of fever in HIV-infected patients.

Fever is common among HIV-infected patients. Because it may signal a serious, potentially fatal underlying infection, a thorough investigation is merited. Where does evaluation begin and end? Drs Gleckman and Czachor discuss a diagnostic approach for primary care physicians that emphasizes rapid identification of the source of fever.

AIDS-Related Opportunistic Infections↗
PubMed1995

Tuberculous pancreatic abscess as an initial AIDS-defining disorder in a patient infected with the human immunodeficiency virus: case report and review.

Tuberculosis (TB) is the most common opportunistic infection worldwide in human immunodeficiency virus (HIV)-infected patients. Intraabdominal TB includes lymphadenopathy and focal lesions of solid viscera. Symptomatic expression of tuberculous invasion of the pancreas (supplemented by demonstration of a mass on imaging) is rare among HIV-infected patients. We report the case of an HIV-infected patient with a tuberculous pancreatic abscess and review nine similar cases. All patients presented with persistent fever and abdominal pain. The diagnosis was made on the basis of detection of pancreatic mass lesions on computed tomographic (CT) scans and the results of cultures and/or acid-fast stains of peripancreatic abscess material and/or other body fluids. Despite an excellent response to antituberculous therapy, three patients died of unrelated causes. In the setting of a febrile illness with abdominal symptoms, tuberculous pancreatic abscess should be considered in the differential diagnosis for HIV-infected patients with a CT-identified mass lesion.

AIDS-Related Opportunistic Infections↗
PubMed1994

Diabetes-related foot infections.

The best choices for diagnostic studies in evaluating patients with possible soft tissue infections, osteomyelitis, and Charcot's foot are presented. The role of surgery with drug therapy and the most appropriate antibiotics are considered.

Diabetic Foot↗
PubMed1988

Sputum gram stain assessment in community-acquired bacteremic pneumonia.

A prospective study was performed over a 4.5-year period to determine the ability of a sputum Gram stain to predict the cause of community-acquired bacterial pneumonia. A blood culture isolate, rather than a sputum culture, served as the reference standard to provide precise identification of the etiologic agent. The study population comprised 59 bacteremic adults who expectorated a valid sputum sample. Data are presented that indicate that a physician, aided by the morphology of the stained sputum, could theoretically select appropriate monotherapy approximately 94% of the time when selective, defined criteria for the microbiology of valid sputum are met. Three of the five patients with pneumonia caused by Haemophilus influenzae, however, had sputum stains that suggested alternative pathogens. This study reaffirms that the Gram-stained sputum is a reliable, but not infallible, guide to direct initial antibiotic therapy in adults with community-acquired bacterial pneumonia.

Adolescent↗
PubMed1985

Therapy of symptomatic pyelonephritis in women.

A prospective randomized controlled study was performed on 44 women with community-acquired, uncomplicated pyelonephritis requiring hospitalization. The study was designed to determine if an extended course of therapy (21 days) would be more effective than the conventional 10-day course of therapy. All patients initially received either gentamicin or tobramycin parenterally for 48 to 72 hours, and then were prescribed an oral agent that possessed in vitro inhibitory activity for the urinary pathogen to complete the course of therapy. Duration of medication was assigned according to a table of random digits. Of the 22 women receiving the 10-day treatment 17 were cured, 4 experienced a reinfection and none had a relapse, compared to 12, 5 and 3, respectively, of 22 receiving the 21-day treatment. Analysis of the therapeutic failures did not demonstrate any superior response for either treatment program (p less than 0.75 and greater than 0.50). No statistically increased incidence of adverse drug reactions occurred in patients receiving the extended course of therapy. Our data do not support an extended course of therapy in women with acute symptomatic pyelonephritis uncomplicated by structural abnormalities.

Adolescent↗
PubMed1982

Community-acquired bacteremic urosepsis in the elderly patients: a prospective study of 34 consecutive episodes.

A prospective study was done on the clinical, laboratory, radiological, immunological and therapeutic features of acute, symptomatic, bacteremic urosepsis in 34 consecutive, elderly patients who required hospitalization. Urinary tract infection was identified as the most common cause of gram-negative bacteremia in elderly patients admitted to a community hospital. Appropriate antibiotic therapy and a lack of serious associated medical illnesses contributed to the high survival rate. Bacteremia and shock occurring in the wake of pyelonephritis develop more commonly in elderly than in young women. In the elderly patient with bacteremia and pyelonephritis radiographic evaluation invariably demonstrates obstruction to urine flow, calculous disease or abscess. Guidelines are provided for the therapy of acute, symptomatic bacteremic urosepsis.

Aged↗
PubMed1982

Acute pyelonephritis in the elderly.

We did a prospective study of the clinical, laboratory, radiologic, and therapeutic features of acute, symptomatic, bacterial pyelonephritis in 35 consecutive elderly, noncatheterized patients who required hospitalization. Pyelonephritis had been identified as the most common cause of gram-negative bacteremia in elderly patients admitted to a community hospital. Appropriate antibiotic therapy and, of equal importance, a lack of serious associated medical illnesses contributed to the 97% survival. Two features appear to distinguish acute, symptomatic, bacterial pyelonephritis in elderly women from that in young women: an increased incidence of bacteremia and septic shock. We provide guidelines for the diagnostic evaluation and antibiotic therapy of acute, symptomatic, community-acquired, bacterial pyelonephritis in the elderly.

Acute Disease↗
PubMed1982

Symptomatic pyelonephritis in elderly men.

A prospective study was carried out of the clinical, laboratory, radiologic and therapeutic features of acute, symptomatic, bacterial pyelonephritis as experienced by 12 consecutive elderly, noncatheterized men who required hospitalization. In spite of the advanced ages of the men and the inordinate frequency of bacteremia and septic shock, no patient died. "Appropriate" antibiotic therapy, supportive treatment, and, as importantly, a lack of associated "imminently" or "ultimately" fatal illnesses contributed to the 100 per cent survival rate. Guidelines are provided for the diagnostic evaluation and antibiotic therapy of community-acquired pyelonephritis in elderly men.

Aged↗