Search PubMed⌕ Search

Biomedical subjects

R H Eng

Publications and source records attributed to R H Eng.

At least 55 records · Page 3Linked to original sources
PubMed1988

A multicenter comparative study of cefotetan once daily and cefoxitin thrice daily for the treatment of infections of the skin and superficial soft tissue.

To compare the effectiveness of cefotetan administered at 2 g once a day with cefoxitin at 1 or 2 g three times a day in the treatment of hospitalized patients with skin and superficial soft tissue infections, 194 patients from eight centers were enrolled in an open, randomized trial. Most of the 104 evaluable patients in the cefotetan group and 50 in the cefoxitin group were young men with community-acquired, moderate or severe cellulitis, or abscesses of the upper and lower extremities caused by Staphylococcus aureus, Streptococcus species, Escherichia coli, Proteus mirabilis, Bacteroides fragilis and other species of bacteroides, peptococcus species, and peptostreptococcus species. The mean duration of treatment was 7.5 days for cefotetan and 7.1 days for cefoxitin. A successful clinical response was achieved in 97 percent of the cefotetan patients and in 94 percent of the cefoxitin patients. Of the 88 and 39 bacteriologically evaluable patients in the cefotetan and cefoxitin groups, respectively, a satisfactory bacteriologic response occurred in 96 percent and 87 percent of the patients. No clinically significant changes in clinical laboratory determinations were noted. The incidence of adverse reactions in the cefotetan group (17 percent) was significantly different from that for the cefoxitin group (6 percent) (p less than 0.05); however, the incidence of treatment-related reactions was not significant and the events were mild. Discontinuation of therapy was necessary only in two patients in whom allergic-type reactions developed. A once-daily regimen of cefotetan was as effective as thrice-daily cefoxitin in this study in the treatment of primarily polymicrobial, moderate, or severe infections of the skin and superficial soft tissue.

Abscess↗
PubMed1988

Interaction of ciprofloxacin with ampicillin and vancomycin for Streptococcus faecalis.

Streptococcus faecalis is known to be resistant to killing by many of the commonly used antimicrobial agents. Ciprofloxacin, a member of the quinolone class of compounds, was studied for its ability to inhibit and to kill S. faecalis. The rate of killing by ciprofloxacin was slow and was comparable to that of ampicillin or vancomycin. The antimicrobial effect of combining ciprofloxacin with ampicillin or with vancomycin was also studied using checkerboard double-dilution and killing kinetics. There was no synergy or antagonism between ciprofloxacin and either cell wall active agent. Unlike the aminoglycosides, the addition of ciprofloxacin did not produce additional killing over that of ampicillin or of vancomycin alone.

Ampicillin↗
PubMed1988

Amdinocillin: interaction with other beta-lactam antibiotics for gram-negative bacteria.

Amdinocillin was studied alone and in combination with three other beta-lactam antibiotics (aztreonam, cefoperazone, and ceftriaxone) for activity against gram-negative bacilli. These antibiotic combinations failed to show synergy by the checker-board double-dilution test or by killing kinetic studies. However, amdinocillin did show additive killing action when combined with the other beta-lactam antibiotics studied. Amdinocillin failed to induce or inhibit beta-lactamase production in species of Enterobacteriaceae, but with Pseudomonas aeruginosa, beta-lactamase production was induced. It is concluded that the activity of amdinocillin alone or in combination with another beta-lactam antibiotic should not be more effective in the treatment of infections by gram-negative bacilli than just using the beta-lactam antibiotic alone at a higher dose.

Amdinocillin↗
PubMed1988

Conditions affecting the results of susceptibility testing for the quinolone compounds.

The quinolone class of compounds was studied for conditions which might affect susceptibility results. These compounds included amifloxacin, ciprofloxacin, difloxacin, enoxacin, norfloxacin, ofloxacin, and RO 23-6240. Ciprofloxacin, a representative quinolone, was found to have rapid bactericidal activity, equivalent to that of gentamicin, in contrast to the slower activity of a cephalosporin, cefotaxime. Test conditions that might affect susceptibility test results included divalent magnesium and calcium cation concentrations and pH. For strains of Staphylococcus aureus, Enterobacteriaceae, and enterococcus, the effects were not large. A pH of 5.0 in general increased the minimum inhibitory concentrations (MICs) for the organisms against most carboxyquinolones, up to 8-fold, as compared to that at pH 7.4. In comparison, a similar lowering of pH caused an increased in MIC of 32-fold for gentamicin and no change for cefotaxime. Increasing the concentrations of divalent cations increased the MICs on the average of only 4-fold. Of the quinolones, difloxacin was the least affected by change in concentration of divalent cations and by pH. Such changes are not expected to greatly affect the efficacy of therapy of those members of Enterobacteriaceae which have MICs much less than 0.1 micrograms/ml, but might diminish therapeutic efficacy for those organisms such as Streptococcus aureus with MICs of 1.0 microgram/ml or higher.

Bacteria↗
PubMed1988

Activity of cefixime (FK 027) for resistant gram-negative bacilli.

Cefixime is an orally absorbable cephalosporin with an extended spectrum of in vitro activity for gram-negative bacteria especially members of the Enterobacteriaceae. Gram-negative rod isolates collected over a three month period were tested against cefixime. Greater than 99% of Escherichia coli isolates was susceptible to cefixime including those resistant to ampicillin. Similarly isolates of Klebsiella, Proteus and Providencia were also exquisitely susceptible to cefixime as were 91% of Enterobacter cloacae and 71% of Enterobacter aerogenes. Killing kinetics of cefixime did not differ from that of the intravenously administered third-generation cephalosporin, cefotaxime. The addition of magnesium and calcium divalent cations or the lowering of the pH to 5.0 did not affect the action of this antibiotic. The extended spectrum of this oral antibiotic may be useful in treatment of urinary tract and skin and soft tissue infections caused by the more resistant gram-negative rods.

Ampicillin Resistance↗
PubMed1987

Norfloxacin in the treatment of complicated and uncomplicated urinary tract infections. A comparative multicenter trial.

In a multicenter, prospective treatment study, 59 patients with complicated or uncomplicated urinary tract infections (UTIs) were treated with norfloxacin (400 mg orally twice daily) and compared with 45 patients treated with trimethoprim/sulfamethoxazole. Norfloxacin was relatively safe and highly effective in treating both uncomplicated UTIs (86 percent cure rate) and complicated UTIs (75 percent cure rate). Failure of trimethoprim/sulfamethoxazole therapy was associated with initial bacterial resistance, e.g., from Pseudomonas aeruginosa and Serratia marcescens; such multiresistant bacteria were successfully treated with norfloxacin. Thus, norfloxacin appears to extend the range of oral agents available to treat UTIs.

Adult↗
PubMed1987

Nontyphoid salmonella urinary tract infections.

Urinary tract infection caused by nontyphoid salmonella is rare. A case is described in a patient with acquired immunodeficiency syndrome who had multiple recurrences. A review of cases in which salmonella involved the urinary tract indicates that this infection usually occurs in patients who are structurally or immunologically compromised. Recurrence is expected and treatment plan should include an extended course of antibiotic therapy.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Treatment failures of cefotaxime and latamoxef in meningitis caused by Enterobacter and Serratia spp.

Despite the apparent success of several new cephalosporins in the treatment of Gram-negative bacterial meningitis, four treatment failures with cefotaxime or latamoxef were encountered (two caused by Enterobacter and two by Serratia spp.) In-vitro parameters of susceptibility of these clinical isolates were compared with those of a meningeal Ent. cloacae isolate from a successfully treated patient. The MIC and MBC values, degrees of inoculum effect, and amounts of beta-lactamase produced correlated poorly with the observed clinical outcome. However, the extent to which an isolate was killed by the cephalosporin used for treatment, in a 6-h in-vitro incubation, showed good correlation. We suggest that such a test should be used to predict clinical outcome of therapy because the other parameters such as the MIC and MBC values are not sufficiently discriminatory.

Adult↗
PubMed1987

Evidence for destruction of lung tissues during Pneumocystis carinii infection.

Five cases of Pneumocystis carinii infection with evidence of lung tissue destruction that occurred in patients with the acquired immunodeficiency syndrome were reviewed. None of the patients had a history of cigarette smoking, but all five had either cavitarylike lesions in the lungs or had pneumothorax at the time of presentation to the hospital. All patients had P carinii identified in specimens obtained either from bronchial washings or from open-lung biopsy. In four of the five patients, no other pathogens were involved in the lungs, while the fifth patient had concomitant cytomegalovirus infection. Findings on chest roentgenograms included large thin-walled cavitarylike lesions, multiple cavitary lesions, or pneumothorax. These presentations of the infection have not been previously described, and the mechanisms for lung tissue damage are as yet unknown. Cavitary lung disease found on chest roentgenograms in patients should not exclude the diagnosis of P carinii pneumonia, and patients with the acquired immunodeficiency syndrome presenting with pneumothorax should have the possibility of P carinii infection included in the differential diagnosis.

Adult↗
PubMed1987

Unusual features of arthritis caused by Candida parapsilosis.

A case of arthritis caused by Candida parapsilosis was observed, in which the only manifestation was intermittent knee effusion. The synovial fluid had a normal cell count with a mononuclear cell predominance. A review of such infections substantiates the relative paucity of symptoms seen in septic arthritis caused by this species of Candida, as opposed to other species of Candida that generally cause an acute course with more symptoms.

Adult↗
PubMed1986

Cephalosporin therapy for salmonellosis. Questions of efficacy and cross resistance with ampicillin.

The new cephalosporins should be explored for Salmonella septicemia efficacy, because of multiple-drug resistance, the high incidence of patient allergies to ampicillin and sulfamethoxazole-trimethoprim, and the limited number of antibiotics with proven efficacy. This study reports on six widely used cephalosporins: cephalothin, cefamandole, cefoperazone, cefoxitin, cefotaxime, and ceftriaxone with respect to in vitro killing of Salmonella. This in vitro activity was related to the stability of the agents to beta-lactamases. Cefoperazone was the least stable, followed by cefamandole and cephalothin. Cefoxitin, cefotaxime, and ceftriaxone were the most stable. The beta-lactamase-unstable agents permitted regrowth of beta-lactamase-producing salmonella within 36 hours. Standard susceptibility tests showed good inhibitory levels by these unstable agents at 18 hours, but the minimum inhibitory concentrations increased dramatically with longer incubation periods. Based on these results, past cephalothin failures for ampicillin-resistant Salmonella can be explained. Additionally, there should be a dichotomy of effectiveness in the new cephalosporins depending on their beta-lactamase stability. The stable cephalosporins deserve further clinical trials in the treatment of beta-lactamase-producing Salmonella infections.

Ampicillin↗
PubMed1986

Cryptococcal infections in patients with acquired immune deficiency syndrome.

Cryptococcus neoformans is a major pathogen in patients with acquired immune deficiency syndrome and was found to infect 13.3 percent of such patients seen at two medical centers. Serum cryptococcal antigen levels were as high as 1:2,000,000 and, despite therapy, often remained elevated. Antigen titers in the cerebrospinal fluid generally declined at an expected rate in the survivors. The significance of high antigen titers in the blood after a prolonged course of therapy with amphotericin B and 5-flucytosine is unknown.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Experience with the use of cefotaxime in the treatment of bacterial meningitis.

Information on 62 bacteriologically confirmed cases of bacterial meningitis treated with cefotaxime in this country was obtained retrospectively from infectious disease consultants. This series of cases differed markedly from the world cumulative case data thus far presented. One of the two most common organisms treated was the pneumococcus (allergy to penicillin or misdiagnosis of the Gram stain results were the major reasons given). The other organism was Klebsiella. Unanticipated bacteriologic successes were noted in two cases of staphylococcal meningitis secondary to parameningeal foci. The bacteriologic cure rate and survival rate were about 85 percent. Failure of monotherapy was seen in one case of Pseudomonas meningitis, as well as in three of five cases of Enterobacter meningitis. In addition, two cases of Escherichia coli meningitis in which moxalactam therapy inexplicably failed were cured with cefotaxime. Close analysis of killing kinetics appeared to explain the Enterobacter and E. coli failures. Thus, overall not all gram-negative species and not all isolates of any particular species that cause meningitis can be successfully treated by cephalosporins. Data obtained during the investigative trials do not appear to be entirely predicative of what occurred during the free clinical use of an antibiotic. Post-investigatory follow-up and surveillance of all newly introduced therapeutic agents are needed.

Adult↗
PubMed1986

Comparison of antibiotic resistance of gram-negative bacilli with beta-lactam and aminoglycoside antibiotics.

In 1981 a comparison of the resistance rates of aminoglycosides, penicillins, cephalosporins, and nalidixic acid was made in species of gram-negative rods between a hospital in Toulouse, France and one in Brooklyn, New York. The results showed similar rates of resistance from both institutions. Both institutions showed high rates of aminoglycoside resistance; high ampicillin resistance among salmonella and Pseudomonas mirabilis in France and shigella in New York City; similar rates of resistance to cephalosporins and finally, markedly different incidences of resistance to naladixic acid. Analysis of medical records over several years indicated a gradual but continuing increase in resistance to aminoglycosides. The majority of such isolates had been isolated from patients in intensive care units. Few differences in the rates of resistance to the cephalosporins were noted between the two institutions, either for the older or newer agents in this group. Further, no increase in resistance was noted to this group of antibiotics in the previous 5 yr.

Aminoglycosides↗
PubMed1986

Bacteremia and fungemia in patients with acquired immune deficiency syndrome.

Patients with acquired immune deficiency syndrome (AIDS) are known to have identifiable host defense deficiencies, especially deficiencies in cell-mediated immunity. They are at increased risk for developing infections of the bloodstream caused by Cryptococcus neoformans and Salmonella species. However, bacteremias caused by other enteric gram-negative rods and Pseudomonas aeruginosa are found less frequently in patients with AIDS than in patients without AIDS (P less than 0.001 and P less than 0.01, respectively). The findings of specific organisms in blood is consistent with the known types of host defense deficiencies in these patients.

Acquired Immunodeficiency Syndrome↗