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Biomedical subjects

R L Perkins

Publications and source records attributed to R L Perkins.

65 records · Page 4Linked to original sources
PubMedDate not supplied

Therapy of skin, soft tissue, and bone infections with cefoxitin sodium.

Twenty-seven patients with skin and soft tissue infections, including three with contiguous osteomyelitis, were given cefoxitin intravenously or intramuscularly; the infections of 25 (93%) were resolved with cefoxitin therapy. Etiologic agents included staphylococci, streptococci, Enterobacteriaceae, and anaerobes. Susceptible pathogens were inhibited by less than or equal to 8 micrograms of cefoxitin/ml. This level of drug was surpassed by mean peak serum concentrations eight- to 12-fold after intravenous infusions and two- to threefold after intramuscular injections and resulted in eradication of susceptible organisms from lesions during treatment. Intravenously administered cefoxitin was well tolerated, although eosinophilia, phlebitis, elevation of levels of hepatic enzymes, and a positive direct Coombs' test were observed. Intramuscular injections of cefoxitin in 0.5% lidocaine caused pain and induration and thus were poorly tolerated.

Abscess↗
PubMedDate not supplied

Clinical trials of cefotaxime for the treatment of bacterial infections of the lower respiratory tract.

The efficacy of cefotaxime sodium for treatment of patients with lower respiratory infections was evaluated by three protocols in multicenter trials. The first trial studied cefotaxime alone; the second and third trials compared cefotaxime with cefazolin in observer-blind and single-blind randomized controlled studies, respectively. A total of 656 patients were entered in the three trials; 527 received cefotaxime. Overall rates of bacteriologic and clinical cure, analyzed by pathogen, for the cefotaxime treated patients were 89.9% and 93.9%, respectively. In the two comparative trials, overall rates of bacteriologic and clinical cure with cefotaxime, by pathogen, were greater than 94% and numerically exceeded those for cefazolin in each instance. The efficacies in the comparative studies, when analyzed by total patient responses, were significantly different only for clinical responses to cefotaxime in the single-blind randomized trial (P = 0.03). Favorable cure rates with cefotaxime were obtained in patients with infections due to Streptococcus pneumoniae, Haemophilus influenzae, Streptococcus pyogenes, Staphylococcus aureus, and Escherichia coli, and nearly comparable responses were obtained for infections due to Proteus, Enterobacter, and Klebsiella species. Cefotaxime was clinically effective in some of the infections due to Serratia marcescens and Pseudomonas aeruginosa, but bacteriologic failures occurred in 67% and 61% of cases, respectively. All Serratia strains were highly susceptible in vitro to cefotaxime, but the range of minimal inhibitory concentrations of cefotaxime for Pseudomonas isolates was wide.

Adolescent↗
PubMedDate not supplied

Acute bacterial meningitis: an analysis of factors influencing prognosis.

Three-hundred and forty-nine cases of acute bacterial meningitis treated during a 25-year period (1949 through 1973) were reviewed to determine the prognostic significance of initial historical, physical and laboratory findings. A poor prognosis was associated with age greater than or equal to 40 years (p less than 0.01), presence of predisposing illness (p less than 0.01), associated illness (p less than 0.01), absence of nuchal ridity (p less than 0.05), and derangement of cerebral function (p less than 0.01). The effects of predisposing illness and moderate cerebral dysfunction were dependent upon age. In contrast, the effects of associated illness, mild or severe cerebral dysfunction, and absent nuchal rigidity were independent of age. Laboratory studies associated with a poor prognosis included an elevated cerebrospinal fluid (CSF) protein (p less than 0.05), a positive CSF smear (p less than 0.05), or culture (p less than 0.01), or bacteremia (p less than 0.01). No prognostic significance could be attributed to race (p greater than 0.05), sex (p greater than 0.05), prior antibiotic therapy (p greater than 0.05), duration of illness before institution of adequate therapy (p greater than 0.05), CSF leukocyte count (p greater than 0.05), frequency of polymorphonuclear leukocytes in CSF (p greater than 0.05), CSF sugar less than or equal to 40 mg/100 ml (p greater than 0.05), or a CSF sugar-simultaneous blood sugar ratio less than or equal to 0.40 (p greater than 0.05).

Acute Disease↗
PubMedDate not supplied

Tobramycin: in vitro and clinical evaluation in 30 patients.

Clinical evaluation of intramuscular tobramycin was accomplished in 30 patients with respiratory, soft tissue, urinary tract, bone or septicemic infections due to gram negative bacilli. Median sensitivity to tobramycin of Pseudomonas aeruginosa isolates (19 strains) was 0.62 mug/ml and range 0.31-2.5 mug/ml; less activity was observed for Escherichia coli, Proteus mirabilis, Klebsiella pneumoniae and Enterobacter species isolates but median minimum inhibitory concentrations were less than or equal to 2.5 mug/ml. Therapy resulted in clinical and bacteriologic cures in 16 patients (53 per cent) including 13 of 16 (181 per cent) with urinary tract infections; 9 of the 14 patients who did not obtain bacteriologic cure had satisfactory clinical responses. Tobramycin was effective for selected gram negative bacillary infections and particularly for P. aeruginosa.

Adult↗
PubMedDate not supplied

Hospital-associated bacterial meningitis.

Eighteen of 349 cases (5.2 per cent) of bacterial meningitis seen between 1949 and 1973 were hospital-associated (developed after admission to the hospital). The patients were adults, usually males, and developed symptoms and signs of meningitis from 2 to 23 days (mean, 10.1 days) after hospital admission. The diagnosis of bacterial meningitis was made from less than 1 day to 15 days (mean, 4.8 days) after the onset of symptoms. Fourteen of the 18 patients had received antibiotics during the week prior to developing meningitis. Nine (50 per cent) had a chronic, noninfection, underlying illness. Diagnostic or surgical procedures involving the neuraxis or adjacent structures preceded the development of meningitis in 10 of the 18 patients (56 per cent). Only 6 of the 18 patients survived their infection. Prompt recognition, diagnosis, and therapy of hospital-associated meningitis in high-risk patients may reduce the significant mortality.

Adolescent↗
PubMedDate not supplied

Pneumonia and empyema caused by Clostridium sordellii.

A case of pleuropulmonary infection caused by Clostridium sordellii is reported for the first time. The clinical presentation with acute onset resembling pulmonary infarction, the absence of toxicity, hemolysis and shock, and response to penicillin and drainage was similar to that of patients with pleuropulmonary infection caused by C. perfringens.

Clostridium Infections↗
PubMedDate not supplied

A single large dose of trimethoprim-sulfamethoxazole fails to cure gonococcal urethritis in men.

In a single-blind study, 50 men who had acute gonococcal urethritis were treated with a single oral dose of either 720 mg trimethoprim (TMP) plus 3,600 mg sulfamethoxazole (SMZ) or 3.5 g ampicillin plus 1 g probenecid. Isolates of Neisseria gonorrhoeae were tested for in-vitro susceptibility to the chemotherapeutic agents administered by agar-dilution and disk-diffusion methods, and results were correlated with cure or failure to cure as determined bacteriologically. Among patients returning for follow up, the cure rate after TMP/SMZ was 69%. Cure was predictable when the isolates of N. gonorrhoeae were inhibited by < or = 0.63/11.87 micrograms/ml of TMP/SMZ (fixed ratio, 1:19) or when the zones of inhibition were > or = 23 mm; failure was predictable when > or = 1.25/23.75 micrograms/ml of TMP/SMZ was necessary for inhibition and when zones of inhibition were < or = 21 mm (P < 0.02). The cure rate after therapy with ampicillin was 100%, a rate significantly higher than that found after TMP/SMZ (P < 0.02); all isolates were inhibited by < or = 0.16 microgram/ml of ampicillin. Adverse reactions were not seen after either TMP/SMZ or ampicillin.

Adult↗
PubMedDate not supplied

Successful treatment with cefaclor of gonococcal urethritis in men.

Cefaclor, a new orally administered cephalosporin, was evaluated by a randomized trial for effectiveness in the treatment of uncomplicated urethritis due to Neisseria gonorrhoeae in men. Regimens included 2,3, and 4 g of cefaclor, with or without 1 g of orally administered probenecid, as single daily doses for three days. The diagnoses were confirmed by isolation of N. gonorrhoeae; cures or therapeutic failures were determined by follow-up cultures on day 7 after completion of therapy. Sixty-six (73%) of 90 treated patients were evaluable for efficacy. The bacteriologic cure rate was 98% (65/66); one patient treated with 2 g of cefaclor plus probenecid had a positive culture for N. gonorrhoeae on follow-up examination. Adverse reactions consisted of mild nausea in five patients (7%) and vomiting in one patient (1%) who received 3- or 4-g doses. No treatment was discontinued, and no abnormality of screening hematologic tests or enzymes was observed. Thus, cefaclor, given in multiple doses, was highly efficacious for treatment of uncomplicated gonococcal urethritis in men.

Cefaclor↗
PubMedDate not supplied

Detection of polysaccharide cell wall antigen of Neisseria gonorrhoeae in a rabbit model by counterimmunoelectrophoresis.

A rabbit chamber model was developed and inoculated with 10(9) colony-forming units (cfu) of viable Neisseria gonorrhoeae to determine whether the lipopolysaccharide-derived Gc2 polysaccharide cell wall antigens could be detected by counterimmunoelectrophoresis (CIE). Four hours after inoculation, a polymorphonuclear leukocyte response was noted in the chambers; this response was followed by progressive phagocytosis of the organisms and a fall in number of cfu/ml. All visible bacteria were intracellular, and chamber fluids were sterile 6 hr after inoculation. Use of sero specific antisera permitted detection by CIE of the Gc2 polysaccharide antigen in sera of all rabbits within 48 hr after inoculation of the chambers, whereas blood cultures remained sterile throughout the experiment. At 2-6 hr after inoculation, the Gc2 polysaccharide antigen was also detected as a single precipitin band in the chamber fluid of inoculated rabbits. At 24 hr the precipitin band was not observed; rather, a halo above the antigen well was noted. The halo was found to be a nonspecific complex containing the Gc2 polysaccharide antigen and no antibody. In the rabbit model studied, CIE was sufficiently sensitive to detect concentrations of the Gc2 polysaccharide antigen of greater than or equal to 0.97 microgram/ml in serum and chamber fluid.

Animals↗