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Biomedical subjects

R M Echols

Publications and source records attributed to R M Echols.

At least 37 records · Page 2Linked 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

Comparative study of cefotetan and cefoxitin in the treatment of intra-abdominal infections.

One hundred eighty-eight patients were enrolled in a multicenter, randomized clinical trial to compare the safety and effectiveness of 1 to 2 gm cefotetan every 12 hours with those of 1 to 2 gm cefoxitin every 6 hours in patients with intra-abdominal infections. Most of the infections were community acquired, were associated with gastrointestinal tract perforation, and were caused by both anaerobic and aerobic bacteria. The median duration of therapy was 6 days for each group. The clinical response rate for the 95 evaluable patients in the cefotetan group was 98%, and that for the 43 evaluable patients in the cefoxitin group was 95%. Bacteriologically, 97% of the 58 evaluable patients in the cefotetan group and 89% of the 27 evaluable patients in the cefoxitin group had a satisfactory or presumed satisfactory response; two patients in the cefotetan group and three in the cefoxitin group were considered bacteriologic failures. Cefotetan was as effective as cefoxitin in eradicating Bacteroides fragilis and other species of Bacteroides, Clostridium sp., and gram-negative bacilli. The incidence of treatment-related adverse reactions for cefotetan (27%) was not statistically different from that for cefoxitin (17%). No clinically significant differences were detected between the treatment groups in changes in the results of clinical laboratory tests performed before and after treatment; a decrease in hematocrit among the cefotetan group was statistically greater (p = 0.04) than that for the cefoxitin group, and a decrease in serum creatinine level for the cefoxitin group was greater than that for the cefotetan group (p = 0.02). Cefotetan may represent an effective, safe, and cost-saving alternative to cefoxitin for the prompt treatment of community-acquired intra-abdominal infections.

Abdomen↗
PubMed1988

Rapid detection of cytomegalovirus by fluorescent monoclonal antibody staining and in situ DNA hybridization in a dram vial cell culture system.

By using dram vial cell culture methods, three commercially available tests for cytomegalovirus (CMV) detection were compared: direct fluorescent monoclonal antibody staining for CMV-specific early and late antigens (direct FA), indirect fluorescent monoclonal antibody staining for a CMV-specific early antigen (indirect FA), and in situ DNA hybridization with a biotinylated CMV-specific DNA probe kit (DNA probe). Of those tests, only the indirect FA provided consistent, reliable virus detection within the initial 24 h postinfection for serial 10-fold dilutions of CMV AD169 (laboratory strain) and for three selected urine samples. However, when used prospectively, the indirect FA failed to detect virus within the initial 10 days postinfection in 15 of 78 consecutive specimens that were eventually positive by cell culture. Although the indirect FA was more sensitive than the direct FA or DNA probe, its utility appeared limited to specimens with high CMV concentrations. On the basis of these data, we recommend that indirect FA be reserved as an adjunct to standard cell culture for selected samples in diagnostic hospital laboratories.

Antibodies, Monoclonal↗
PubMed1987

Effect of peritoneal dialysis fluid and pH on bactericidal activity of ciprofloxacin.

Ciprofloxacin is active in vitro against most bacteria that cause peritonitis associated with peritoneal dialysis. We compared the effects of pH (5.5 and 7.4) and medium (dialysis fluid) on the bactericidal activity of ciprofloxacin, tobramycin, vancomycin plus rifampin, and rifampin against Pseudomonas aeruginosa, Escherichia coli, and three strains of staphylococci. The bactericidal activity of ciprofloxacin was not significantly affected by pH or medium, in contrast to the activity of tobramycin, which was decreased by low pH.

Anti-Bacterial Agents↗
PubMed1986

Lung abscess due to Corynebacterium equi. Report of the first case in a patient with acquired immune deficiency syndrome.

A lung abscess and persistent bacteremia due to Corynebacterium equi are described in a bisexual man with the acquired immune deficiency syndrome (AIDS). Eleven of the 12 previously reported cases have occurred in immunocompromised humans. The occurrence of this infection in a patient with AIDS has not been previously described. Development of resistance to beta-lactam antibiotics was noted following initial therapy. Because this organism resembles nonpathogenic organisms, it may easily be overlooked despite its ability to cause serious infection and persist even with aggressive antimicrobial and surgical therapy.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Clindamycin phosphate kinetics in subjects undergoing CAPD.

The kinetics of intraperitoneally administered clindamycin phosphate were studied in 9 volunteer subjects undergoing CAPD. Volunteers were assigned to 2 groups with the first group receiving clindamycin phosphate 300 mg/l in exchanges 1 through 5, and the second group receiving clindamycin phosphate 300 mg/l in exchange 1, and then 30 mg/l in exchanges 2 through 5. Clindamycin serum and dialysate effluent levels were determined by bioassay. When admixed with dialysate fluid and instilled into the peritoneal cavity, clindamycin phosphate is rapidly activated. Serum concentrations of clindamycin were rapidly achieved in both groups during the first exchange. Subjects in groups I and II had peak serum levels of active drug within 3 (3.94 ug/ml) and 5 (7.35 ug/ml) h, respectively. These results support the practice of not only administering intraperitoneal clindamycin phosphate to treat CAPD-related peritonitis, but using this route of administration to treat systemic infections due to susceptible bacteria in patients without intravenous access.

Adult↗
PubMed1984

The use of an antibiotic order form for antibiotic utilization review: influence on physicians' prescribing patterns.

An antibiotic order form was implemented for all inpatient antibiotic orders at an 800-bed hospital in April 1981 to provide an ongoing, concurrent audit of antibiotic use. The prescribing physician provided the clinical indication for the antibiotic order, and individual patient treatment courses were identified. During the 25-month study period, cephalosporins, penicillin plus ampicillin, and aminoglycosides accounted for 44%, 22%, and 17% of all treatment courses, respectively. Sixty-nine percent of first-generation cephalosporin treatment courses were for prophylaxis, whereas the remaining antibiotics were used for either empirical therapy or documented infection in 56%-79% of cases. After the introduction of the antibiotic order form, there was a significant decline in both the number of antibiotic treatment courses (P = .025) and the percentage of patients receiving any antibiotic (P = .007). We conclude that a specialized antibiotic order form is an effective method for antibiotic utilization review and can have a significant impact on a physician's prescribing patterns.

Anti-Bacterial Agents↗
PubMed1984

Multidrug-resistant Serratia marcescens bacteriuria related to urologic instrumentation.

An outbreak of urinary tract infections caused by multidrug-resistant Serratia marcescens lasted for 12 months and was found to be related to urologic instrumentation. Thirty-four patients had primary infections; four had cross-infections. Only six patients had indwelling bladder catheters. The median interval between instrumentation and initial isolation of Serratia was six days. Seventy-three percent of patients were symptomatic, two were bacteremic. No common instruments, personnel, or wards were identified, and environmental cultures failed to reveal the epidemic strain of Serratia. The outbreak ended when the instrument disinfectant was changed. Serotyping was identical in nine of ten isolates. Intraspecies conjugation demonstrated resistance transfer of gentamicin, tobramycin, carbenicillin, chloramphenicol, and co-trimoxazole. The enzyme 6'-N-acetyl transferase was responsible for gentamicin-inactivation in patient isolates and a transconjugate. Although no significant spread of this multidrug-resistance plasmid to other Enterobacteriaceae occurred in the hospital, two instances of apparent in vivo transfer to other bladder organisms occurred.

Adult↗
PubMed1984

Liquid chromatographic assay of ceftizoxime in sera of normal and uremic patients.

The application of high-pressure liquid chromatography assays for cephalosporin serum concentrations is difficult in uremic patients because of interference from nondialyzable substances. We developed a high-pressure liquid chromatography method for determining the serum concentration of ceftizoxime in normal and uremic patients. The method involves protein precipitation with acetonitrile, followed by removal of the acetonitrile with dichloromethane. Separation was accomplished with a reverse-phase (C-18) column and a mobile phase of 13% acetonitrile and 2.8% acetic acid. UV detection at 310 nm was used to monitor the peaks. This assay produced a linear relationship between peak height ratio and ceftizoxime concentration from 1.5 to 100 micrograms/ml. Samples from 30 patients were assayed by this method and by a bioassay, with a good correlation of results (r = 0.9832). The method was applicable equally to normal and uremic serum samples.

Cefotaxime↗
PubMed1983

Pharmacokinetics of ceftizoxime in subjects with various degrees of renal function.

The pharmacokinetics of ceftizoxime (FK-749) were studied in 20 volunteers with various degrees of renal function. Creatinine clearances ranged from zero to 157 ml/min per 1.73 m2. One gram of ceftizoxime was administered by a 30-min drip infusion, and blood and urine samples were collected for up to 48 h after drug administration. For volunteers with a creatinine clearance of greater than or equal to 80 ml/min per 1.73 m2 (group I), the mean half-life was 1.65 h, whereas for volunteers with a creatinine clearance of less than 10 ml/min per 1.73 m2 (group IV), the half-life was 34.7 h. The volume of distribution at steady state (Vdss) and the volume of distribution area (Vdarea) were calculated for each group and ranged from 0.377 to 0.263 and 0.421 to 0.264 liters/kg for groups I and IV, respectively. Total body clearance of ceftizoxime correlated with creatinine clearance (r = 0.953), and the mean urinary recovery of unchanged drug in normal volunteers was 72.4%. A 4-h hemodialysis procedure reduced serum ceftizoxime concentrations by approximately 52%; however, serum concentrations at 48 h after drug administration were still greater than 10 micrograms/ml in dialysis subjects. By using the relationship between total body clearance of ceftizoxime and creatinine clearance, a nomogram was developed to assist in the administration of ceftizoxime to patients with renal dysfunction.

Adult↗
PubMed1979

Serratia marcescens.

Explore the source record for details and available documents.

Penicillin Resistance↗
PubMed1979

Rhizopus osteomyelitis. A case report and review.

Mucormycosis osteomyelitis has previously been described exclusively in association with contiguous infections of rhinocerebral mucormycosis. In a patient with corticosteroid-dependent neutropenia and anemia osteomyelitis of the femur developed caused by the Mucoraceae Rhizopus. Although a primary focus was not identified, we believe this infection was hematogenous in origin. Mitogen stimulation to phytohemagglutinin (PHA) of the patient's lymphocytes revealed depressed cellullar immunity; however, there was specific response to Rhizopus extract. Treatment with systemic amphotericin B prevented further progression of the infection. A review of mucormycosis osteomyelitis is presented.

Adolescent↗
PubMedDate not supplied

Tissue eosinophilia in human coccidioidomycosis.

Eosinophilia in peripheral blood and tissue of patients with coccidioidomyocsis was reviewed in an examination of the importance of this cellular response to Coccidioides immitis. Peripheral blood eosinophilia (greater than 5%) was found in each of two patients with primary infection but was markedly more pronounced (27%-53%) in three of five patients with disseminated coccidioidomycosis. Unusually large numbers of tissue eosinophils and organized microabscesses containing eosinophils were found in six patients with progressive or disseminated disease. These six patients all demonstrated cutaneous anergy to coccidioidin. Eosinophilic microabscesses were found surrounding rupturing spherules and free endospores. Phagocytosis of free endospores was not demonstrated by the technique used. The bone marrow of two patients with disseminated disease showed a marked increase in eosinophilic myeloid precursors; this result suggested the presence of an eosinophilopoietin. Although peripheral blood eosinophilia has been explained as a hypersensitivity response to C. immitis that represents a favorable prognosis, the data reported herein suggest that peripheral blood eosinophilia of greater than 20% and the presence of eosinophilic microabscesses correlate with progressive or disseminated infection and thus are indicative of a poor prognosis.

Adolescent↗