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Biomedical subjects

R Quintiliani

Publications and source records attributed to R Quintiliani.

At least 181 records · Page 10Linked to original sources
PubMed1984

Comparative pharmacokinetics of cefotaxime and ceftizoxime and the role of desacetylcefotaxime in the antibacterial activity of cefotaxime.

A single 15 mg/kg i.v. dose of cefotaxime (CTX) and ceftizoxime (CTZ) were given to six adult volunteers on two separate occasions in a cross-over experiment to determine the pharmacokinetics of each drug and the desacetyl metabolite of cefotaxime, desacetylcefotaxime (des-CTX). From these data, mock serum samples were prepared in human serum to simulate the concentrations of CTX, CTZ, and des-CTX at the following times postdose: 5, 10, 30, and 45 min; 1, 1.5, 2, 3, 4, 5, 6, 8, and 10 hr. At each of these time periods, serum bacteriostatic and bactericidal assays were performed against selected pathogens (Escherichia coli, Serratia marcescens, Enterobacter species) with similar susceptibilities to CTX and CTZ, but with varying sensitivity to des-CTX, and against one organism (Bacteroides fragilis) toward which CTX and des-CTX exhibited synergistic activity. From these studies, it was found that des-CTX can appreciably lengthen the microbiologic action of CTX when it has a high degree of inherent activity (MIC less than or equal to mcg/ml) against the organism, or when it behaves synergistically with CTX toward the bacterium, or both. It is possible that the major advance of CTX and CTZ pertains to their ability to kill many organisms at extremely low concentrations, allowing for monotherapy with low and infrequent dosing, which is very cost-effective in comparison with high and more frequent dosing required by older agents or with antibiotic combinations.

Adult↗
PubMed1984

Ketoconazole.

Explore the source record for details and available documents.

Candidiasis↗
PubMed1984

Prophylaxis of oral candidiasis with clotrimazole troches.

Oropharyngeal candidiasis is frequently a complication of patients with altered immune states. Clotrimazole troches are effective in the treatment of Candida and were evaluated in this study in a prophylaxis regimen. Patients with malignant neoplasms who were receiving chemotherapy and renal transplant recipients who were receiving immunosuppressives were randomized to receive either clotrimazole (10 mg) or placebo troches three times a day in a prospective, double-blinded study. Eighty-four patients were randomized into the study, 18 patients with leukemia, 19 patients with malignant neoplasms, and 47 patients with renal transplants. Among all patients, thrush developed in 57% while receiving placebo compared with 13% while receiving clotrimazole prophylaxis. Prophylaxis showed significant benefit for the renal transplant recipients and for patients with solid malignant neoplasms, but not for the leukemic patients. Clotrimazole troches are effective in preventing oral candidiasis in a select group of patients.

Administration, Oral↗
PubMed1984

Principles of antibiotic usage.

New antibiotics must demonstrate an advantage over older agents with respect to therapeutic efficacy, protection against infection, toxicity, cost, and pharmacokinetic properties before they can be approved for public consumption. In order to use antibiotics properly, we must know more about whether certain organisms are resistant or sensitive to the drug; it must also be determined how sensitive or resistant the bacterium is to the drug and how long serum and tissue levels remain above inhibitory or bactericidal concentrations of the drug for the suspected or proven pathogen. Cost issues and potential for adverse reactions must also be considered. In brief, to prevent or treat infections the clinician must be familiar with the microbiology, pharmacology, toxicology, and cost of antibiotics.

Aminoglycosides↗
PubMed1984

The use of beta-lactam antibiotics in infections--an overview.

Any new antibiotic must be compared with older agents with respect to therapeutic efficacy, protection against infection, toxicity, cost and pharmacokinetic properties. For a new drug to be considered an "advance", it should achieve some definite advantage in one or more of these areas. By expanding their microbiologic activity and by killing many organisms at extremely low concentration, a number of new beta-lactam antibiotics have become useful agents in the therapy of difficult infections, particularly those occurring in patients with generalized immunodeficiencies or those occurring in body sites of localized immunodeficiency. Of additional clinical relevance has been the ability of some of these new drugs to replace the necessity of combination antibiotic therapy, reducing the chances for adverse reactions. To use the new beta-lactam antibiotics properly, one must now know much more than whether an organism is merely resistant or sensitive to the drug. One must know how sensitive and how resistant the bacterium is to the drug and for how long do serum and tissue levels remain above inhibitory or bactericidal concentrations of the drug for the suspected or proven pathogen. Of course, we cannot forget the cost of the drug and its potential for adverse reactions. In brief to prevent or to treat infections, the clinicians must be familiar with the microbiology, pharmacology, toxicology and cost of antibiotics.

Anti-Bacterial Agents↗
PubMed1983

Serum and tissue concentrations of cefoxitin and cefamandole in women undergoing hysterectomy.

To prevent infection in 40 patients who underwent vaginal or abdominal hysterectomy, each patient received a single 15-mg/kg dose of either cefoxitin or cefamandole by rapid (5-minute) intravenous injection before the operation. Samples of serum, myometrium, endometrium, ovaries, and tubes were obtained at various intervals after injection of the antibiotic and were assayed for cephalosporin concentration. Maximum tissue concentrations of 30 micrograms/g of both drugs were detected approximately 30 minutes after the dose, with levels dropping below 3 micrograms/g in approximately 2 hours. Although both antibiotics achieved closely similar concentrations in serum and tissues, the ratios of these levels to their usual mean minimum inhibitory concentrations for Bacteroides fragilis were appreciably higher for cefoxitin than for cefamandole. These pharmacokinetic observations support the current dosage recommendations for the use of cefoxitin in treating and preventing gynecologic infections, as well as the recommendation that it be administered shortly before the operation to maximize tissue levels during the perioperative period.

Adult↗
PubMed1982

A prospective analysis of hospital-acquired fever in obstetric and gynecologic patients.

Of 2,725 obstetric and 4,090 gynecologic patients admitted to a community hospital during a 12-month period, 131 obstetric patients (4.8%) and 294 gynecologic patients (7.2%) had temperature elevations (rectal) of 38.3 degrees C or higher. All patients with fever were seen and followed up until discharge, and 80 different parameters were recorded for each patient, including sex, age, underlying illness, operative or diagnostic procedures, height and duration of fever, laboratory data, medications received, and ultimate cause of fever. Sixty-three obstetric patients (48%) with temperature elevations were found to have infections and fever, with skin and soft-tissue infections (59%), urinary tract infections (16%), and bacteremias (10%) being most common. Sixty-eight febrile obstetric patients (52%) were not found to have an infection. Eighty-six gynecologic patients (29%) with fever had an infection. Pelvic inflammatory disease (37%), urinary tract infection (18%), and abscess (14%) were the most common infections. Two hundred eight gynecologic patients (71%) had fever, but the exact cause of the fever in these patients remains obscure. While fever can be an early indicator of infection, it may be due to noninfectious causes in almost two thirds of hospitalized obstetric-gynecologic patients.

Bacterial Infections↗
PubMed1982

In vivo inactivation of tobramycin by ticarcillin. A case report.

Inactivation of tobramycin sulfate by ticarcillin disodium was observed in a patient with impaired renal function. Tobramycin elimination half-life was seven hours with concurrent ticarcillin therapy but 35 hours without ticarcillin therapy. The magnitude of change cannot be attributed to changing renal function or tobramycin accumulation. The present case demonstrates that in vivo inactivation of tobramycin by ticarcillin can substantially increase the overall tobramycin elimination rate in patients with severe renal failure; however, in patients with normal renal function such inactivation is predicted to cause little change in overall tobramycin elimination rate.

Aged↗
PubMed1982

First and second generation cephalosporins.

Data on tissue levels of drugs are important, for they provide us with information on concentrations that can be achieved at the site of an infection. Yet many questions remain unanswered in this area such as whether it is better to achieve high levels in tissue rapidly as with bolus administration of a drug, or whether it is preferable to maintain levels of drug at lower but more prolonged levels, as with constant infusion administration of a drug. The goal in the future will be to correlate pharmacologic principles with the efficiency of various dosing programs and tissue levels in the clinical setting.

Bacteria↗
PubMed1982

Penetration of amoxicillin, cefaclor, erythromycin-sulfisoxazole, and trimethoprim-sulfamethoxazole into the middle ear fluid of patients with chronic serous otitis media.

Penetration into the middle ear of four antibiotics commonly used in treatment of otitis media was studied by administering a single oral dose of amoxicillin, cefaclor, erythromycin-sulfisoxazole, or trimethoprim-sulfamethoxazole to 83 children with chronic serous otitis media. The antibiotic was given 15-240 min before the removal of middle ear fluid (MEF) by ventilation tubes inserted through the tympanic membrane. At the time MEF was obtained, a sample of blood was drawn from the patient, and concentrations of antibiotic in both specimens were assayed either microbiologically by a disk diffusion method or by high-pressure liquid chromatography. Amoxicillin had the highest ratio of mean peak concentration in MEF to minimal inhibitory concentration (MIC) for the three most common pathogens of otitis media (Streptococcus pneumoniae, ampicillin-sensitive Haemophilus influenzae, and Streptococcus pyogenes), whereas trimethoprim-sulfamethoxazole had the highest ratio of mean peak concentration in MEF to MIC for ampicillin-resistant Haemophilus influenzae.

Amoxicillin↗
PubMed1982

Penetration of ceforanide and cefamandole into the right atrial appendage, pericardial fluid, sternum, and intercostal muscle of patients undergoing open heart surgery.

Doses of 30 mg of ceforanide or cefamandole per kg were administered intravenously to 26 patients just before their chests were opened for coronary artery bypass or cardiac valve replacement surgery. Samples of right atrial appendage, pericardial fluid, plasma, aortic wall, intercostal muscle, and sternum were obtained at different times after the antibiotic was injected, and these samples were assayed for cephalosporin concentration. For ceforanide the pre-bypass plasma half-life was 2.5 h, and the atrial appendage half-life was 2.1 h; for cefamandole the pre-bypass plasma half-life was 0.75 h and the atrial appendage half-life was 0.72 h. At 3 h the concentrations of ceforanide and cefamandole in atrial appendages were 28.0 and 5.0 micrograms/g, respectively. Ceforanide achieved higher and more sustained concentrations in other tissues than cefamandole. Considering the minimal inhibitory concentrations of these drugs for staphylococci, cefamandole and ceforanide should provide adequate protection against infection by these organisms for the duration of the surgical procedure.

Cardiac Surgical Procedures↗
PubMed1982

Meningovascular syphilis after 'appropriate' treatment of primary syphilis.

Meningovascular syphilis developed in a patient two years after the treatment of primary syphilis with a single intramuscular injection of 2.4 million units of penicillin G benzathine as recommended by the Centers for Disease Control. Although it could not be established with certainty whether this infection represented a reinfection or a treatment failure, the case emphasizes the necessity for serologic follow-up examination in all patients treated for primary syphilis.

Adult↗
PubMed1981

A comparison of the penetration characteristics of cephapirin and cephalothin into right atrial appendage, muscle, fat, and pericardial fluid of pediatric patients undergoing open-heart operation.

Thirty-two pediatric patients having open-heart operation received a single dose of either cephalothin or cephapirin intravenously, 30 mg per kilogram of body weight, in the operating room, for prophylaxis before the chest cavity was opened. Samples of right atrial appendage, pericardial fluid, muscle, fat, and plasma were obtained at various time intervals after injection of the antibiotics, and assayed for cephalosporin concentration. The concentration-time profiles of cephalothin and cephapirin in atrial appendage, muscle, fat, and plasma were identical. Cephapirin produced higher total and free concentrations in pericardial fluid compared with cephalothin. This presumably was due to the lower protein binding of cephapirin. Antibiotic concentrations above the minimal inhibitory concentration for Staphylococcus aureus and S. epidermidis were present in myocardial tissue for at least 90 minutes after the dose was administered. These data support the need to administer these antibiotics shortly before surgical intervention and, if the operation is prolonged, the need to administer a second dose of antibiotic.

Adipose Tissue↗