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Biomedical subjects

R Quintiliani

Publications and source records attributed to R Quintiliani.

At least 55 records · Page 3Linked to original sources
PubMed1998

Formulary review of the carbapenems: comparison of imipenem/cilastatin and meropenem.

In comparison with imipenem, meropenem exhibits closely similar microbiological activity. Although meropenem has slightly greater gram-negative activity against organisms, like Pseudomonas aeruginosa and Burkholderia cepacia, imipenem demonstrates more intense gram-positive activity, particularly towards Enterococcus faecalis which may reduce or even cancel out, the clinical relevance of these microbiological differences. However, an aminoglycoside is usually added in the treatment of serious infections from these bacteria. The pharmacokinetics of these two agents are also closely similar both in normal healthy volunteers and in patients with normal or impaired renal function. Moreover, there is little, if any, difference in the acquisition costs for meropenem and imipenem in most hospitals. Cost-avoidance with meropenem is, therefore, mainly the result of less frequent dosing and the ability to administer meropenem by rapid intravenous injection. Additionally, meropenem's FDA approved indication for central nervous system infection offers an additional advantage when compared to imipenem/cilastatin. It was for these reasons that our hospital's Pharmacy and Therapeutics Committee replaced imipenem/cilastatin with meropenem.

Carbapenems↗
PubMed1997

Cost comparison of single daily i.v. doses of ceftriaxone versus continuous infusion of cefotaxime.

The costs of administering ceftriaxone 1 g in a once-daily 30-minute infusion were compared with the costs of administering cefotaxime 2 g/day (with an additional 1 g given on day 1) by continuous intravenous infusion. Time and motion studies were conducted to determine the pharmacy and nursing labor required to prepare and administer the intermittent and continuously infused antimicrobials. Mean times were multiplied by the mean New England hourly wage for pharmacy technicians, pharmacists, and nurses to determine the total labor costs of each regimen. Hospital acquisition costs of items used in preparing antimicrobial doses for administration by each method were also compared. Wholesale acquisition costs of the two drugs were used in the analysis. Labor costs were higher for the continuously infused antimicrobial because of the additional nursing time required for monitoring. Supply costs were greater for continuous infusion. Drug acquisition cost was the major component of the overall cost of therapy and was lower for continuous infusion. A cost analysis showed that continuous i.v. infusion of cefotaxime 2 g/day was less expensive from day 2 onward than intermittent daily i.v. doses of ceftriaxone 1 g.

Cefotaxime↗
PubMed1997

Streamlining antimicrobial therapy for lower respiratory tract infections.

Antimicrobial streamlining is the practice of converting a broad-spectrum empirical regimen to therapy with either a single, narrow-spectrum parenteral agent or an oral agent as soon as possible. This practice results in many benefits for the patient and the hospital. When intravenous catheters can be removed early, the frequencies of catheter-associated bacteremias and phlebitis are reduced, thus making it possible to avoid incurring major costs. With the availability of newer oral agents with favorable pharmacokinetic, pharmacodynamic, and microbiological profiles, such as the fluoroquinolones, the macrolides/azalides, and the cephalosporins, the clinician has greater opportunity to employ streamlining tactics. The patient who is hospitalized with a lower respiratory tract infection (LRTI) often requires empirical antimicrobial therapy before the pathogen is identified. By day 3 of the hospital course, the pathogen is often known, the patient's condition may have stabilized, or both events may have occurred. At this point, streamlining is possible. At present, data suggest that rapid conversion from intravenous to oral antimicrobial therapy is safe and efficacious and should be considered for appropriate patients requiring hospitalization for LRTIs.

Administration, Oral↗
PubMed1997

Influence of gentamicin dosing interval on the efficacy of penicillin-containing regimens in experimental Enterococcus faecalis endocarditis.

The influence of the gentamicin dosing regimen was studied in experimental Enterococcus faecalis endocarditis. After inoculation, animals received penicillin, or penicillin plus once-daily gentamicin, or penicillin plus thrice-daily gentamicin, or no treatment. After the treatment period, bacterial densities within the vegetations (mean +/- SEM) were 6.06 +/- 0.30, 5.42 +/- 0.29, 4.98 +/- 0.10 and 9.97 +/- 0.16 log cfu/g for the four groups. All regimens produced significant reductions in bacterial density when compared with controls; penicillin plus thrice-daily gentamicin resulted in a significant difference from penicillin alone. Although once-daily regimens have proved effective in trials involving other organisms, such regimens do not appear to be so optimal for the treatment of enterococcal endocarditis.

Animals↗
PubMed1997

In vitro synergistic activities of tobramycin and selected beta-lactams against 75 gram-negative clinical isolates.

The microdilution checkerboard technique was utilized to distinguish synergistic activity between tobramycin and four beta-lactams: piperacillin-tazobactam, ticarcillin-clavulanate, ceftazidime, and ceftriaxone. Beta-lactam-aminoglycoside combinations were tested against 75 clinical isolates of Pseudomonas aeruginosa, Acinetobacter baumanii, Citrobacterfreundii, Serratia marcescens, and Enterobacter cloacae. Despite in vitro susceptibilities, all isolates demonstrated either synergism or indifference; no antagonism was observed. Against pathogenic gram-negative nosocomial isolates, a greater percentage of synergy was consistently observed with combination regimens containing tobramycin and piperacillin-tazobactam or ticarcillin-clavulanate than with the cephalosporin-containing regimens.

Anti-Bacterial Agents↗
PubMed1997

Comparison of the bactericidal activities of piperacillin-tazobactam, ticarcillin-clavulanate, and ampicillin-sulbactam against clinical isolates of Bacteroides fragilis, Enterococcus faecalis, Escherichia coli, and Pseudomonas aeruginosa.

Owing to the broad spectrum of activity afforded by beta-lactam-beta-lactamase inhibitor preparations, these agents are frequently selected as empiric therapy for the treatment of mixed infections such as intra-abdominal and diabetic foot infections, either alone or in combination with an aminoglycoside. Twelve healthy volunteers were enrolled in a randomized, open-label, four-way crossover trial comparing the bactericidal activities of piperacillin-tazobactam, ticarcillin-clavulanate, and ampicillin-sulbactam against microorganisms commonly isolated from mixed infections. Subjects received the following regimes: (i) 3.375 g of piperacillin-tazobactam intravenously (i.v.) every 6 h (q6h) (ii) 4.5 g of piperacillin-tazobactam i.v. q8h, (iii) 3.1 g of ticarcillin-clavulanate i.v. q6h, and (iv) 3.0 g of ampicillin-sulbactam i.v. q6h. Serum bactericidal titers were determined and used to calculate the duration of measurable bactericidal activity over the dosing interval of each of the regimens against two clinical isolates of Bacillus fragilis, Escherichia coli, Enterococcus faecalis, and Pseudomonas aeruginosa. The percentage of the dosing interval over which drug concentrations in serum remained above the MIC for each organism was determined and compared with the observed duration of bactericidal activity was noted (r = 0.78; P < 0.001). All of the regimens demonstrated good activity against B. fragilis and E. coli. Against E. faecalis and P. aeruginosa, however, all of the regimens provided bactericidal activity for less than 50% of the respective dosing intervals. These data suggest that use of shorter dosing intervals or continuous-infusion regimens should be considered in combination with an aminoglycoside to improve the bactericidal profiles of these agents for E. faecalis and P. aeruginosa.

Adult↗
PubMed1997

Bactericidal activity of low-dose clindamycin administered at 8- and 12-hour intervals against Staphylococcus aureus, Streptococcus pneumoniae, and Bacteroides fragilis.

Twelve volunteers received 300 mg of clindamycin intravenously (i.v.) or orally (p.o.) administered every 8 h (q8h) or q12h by random assignment over four study periods. Serum bactericidal titers were determined for each regimen against two isolates each of Staphylococcus aureus, Streptococcus pneumoniae (one penicillin-sensitive isolate and one penicillin-resistant isolate), and Bacteroides fragilis. The duration of measurable bactericidal activity over the dosing interval (expressed as a percentage of the dosing interval) was determined for each isolate. No significant differences in the duration of activity were observed between i.v. and p.o. regimens dosed according to the same interval (P > 0.05). All regimens provided bactericidal activity against S. pneumoniae for 100% of their respective dosing intervals. Against B. fragilis, bactericidal activity was observed for greater than 80% of the dosing interval for each of the regimens. Although a statistically significant difference favoring the q8h i.v. regimen (P < 0.05) was detected, this difference is not believed to be clinically significant. The q8h and q12h regimens provided measurable bactericidal activity against S. aureus for greater than 85 and 50% of the dosing intervals, respectively (P < 0.001). Clindamycin dosed at 300 mg i.v. or p.o., q8h or q12h, provides adequate coverage against S. aureus, S. pneumoniae, and B. fragilis.

Administration, Oral↗
PubMed1997

Oral bioavailability and pharmacokinetics of ciprofloxacin in patients with AIDS.

Few reports on the effects of AIDS on the absorption of orally (p.o.) administered agents exist. To help fill this informational gap, we administered ciprofloxacin to 12 patients with AIDS by two dosing regimens (400 mg given intravenously [i.v.] and 500 mg given p.o. every 12 h) in a randomized, crossover fashion. Pharmacokinetic parameters were determined by noncompartmental methods. Mean values (+/- standard deviations [SD]) for p.o. ciprofloxacin were as follows: peak concentration of drug in serum (Cmax), 2.94 +/- 0.51 microg/ml; time to Cmax, 1.38 +/- 0.43 h; area under the concentration-time curve from 0 to 12 h (AUC(0-12)), 12.13 +/- 3.21 microg x h/ml; and half-life (t(1/2)), 3.86 +/- 0.48 h. Mean values (+/- SD) for i.v. ciprofloxacin were as follows: Cmax, 3.61 +/- 0.82 microg/ml; time to Cmax, 1.0 h; AUC(0-12), 11.92 +/- 2.92 microg x h/ml; and t(1/2), 3.98 +/- 0.94 h. The mean percent absolute bioavailability for ciprofloxacin was calculated to be 82% +/- 13%, similar to the value for healthy volunteers. We conclude that ciprofloxacin when administered p.o. to patients with AIDS is well absorbed, as evidenced by excellent bioavailability and is not affected by gastrointestinal changes in the absence of infectious gastroenteritis and severe diarrhea.

AIDS-Related Opportunistic Infections↗
PubMed1997

In vitro reduction of endotoxin concentrations with the 5S fragment of immunoglobulin G.

Endotoxin has long been implicated as an inducer for the development and progression of gram-negative sepsis. Accordingly, antiendotoxin therapy has been considered one of the major targets for the treatment of sepsis. To investigate the influence of a human immunoglobulin G (IgG) derivative, the 5S fragment of IgG (5S-IgG; Gamma-Venin, Centeon Pharma GmbH, Frankfurt-Niederrad, Germany), on endotoxin release during bacterial proliferation and under antibiotic bactericidal action, time-kill studies were performed by using Escherichia coli ATCC 25922 starting inocula of 10(3), 10(5), and 10(7) CFU/ml with cefotaxime (120 microg/ml) alone and in combination with 5S-IgG (2,100 microg/ml). Samples were collected for bacterial colony count and endotoxin concentration determinations; the area under the free endotoxin concentration curve (AUFEC) was calculated by using the trapezoidal rule. Colony counts showed that cefotaxime had a rapid bactericidal effect because it achieved greater than a 4-log decrease in the numbers of E. coli CFU per milliliter over the first 2 h; the addition of 5S-IgG did not appear to alter the kinetics of killing. Comparison of the AUFEC revealed that the addition of 5S-IgG resulted in a mean reduction of 50, 66, and 27% in the free endotoxin concentration at starting inocula of 10(3), 10(5), and 10(7) CFU/ml, respectively. Moreover, experiments were conducted with a starting inoculum of 10(5) CFU/ml and various amounts of 5S-IgG (2 to 20 mg/ml) to further investigate the dose-effect relation of 5S-IgG on endotoxin release. Decreased AUFECs were observed with increasing concentrations of 5S-IgG, suggesting the dose-dependent antiendotoxin activity of 5S-IgG. Further study is required to investigate the mechanism(s) responsible for this observation, the biological significance of this antiendotoxin activity, and the potential utility of 5S-IgG as an adjuvant therapy in the treatment of gram-negative sepsis.

Cefotaxime↗
PubMed1996

Characterization of Tn1547, a composite transposon flanked by the IS16 and IS256-like elements, that confers vancomycin resistance in Enterococcus faecalis BM4281.

A 64-kb genetic element harboring a vanB vancomycin-resistance (VmR) gene cluster was shown to translocate from the chromosome of Enterococcus faecalis BM4281 into the hemolysin (Hly) plasmid, pIP964. Sequence analysis of the resulting junction fragments indicated that the VmR genes were carried by a composite transposon, Tn1547, bounded by two distantly related insertion sequences (IS), designated IS256-like and IS16, in a direct orientation. IS256-like (1324 bp) was identical to IS256, except for two nucleotide (nt) transitions in the putative transposase gene. IS16 (1466 bp) contained a large open reading frame (ORF) that was 61% identical to the gene encoding the putative transposase of IS256. There was 58% identity between the deduced amino acid (aa) sequences of the putative transposases of IS256-like (390 aa) and IS16 (395 aa). IS16 was delineated by imperfect inverted repeats (IR) (18 out of 26 bp) which were related (23/26 bp identity) to their respective imperfect IR counterparts in IS256. The difference between the IS was not a barrier for transposition of Tn1547 which generated an 8-bp duplication at the target site. Dissemination of VanB-type resistance among enterococci results from two mechanisms: (i) large conjugative elements translocate from chromosome to chromosome following inter-strain transfer; and (ii) as described in this report, the VmR genes transpose from replicon to replicon within the same strain as part of composite transposons that are internal to the conjugative elements.

Amino Acid Sequence↗
PubMed1996

Serum bactericidal activity of ceftizoxime and ceftriaxone against pathogens associated with community-acquired and nosocomial pneumonias.

The serum bactericidal activities of ceftizoxime and ceftriaxone against organisms commonly implicated in community-acquired and nosocomial pneumonias were studied. Ceftizoxime 1 g (as the sodium salt) every 12 hours for two doses and ceftriaxone 1 g (as the sodium salt) every 24 hours for two doses were administered to 20 healthy volunteers in a crossover fashion. Blood samples were drawn immediately before and 2,4,6,8,10, and 12 hours after the second ceftizoxime dose and immediately before and 8,12,16,18,20, and 24 hours after the second ceftriaxone dose. Serum drug concentrations were determined by validated high-performance liquid chromatography. Serum bactericidal titers were determined in duplicate for each serum sample against four clinical isolates of each of the following organisms: Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae, Escherichia coli, Enterobacter aerogenes, Klebsiella pneumoniae, and Serratia marcescens. The median duration of serum bactericidal activity during the dosage interval was significantly different between antimicrobial regimens only for S. pneumoniae (92% of the dosage interval for ceftizoxime, versus 100% for ceftriaxone). This difference does not appear to be clinically important since ceftizoxime provides adequate serum bactericidal activity for more than 50% of the dosage interval and its effectiveness against pneumococcal pneumonia has been supported in clinical trials. The ceftriaxone and ceftizoxime regimens did not differ significantly in their duration of serum bactericidal activity against six of the seven organisms tested.

Adolescent↗