Biomedical subjects
Publications and source records attributed to W Stille.
Third-generation cephalosporins are the drugs of choice for serious nosocomial pneumonia; however, the recommended dosages are controversial. Our study compared two of these cephalosporins and showed that 2 g cefotaxime every 12 h and 4 g ceftriaxone once daily or 2 g every 12 h proved to be effective therapies for these chest indications.
To look for possible defects in cells of the monocyte/macrophage system, blood monocytes from patients infected with human immunodeficiency virus (HIV) were cultured on hydrophobic Teflon for 7 days and their ability to differentiate into mature macrophages in the presence of serum was followed. The following parameters were studied as indicative of successful terminal maturation: (1) the expression of maturation-associated antigens (transferrin receptor, surface transferrin, the BA-2 antigen, MAX antigens), (2) the disappearance of the MOP15 antigen, and (3) a more than 20-fold increase in intracellular ferritin concentration. It was found that the patients' blood monocytes did not differentiate in vitro but rather remained immature precursor cells. If the same holds true in vivo, the results could indicate that the pathophysiology of the acquired immunodeficiency syndrome (AIDS) may be, to a large extent, linked with the functional consequences of this impaired monocyte-to-macrophage maturation.
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Of 146 hospitalized patients treated with aztreonam for infections, primarily of the urinary and lower respiratory tracts, 142 had a satisfactory clinical response. An initial microbiologic cure was found in 106 (84%) of 126 patients. Relapse, reinfection, or superinfection occurred in 28 patients. Thirty-nine of 43 patients treated with a control drug (gentamicin, cefotaxime, cefamandole, or tobramycin) had a satisfactory clinical response, 25 of 34 such patients showed microbiologic cure, and 12 experienced relapse, reinfection, or superinfection. Short-term perioperative treatment with aztreonam in male patients whose urine was positive for gram-negative organisms was successful for 10 of 11 patients. Pharmacokinetic studies demonstrated that dosage adjustment of aztreonam in geriatric patients should be based on creatinine clearance. No nephrotoxicity was demonstrated in 10 healthy male volunteers. Satisfactory concentrations of aztreonam were found in sputum, vagina, cervix, perimetrium, myometrium, endometrium, parametrium, fallopian tube, fat, muscle, and kidney tissues.
106 HIV-positive patients with 129 episodes of oropharyngeal Candida infection were treated with fluconazole (50-300 mg/d). Treatment lasted from 4 to 23 days. The majority of patients were in more advanced stages of HIV infection (82% AIDS cases). Therapy with fluconazole led to complete healing or improvement of clinical symptoms in 93% of all treatment courses. However, according to cultural findings, an elimination or recession of pathogens was achieved in only 70% of cases. Cultural monitoring showed a slow reduction of pathogens, as opposed to a fairly rapid clinical improvement. Candida albicans was the most frequently isolated Candida species (n = 128); the most selected Candida species during treatment were C. glabrata, C. krusei, and C. inconspicua. It is remarkable that C. glabrata, a low-grade pathogen, caused enanthema in 2 patients and a typical oral thrush in 1 patient. Fluconazole was well-tolerated, and apart from mild gastro-intestinal symptoms in 1 patient, no severe side effects were observed.