Management of severe systemic infections caused by multiple resistant organisms.
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Biomedical subjects
Publications and source records attributed to W Stille.
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In 25 patients with urinary tract infections (pathogen Escherichia coli), colony counts from bacteria in the urine were done before and after treatment with antibiotics. Both 800 mg bacampicillin and ampicillin have a higher bactericidal effect in urine than co-trimoxazole. Patients with acute urinary tract infections given 400 mg bacampicillin and patients with chronic infections given double that dosage showed equally good results. In uncomplicated urinary tract infections with sensitive strains treated with cefotaxime, the colony count was reduced markedly faster than in infections in patients with kidney insufficiency or infection with multiresistant strains. The reduction of the colony count from the urine of patients with urinary tract infections and multiresistant strains during treatment with antibiotics is an important criterion in the evaluation of antibiotics. Such tests should supplement the customary sensitivity checks of antibiotics, the MIC and the agar diffusion test in the early phases of clinical trials.
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The effect of the aminoglycosides amikacin, gentamicin, netilmicin sisomicin and tobramycin on the proximal tubule of the human kidney was investigated in 78 healthy subjects. Fifteen adults were each given gentamicin, sisomicin or tobramycin 3 mg/kg bodyweight, 10 subjects received netilmicin 3 mg/kg or amikacin 15 mg/kg additionally seven subjects amikacin 10 mg and six subjects netilmicin 6 mg on three consecutive days. The principal enzyme of the brush border membrane of the proximal tubule, alanine aminopeptidase (AAP), was determined enzymatically and immunologically in 24-hour urines. The effects of the various aminoglycosides on the membranes were different. Less of membrane AAP was greatest after amikacin and was least after tobramycin. There was no difference between gentamicin, netilmicin, and sisomicin, which had an effect intermediate between the other two compounds. The elimination of AAP occurred at intervals which might possibly have been caused by impairment of cell cycles.
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As a result of our experience in 266 persons vaccinated with HDC vaccine we consider this type of vaccine to be a great advance. In spite of our very positive judgement we are of the opinion that vaccination should not be done without adequate indication. This type of vaccine contains certain imponderables which argue against widespread vaccination. At any rate, complications occurred in one of our patients vaccinated with HDC vaccine Mérieux. Nevertheless we consider vaccination before exposure of persons who are genuinely at risk, such as veterinarians, laboratory staff in rabies laboratories and possibly also hunters and agriculturalists in infected areas to be acceptable.
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The in vitro activity of HR 756, a new cephalosporin, has been determined against recent clinical isolates and compared with that of other beta-lactam antibiotics. The geometric means of the minimum inhibitory concentrations (MIC) for different isolates of Escherichia coli (100 isolates), Klebsiella pneumoniae (84), Pseudomonas aeruginosa (121), Proteus mirabilis (52), indole-positive Proteus species (9), Salmonella species (19), Staphylococcus aureus penicillin-sensitive (29) and penicillin-resistant (39) were: 0.095, 0.124, 11.1, 0.095, 0.0107, 0.078, 1 and 0.95 mcg/ml, respectively. Its activity was affected by rise in inoculum against S. aureus and P. aeruginosa but not against K. pneumoniae and E. coli. Bactericidal activity was determined by membrane filtration method. HR 756 was found to be bactericidal to E. coli, K. pneumoniae, P. aeruginosa and Proteus species. Although the MICs of the tested S. aureus strains were 1 mcg/ml, 5 mcg/ml of HR 756 failed to kill 99% of the inoculum within 24 hours.