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Cefotaxime treatment of skin and skin structure infections: a multicenter study.

The efficacy, safety, and tolerability of cefotaxime, a new parenteral cephalosporin resistant to beta-lactamase, were evaluated in a multicenter open trial. The study population comprised 594 hospitalized patients with infections of the skin or subcutaneous tissue. Of these, 409 patients fulfilled the protocol requirements for assessment of clinical efficacy. Usual dosages of cefotaxime were in the range of 1.5 to 12 gm/day for 5 to 85 days. Staphylococcus aureus was the most frequent gram-positive organism; Proteus mirabilis, Escherichia coli, and Pseudomonas aeruginosa, the most frequent gram-negative bacilli; and Peptococcus sp, the most frequent anaerobic organism isolated. Of the 409 evaluable patients, 382 (93.4%) were clinically cured. Bacteriological cures were obtained in 316 of 372 (84.9%) patients. Reactions to cefotaxime included asymptomatic eosinophilia, rash, drug fever, phlebitis, and elevated hepatic enzyme levels. All reactions were transient, and drug therapy had to be terminated in only eight patients. Cefotaxime proved effective for treating a variety of skin and soft tissue infections. The lack of serious toxicity and adverse reactions associated with cefotaxime, together with its broad antimicrobial spectrum, makes it a suitable substitute for aminoglycosides in certain clinical settings.

Cefotaxime↗

[Antibacterial effects of niridazole. II. Effects on aerobic and anaerobic bacteria].

Niridazole which is chemically related to metronidazole is endowed with much better antibacterial activity. First, several genera of aerobic bacteria, such as Salmonella and Escherichia, are susceptible to niridazole, whereas metronidazole is completely ineffective. There exist, however, some particular strains which are naturally resistant to niridazole. The in vitro activity of niridazole is still increased, if these facultative anaerobic bacteria are tested under anaerobic growth conditions. Second, niridazole has a higher in vitro activity against anaerobic bacteria, such as Bacteroides spp., Clostridium spp., Fusobacterium spp. and Peptococcus sp., than metronidazole. Extremely low MIC values of niridazole were found ranging from 0.0037 to 0.06 microgram/ml. Propionibacterium acnes, which are resistant to the action of metronidazole, are also relatively resistant to niridazole.

Aerobiosis↗

[Clinical experience with cefotiam in otorhinolaryngologic infections].

Clinical studies of cefotiam (CTM), a new cephalosporin derivative, in otorhinolaryngological field were performed, and the results were summarized as follows. CTM was intravenously injected to 31 cases of otorhinolaryngological infections in daily dose of 1--4 g. Clinical efficacy was 33.3% in acute otitis media and chronic otitis media (acute exacerbation) (6 cases), 90% in acute tonsillitis (including peritonsillitis, peritonsillar abscess) (20 cases), 50% in acute pharyngitis (2 cases), 100% in acute sinusitis (2 cases) and 100% in epiglottis abscess (1 case), respectively. Bacteriological efficacy was 80% for beta-Streptococcus, 100% for K. pneumoniae, 50% for P. aeruginosa, and 85.7% for Peptococcus and Peptostreptococcus, respectively. No difference was observed in various daily doses for clinical efficacy. As for side effects and laboratory findings, eruption in 1 case, elevation of GOT in 1 case and elevation of GOT, GPT in 2 cases were observed. But, all of the cases were normalized after stoppage of administration or postadministration.

Adult↗

N-nitrosamine formation by intestinal bacteria.

N-Nitrosamine formation by various intestinal bacteria was investigated. N-Nitroso-dimethylamine (NDMA) formation by viable resting cells of Escherichia coli A10 was proportional to the incubation time and the enzyme concentration, while boiled cells were incapable of nitrosation. The enzyme was optimal at pH 7.5 and showed about the same specificities for dimethylamine, diethylamine, dibutylamine, di-isobutylamine, piperidine and pyrrolidine, but high specificity for morpholine. The intestinal bacteria harbouring nitrosating enzyme were mainly aerobic, i.e., Escherichia coli, Proteus morganii, Klebsiella pneumonia and Pseudomonas aeruginosa. Only one of the 32 anaerobic intestinal bacterial species, i.e., Peptococcus asaccharolyticus, was positive. The enzyme activities of these nitrosating bacteria covered a range of 0.06-0.90 nmol NDMA formed per hour per mg protein. These results support the theory of enzymatic catalysis of N-nitrosamine formation by microorganisms and suggest the possibility of endogenous nitrosation in the digestive tract.

Dimethylnitrosamine↗

Microorganisms isolated from infected aural fistulas.

Aural fistula is a congenital deformity of the external ear relatively common in Orientals and rare in Caucasians. Suppuration tends to occur, and chemotherapy rather than surgical drainage should be attempted. However, the lack of information concerning infected aural fistulas has made appropriate chemotherapy difficult. Microorganisms isolated from 13 cases of infected aural fistulas were studied from January 1981 to December 1982. Six species and 22 strains were isolated; nonsporeforming faculative anaerobes were detected in 12 cases. The isolated pathogens included Peptococcus sp (10 cases), Peptostreptococcus sp (3), Bacteroides sp (3), and Fusobacterium sp (2). One case exhibited only Staphylococcus aureus. Our data also stresses the etiologic importance of anaerobic gram-positive cocci in infected aural fistulas.

Abscess↗

Gardnerella vaginalis and anaerobic bacteria in the etiology of bacterial (nonspecific) vaginosis.

G. vaginalis was originally described as the etiologic agent of bacterial vaginosis (nonspecific vaginitis) because it was recovered only from women with signs and symptoms of "bacterial vaginitis" and not from normal controls. Recent data have shown that G. vaginalis is present in normal women but at concentrations lower than the limit of sensitivity of the media formerly used. Detection of low concentrations of G. vaginalis in normal controls has been made possible by development of a selective and differential medium (HBT). Anaerobically performed studies of the vaginal flora have indicated that while lactobacilli predominate in the normal vagina with or without G. vaginalis, anaerobic bacteria including Bacteroides spp., Peptococcus spp., Eubacterium spp. and curved rods as well as G. vaginalis predominate in bacterial vaginosis. Anaerobic bacteria and G. vaginalis are decreased after appropriate therapy. After treatment with metronidazole, lactobacilli again predominate. Lactobacilli are less prevalent after treatment with ampicillin or amoxicillin. These data suggest that as in infections at other mucous membrane sites, bacterial vaginosis is a mixed infection involving a finite number of facultative and anaerobic species. The data also suggest an important role for facultative lactobacilli.

Anti-Bacterial Agents↗

[Fundamental and clinical studies of T-1982 (cefbuperazone) in the field of obstetrics and gynecology].

Tissue concentrations of T-1982 (cefbuperazone) at 100-220 minutes after the completion of 1 g/60 minutes dripping infusion were 8.9-10.6 micrograms/g in the uterus, ovary and oviduct. These concentrations were higher than 80% MIC of the causative organisms, including E. coli, K. pneumoniae, P. mirabilis, Bacteroides and Peptococcus isolated from infections in the field of obstetrics and gynecology. The T-1982 concentration in the retroperitoneal space exudate reached a peak value of 19.6 micrograms/ml at 2 hours after the completion of 1 g/60 minutes dripping infusion and decreased at a constant rate. We administered T-1982 at 2 g per day for a period of 7-9 days to 3 patients with gynecological infectious diseases. All cases proved to respond effectively. No side effects and abnormal laboratory findings were observed.

Aged↗

Cefamandole-erythromycin-heparin peritoneal irrigation: an adjunct to the surgical treatment of diffuse bacterial peritonitis.

The enthusiasm for the use of peritoneal irrigation has waxed and waned since its introduction by Dr. Pierce in 1905. The purpose of this study was to devise a relatively low-cost irrigant that could be used for continuous intraperitoneal lavage, with the intent of decreasing abscess formation following surgical treatment for generalized bacterial peritonitis. A solution of 1 L of normal saline containing 50 mg erythromycin, 50 mg cefamandole, 500 U heparin, and 5 mEq KCl was proven in in vitro studies to be bactericidal to Peptococcus anaerobius and Clostridium perfringens, and bacteriostatic to Klebsiella pneumoniae, Escherichia coli, Enterobacter aerogenes, Streptococcus faecalis, and Bacteroides fragilis. In a prospective study 50 patients underwent peritoneal lavage with 36 L over 2 days. No lavage patients developed intraabdominal abscesses. In a control group of 44 patients seven patients (15.9%) developed postoperative abscesses.

Adult↗

The identification and antimicrobial susceptibility of anaerobic bacteria from pneumonic cattle lungs.

One hundred and forty-four lungs obtained postmortem from cattle with pneumonia were cultured for anaerobic bacteria. Forty-five lungs yielded 73 anaerobic isolates belonging to 20 species. The number of isolations of anaerobes from acute fibrinous or suppurative bronchopneumonias (32.5%) was slightly lower than from similar chronic bronchopneumonias (36.5%). Anaerobes were not recovered from 15 lungs showing macroscopic changes not of bacterial origin, nor from 13 healthy lungs. The predominant genera isolated were Bacteroides, Peptococcus, Fusobacterium and Clostridium. The most common species were P. indolicus (15 isolates), B. asaccharolyticus (nine), F. necrophorum (six), C. perfringens (four) and B. fragilis (four). There was a significant correlation between the presence of Corynebacterium pyogenes (p less than 0.001) or Escherichia coli (p less than 0.01) and the presence of anaerobes in the lungs. The isolated anaerobic bacteria were generally susceptible to ampicillin, penicillin G, cefoxitin, cephalothin, clindamycin, chloramphenicol, erythromycin, tetracycline and metronidazole. The B. fragilis and C. perfringens isolates showed multiple antibiotic resistance, and five P. indolicus isolates were resistant to tetracycline.

Animals↗

[Experimental and clinical evaluation of cefroxadine in the field of obstetrics and gynecology].

Cefroxadine (CXD) was studied in the field of obstetrics and gynecology and the following results were obtained. MIC values of CXD against 55 clinical isolates were investigated, from 6.25 to 12.5 micrograms/ml for 8 strains of E. coli, 6.25 micrograms/ml for 3 strains of K. pneumoniae and from 0.39 to 3.13 micrograms/ml for 9 strains of anaerobes such as Peptostreptococcus and Peptococcus in 10(6) cells/ml. Transfer of CXD into intrapelvic organ such as uterus, uterine tube and ovary after the oral administration of 500 mg was investigated. The concentrations in the tissues of genitalia ranged from 5.84 to 7.44 micrograms/g about 2 hours later after the administration. CXD was orally given to 18 patients with infections of genital organs at daily dose of 1,500 mg (500 mg 3 times a day). The clinical response was good, and efficacy rate was 88.9%. No remarkable side effects were observed.

Adult↗

[Clinical study of cefroxadine in the field of obstetrics and gynecology].

Clinical study of cefroxadine (CXD), an orally active cephalosporin, for the treatment of infections in the field of obstetrics and gynecology was carried out and the following results were obtained. Fifteen strains were isolated in present study. These isolates were mainly E. coli and anaerobes (Peptococcus sp., Peptostreptococcus sp.). The distribution of susceptibilities to CXD of E. coli was between 6.25 approximately 12.5 micrograms/ml and that of anaerobes was between 0.39 approximately 1.56 micrograms/ml. These results were similar to those of CEX. CXD was used in the treatment of 11 patients (endometritis 1 case, adnexitis 3 cases, bartholinitis 7 cases). In overall clinical efficacies, patients evaluated as better than "good" were 10 out of 11 (90.9%). Skin eruption was observed in 2 cases. No abnormality in laboratory findings was recognized.

Adult↗

[Fosfomycin susceptibility of clinical isolates from otorhinolaryngological infections].

To investigate the clinical and bacteriological usefulness of orally administered fosfomycin calcium (FOM), the susceptibility of 558 strains to FOM was determined. These strains were isolated at our Center, between Feb. 1982 and Feb. 1983 from otorhinolaryngological infections. Several other drugs were also tested on the same strains for comparison. The results were as follows. The MIC80 of FOM was 6.25 micrograms/ml against each of aerobic Gram-positive cocci such as S. aureus, S. pyogenes, S. pneumoniae, anaerobic Gram-positive cocci such as Peptococcus spp., and H. influenzae. P. mirabilis, indole-positive Proteus spp., P. aeruginosa and K. pneumoniae were inhibited, respectively, at 3.13, 12.5, 12.5 and 50 micrograms/ml. Most of the MICs were between 3.13 and 12.5 micrograms/ml, and the difference between the MIC50 and the MIC90 was only 1 to 2 tubes since there were few resistant strains. With the comparative drugs, there was a reduction seen in the sensitivities of pipemidic acid (PPA), ampicillin (ABPC), and cephalexin (CEX) against, respectively, P. aeruginosa, beta-lactamase-producing H. influenzae and S. aureus. FOM showed good and constant sensitivity for the weakly PPA-sensitive P. aeruginosa, weakly ABPC-sensitive beta-lactamase-producing H. influenzae and weakly CEX-sensitive S. aureus. The MICs of FOM against the main problematic isolates from otorhinolaryngological infections were mostly between 3.13 and 12.5 micrograms/ml, including the above weakly PPA-, ABPC- and CEX-sensitive strains. Based on these values, FOM may be said to have moderate antibacterial efficacy when administered orally in the usual dose.(ABSTRACT TRUNCATED AT 250 WORDS)

Anti-Bacterial Agents↗

[Evaluation of clinical efficacy of a cephem antibiotic, cefmetazole, in inflammatory infections of the upper respiratory tract].

We had reported the fundamental study on the utility of a new cephem antibiotic, cefmetazole (CMZ). On the basis of the results we administered CMZ to patients to investigate its clinical utility in this study. 1. CMZ was administered to 53 patients including 4 infants. They consisted of 30 cases of acute tonsillitis, 10 of peritonsillar abscess, 10 of laryngitis or pharyngitis, and 3 of sinusitis. 2. One of 2 g CMZ was administered to an adult patient except for l case and 0.5 g to an infant patient once or twice daily for at least 3 days. The method of administration was one shot intravenous injection, intravenous drip infusion or intramuscular injection. 3. The strict criteria for evaluating the efficacy of a drug were made and used for judging the efficacy of CMZ. 4. CMZ was clinically effective in 100% of patients with acute tonsillitis, 100% of those with peritonsillar abscess, 90% of those with laryngitis or pharyngitis, and 67% of those with sinusitis. 5. Bacteriologically, a single sort of bacterium was isolated in most cases of acute tonsillitis, laryngitis and pharyngitis and in the half of cases of peritonsillar abscess. Two and more sorts of bacteria were isolated in the other cases. The main bacteria isolated were beta-Streptococcus, S. pneumoniae and H. influenzae. Anaerobic bacteria, mostly Peptococcus spp. and Peptostreptococcus spp., were detected in peritonsillar abscess. 6. The clinical results agreed with the clinicobacteriological results. All the bacteria detected before treatment of CMZ disappeared. CMZ also acted effectively in cases in which H. influenzae was suspected to be a causative organism. 7. The present results of CMZ treatment were similar to those of cefazolin (CEZ) treatment published so far. 8. Thus, CMZ was confirmed fundamentally and clinically to be a very useful drug for infection of the upper respiratory tract.

Adolescent↗

[Endometrial bacteriology in puerperal infections (author's transl)].

From the third to the sixth day postpartum transcervical endometrial swabs were taken from 51 women with the clinical signs of endometritis, like fever over 38 degree C, uterine tenderness and purulent lochia using prereduced anaerobic transport-media. The specimens were cultured aerobically and anaerobically. 27 women had an endometritis following vaginal delivery, 24 following caesarian section. Following vaginal delivery aerobic bacteria were isolated in 85.2% of the cases and anaerobic bacteria in 62.9%, post caesarian section in 75.1% aerobic and in 83.3% anaerobic bacteria. A mixed aerobic/anaerobic infection was found in 48.1% following vaginal delivery and in 58.4% post caesarian section. The aerobes most frequently recovered were Staphylococcus epidermidis, E. coli, Enterocococci and Streptococci, the prevalent anaerobes were the grampositive anaerobic cocci, Peptostreptococcus and Peptococcus, and Bacteroides species. Our results suggest that anaerobic bacterial play an important role in the endometritis post partum and that frequently a polymicrobial aerobic/anaerobic infection is present. Therapeutically, anaerobes should be taken into consideration especially for the treatment of severer infections following caesarian section. In such cases the 5-Nitroimidazoles, such as Metronidazole or antibiotics effective against anaerobes as Clindamycin or Cefoxitin should be administered.

Anaerobiosis↗

A modified plate holding system for anaerobic cultures.

A modified plate holding system for anaerobes has been developed which: 1) effectively reduces the volume of oxygen-free gas required, 2) promotes earlier bacterial growth, and 3) monitors the anaerobic atmosphere of the holding vessel and the rate of gas flow. Cultures of Bacteroides fragilis, Clostridium perfringens, C. septicum, Fusobacterium nucleatum, Peptococcus sp. and Propionibacterium sp. were evaluated for optimal growth. All cultures grew as well as or better when preincubated in the holding system for one to three hours then incubated in a GasPak system for the remainder of the 24 hours, as compared to incubation only in the GasPak or holding system for the entire 24-hour period.

Bacteria↗

Microflora in postirradiated cancer cervix.

Cases of cancer cervix receiving radiation therapy revealed more anaerobes (50%) in comparison to normal controls (44.6%). The aerobic organisms were suppressed in the former cases (63.6%) in contrast to the latter group (90.7%). Of the anaerobes, the Gram-negative bacilli were more notable (18.1%) in cancer cervix than the normal controls (4.6%). The anaerobes like Peptococcus prevotii (18.1%) and Bacteroides oralis (9%) and the aerobes, Staph aureus (13.6%) and klebsiella (13.6%) were prevalent in cancer cervix. The higher incidence of aerobic and anaerobic organisms in stage III elderly (> 45 years) patients of cancer cervix may necessitate antibacterial therapy.

Adult↗

Azotobacter vinelandii ferredoxin I. Alteration of individual surface charges and the [4FE-4S]2+/+ cluster reduction potential.

The structures of Azotobacter vinelandii ferredoxin I (AvFdI) and Peptococcus aerogenes ferredoxin (PaFd), near their analogous [4e-4S]2+/+ clusters, are highly conserved (Backes, G., Mino, Y., Loehr, T.M., Meyer, T.E., Cusanovich, M.A., Sweeney, W.V., Adman, E.T., and Sanders-Loehr, J. (1991) J. Am. Chem. Soc. 11, 2055-2064). Despite these similarities, the reduction potential (E0') of the AvFdI [4Fe-4S]2+/+ cluster is more than 200 mV more negative than that of PaFd. We have tested the contribution that individual amino acid residues make to the control of E0' by converting residues in AvFdI into the corresponding residue in PaFd. Four mutations involved substitutions of negatively charged surface residues with neutral residues and two involved substitution of buried hydrophobic residues. All AvFdI variants were characterized by x-ray crystallography, absorption, CD, EPR, and 1H NMR spectroscopies and by electrochemical methods. For the F25I mutation, significant structural changes occurred that affected the EPR and 1H NMR spectroscopic properties of AvFdI and had a minor influence on E0'. For all other mutations there were no changes in reduction potential. Thus we conclude, that variations in charged surface residues do not account for the observed differences in E0' between the analogous [4Fe-4S]2+/+ cluster of PaFd and AvFdI. These differences are therefore most likely to be due to differences in solvent accessibility.

Amino Acid Sequence↗

[Inhibition of Proteus sp. by Nalidixic acid].

The investigation comprised 192-positive and Gram-negative strains of bacteria, including 111 Proteus sp. The degree of resistance of these strains to nalidixic-acid was investigated on blood agar with 25 mug, 40 mug, and 50 mug nalidixin-acid per ml medium. None of the Proteus strains were able to grow on medium with 50 mug nalidixic-acid per ml, whereas Streptococcus sp., Corynebacterium pyogenes, Peptococcus indolicus, Pseudomonas aeruginosa, and beta-toxic staphylococci all were found resistant to this concentration (Tables I and II), and could be reisolated in pure culture after having grown together with a Proteus strain on such medium (Table III). Blood agar with 50 mug nalidixic-acid per ml is therefore suitable for isolation of the above mentioned Gram-positive bacteria and Pseudomonas aeruginosa from Proteus contaminated material.

Dose-Response Relationship, Drug↗