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PubMed1986

Use of ciprofloxacin in the treatment of Pseudomonas aeruginosa infections.

The therapeutic efficacy and safety of ciprofloxacin was studied in 30 patients with Pseudomonas aeruginosa infections. In 20 patients ciprofloxacin was given alone and in 10 patients (including 8 compromised hosts) in combination with an aminoglycoside (9) or azlocillin (1). Ciprofloxacin was given in doses of 500 mg orally or 200-300 mg i.v. every 12 h. In patients receiving only ciprofloxacin clinical cure with eradication of bacteria was obtained in 15 patients (75%) with infections of bone and joint (6), skin and soft tissue (4), lung (2), middle ear (2) and CSF (1). Two patients with lymphoma and Pseudomonas aeruginosa pneumonia died. In patients receiving combination therapy a definite therapeutic success was achieved in four (40%). Three patients with Pseudomonas aeruginosa septicemia died. In seven patients nine bacterial strains with decreasing susceptibility of ciprofloxacin (increase in MIC from less than or equal to 0.5 micrograms/ml to 2-16 micrograms/ml) were selected (6 Pseudomonas aeruginosa, 1 Enterobacter cloacae, 1 Serratia marcescens, 1 Staphylococcus aureus). Ciprofloxacin was well tolerated. This new quinolone seems to be suitable for single drug treatment of Pseudomonas aeruginosa infections in patients with normal host defense mechanisms, while its therapeutic potential in compromised hosts requires further evaluation.

Administration, Oral↗
PubMed1986

Renal function in cystic fibrosis: proteinuria and enzymuria before and after tobramycin therapy.

Proteinuria and enzymuria were measured in 27 patients with Cystic Fibrosis before and after tobramycin therapy. Prior to treatment, kidney function was normal in 23 patients. Four patients showed a pathological proteinuria and two haematuria. Renal biopsy in one patient showed segmental basement membrane alterations on electron microscopy; there were no immunoglobulin deposits. During intravenous therapy with tobramycin (10 mg/kg per day) and azlocillin (100 mg/kg per day) mean urinary N-acetyl-beta-D-glucosaminidase (NAG) excretion rose six-fold and mean urinary alaninaminopeptidase excretion increased ten-fold. After cessation of therapy, enzymuria rapidly returned to pretreatment values in all 14 patients. Aerosol tobramycin therapy in four patients did not affect urinary excretion of NAG. It can be concluded that tobramycin did not cause persistent renal damage in our patients, whether given intravenously or as an aerosol.

Acetylglucosaminidase↗
PubMed2004

Characterization of the susceptibility of mycobacteria in BACTEC 12B media containing PANTA that had been supplemented with ceftazidime, and characterization of the individual components of PANTA in the presence of C18-carboxypropylbetaine.

C(18)-carboxypropylbetaine (CB-18) specimen processing has enhanced the diagnosis of mycobacterioses by smear, culture, and nucleic acid amplification. However, toxic side effects of CB-18 in liquid culture, especially in the presence of antibiotics, have been reported. The interaction of CB-18 at 20-25 microg/ml with the individual components of the antibiotic supplement PANTA that had been fortified with ceftazidime (PANTA-caz) was characterized in BACTEC 12B cultures using four mycobacterial isolates. When the Mycobacterium tuberculosis isolate ATCC 27294 was examined CB-18 plus PANTA-caz did not significantly alter the time-to-positive (i.e., time to a growth index (GI) of 15 (GI(15))), but did significantly increase the time to a GI of 500 (GI(500)) by approximately 8.5 days. This result could be attributed primarily to nalidixic acid, but also to ceftazidime to a lesser degree. Statistically significant increases in GI(15) of 12.5 days and GI(500) of 16.5 days were observed in the presence of CB-18 plus PANTA-caz with the Mycobacterium avium isolate ATCC 25291. These increases were due exclusively to trimethoprim. Statistically significant increases of approximately 2.5 and 9 days in GI(15) and GI(500), respectively, were observed with Mycobacterium kansasii ATCC 12478 in CB-18 plus PANTA-caz. The presence of nalidixic acid and ceftazidime were responsible for these alterations. When the behavior of the Mycobacterium fortuitum isolate ATCC 6841 was investigated in CB-18 plus PANTA-caz, significant increases in GI(15) of 8.5 days and GI(500) of 13 days were observed. The additive effects of nalidixic acid and azlocillin were responsible for these results. No single component of the PANTA-caz formulation was responsible for the interaction between CB-18 and PANTA-caz, although nalidixic acid contributed to these effects most often. These findings are consistent with the previous recommendation that CB-18 specimen processing follow a dilution-based format to ensure that the concentration of CB-18 carried-over into liquid media falls below 5-10 microg/ml.

Anti-Bacterial Agents↗
PubMed1987

Oral ciprofloxacin compared with conventional intravenous treatment for Pseudomonas aeruginosa infection in adults with cystic fibrosis.

40 adult patients with cystic fibrosis (CF) were admitted to hospital with acute exacerbations of infection associated with isolation of Pseudomonas aeruginosa from sputum. The patients were randomly allocated (20 per group) to receive intravenous azlocillin 5 g and gentamicin 80 mg, or oral ciprofloxacin 500 mg. Both treatments were given three times a day for 10 days. The patients were assessed on days 1 and 10, and at 6 weeks. There was a significant improvement in lung function between days 1 and 10 in both groups (p less than 0.001). Significant improvement was maintained at 6 weeks after ciprofloxacin but not in the intravenous group. Improvement after ciprofloxacin was superior at day 10. Sputum weight decreased in both groups (p less than 0.001). Patient-recorded symptoms also improved in both groups. There was no serious toxicity or side-effects. Drug resistant organisms were isolated no more frequently after ciprofloxacin than after intravenous therapy. 17 of the ciprofloxacin-treated patients said they preferred oral treatment to intravenous therapy. Oral ciprofloxacin is a useful short-term treatment for patients with CF who are infected with Ps aeruginosa.

Acute Disease↗
PubMed2000

An outbreak of multidrug-resistant Pseudomonas aeruginosa infection associated with contamination of bronchoscopes and an endoscope washer-disinfector.

Over a two-month period, two distinct types of Pseudomonas aeruginosa resistant to ceftazidime and azlocillin were isolated from bronchial specimens of ITU patients who had been previously bronchoscoped. The source of the outbreak was probably a faulty contaminated bronchoscope washer-disinfector which had been purchased a year earlier but not properly maintained. This paper describes the outbreak, the identification and elimination of the source, and the steps taken to prevent recurrence. Several automated, closed washer-disinfectors had been bought by the hospital in response to health and safety concerns about glutaraldehyde disinfection toxicity, but the operation and maintenance of these machines had not been supervised. Several other washer-disinfectors were also found to be faulty. The potential hazards of automated endoscope washer-disinfectors and the importance of controlled professional maintenance, servicing and training is discussed.

Azlocillin↗
PubMed2000

[Local antibiotic administration decreases risk of inner ear damage in effodation].

BACKGROUND: Mobilising the stapes via the removal of the tympanosclerotic plaques from the oval window niche (effodation) and stapedectomy or malleovestibulopexy are the different procedures generally available for the surgical therapy of stapes fixation due to tympanosclerosis. These techniques bear a significant risk of sensory hearing loss. Here we analyse our results using the mobilisation technique together with locally applied antibiotics. PATIENTS: Nineteen ears in seventeen patients with tympanosclerosis involving the stapes and its footplate which underwent stapes mobilisation between 1991 and 1999 have been investigated retrospectively. According to the literature this operation has a high risk of cochlear hearing loss. To reduce this risk, azlocillin was instilled locally during removal of tympanosclerotic plaques. RESULTS: Different operation techniques have been used: classic type III with placement of a cartilage disc on the head of the stapes (4), interposition of the incus (3), interposition of the head of malleus (1), interposition of a ceramic-PORP (6) and cartilage columella in cases of significant stapes footplate erosion (3). In two operations the chain was intact and no reconstruction was necessary. Pure-tone-audiometry showed no significant decrease of bone-conduction thresholds. Preoperatively 4 (21.1%) ears had an average air-bone-gap < or = 30 dB, while postoperatively 15 (78.9%) ears had this level of hearing. CONCLUSIONS: Until the exact causes of the loss of hearing after mobilisation or stapedectomy in cases of tympanosclerosis are known, the local administration of antibiotics is certainly recommended, bearing in mind the initial hypothesis that infection may be jointly responsible for cochlear hearing loss on mobilisation or stapedectomy in cases of tympanosclerosis.

Adult↗
PubMed1985

[Current aspects of pseudomonas meningitis].

The article reports on the incidence, the conditions of occurrence, possibilities and successes of treatment with certain (combinations of) antibiotics, in dealing with cases of pseudomonas meningitis. The various possible substances used for treatment are discussed. Rates of penetration and CSF concentrations of azlocillin and cefsulodin are stated. Alternative possibilities for treatment are pointed out.

Aminoglycosides↗
PubMed1994

[Pulmonary aspergillosis in an immunocompetent female patient].

Symptoms of bronchopneumonia developed over 4 months in a 63-year-old woman in previously good health. The symptoms worsened despite treatment with tetracycline (500 mg twice daily for 10 days). Middle-lobe pneumonia was diagnosed both clinically and radiologically, but monotherapy with ofloxacin (200 mg twice daily) was ineffective, as well as combined treatment with gentamycin (80 mg), oxacillin (1 g) and azlocillin (5 g), each three times daily intravenously. Bronchoscopy revealed obstruction of the lumen of the right middle lobe bronchus by viscous purulent secretion which contained a high count of Aspergillus fumigatus, previously found in several sputum samples. The inflammatory process regressed completely within 12 days on itraconazole (200 mg twice daily), combined with nystatin inhalation (100,000 IU five times daily). The only possible aetiologically significant risk factor in this immunocompetent woman could have been her frequent use of a bio-waste container.

Administration, Inhalation↗
PubMed1982

Effect of beta-lactam antibiotics of the resistance of the digestive tract of mice to colonization.

Four broad-spectrum antibiotics-azlocillin, mezlocillin, cefuroxime, and moxalactam - were injected subcutaneously into mice twice a day. The animals divided into treatment groups for each antibiotic and then into subgroups, each subgroup receiving a different dose of antibiotic. The effect of treatment on the resistance of the digestive tract to colonization and the effect of treatment on endogenous gram-negative and intestinal streptococcal flora was studied: resistance to colonization decreased during treatment with approximately 0.9 mg of antibiotic per mouse per day. During treatment with this dose or a higher dose, Escherichia coli or a strain of Enterobacter resistant to the antibiotic being used grew to significantly higher numbers per gram of feces than in the control groups. The resistance of the digestive tract to colonization in mice decreases during systemic treatment with all four antibiotics at or above certain dose levels, a result also likely to occur in humans.

Animals↗
PubMed1984

Bactericidal effect of polymorphonuclear neutrophils on antibiotic-induced filaments of gram-negative bacilli.

Exposure of strains of Escherichia coli to ampicillin and mezlocillin and of strains of Pseudomonas aeruginosa to azlocillin and cefsulodin caused the bacilli to elongate into filaments. The bacilli and their filaments were incubated with fresh human polymorphonuclear neutrophils (PMNs), and the phagocytic process was recorded by means of phase-contrast microscopy. The bactericidal effect of PMNs on both filaments and bacilli was quantitated by counts of colony-forming units. A single PMN phagocytized one or more filaments, some of which were as long as 90 micron and contained as many as 20 genomes. Two predominant patterns of phagocytosis of filaments were observed. When the ratio of bacteria to PMNs was low (0.2-1.8), the rate of killing was 62%-81%. When the ratio was higher (5-12), the rate of killing of both filaments and bacilli was lower. As an alternative to colony-forming units, cell mass was used as a gauge of phagocytic activity. The relative mass of killed filaments was considerably greater than that of killed bacilli; this finding indicated that filaments were much more susceptible than were bacilli to the bactericidal activity of PMNs.

Ampicillin↗
PubMed1984

Single versus combination antibiotic therapy for pneumonia due to Pseudomonas aeruginosa in neutropenic guinea pigs.

Studies of therapy for experimental pneumonia due to Pseudomonas aeruginosa have failed to document beta-lactam-aminoglycoside synergy for most antibiotics examined, in contrast to results usually observed with pseudomonas infections at other sites. The neutropenic guinea-pig model of pseudomonas pneumonia was modified to resemble more closely therapy for clinical infections. Animals were treated 16 hr after infection with ticarcillin, azlocillin, ceftazidime, tobramycin, and netilmicin, alone and in combination. As predicted by in vitro synergy testing, in all cases combination drug therapy was more effective than the corresponding drugs given alone (P less than .05), as assessed by quantitative lung culture. Among single-drug regimens, those in which peak antibiotic levels did not exceed the minimal bactericidal concentration for the organism were significantly less effective. Resistance to aminoglycosides did not develop during therapy, and therefore, in this study does not explain the mechanism of synergy observed with beta-lactam antibiotics.

Agranulocytosis↗
PubMed1983

Ceftazidime as a single agent in the management of children with fever and neutropenia.

Fifty consecutive episodes of fever in neutropenic children with malignant disease or aplastic anaemia were randomized to treatment with either ceftazidime alone or a combination of azlocillin and tobramycin, pending the results of bacteriological investigation. More than 90% of organisms isolated from these episodes were sensitive to ceftazidime, which appears to be a non-toxic alternative to aminoglycosides in such circumstances.

Adolescent↗
PubMed1985

Effect on growth curve patterns of brief exposure of bacteria to different concentrations of beta-lactam antibiotics.

The effect of a brief beta-lactam action on a bacterial culture has been studied by combining the use of a high performance photometer with phase contrast microscopic examination. After exposure of the culture with the antibiotic, the growth curves presented in logn OD have shown the importance of the pre-lytic increase in OD (PIOD). Using Escherichia coli a study of the PIOD values allowed us to separate the beta-lactam antibiotics studied into two groups: those whose PIOD were concentration-dependent (ampicillin, carbenicillin, ticarcillin, moxalactam, ceftazidime, cefsulodin, cefotaxime) and those whose PIOD were concentration-independent (or weakly dependent) (azlocillin, mezlocillin, piperacillin). When the PIOD was independent of the concentrations, long filaments were observed by phase contrast microscopy. Using Pseudomonas aeruginosa, all the antibiotics studied produced PIOD values that were barely dependent of the concentrations, and long filaments were observed by phase contrast microscopy. Study of the lag of regrowth in the post antibiotic period using a beta-lactamase technique showed that, if the PIOD was hardly concentration dependent, so was the lag of regrowth.

Ampicillin↗
PubMed1985

Comparative analysis of the antimicrobial action of polymorphonuclear leucocytes in vitro, ex vivo and in vivo.

A comparative study on the phagocytic capacity of human and rat polymorphonuclear leucocytes was performed. The activity of rat leucocytes was assessed by using the rat polyvinyl sponge model and the granuloma pouch model. Isolated human leucocytes were either suspended in buffer or homologous serum. Assessments of the susceptibility of Pseudomonas aeruginosa or Klebsiella pneumoniae to the antimicrobial action of leucocytes revealed that the activity of normal human leucocytes and rat leucocytes was very similar, whereas human leucocytes obtained from chronically infected patients were significantly more active. Pretreatment of the bacteria with subinhibitory mezlocillin and azlocillin concentrations with or without immunoglobulin G rendered the bacteria more susceptible to the antimicrobial action of both types of leucocytes. Again results obtained by the different methods were very similar.

Animals↗
PubMed1986

In-vitro studies of antibiotic combinations with special emphasis on the evaluation of newly developed methods.

We have described an in-vitro pharmacokinetic model that mimics the serum and tissue concentrations of antibiotics during therapy of human patients, and thus presents a changing concentration of antibiotics to the bacterial inoculum. This pharmacokinetic model has been used to study antibiotic combinations that are used in the treatment of infections in granulocytopenic patients. In this model the addition of piperacillin to amikacin or of ceftazidime or azlocillin to another aminoglycoside prevented the regrowth of resistant subpopulations of Pseudomonas aeruginosa. The activities of several antibiotic combinations were studied in the in-vitro model, the conventional checker-board method and the time-kill method. Discrepant results were found with the model and the conventional tests in one-third of the combinations. The model may be useful in the preclinical study of antibiotic combinations and may be proved more predictive of clinical outcome than conventional tests.

Amikacin↗
PubMed1986

Ureidopenicillins, aztreonam, and thienamycin: efficacy as single-drug therapy of severe infections and potential as components of combined therapy.

The ureidopenicillins (piperacillin, mezlocillin, and azlocillin), aztreonam, and thienamycin are new broad-spectrum beta-lactams with more potent antibacterial activity than the older cephalosporins and penicillins. However, therapy of severe infections with the ureidopenicillins alone is limited by the potential for emergence of resistant organisms, while monotherapy with aztreonam does not provide adequate coverage for Gram-positive aerobic organisms and anaerobes. In combination therapy with the aminoglycosides, the ureidopenicillins may be preferred to carbenicillin or ticarcillin in the treatment of Pseudomonas aeruginosa infections and in institutions with a high prevalence of carbenicillin or ticarcillin-resistant organisms. Double beta-lactam therapy with piperacillin plus either latamoxef (moxalactam) or ceftazidime may be advantageous in patients for whom aminoglycoside toxicity is a concern. Thienamycin is the most promising of the new beta-lactams for single-agent therapy of severe infections but may also be associated with the emergence of resistant P. aeruginosa during monotherapy. In febrile granulocytopenic patients or other severely ill patients at risk of severe P. aeruginosa infections, thienamycin or another antipseudomonal beta-lactam should be combined with an aminoglycoside.

Aminoglycosides↗
PubMed1986

Ciprofloxacin in the treatment of Pseudomonas infection in cystic fibrosis patients.

Ten patients with cystic fibrosis received 19 therapeutic courses of ciprofloxacin at a dose of 750 mg orally twice daily. The length of therapy ranged from two to five weeks except for one patient who was treated for six weeks. The mean peak serum concentration of ciprofloxacin was 3.41 mg/l and the mean trough level was 1.11 mg/l. For comparison nine patients were treated with the combination of azlocillin at a dose of 350 mg/kg/day in four divided doses and tobramycin at an initial dose of 9 mg/kg/day in three divided doses. All patients were infected with Pseudomonas aeruginosa except for one patient in whom P. cepacia grew in the sputum cultures; the MICs of ciprofloxacin ranged from 0.05 to 1.56 mg/l. The results obtained with these two therapeutic regimens were comparable. The patient treated for P. cepacia infection developed resistance to ciprofloxacin (MIC greater than 6.24 mg/l) during the course of treatment. Ciprofloxacin appears to be an alternative treatment to the use of an aminoglycoside and a penicillin in cystic fibrosis patients.

Adolescent↗
PubMed1989

Serum and sputum concentrations of netilmicin in combination with acylureidopenicillin and cephalosporins in clinical treatment of pulmonary exacerbations in cystic fibrosis.

The pharmacokinetics of netilmicin was studied in 14 patients with cystic fibrosis, aged 4-21 years (mean 16 years) during treatment of pulmonary exacerbations of pseudomonas infection. The patients received 24 courses of netilmicin (10 mg/kg/day) in combination with azlocillin (600 mg/kg/day), cefsulodin (200 mg/kg/day) or ceftazidime (150 mg/kg/day) for 9-14 days. Seven patients received two or three courses of different combinations. Serum and sputum concentrations of netilmicin were determined on day 2 and 6. Mean (+/- S.E.M.) trough serum values were 1.4 +/- 0.2 mg/l (same on day 2 and 6), peak values at 10 min 13.6 +/- 1.0 and 13.7 +/- 0.9 mg/l, and serum concentration at 1 h 7.5 +/- 0.6 and 7.5 +/- 0.5 mg/l, on days 2 and 6 respectively. The half-life was about 1 h. The pharmacokinetics did not differ on day 2 and 6. Sputum concentrations increased up to 2-3 h after administration, mean (+/- S.E.M.) peak values being 2.6 +/- 0.6 and 1.5 +/- 0.4 mg/l at day 2 and 6, respectively. The study shows that the pharmacokinetics of netilmicin was not influenced by different combinations with beta-lactams. All patients improved clinically, but pseudomonas growth was only reduced in nine courses. In one case transient resistance to netilmicin developed during the treatment. The clinical efficacy and tolerance were good and similar to those seen with combinations with other aminoglycosides.

Adolescent↗