Azlocillin in the treatment of serious infection with Pseudomonas aeruginosa.
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Techniques have been described for the purification of mouse polymorphonuclear leukocytes (PMN) and macrophages and for determining their bactericidal activity against Pseudomonas aeruginosa in a rotating suspension. Requirements for human anti-Pseudomonas opsonins and heat-labile mouse serum factors have been determined. In the macrophage system, although heat-labile mouse serum factors had enhancing properties, both immunoglobulin G (IgG) and immunoglobulin M (IgM) opsonins alone sufficed to induce bactericidal activity. In contrast, both opsonins and heat-labile mouse serum factors were required for bactericidal activity by the mouse PMN. In the absence of heat-labile mouse serum factors, IgG and IgM opsonins contributed to the bactericidal activity of mouse macrophages to the same extent. However, in the presence of these factors, much less IgG than IgM antibody was required to achieve maximum bactericidal activity by these cells. Similarly, IgG opsonins were found to be more efficient than IgM opsonins in enhancing the killing of P. aeruginosa by mouse PMN.
Swiss white mice were given ampicillin, clindamycin, kanamycin, metronidazole, or streptomycin in drinking water for a period of 3 weeks. One week after the initiation of antibiotic administration, the treated mice and untreated control mice were challenged orally with approximately 10(8) viable, streptomycin-resistant (SR) Pseudomonas aeruginosa isolates. All five of the antibiotics decreased the resistance of the mice to intestinal colonization with SR P. aeruginosa, as reflected by an increased fecal carriage of the organism and an increase in population levels of SR P. aeruginosa in feces as compared with untreated controls. Metronidazole was least effective in this regard. The antibiotics lowered the dose of SR P. aeruginosa that resulted in implantation in 50% of the mice ID50 to various degrees. Administration of streptomycin, the most effective antibiotic, caused a 10,000-fold decrease in ID50 as compared with untreated controls. Oral inoculation of approximately 10(8) organisms of SR P. aeruginosa resulted in translocation of the organism to the mesenteric lymph nodes, spleens, or livers of 13 or 17 streptomycin-treated mice, 1 of 20 clindamycin-treated mice, and 1 of 14 metronidazole-treated mice. Translocation was not observed, however, in ampicillin- or kanamycin-treated animals. Antibiotic activity was detected in the cecal contents of streptomycin-, kanamycin, and clindamycin-treated mice but not in the cecal contents of ampicillin- or metronidazole-treated animals.
The opsonic, agglutinative, and mouse protective capacities of anti-Pseudomonas antibodies in immune and normal human immunoglobulin G (IgG) preparations were investigated. Opsonic activities of the immune IgG preparations correlated well with their protective activities. Antibodies present in normal IgG showed a substantial agglutinative activity but were poorly protective. Anti-Pseudomonas antibodies of both normal and immune IgG preparations were directed against the same serotype antigen as demonstrated by absorption experiments. Immune anti-Pseudomonas IgG antibodies fixed complement very efficiently as demonstrated by opsonophagocytic and hemolytic tests. Natural anti-Pseudomonas IgG antibodies fixed complement very poorly although they promoted phagocytic killing of bacteria only in the presence of heat-labile serum factors. It was concluded that, although agglutination can be used for qualitative measurement of antibacterial antibodies, it fails to measure their functional capacities.
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A case of infection with Pseudomonas maltophilia is described. The clinical record and bacteriological findings are reported, and the possible aetiology is discussed.
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Fourteen cystic fibrosis patients (aged 9 to 20 years), chronically infected with Pseudomonas aeruginosa (PA), inhaled 80 mg (2 ml) tobramycin twice daily, because a significant clinical deterioration had occurred. Mean duration of aerosol therapy was 20.3 months (range, 11 to 38 months). There were no toxic side effects and no significant systemic absorption, 50 of 70 tobramycin serum levels being below the minimal detectable value of 0.1 mg/l. After 12 months of therapy there was an improvement of lung function, Po2, and weight. The frequency of intravenous therapy was reduced. Tobramycin resistance occurred in 5.8% of all PA strains after 10 to 29 months and did not represent a clinical problem. In a few patients PA was eradicated from sputum.
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