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The two antibiotic combinations ceftriaxone (Rocephin)/gentamicin and azlocillin/gentamicin were compared in a randomized study in a total of 49 premature and full-term neonates with the clinical symptoms of sepsis. In both groups, equally good efficacy and reliability and very good tolerability were observed.
A young woman with acute upper extremity edema and ischemia after intraarterial drug injection is presented. Unsatisfactory results from standard treatment were the reason for changing the therapy to temporary thrombolysis, which led to significant improvement. Some days later severe impairment forced another attempt at applying standard therapy, again unsuccessful. Only after continuous intraarterial infusion of Iloprost, a new improvement occurred and saving of the hand was possible. It became obvious that more effective therapeutic measures ought to be applied when severe hand ischemia following intraarterial drug injection is present.
The MIC values of 99 isolates of Enterobacteriaceae to 11 of the newer beta-lactam antibiotics, and 25 isolates of Pseudomonas aeruginosa to 9 of these drugs were compared with representatives of the established beta-lactam antibiotics and gentamicin. The MIC values for the newer agents were significantly lower in comparison with the older reference compounds. The potential clinical use of these newer antibiotics is discussed.
A deletion in the structural gene for the soluble lytic transglycosylase, the predominant murein hydrolase in the soluble fraction of Escherichia coli, has been constructed. The mutant grows normally but exhibits increased sensitivity toward mecillinam, a beta-lactam specific for penicillin-binding protein 2. In the presence of furazlocillin or other beta-lactams with a specificity for penicillin-binding protein 3 which normally cause filamentation, bulges were formed prior to rapid bacteriolysis. Similar morphological alterations are known to develop in wild type E. coli cells when furazlocillin is combined with bulgecin, an antibiotic of unusual glucosaminyl structure. It turned out that bulgecin specifically inhibits the Sl-transglycosylase in a noncompetitive manner. Since bulgecin shows some structural analogy to the murein subunits we postulate that the soluble lytic transglycosylase, in addition to its active site, has a recognition site for specific murein structures. The possibility of an allosteric modulation of the activity of the enzyme by changes in the structure of the murein sacculus is discussed.
The results of five consecutive prospective trials define the role of perioperative antibiotic prophylaxis in head and neck surgery. For contaminated head and neck cases and for endonasal sinus surgery, a single-dose prophylaxis seems to be sufficient. Most clean cases do not need antibiotic prophylaxis. Risk factors for wound infection include nicotine or alcohol abuse, poor oral hygiene and increasing age. Previous radiotherapy seems to be of minor importance.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
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The efficacy of the combinations of aminoglycosides and penicillin with respect to Pseudomonas, Klebsiella and Escherichia strains was estimated with the methods of two-fold serial dilutions of aminoglycosides and constant concentrations of penicillin and the "chess board" method. Correlation between the synergistic effect and sensitivity of the strains to separate components of the combinations was observed. For prediction of the combination efficacy these methods are not useful, since they are labour-intensive and their results are very variable. In this connection a simple informative test is recommended. With the use of this test it is possible to judge the chemotherapeutic efficacy of antibiotics and their combinations by the value of the serum antibacterial activity (titer) against the infection causative agent. The blood serum titer of at least 1:8 is accompanied by a pronounced effect. The test also indirectly provides information on the sensitivity of isolated pathogens and adequacy of the drug blood levels after administration of the chosen dose.
The impact of the antibiotics carbenicilin and gentamycin on the aggregation and adhesiveness of thrombocytes and on the rotation thrombelastogramme is investigated in healthy newborns. Thrombocyte aggregation was markedly inhibited by carbenicilline; gentamycine had no influence. Thrombocyte adhesiveness was less influenced by both medicaments. The parameters of TEG, viz. reaction time, clotforming time, thrombus elasticity and index were compared before and after rotation and with and without medicaments. Under carbenicilline a prolongation of the clotforming time and a decrease of thrombus elasticity could be shown to exist after rotation. The impact of medicaments on the rotation thrombelastogramme can only be conceived by comparing the values before and after rotation in each case with and without medicament and not simply evaluating it, so that the rotation thrombelastogramms cannot be recommended to be used for assessing the disturbance of thrombocyte function induced by medicaments.
At the present time, gram-negative bacillary bacteremia in patients with neutropenia will respond favorably in 60% to 70% of the patients when carbenicillin-ticarcillin or cephalothin-cefazolin combined with aminoglycosides (gentamicin, tobramycin, sisomicin, netilmicin, or amikacin) are given. Piperacillin alone will cure 20/34 (59%) of bacteremic episodes in patients without granulocytopenia who have a severe underlying disease. In patients with neutropenia, the combination of piperacillin with amikacin was found to be associated with a favorable response in 76/121 patients (63%). These results are thus as good as those obtained with other broad-spectrum, beta-lactam antibiotics whether used alone in patients without granulocytopenia or in combination with aminoglycosides in patients with neutropenia. It seems likely that in patients with severe underlying disease and/or granulocytopenia, antibiotic combinations have reached an optimal efficacy. More attention should be paid to the correction of the basic predisposing factors to infection (granulocytopenia and immunodepression) and to infections caused by nonbacterial pathogens.
In a multicentre study of the distribution in France of constitutive beta-lactamases produced by Ps. aeruginosa, the activities of 12 antibiotics were investigated comparatively according to resistance phenotypes. Antibiotics with the best activity, on a weight-for-weight basis, against "wild" non carboxypenicillin-resistant strains were ureidopenicillins among penicillins, ceftazidime and cefsulodin among cephalosporins and a new beta-lactam compound: N-formimidoyl-thienamycin. Thirty per cent of carboxypenicillin-resistant strains do not possess constitutive beta-lactamases. With most antibiotics, except N-f-thienamycin, minimum inhibitory concentrations (MICs) against these strains were increased 2 or 3-fold. However, the MICs of ureidopenicillins remained well below critical concentrations. The activities of the penicillins tested and of cefoperazone and cefsulodin against strains with constitutive beta-lactamases were considerably reduced. Those of other cephalosporins, such as cefotaxime, ceftriaxone, moxalactam, ceftazidime and azthreonam were little modified. However, in view of the plasma concentrations obtained, with the exception of ceftazidime and azthreonam the MICs of these cephalosporins were too high for satisfactory therapeutic results to be expected. Ps. aeruginosa strains producing beta-lactamases of the chromosomal cephalosporinase type are still rare (0.9%), but their number seems to be increasing. These strains, probably selected by treatments, are resistant to all beta-lactam antibiotics, and their degree of resistance to cephalosporins, ceftazidime included, is particularly high.
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