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PubMed1983

Antimicrobial prophylaxis of infections in head and neck cancer surgery.

429 patients undergoing surgery for head and neck tumors were involved in 4 consecutive, randomized clinical trials of antimicrobial prophylaxis: placebo versus ampicillin plus cloxacillin (2 g of each daily for 6 days), ticarcillin (5 g X 12, 8-hourly) versus carbenicillin (10 g X 12, 8-hourly) short carbenicillin prophylaxis (1 day) versus prolonged carbenicillin prophylaxis (4 days) and clindamycin (900 mg, 4 daily doses) versus clindamycin plus netilmicin (90 mg, 4 daily doses). Aerobic gram-negative strains were the microorganisms most frequently isolated either from colonized or infected wounds. The first controlled study showed a significant decrease in the rate of postoperative bacterial infections in the treated group as compared to the placebo-treated group (p less than 0.05). In all the subsequent treatment groups, postoperative infection rates ranged from 6 to 16%. Short prophylaxis was as effective as prolonged prophylaxis. A regimen directed mainly against anaerobes (clindamycin) did not seem of less value than broad spectrum regimens covering most aerobic gram-negative bacilli.

Anti-Bacterial Agents↗
PubMed1984

Administration of antibiotics in combination. The antibacterial activity of blood serum and urine after a simultaneous administration of aminoglycosides and ampicillin.

Blood serum and urine samples collected from a group of volunteers treated with single doses of ampicillin and aminoglycoside preparations given separately or in combination were tested for their antimicrobial activity against the reference strains Staphylococcus aureus SZK 76/69 and ATCC 6538, Pseudomonas aeruginosa SZK 444 and SZK 385, and Escherichia coli SZK 326/71. Out of all antimicrobials and their combinations tested the most powerful was the combination of netilmicin with ampicillin. Of the therapeutic combinations used nowadays in clinical practice the combined use of gentamicin and ampicillin proved also effective. These antibiotic combinations appear thus to be best suited for the treatment of mixed Pseudomonas aeruginosa and Staphylococcus aureus infections and of urinary tract infections caused by bacterial strains exhibiting in the in vitro susceptibility assays a reduced sensitivity to some of the antibiotic preparations used.

Adult↗
PubMed1983

Clinical aspects of continuous ambulatory peritoneal dialysis.

Clinical aspects of Continuous Ambulatory Peritoneal Dialysis (CAPD) were studied in the first fifty patients started on CAPD at our hospital. CAPD was found to achieve good control of the uremic symptoms and of the biochemical values studied. Hypertension became less pronounced. The costs were found to be low. Twenty-four diabetic subjects were studied in detail. Intraperitoneal administration of insulin resulted in good metabolic control of the diabetes. The two catheters used for peritoneal access were compared. Because of problems related to the removal of the Toronto Western Hospital catheter it was concluded that the Tenckhoff catheter was to be preferred. Peritonitis was found to be the worst complication. Coagulase negative staphylococci accounted for 57% of the cases. During the study an increasing percentage of infections were caused by bacteria with multiple resistance to antibiotics. Netilmicin, a new aminoglycoside, was evaluated for the treatment of CAPD-related peritonitis. 84% of the cases responded. One of the nineteen patients treated sustained reversible vestibular toxicity. No other side effects were noted. In two patients right-sided hydrothorax was found to be a complication of peritoneal dialysis. In one case it was demonstrated that defects in the right diaphragm was the cause of the complication. In the other CAPD was continued despite the complication.

Anti-Bacterial Agents↗
PubMed1984

Interactions between renal brush border membranes and polyamines.

Aminoglycosides are cationic polyamines which accumulate in renal cortex and cause functional as well as structural tubular lesions. To examine the characteristics of aminoglycoside interaction with the kidney brush border membrane, we have measured the aggregation of isolated membranes induced by clinically achievable concentrations of gentamicin and netilmicin. In this assay, competition was observed between the aminoglycoside and other drugs which share the property of inducing a phospholipidosis of lysosomes or displacing Ca++ from anionic phospholipids. Competition for aggregation was demonstrated also between gentamicin and spermine which is a native polyamine product of cell metabolism. Additional data supporting a direct effect of the aminoglycosides on membrane structure came from fluorescence analysis utilizing 8-anilino-1-naphthalene sulfonic acid. Concentrations of gentamicin well below therapeutic levels enhanced the fluorescence intensity of 8-anilino-1-naphthalene sulfonic acid several-fold as did low concentrations of Ca++ and Mg++. The effects of gentamicin and Ca++ on 8-anilino-1-naphthalene sulfonic acid fluorescence were additive. These results indicate that membrane characteristics may be modified by the interaction of native polyamines or subtoxic levels of extrinsic polycations with intrinsic anions on the renal cell surface. The physiologic consequences of these changes warrant further study.

Anilino Naphthalenesulfonates↗
PubMed1980

Outbreak of amikacin-resistant Enterobacteriaceae in an intensive care nursery.

An outbreak of amikacin-resistant Enterobacteriaceae (KES) occurred in the Intensive Care Nursery (ICN) of the Louisville General Hospital from January 1978 through March 1978. Epidemic disease and an increased colonization rate in newborn infants due to amikacin-resistant microorganisms has not been documented previously. Three of the 11 neonates died. The organisms isolated were resistant to amikacin and two experimental aminoglycosides, sissomicin and netilmicin. The outbreak was contained following institution of several control measures, including pharyngeal inoculation of an experimental strain of alpha streptococcus in four infants.

Amikacin↗
PubMedDate not supplied

[The use of clindamycin in the prevention and treatment of infectious complications in the cancer clinic].

Clindamycin used alone or in combination with other antimicrobial drugs such as aminoglycosides, dioxidin and fluoroquinolones in the prophylaxis and treatment of infectious complications in oncological patients was shown to be highly efficient. When clindamycin was used prophylactically in combination with netilmicin, the postoperative infectious complications developed in 3 out of 27 patients with tumors of the head and neck, in 1 out of 24 patients with tumors of the rectum and colon and in 3 out of 16 patients with tumors of the female genitalia. The clinical effect was observed in 36 (87.8 per cent) out of 41 patients with postoperative wound infections and in 38 (82.5 per cent) out of 40 patients with pneumonia. Therefore, the use of clindamycin alone or in combination with other antimicrobial drugs is essential in the treatment of infectious complications in oncological patients.

Adolescent↗
PubMed1993

[Pituitary abscess, treated by medication].

Pituitary abscesses are rare. The case reported here concerns a 28-year old African. Gradual development of diplopia over 6 months was the first clinical manifestation. Three months later this development had reached a more severe and infectious context, with complete right ophthalmoplegia, meningitis and coma (GCS = 9). CT scan showed an image in favour of a pituitary abscess with suprasellar extension, associated with thrombophlebitis of the cavernous sinus. An antibiotic therapy consisting of cefotaxime and metronidazole administered for 1 month, and netilmicin for 15 days succeeded in controlling the infectious syndrome. This resulted in cure of visual disorders, reduction in size of the CT scan image and reconstruction of the pituitary sella which had been destroyed. The diagnosis of pituitary abscess should be made when confronted with an infectious syndrome (unexplained fever, repeated meningitis). CT does not recognize the nature of the hypophyseal mass it shows: necrosis of a pituitary adenoma, giant aneurysm or craniopharyngioma may mimic local infection. Surgery confirms the diagnosis and is regarded as the best treatment. The patient's life is threatened when meningitis is present, and the functional prognosis is poor when recovery from visual disorders is compromised due to late diagnosis. In this paper a comparative analysis of the clinical course of the disease and therapeutic data in our patient is presented and compared with other reported cases.

Abscess↗
PubMed1994

[Evaluation of bactericidal activity of arbekacin in mixed culture with MRSA and Pseudomonas aeruginosa using an in vitro pharmacokinetic simulation system].

The bactericidal activities of arbekacin (ABK), vancomycin (VCM), gentamicin (GM) and netilmicin (NTL) in mixed culture with Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa were examined using an in vitro computer programmed pharmacokinetic simulation system and also the protective effect of these agents on systemic infection in neutropenic mice was examined. In a mixed culture of S. aureus No. 235 (MRSA) and P. aeruginosa E7, ABK showed a strong bactericidal activity and an inhibition of regrowth against both bacteria, and GM and NTL showed similar effects. On the other hand, VCM showed a bactericidal activity against S. aureus No. 235, but not against P. aeruginosa. In the protective study, ABK was evidently more effective than GM, NTL or VCM against a systemic mixed infection of mice with S. aureus No. 235 and P. aeruginosa E7. In brief, the ED50 values of ABK, VCM, GM and NTL were 19.5, > 100, 40.5 and 45.2 mg/kg, respectively.

Aminoglycosides↗
PubMed1993

[Susceptibility to antibiotics and biochemical activity of strains of Acinetobacter sp. isolated from various sources].

The study was performed on 576 Acinetobacter strains isolated from clinical material, objects from hospital, environment, soil, water and from animals. Applying API 20NE system identification was following: A. baumanii (61.1%), A. junii (19.4%), A. haemolyticus (4.3%), A. lwoffii (3.3%), A. johnsonii (0.52%) and not belonging to above genus strains (11.3%). Over 47% strains of Acinetobacter were isolated from clinical material as the only bacteria (mainly from samples received from intensive care units and surgical and urological wards). Out of 23 antibiotics and antimicrobials used for investigation of 535 strains of Acinetobacter, most active were imipenem (99%) of susceptible strains, ofloxacin and ciprofloxacin (95%) and netilmicin (88%). Multiple resistant strains were isolated more frequently from hospital environment than from other sources--these were mostly A. baumanii and A. junii.

Acinetobacter↗
PubMed1993

[Detection of the phenotypes of resistance of enterobacteriaceae to aminoglycosides with ATB Plus Expert System].

ATB Plus Expert (Biomérieux SA) is an expert system which has been developed to perform an interpretative reading of ATB susceptibility tests. The system was tested on the results obtained for 217 strains of enterobacteriaceae. These strains were selected in order to cover a maximum of bacterial species and resistance mechanisms. The isolates were tested on rapid ATB E, rapid ATB G-, rapid ATB Ur, ATB G- and ATB Ur strips. In parallel, a disc diffusion susceptibility test was performed with 5 discs of aminoglycosides (kanamycin, gentamicin, tobramycin, netilmicin, amikacin) and the interpretation was carried out according to the criteria usually followed. Of the 217 strains tested, 122 showed a resistance phenotype. Only the rapid ATB E strips included kanamycin and allowed the detection of APH(3') phenotypes. Amikacin was not included in the ATB Ur strip, consequently it was impossible to discriminate AAC(3)-II and AAC(6') + AAC(3)-I phenotypes. 12 strains did not grow within 5 hours using the rapid ATB methodology. Not taking into account the problems previously encountered, different phenotypes between the 6 susceptibility tests were found for 16 strains. In 5 cases the expert system detected an anomaly instead of the correct phenotype, and in 3 cases of unknown phenotypes, the answers were variable. In the other cases, the main difficulty was the detection of the isolated resistance to gentamicin (AAC(3)-I phenotype). The expert system automatically corrects the susceptibility test result according to the phenotype observed.

Amikacin↗
PubMed1993

[Neisseria mucosa endocarditis complicated by intracerebral aneurysm].

BACKGROUND: Serious complications, such as emboli and mycotic aneurysms, are still frequent in documented cases of infective endocarditis. Infecting organisms other than Streptococcus viridans and Staphylococcus are becoming more common. CASE REPORT: A 8 year-old girl was admitted because of a sudden pain in the right calf followed by complete disability. She had low-grade fever and presented with a moderate heart murmur with no sign of congestive heart failure, a severe pain at palpation of her calf with no Homans sign; she had many dental caries. Laboratory data indicated leukocytosis with increased percentage of polymorphonuclear cells and increased sedimentation rate. Ultrasonography of the calf showed laceration of the muscle with blood suffusion. Echocardiography showed vegetations involving the mitral valve. Intravenous antibiotic therapy with penicillin G and netilmicin was instituted, but mitral insufficiency appeared 7 days later while the fever persisted. At that time, the brain CT scan showed ischemic lesions, while angiography showed several mycotic aneurysms. Neisseria mucosa was recovered from the 5 initial blood cultures 16 days after the onset, and penicillin G was replaced by ampicillin. A second vegetation involving the aortic valve was seen a few days later, and a recent arterial embolism to the right leg was suspected because fever and pain reappeared. The brain ischemic lesions gradually disappeared and a second angiography performed 3 months after the first showed that all but one large mycotic aneurysm had disappeared; this last aneurysm was excised. Four years later, the child is in good health without any neurological sequelae but having mitral insufficiency. CONCLUSION: This girl presented with classical complication of infective endocarditis due to Neisseria mucosa, a saprophytic organism of the oral cavity. This is the second report of such an infection in children.

Ampicillin↗
PubMed1993

Subinhibitory concentrations of antibacterial drugs and Pseudomonas aeruginosa virulence factors.

Pseudomonas aeruginosa is an important, opportunistic pathogen responsible for nosocomial infections in the immunocompromised host and resistant to antibacterial drugs. Its pathogenicity is related to many virulence factors such as proteases, alginate, exotoxin A and exoenzyme S. Our previous study showed a down-regulation of some P. aeruginosa virulence factors by subinhibitory concentrations of antibacterial drugs. This study aimed to compare the effects of subinhibitory concentrations of a new difluoroquinolone, PD 131,628, a betalactam, aztreonam and an aminoglycoside, netilmicin.

Alginates↗
PubMed1993

[Noma in a patient with acute leukemia allergic to penicillin].

Noma has virtually disappeared from Europe, but is still found in certain parts of Africa, South America and Asia. In our case the etiologic agent was Pseudomonas aeruginosa sensitive to antibiotic therapy that we used (pefloxacin and netilmicin). Another characteristic aspect of our case is the rapid infaust evolution. In this report will be discuss the pathogenesis and the reason of the failure of the antibiotic therapy especially in immunodeficiency patients.

4-Quinolones↗
PubMed1995

[Standardization of conditions for the evaluation of effectiveness of antibacterial drugs in pneumonic plague in sacred baboons].

The signs of pneumonic plague in sacred baboons infected by aerosol are: fever, hurried breathing, depression and constantly increasing bacteremia. Some infected animals isolate the plague microbes while coughing and thus could be a source of the infection. By the clinical and pathomorphological signs, pneumonic plague in sacred baboons is similar to that in humans which makes it possible to use the animals in the development of schemes for special prophylaxis and treatment of the disease. In efficacy estimation of antibacterial drugs sacred baboons should be infected by aerosol by highly virulent strains of Y. pestis in doses of 1.10(4)-1.10(5) live microbes. The treatment of the animals should be started from the moment of the rectal temperature increase to 39.5 degrees C or higher after collecting the blood specimens for the bacteriological tests. It was shown that a two-day course of the treatment with antibacterial drugs was not efficient in the animals with pneumonic plague. The use of streptomycin, gentamicin, netilmicin or ciprofloxacin for 7 days cured all the infected animals. The use of streptomycin in the therapeutic doses was not efficient in the animals whose blood specimens of 1 cm3 contained 4.10(4) or more plague microbes by the moment when the treatment was started.

Animals↗
PubMed1995

[An attempt to choose the optimal antibiotic for early treatment of neonates with bacterial sepsis].

Aim of our study was making easier choice of right antibiotic to treatment newborns with sepsis after receiving results of bacteriological test. We analysed antibiograms that were results of first bacteriological test of blood samples taken from 59 neonates, who were admitted in first week of life to the Neonatal Pathology Clinic in Zabrze. On the ground of our analysis we propose applying netilmicin and cephalotin in every case of neonate with symptoms suggesting the sepsis. These two antibiotics have the best effects in treatment the sepsis.

Bacterial Infections↗
PubMed1996

Postantibiotic effect and virulence factors depression induced by ciprofloxacin and by aminoglycosides in a clinical isolate of Pseudomonas aeruginosa.

The postantibiotic effect (PAE) was induced in Pseudomonas aeruginosa by ciprofloxacin, tobramycin and netilmicin (2x or 4x MIC). A longer PAE was evoked by a higher concentration of antibiotics. The evaluation of Pseudomonas aeruginosa virulence factors after treatment with suprainhibitory concentrations of the antibiotics tested showed that a higher suppression of elastase activity was associated with a longer PAE. Elastase was suppressed more effectively than proteinase. The highest reduction of elastase and proteinase activity (to 24.9% and 76.4% of the control values) was observed after treatment with ciprofloxacin.

Anti-Bacterial Agents↗
PubMed1998

Transient 5-oxoprolinuria (pyroglutamic aciduria) with systemic acidosis in an adult receiving antibiotic therapy.

5-Oxoprolinuria is a recognized condition with increased urinary excretion of 5-oxoproline and is associated with a variety of inborn metabolic defects involving the series of enzyme-linked reactions known as the gamma-glutamyl cycle. We report the unusual case of a 35-year-old woman who initially presented with staphylococcal pneumonia but went on to develop a transient high anion gap metabolic acidosis. The development and subsequent complete recovery from this acidosis were subsequently shown to be related in time to the intravenous administration of the antibiotics flucloxacillin and netilmicin. Analysis of the patient's urine for organic acids revealed massively increased excretions of 5-oxoproline at the peak of her acidosis. We suggest that this patient developed a transient disturbance in the gamma-glutamyl cycle involving the 5-oxoprolinase step, which resulted in accumulation of 5-oxoproline that caused a severe high anion gap metabolic acidosis. The administered antibiotics remain as possible causative agents.

Acidosis↗