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PubMed1990

[Antibiotherapy in chronic familial granulomatosis].

Antibacterial therapy in chronic granulomatous disease requires antimicrobials active on Staphylococcus aureus and enterobacteria, which also have a good intracellular penetration and activity as rifampicin, fluoroquinolone, fosfomycin, cotrimoxazole. Several trials showed that cotrimoxazole was effective for the prevention of bacterial infection: thus, this antimicrobial can be used as long-term and continuous prophylaxia. Fungal infections require the use of amphotericin B. The place of new imidazole compounds as itraconazole should be assessed.

Amphotericin B↗
PubMed1990

Role of new cephamycins in the management of obstetric and gynecologic infections.

The results of in vitro and in vivo studies of cefmetazole, a second-generation cephamycin, were reviewed. Cefmetazole's spectrum of activity includes clinical coverage of many Enterobacteriaceae, staphylococci, streptococci, Haemophilus species, pathogenic Neisseria organisms, Moraxella (Branhamella) catarrhalis and anaerobic bacteria. Cefmetazole is generally two to eight times more potent than cefoxitin against organisms within their spectra and is most active against staphylococci (minimal inhibitory concentration90 = 2.0 micrograms/mL). Methicillin-resistant Staphylococcus aureus strains are more susceptible to cefmetazole, alone or in combination with fosfomycin, than to any other cephamycins, and cefmetazole is remarkably resistant to the beta-lactamases produced by aerobic and anaerobic bacteria. The incidence of adverse drug reactions is low (8.8% in the United States, 2.2% in Japan), and the drug has been demonstrated to have cost-containment potential.

Bacteria↗
PubMed1990

[Nosocomial Staphylococcus epidermidis and Staphylococcus aureus septicemias in neonates].

Sixteen neonates developed staphylococcal septicemia (S. epidermidis in 10 cases and S. aureus in six). Two infections were due to maternofetal contamination and four to contaminated foreign material. Clinical symptoms included non-specific evidence of neonatal bacterial infection and, in S. aureus infections, suggestive skin or bone localizations. Fifteen patients recovered without sequelae and one died as a result of S. aureus septicopyemia. In view of the patterns of resistance to antimicrobial agents exhibited by S. aureus and S. epidermidis, the vancomycin-amikacin combination seems the most appropriate treatment in neonatal staphylococcal septicemias. However, the fosfomycin-cefotaxim combination can be proposed for the treatment of staphylococcal infections with osteoarticular or meningeal involvement.

Anti-Bacterial Agents↗
PubMed1990

[Annual changes in isolation of MRSA in our department and chemotherapeutic effect of antibiotics including minocycline against postoperative infections of methicillin-resistant S. aureus].

Assessment has been made, using MIC values and coagulase types, of 214 strains of Staphylococcus aureus isolated from the lesions of inpatients at the First Surgical Department, Hiroshima University, from 1983 to 1988. The obtained results are summarized below: 1. Frequency of MRSA among all the strains of S. aureus during a period from 1983 to 1987 was higher than 50%. 2. Highly methicillin-resistant strains (MIC of methicillin greater than 100 micrograms/ml) emerged in 1984 and thereafter, showed a trend of increase through 1987. 3. The highly methicillin-resistant strains are of coagulase II type strain and they are considered to be inhospital epidemic strains. 4. Both ofloxacin and minocycline (MINO) showed good activities against highly methicillin-resistant strains, but many resistant strains were resistant to beta-lactam and aminoglycoside agents. Based on the above basic assessment, chemotherapies mainly using MINO were performed on cases of MRSA infections experienced at the First Surgical Department, Hiroshima University in a period from July, 1987, to November, 1988, and the following results were obtained. 1. Drugs used were: single MINO in 2 cases; MINO+imipenem/cilastatin (IPM/CS) in 4 cases; MINO+IPM/CS+tobramycin in 1 case; MINO+cefmetazole (CMZ) in 1 cases; and MINO+fosfomycin+CMZ (changed to MINO+Amikacin) in 1 case, a total of 9 cases. Clinical result showed remarkable effectiveness of these therapies in 3 cases with some degrees of effectiveness in 6 cases, thus the therapies were all effective or better. 2. No particular abnormality was observed in subjective or objective symptoms or clinical laboratory tests, judged from values obtained before and after administration of MINO. The above results agreed with well those of the basic assessment, suggesting the possibility that the chemotherapies mainly using MINO would exhibit effectiveness on MRSA infections.

Adult↗
PubMed1990

[Antibacterial activity of various antibacterial agents against methicillin-resistant Staphylococcus aureus, and difference in antibacterial activity between aminoglycosides by coagulase type. Comparison of isolates obtained in the period from 1982 to 1986 and isolates in recent 6 months].

The sensitivity of methicillin-resistant Staphylococcus aureus (MRSA) isolated in our hospital during the period from November 1988 through April 1989 to various antibacterial agents was examined. Isolates were obtained from blood (4 isolates), sputum (40), bile (1), ascites (1) and urine (4). All isolated MRSA were resistant to cefazolin, cefmetazole, cefuzonam, flomoxef, and tobramycin. More than 80% of the isolates were resistant to fosfomycin and amikacin. 60% were resistant to ofloxacin (OFLX). 46% were sensitive to minocycline. 50% or more of the isolates were sensitive to gentamicin (GM), dibekacin (DKB) and astromicin (ASTM). 88% were sensitive to netilmicin. All the isolates were sensitive to vancomycin and arbekacin. The incidence of OFLX-resistant isolates was increased compared with the results of the previous study. Most of the isolates were coagulase type II. GM, ASTM and DKB were less active against type IV isolates, but they had sufficient antibacterial activity against the type II isolates.

Aminoglycosides↗
PubMed1990

[Antibacterial activity of norfloxacin on methicillin-resistant Staphylococcus aureus. Comparison with oral antibacterial agents].

Minimum inhibitory concentrations (MIC) of norfloxacin (NFLX) to 133 strains of methicillin-resistant Staphylococcus aureus (MRSA) isolated from clinical patients were investigated and compared with those of minocycline (MINO), erythromycin (EM), amoxicillin (AMPC), cefaclor (CCL) and fosfomycin (FOM). MIC90 of these drugs were 3.13 micrograms/ml with NFLX, 0.39 micrograms/ml with MINO, greater than 100 micrograms/ml with EM, 50 micrograms/ml with AMPC, greater than 100 micrograms/ml with CCL and greater than 100 micrograms/ml with CCL and greater than 100 micrograms/ml with FOM. MIC distribution patterns with 2 peaks were recognized with EM and FOM. Of 55 strains resistant to all of EM, AMPC, CCL and FOM, 50 and 54 strains were well susceptible to NFLX and MINO, respectively. The present investigation demonstrated relatively potent antibiotic effect of NFLX against MRSA. Considering the safety of NFLX to children which have been confirmed and reported separately, it can be concluded that NFLX is a useful oral antimicrobial drug in the treatment of children with MRSA infections.

Administration, Oral↗
PubMed1990

[Measurement of MICs on 16 antimicrobial agents for freshly isolated methicillin-resistant Staphylococcus aureus strains].

MICs of 16 antimicrobial agents including a newly synthesized aminoglycoside antibiotic, arbekacin (HBK), were determined against methicillin-resistant Staphylococcus aureus (MRSA) strains which had been isolated since 1988 from patients with refractory infections. 1. The proportion of highly methicillin-resistant strains was large, especially among those isolated from blood and respiratory tract. 2. All the MRSA strains were resistant to all the beta-lactam antibiotics tested. 3. Most of the strains were also resistant to aminoglycosides. However, HBK inhibited the growth of 95% of the strains at 3.13 micrograms/ml or less, showing potent activities even against highly resistant MRSA strains. 4. The MIC distribution of HBK against MRSA strains showed no change since 1986 when year to year data were compared. Based on our studies on the drug resistance pattern of MRSA since 1986, a large proportion of MRSA strains isolated from blood and respiratory tract appeared to be coagulase type II. 5. Netilmicin-resistant MRSAs have increased since 1986, and MRSA resistant to fosfomycin, minocycline, ofloxacin and norfloxacin have also increased in 1989 compared to 1988. 6. The drug resistance pattern of MRSA has been changing every year and they are acquiring multi-drug resistance. Thus, in the treatment of MRSA infections, it is very important to identify the drug susceptibility of MRSA quickly and accurately.

Aminoglycosides↗
PubMed1990

[Laboratory and clinical studies on norfloxacin in the pediatric field].

In bacteriological, pharmacokinetic and clinical studies on norfloxacin (NFLX, AM-715), the following results were obtained: 1. Antibacterial activity of NFLX, nalidixic acid (NA), amoxicillin (AMPC), cefaclor (CCL), erythromycin (EM) and fosfomycin (FOM) against clinically isolated bacteria was examined, and it was found that MIC80 of NFLX against Staphylococcus aureus was 3.13 micrograms/ml, thus NFLX exhibited stronger antimicrobial activity than NA, AMPC, CCL, EM and FOM. NFLX also showed good activities to those strains of S. aureus which were resistance to NA, AMPC, CCL, EM and FOM. 2. MIC80 of NFLX against Escherichia coli was 0.05 micrograms/ml or lower, thus NFLX showed better activity than NA, AMPC, CCL, EM and FOM. 3. In single oral administration at fasting of NFLX at dose levels of 1.5-2.4 and 2.5-3.4 mg/kg in tablet form mean peak values of serum concentration were 0.32 micrograms/ml reached in 1 hour and 0.38 micrograms/ml in 2 hours, T1/2's obtained were 1.7-4.0 and 2.2-2.9 hours and AUC's were 1.54 +/- 0.52 and 2.02 +/- 0.93 micrograms.hr/ml, respectively. Urinary recovery rates of 11.6-46.9%, 13.8-35.4% in 6-8 hours were demonstrated with the 2 ranges of dose levels, respectively. 4. NFLX was administrated to 34 patients consisting of 8 cases of acute pneumonia, 3 cases of acute tonsillitis, 3 cases of bacterial colitis, 19 cases of urinary tract infections and 1 case of purulent parotitis. The clinical efficacy rate was 97.1% including 34 cases with excellent results in 28, good in 5 and fair in 1. 5. The bacterial eradication rate was 96.8% (30/31) with one exception of a Campylobacter jejuni strain. 6. NFLX was given to patients according to a dosing regimen with 4.5-21.4 mg/kg/day dose levels for 3 doses daily except 1 case of UTI where 2 daily doses were given daily. 7. No adverse reactions were observed. Abnormal laboratory test value was obtained in 1 case where eosinophilia was found. The above results have suggested that NFLX is a useful and safe antimicrobial agent against bacterial infections in children.

Adolescent↗
PubMed1990

[Bacteriological and clinical studies on norfloxacin in the field of pediatrics].

Bacteriological and clinical studies on norfloxacin (NFLX) were carried out in the field of pediatrics, and the results obtained are summarized as follows: 1. The MICs of NFLX against clinically isolated organisms were determined to compare with MICs of nalidixic acid, amoxicillin, cefaclor, erythromycin and fosfomycin. NFLX had low MICs against both Gram-positive and Gram-negative bacteria and, particularly, showed higher antimicrobial activity to Escherichia coli, Salmonella sp., Klebsiella pneumoniae, Pseudomonas aeruginosa, Haemophilus influenzae and Campylobacter jejuni than any other drugs tested. 2. Seventeen pediatric patients (11 cases of enteritis, 4 cases of urinary tract infections, 1 case of tonsillitis and 1 case of pyoderma) were treated orally with NFLX in daily doses ranging from 3.1 to 16.7 mg/kg t.i.d. for 6-14 days. Rates of clinical effectiveness and bacterial elimination were 94.1% and 58.8%, respectively. 3. None of the treated children showed clinical symptoms indicating the occurrence of side effects nor abnormal laboratory findings except 1 patient with eosinophilia. These results indicate the usefulness of NFLX in the treatment of bacterial infections in the pediatric field.

Administration, Oral↗
PubMed1990

[Clinical effect of norfloxacin in pediatric field].

We have investigated bioavailability, clinical efficacy, side effect and antimicrobial activity of norfloxacin (NFLX) to evaluate the efficacy and safety in the pediatric field. Results are summarized as follows 1. After oral administration of 100 mg, Tmax was 2 hours and T 1/2 were 4.2 and 2.6 hours in 2 cases. 2. In 10 cases of urinary tract infection (UTI) and 4 cases of intestinal tract infection (ITI), clinical efficacy rate was 100% (14/14). 3. In UTI, causative bacteria were all eradicated. In ITI, 1 case with Campylobacter jejuni remained unchanged. Overall eradication rate was 92.9% (13/14). 4. Antimicrobial activities to clinically isolated organisms such as Gram-negative rods or Staphylococcus aureus, MIC of NFLX was clearly superior to those of cefaclor, amoxicillin, nalidixic acid, fosfomycin and erythromycin. 5. Side effect of dipsia was observed in 1 case and eosinophilia was found in 1 case. But these reactions were mild and we were able to continue the administration of the drug. The above results suggest that NFLX is a useful and safe drug for the therapy of UTI and ITI in the pediatric field.

Adolescent↗
PubMed1989

Bacteriological study of genital tract infection in puerperium.

Of 185 vaginal and 13 wound swabs obtained from febrile females after delivery and abortions, 140 (75.6%) vaginal and 10 (76.9%) wound swabs were positive for bacteria. Infection caused by a single bacterium was found in 100 (71.4%) and mixed infection in 40 (28.5%). E. coli was mainly isolated followed by Staph. aureus and Klebsiella. Fosfomycin was the most effective antibiotic against E. coli and Gentamycin against Staph. aureus.

Bacteria↗
PubMed1989

[Cost and effectiveness of fecal culture in the etiologic diagnosis of acute diarrhea].

To study the cost-effectiveness of fecal culture in the detection of enteropathogenic or enteroinvasive bacteria, a review and analysis was done of fecal cultures from ambulatory or hospitalized patients treated for acute diarrhea at a Buenos Aires sanatorium during 1985. Of 1,295 fecal cultures performed, pathogens were isolated in 369 cases (28.5%), of which 79 corresponded to Shigella sp. (S. flexnerii, 49; S. sonnei, 29; S. dysenteriae, 2), 25 to Salmonella sp., and 270 to enteropathogenic Escherichia coli (EPEC) of the infant. There was no statistically significant difference between the ambulatory patients and the hospitalized patients in the proportion of positive fecal cultures. The cost of each positive fecal culture was US$ 60.36, while the cost of diagnosing invasion of the mucous membrane (isolation of Shigella sp. or detection of leukocytes in feces) was US$ 109.74. These costs are excessive and could be greatly reduced if the test were applied in only selected cases. Many of the strains of Shigella sp., Salmonella sp., and EPEC that were found were resistant to ampicillin, chloramphenicol, and cotrimoxazole. These cases of resistance suggest that fosfomycin may be one of the antibiotics of choice for the treatment of diarrhea caused by invasive organisms.

Acute Disease↗
PubMedDate not supplied

[Use of antimicrobial agents and bacterial resistance at a university hospital in Rio de Janeiro].

The oropharynx and intestinal microflora of patients from intensive care and infectious disease units of an university hospital were compared to that of healthy individuals in order to evaluate the influence of antibiotic therapy on the colonization with enterobacteria and antimicrobial resistance patterns. Enterobacteria were recovered from 70% of the throat specimens; 90% of these individuals were under antimicrobial therapy. The antibiotic resistance patterns were suggestive of plasmid-mediated resistance. More than 20% of the strains were resistant to fosfomycin, ampicillin, chloramphenicol, tetracycline or trimethoprim-sulfamethoxazole. Approximately 50% of resistant bacteria showed resistance to at least four antibiotics.

Anti-Bacterial Agents↗
PubMed1989

[Interpretation of the influence of immunoglobulins and glycine on bacterial sensitivity to antibiotics in vitro].

The effect of human immunoglobulins (Ig) and of glycine, often added to commercial preparations as a stabilizer, have been examined in vitro on the growth of E. coli strains in the absence or presence of antibiotics in subminimal inhibitory concentrations (subMic). The Ig's (= 7S or 5S = F(ab')2 as well as glycine had no effect by themselves on bacterial growth at concentrations up to 32 mg and 4.5 mg per ml respectively. In contrast, in the presence of ampicillin, glycine induced a concentration dependent increase of bacterial sensitivity to antibiotics. This is apparently more pronounced in serosensitive than in seroresistant E. coli strains. Such a synergism could equally be shown with cefadroxil and fosfomycin, i.e. with other antibiotics interacting with cell wall synthesis, but not with those of another mode of action, as ciprofloxacin, polymyxin B or chloramphenicol.

Ampicillin↗
PubMed1989

[Neonatal pleuropulmonary staphylococcal infection with multiple abscesses of the liver].

We report the case of a neonate who developed septicemia due to a methicillin-susceptible Staphylococcus aureus strain at six days of age. At eight days of age, physical evaluation revealed a tense, tender abdomen and further enlargement of the liver, and abdominal ultrasonography demonstrated multiple liver abscesses. On the following day, pleuropulmonary lesions developed and required mechanical ventilation. Recovery was achieved using parenteral vancomycin and fosfomycin for 15 days followed by oral pristinamycin for ten days. This case is unusual in that the infection was acquired by the digestive route probably as a result of lymphangitis of the breast in the mother, and multiple liver abscesses were associated with the pleuropulmonary localization. It provides further evidence of the value of ultrasonography for the diagnosis and monitoring of liver abscesses, including multiple abscesses.

Female↗
PubMedDate not supplied

Enoxacin: in vitro efficacy and its future therapeutic role in the Pakistani health-care system.

Because laboratory microbiological diagnosis is not readily available for 80% of the total population of Pakistan (120 million people), clinicians in large rural areas have been compelled to use several antibiotics in any individual case of resistant and severe infection. This practice has resulted in an increasing number of resistant strains, particularly those of Salmonella, Pseudomonas, Escherichia coli, Klebsiella, Enterobacter, Staphylococcus, and Shigella. Also, multiple resistance to penicillin, ampicillin, carbenicillin, cotrimoxazole, chloramphenicol, fosfomycin, gentamicin, nalidixic acid, vancomycin, amoxicillin, cefotaxime, and cloxacillin has been recognized. In view of this limitation in antimicrobial therapy, enoxacin, a second-generation quinolone, has been assessed in vitro against resistant and other organisms, and its breakpoint sensitivity has been compared with another quinolone, ofloxacin. The findings indicate that new quinolones such as enoxacin may prove to be helpful in the treatment of individuals suffering from severe and resistant bacterial infections for which no microbiologic diagnosis is available.

Bacterial Infections↗
PubMed1989

[Peptidoglycan modification of Staphylococcus aureus P18 strain after use of 6 active antibiotics on the bacterial wall].

Six antibiotics active on the cell-wall were tested against a methicillin resistant Staphylococcus aureus P18 strain at the start of exponential growth rate. The concentration was four-fold the MIC determined in a non-hypersaline liquid medium. The peptidoglycan amino-acid content of the various cell wall samples was determined. An antibiotic-free S. aureus P18 and the methicillin-sensitive Cowan I. S. aureus strain were used a controls. Beta lactam antibiotic treatment, oxacillin and cephalothin, induced an increase of alanine content which suggests that only secondary-transpeptidation did not occur. Similar results were obtained using vancomycin. Amino-acid content was not modified by bacitracin, which is in agreement with the results expected. The results obtained for fosfomycin and cefamandole were not easy to interpret.

Anti-Bacterial Agents↗
PubMed1986

[Antibiotic therapy of Pseudomonas aeruginosa infections].

Antibiotics active against Pseudomonas aeruginosa are carboxy- and ureidopenicillins, some cephalosporins, aztreonam, imipenem, aminoglycosides, fluoroquinolones and, in some special circumstances, polymyxins and fosfomycin. The choice of the antibiotic should be based not only on minimal inhibitory concentrations in vitro, but also on the inoculum effect, on the speed with which bacteria are killed, on natural or acquired resistance and on data obtained from experimental infections in animals. Antibiotics used against P. aeruginosa infections must be rapidly bactericidal. Since the prognosis is severe, the initial treatment given before the sensitivity of the strain is known must combine a beta-lactam antibiotic and an aminoglycoside, both being selected among the most regularly active.

Anti-Bacterial Agents↗