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PubMed1984

Aztreonam versus cefamandole in the treatment of urinary tract infections.

The in vivo efficacy and safety of aztreonam compared to that of cefamandole was randomly and prospectively studied in the treatment of 30 patients suffering from recurrent urinary tract infections with a patient ratio of 2 aztreonam to 1 cefamandole. The mean age was 51.6 +/- 15.4 and 59.8 +/- 13 years respectively. Both antibiotics were given at a dose of 1 g, 8 hourly i.m. for 7-13 days. Sixty-seven percent versus 70% of the patients given aztreonam and cefamandole respectively were suffering from upper urinary tract infections. X ray abnormalities predisposing to relapse or reinfections were present in 88% vs 80% of the patients, while all patients had typical symptoms of urinary tract infections, with high fever (greater than or equal to 38.5 degrees C) reported in 70% and 60% of the patients in the two treatment groups respectively. Escherichia coli and Proteus mirabilis were the predominant isolates in urine cultures. During treatment all patients responded favourably both clinically and bacteriologically, while after a 6-week follow-up 20% versus 30% relapsed clinically with 15% vs 30% bacteriologic relapses in the two groups, but only in patients suffering from upper urinary tract infections. No development of bacterial resistance was observed in the relapses, while mainly Enterococcus spp was implicated in reinfections. No appreciable side effects of toxicity were observed. It was concluded that aztreonam is a promising new antibiotic that deserves further clinical trials in systemic infections.

Adolescent↗
PubMed1992

4-week treatment of streptococcal native valve endocarditis with high-dose teicoplanin.

The efficacy and safety of a 4-week course of intravenous teicoplanin (500 mg every 12 h for the first 2 days and 10 mg/kg of body weight every 24 h thereafter) in the treatment of streptococcal native valve endocarditis in 20 patients were evaluated. All blood isolates were inhibited by a concentration of 0.12 micrograms of teicoplanin per ml. Serum bactericidal activity levels were measured 1/2 and 24 h after antibiotic infusion on days 5 to 7 of therapy in 19 patients, and titers of greater than or equal to 1:32 and greater than or equal to 1:8, respectively, were obtained with 17 patients (89%). On the other hand, for two patients who were infected with teicoplanin-tolerant Streptococcus bovis, serum bactericidal activity levels of less than 1:2 were found. Of 20 patients, 4 were excluded from further analysis because of protocol violation or prosthetic valve infection. Of the remaining 16 patients, 6 did not complete teicoplanin therapy because of early death (1 patient) or drug fever (5 patients). Among patients who developed drug fever, three who discontinued teicoplanin by day 15 were switched to penicillin therapy, whereas the remaining two, who discontinued teicoplanin on day 22 and 25, respectively, did not receive any further therapy and have shown no relapse during the follow-up. Of 10 patients who completed trial therapy, 9 were cured and 1 relapsed. It is concluded that a 4-week course of high-dose teicoplanin may be a useful regimen for home treatment of selected cases of streptococcal native valve endocarditis. However, drug fever and infection with teicoplanin-tolerant S. bovis may be factors of concern with this therapeutic approach.

Endocarditis, Bacterial↗
PubMed2006

[Relapse of Plasmodium falciparum malaria in a patient treated with artesunate].

Chemoprophylaxis and the curative treatment of malaria are well documented in France. Nevertheless this data is still not accounted for by healthcare professionals and in the global population, and no longer approved treatments may be prescribed. The authors report the case of a 24-year-old female traveler having stayed in Africa where she was used to treat fever with artesunate. Soon after her return, she presented with uncomplicated Plasmodium falciparum malaria once again treated with artesunate. The evolution was initially favorable but a relapse occurred 3 weeks later. A conventional mefloquine treatment lead to a final cure. This observation confirms that artesunate monotherapy in malaria exposes to a risk of relapse. Artesunate should not be used as monotherapy in P. falciparum malaria.

Adult↗
PubMed1984

The VAB-6 regimen in the treatment of metastatic seminoma.

In an attempt to improve complete remission rates, seven patients with Stage III or bulky Stage II pure seminoma of the testis were treated with the VAB-6 regimen. Cyclophosphamide 600 mg/m2 of body surface, vinblastine 4 mg/m2, dactinomycin 1 mg/m2, and bleomycin 30 mg were given by intravenous (IV) push on the first day. This was immediately followed by 3 days of continuous bleomycin infusion (20 mg/m2/day X 3) and cisplatin 120 mg/m2 IV over 20 to 30 minutes on the fourth day. Induction was repeated three more times. All patients achieved complete remission with chemotherapy alone. Five patients remain in CR 38, 36, 30, 29, and 19 months, respectively, and two relapsed 9 and 18 months, respectively, from beginning of chemotherapy. One patient required broad spectrum antibiotics for fever during severe myelosuppression. One patient developed temporary elevation of serum creatinine to 4 mg/dl after the second treatment with platinum, and was given reduced platinum doses with subsequent inductions. The VAB-6 regimen is effective in the treatment of advanced metastatic seminoma.

Abdominal Neoplasms↗
PubMed1985

Bone marrow necrosis in children with malignant disease.

The authors reviewed the case records of 1419 children with acute leukemia and other types of malignant disease involving the bone marrow to define the clinical and laboratory features associated with marrow necrosis as well as the prognostic significance of this complication. Only seven patients were found to have this abnormality: four with newly diagnosed acute lymphoblastic leukemia (ALL), one with relapsed ALL, and two with disseminated neuroblastoma. All patients presented with severe bone pain, bone tenderness, and fever. Levels of serum lactic dehydrogenase were uniformly increased, being especially high in patients with ALL. There was no evidence of severe infection or disseminated intravascular coagulation, complications that have been causally related to marrow necrosis. Four of the five children with ALL remain in complete remission for 10+ to 48+ months. Both patients with neuroblastoma are off therapy, in remission, for 9+ to 15+ months. In contrast to earlier reports, bone marrow necrosis does not appear to confer a poor prognosis in children with malignancy.

Bone Marrow↗
PubMed1999

Amphotericin B lipid complex for the treatment of patients with acute leukemia and hepatosplenic candidiasis.

Hepatosplenic candidiasis (HSC) is an emerging complication of the treatment of patients with acute leukemia. Treatment of this infection can be very difficult and data on the duration of antifungal therapy are not available. We evaluated the efficacy of amphotericin B lipid complex (ABLC) for the treatment of five patients with acute leukemia and HSC. The dose of the administered ABLC ranged between 5 and 11 mg/kg per day and the median duration of therapy was 4.3 months. Four patients had complete response to the above treatment with resolution of fever and improvement in the radiologic findings. One patient refused to continue treatment and subsequently died with relapsed leukemia and disseminated Candida infection. Preliminary data suggest that ABLC is a well-tolerated and effective treatment for HSC and should be considered for phase II trials as front line treatment for this type of deep seated fungal infections.

Acute Disease↗
PubMed1995

Update on pharmacotherapy of systemic lupus erythematosus.

Established and novel approaches to the pharmacologic management of systemic lupus erythematosus (SLE) are described. SLE is a chronic, multiple-organ-system inflammatory disorder associated with immune system dysfunction. Autoantibodies are produced that react with self-antigens, notably cell membranes and nuclear and cytoplasmic constituents. There are many clinical manifestations, including arthritis, arthralgia, myalgia, skin changes, photosensitivity reactions, fever, anemia, thrombocytopenia, proteinuria, and renal, CNS, and cardiopulmonary involvement. The disease characteristically fluctuates between remission and relapse. Survival has been improving because of new drug treatments and better diagnostic and serologic tests. Minor manifestations can be treated with less toxic agents, such as nonsteroidal anti-inflammatory drugs, sunscreens, topical and intralesional corticosteroids, and antimalarials. Aggressive therapy with high-dose corticosteroids or immunosuppressants is necessary in patients with worsening renal function (lupus nephritis). CNS lupus has responded to various degrees to dexamethasone, methylprednisolone, and cyclophosphamide. Other therapeutic options include methotrexate in corticosteroid-resistant SLE and cyclosporine. The use of monoclonal antibodies is under intensive study. As mortality due to SLE decreases, complications like cardiovascular problems are becoming more prominent; patients may require antihypertensives, cholesterol-lowering drugs, and hypoglycemic agents. The complexity and chronicity of SLE have led to diverse pharmacotherapeutic strategies based on the organ systems involved. Immunologic research may ultimately bring patients greater relief.

Female↗
PubMed2005

A multicenter and open label clinical trial of zoledronic acid 4 mg in patients with hypercalcemia of malignancy.

BACKGROUND: Hypercalcemia of malignancy is a serious complication of cancer. The objective of this study was to investigate the efficacy and safety of zoledronic acid, a new-generation bisphosphonate and the most potent inhibitor of bone resorption identified to date, for hypercalcemia of malignancy in Japanese patients. METHODS: Patients with hypercalcemia of malignancy, defined as an albumin-corrected serum calcium level > or =12.0 mg/dl, were treated with a single dose of zoledronic acid, 4 mg, by 15 min infusion. Clinical end-points included the proportion of patients with complete response, which was defined as a decrease of corrected serum calcium < or =10.8 mg/dl by day 10, and time to relapse, which is defined as the duration in days between the date of infusion and last available corrected serum calcium <11.6 mg/dl. RESULTS: Twenty-seven patients were enrolled in this study and 25 patients were evaluable for the efficacy of zoledronic acid. The mean corrected serum calcium level decreased from 14.5 to 9.6 mg/dl by day 10. The complete response rate was 84%. The median time to relapse was 23 days, ranging from 0 to 56 days. The most frequently observed adverse event was fever (< or =38 degrees C). Electrolyte abnormalities suspected to be drug related including grade 3 or 4 hypocalcemia, hypophosphatemia and hypokalemia were observed in 11 patients; however, all patients were asymptomatic. No serious adverse events associated with renal toxicity were reported. CONCLUSIONS: Zoledronic acid is well tolerated and is effective for hypercalcemia of malignancy in Japanese patients.

Adult↗
PubMed1992

Intracavitary oxytetracycline in malignant pericardial tamponade.

We started a treatment trial for malignant pericardial tamponade with intracavitary oxytetracycline, 500-1,000 mg/day, administered via an indwelling pericardial cannula after extraction of as much pericardial fluid as possible. This procedure was repeated every 24 h for 6 consecutive days or until no more fluid could be drained. Eleven consecutive patients were entered in the study. The responses were obtained by clinical examination, chest roentgenogram and echocardiogram, prior to and after treatment. The primary cancer was located in the breast in 7 patients, in the stomach in 2 patients, and in the lung in 2 patients. In all cases, systemic chemotherapy or hormonal therapy was started after the pericardial tamponade was cured. The mean tetracycline dose per patient was 3,000 mg (range 1,500-6,000). All patients responded to the treatment with rapidly improving symptoms. Response persisted during a median of 9 months coinciding roughly with the median survival because all patients died because of progression of the neoplasm at sites other than the pericardium with no evidence of pericardial relapse. The main concomitant effects were mild local pain during tetracycline instillation in 4 patients, and transient fever (less than 39 degrees C) in 3. These data suggest that intracavitary oxytetracycline is perhaps less toxic and similar by successful as tetracycline hydrochloride in malignant pericardial tamponade.

Adult↗
PubMed1991

[Tick-borne encephalitis associated with other infections].

Possibility of mixed infection arising in encounter of agents from different families (virus-virus, virus-bacteria, virus-protozoa) was demonstrated on 103 cases of chronic tick-borne encephalitis (TBE) association with other acute and chronic infection. The addition of influenza, tuberculosis, pyogenic infection in most cases entails a relapse of TBE or promotes a primary-progressive course of the disease. TBE association with rheumatic fever relieves pain symptoms. It is emphasized that mixed infections used to bring suppression of immune reactivity thus necessitating serological and virological monitoring of the disease run.

Adenovirus Infections, Human↗
PubMed1989

[A rapidly progressing variant of subacute infectious endocarditis].

A total of 122 patients with subacute infectious endocarditis (SIE) were examined. Of these, 33 patients demonstrated an extremely severe disease course. In spite of adequate antibacterial treatment, the lethal outcome ensued within the first 2-2.5 years of the disease. A rapidly progressing variant of SIE was characterized by persistent fever, predominance of aortal heart diseases, renal injuries with an early development of renal failure, hemorrhagic vasculitis, relapsing thromboembolism, refractory heart failure, persistent anemia, lymphopenia, and by the presence of large movable vegetations discovered on echocardiography.

Adolescent↗
PubMed1994

[Chronic recurrent polychondritis].

In a 71-year-old woman suffering from recurrent fever, dry cough, pain during sighing, hoarseness and later severe inflammation of the cartilage of both auricles 'relapsing polychondritis' was diagnosed. This is a rare disease of cartilage and connective tissue. Most frequent symptoms are inflammation of the auricles and nasal septum, joint disorders and inflammation of eye structures, larynx and trachea. The aetiology may be autoimmunity. The clinical diagnosis can be confirmed by a cartilage biopsy. The disease is recurrent and causes substantial morbidity and mortality. Therapy consists of NSAIDs, steroids, and sometimes immunosuppressive agents.

Aged↗
PubMedDate not supplied

[Acalculous cholecystitis in Schöenlein-Henoch syndrome. Apropos of a case].

We describe the case of a 51 year-old man affected of relapsing bouts of abdominal pain and hematuria, who began acutely with pain in the right upper quadrant, fever, hematuria, arthralgias and purpura on the lower extremities; ultrasonography revealed the existence of acalculous cholecystitis. The lack of response to intravenous antibiotherapy and the clinical association of cholecystitis to the renal, cutaneous and articular manifestations, oriented to the diagnosis of Schöenlein-Henoch vasculitis; thereafter, the response to steroids was successful and immediate. The etiologic diagnosis of this case of acalculous cholecystitis based on clinical aspects, avoid the surgical therapy and the possible morbidity that this procedure can produce.

Arthralgia↗
PubMed1993

Cefixime in the treatment of enteric fever in children.

Cefixime in a dose 20 mg/kg/day, orally, divided into two doses 12 h apart for a minimum of 12 days, was administered to 50 children with proven S. typhi septicaemia. Forty four of the patients were infected with strains of S. typhi resistant to multiple antibiotics including chloramphenicol, ampicillin and trimethoprim-sulfamethoxazole. All patients responded rapidly to treatment and were cured clinically and bacteriologically. Fever subsided within a mean of 5.3 days (range 3-8 days). Only two of the 50 patients treated relapsed during the 8 week follow-up period. No serious adverse reactions attributable to the drug were observed. Cefixime proved to be an effective oral drug in this open treatment trial and was associated with minimal side effects. It may provide a therapeutic alternative to the treatment of Salmonella infection with organisms multi-resistant to the standard drug regimens. Its oral formulation may provide an efficient alternative to parenteral therapy in less severely ill patients who can tolerate oral feeding.

Adolescent↗
PubMed2001

Fewer bacterial relapses after oral treatment with norfloxacin than with ceftibuten in acute pyelonephritis initially treated with intravenous cefuroxime.

This double-blind, multicentre study was performed at nine centres on a total of 171 patients who presented with fever (> 38.5 degrees C) and signs of acute pyelonephritis. All were initially treated with intravenous cefuroxime. After 2-3 d, when the fever had subsided and urinary culture had revealed growth of Gram-negative bacteria ( > 10(7) colony-forming units per litre), treatment was changed to oral administration of ceftibuten 200 mg b.i.d. or norfloxacin 400 mg b.i.d. for 10 d. The patients were followed for signs of bacterial or clinical relapse 7-14 d after the end of treatment. The initial clinical and bacteriological cure was excellent in both groups, but there were significantly fewer bacterial relapses after oral treatment with norfloxacin than with ceftibuten in acute febrile pyelonephritis initially treated with intravenous cefuroxime. The causal strain was eradicated in 75% of patients (73% of males, 76% of females) in the ceftibuten group and in 89% of patients (94% of males, 85% of females) in the norfloxacin group. The relative frequency of eradication was 0.84 (p < 0.05; 95%, confidence interval 0.74-0.97). Adverse events were reported by 47% of the patients in the ceftibuten group and by 38% in the norfloxacin group. This difference was not significant, but diarrhoea or loose stools occurred more frequently in the ceftibuten group.

Acute Disease↗
PubMed1978

[Intestinal yersiniosis: 25 cases of infections with Yersinia pseudotuberculosis and Yersinia enterocolitica (author's transl)].

Yersinia infections in 16 adults and 9 children are reported. 15 cases were caused by Yersinia pseudotuberculosis, 8 of them were proved by serological findings. In 4 cases the infection by Yersinia pseudotuberculosis was likely, in 3 other cases possible only. Real infections caused by serotype IV are demonstrated too. Furthermore there were 10 cases caused by Yersinia enterocolitica, 3 of them were proved by bacterial, the other ones by serological findings. Both germs caused identical symptoms: fever (80%), abdominal pains (56%), diarrhoea (52%), erythema nodosum (44%), arthritis (40%), vomiting (16%), weight loss (16%), lymphoma (12%) and others. In children 50% of erythema nodosum was produced by intestinal yersiniosis. The beginning with gastroenteritis and fever mostly was followed by a second phase with returning fever, abdominal pains, erythema nodosum and/or arthritis. Antibiotic therapy had a definite effect only in the first phase of gastroenteritis and in the two possibly relapsing cases. In two of 5 patients with long standing arthritis the HL-AB 27 was present.

Adolescent↗