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PubMed1981

[Experimental investigations of the ototoxicity of aminoglycoside antibiotics and their clinical importance (author's transl)].

The problems of the clinical evaluation of the ototoxicity of an aminoglycoside antibiotic are mentioned. The criteria for a correct performance of experimental ototoxicity tests and the applied methods concerning the functional ahd histological investigations are reported on. The results obtained by the experimental evaluation of the ototoxicity of the clinically important newer aminoglycoside antibiotics (gentamicin, tobramycin, sisomicin, dibekacin, and netilmicin) on the market are described my means of representative graphs. Possible sources of error by using the applied or other tests are discussed. An exact correlation of results obtained by neat experiments and the clinical data is found and by that also the necessity of experimental investigations as to the ototoxicity of new ototoxic drugs before their clinical trials.

Aminoglycosides↗
PubMedDate not supplied

[Therapy of neonatal infection caused by group B beta-hemolytic Streptococcus].

Expectant therapy for early Group B Streptococcus onset septicemia must provide coverage against other microorganism, such as L. Monocytogenes, H. Influenzae and S. Pneumoniae. It is possible to administer a combination of antimicrobial agents with activity against all or the most likely pathogens. Thus initial expectant therapy includes a broad spectrum semisynthetic penicillin (e.g. ampicillin) and an aminoglycoside (e.g. netilmicin). Vancomicin, teicoplanin and cefotaxime may also be used. Supportive therapy consists on temperature control, i.v. administration of fluids, acid-base balance and electrolytes monitoring, seizures control and ventilation. IV immunoglobulins, granulocyte and serum transfusion are also used. The G-Colony Stimulating Factor (G-CSF, filgastrim) usage is also reported.

Age Factors↗
PubMed1995

[Comparative susceptibility of Ochrobactrum anthropi, Agrobacterium tumefaciens, Alcaligenes faecalis, Alcaligenes denitrificans subsp. denitrificans, Alcaligenes denitrificans subsp. xylosidans and Bordetella bronchiseptica against 35 antibiotics including 17 beta-lactams].

Ochrobactrum anthropi, formerly known as "Achromobacter sp." or CDC group Vd has been isolated from water, hospital environment (antiseptic solutions, dialysis fluids ... ). O. anthropi is a Gram negative, motile, strictly aerobic, oxydase positive and non-fermentative bacteria with a strong urease activity. The susceptibility of 13 strains of O. anthropi was determined by agar diffusion method and compared to those of type strains of Agrobacterium tumefaciens, Alcaligenes faecalis, Alcaligenes denitrificans subsp. denitrificans, Alcaligenes denitrificans subsp. xylosoxydans and Bordetella bronchiseptica. The MICs of 20 antimicrobial agents confirmed the distinct phenotype susceptibility of O. anthropi. All the strains of O. anthropi are sensitive to imipenem, amikacin, gentamicin, netilmicin, nalidixic acid, pefloxacin, ciprofloxacin, tetracyclin, colistin, sulphonamides and rifampicin and resistant to ampicillin, amoxycillin + clavulanic acid, ticarcillin, mezlocillin, cefuroxime, cefamandol, cefoxitin, cefotaxime, cefoperazon, ceftazidime, cefsulodin, aztreonam, streptomycin, kanamycin, pipemidic acid, chloramphenicol, erythromicin, pristinamycin, trimethoprim and fosfomycin. O. anthropi is implicated in nosocomial infections. O. anthropi was the species with the greatest resistance to beta-lactamins.

4-Quinolones↗
PubMed1994

[Activity of ofloxacin and other fluoroquinolones against staphylococcus which is either resistant to or susceptible to methicillin].

The activity of 37 antibiotics against 155 strains of Staphylococcus susceptible to methicillin (MS) and 107 strains of Staphylococcus resistant to methicillin (MR) was evaluated. Only vancomycin and teicoplanin remained active in relation to all the studied Staphylococcus strains. A high activity also was demonstrated by netilmicin (99.57%) and quinolones (more than 90%). The percentage of strains resistant to aminoglycoside, linkosamide, fluoroquinolones and other antibiotics was found to be higher within MR strains than in MS strains. All strains resistant to rifampin belonged to the MR Staphylococcus group. Among the 6 studied fluoroquinolones ofloxacin (97.71%) was found to be the most active. Three Staphylococcus aureus strains (MICOFX 16 micrograms/ml), one S-haemolyticus strain and one S. epidermidis strain (MICOFX 8 micrograms/ml) were the most resistant.

Anti-Infective Agents↗
PubMed1994

[Strains of Pseudomonas aeruginosa isolated from patients in surgical and non-surgical wards and their serotypes according to HABS schema].

The purpose of this research was to determine serological types of Pseudomonas aeruginosa according to Habs and their susceptibility to various antibiotics. The material consisted of 316 strains of Pseudomonas aeruginosa isolated in the period from November 1, 1988 to March 30, 1990. Among 259 strains isolated from patients treated in operative wards, the immunotype P 16 (28.18%) was most frequent. Among 57 strains isolated from patients treated in non-operative wards, the immunotype P 16 (36.84%) was also most frequent. The majority of isolated strains were resistant to a number of applied antimicrobial drugs. Such antibiotics as netilmicin, imipenem, amikacin, ceftazidime, carbenicillin and timentin proved to be most effective.

Drug Resistance, Microbial↗
PubMed1995

Aminoglycosides--50 years on.

1. The aminoglycoside antibiotics are 50 years old. Their success and continuing use can be attributed to various factors including rapid concentration-dependent bactericidal effect, synergism with beta-lactam antibiotics, clinical effectiveness, a low rate of true resistance and low cost. 2. The aminoglycosides remain drugs of choice in many circumstances including septicaemia, other serious infections due to Gram negative bacilli, and bacterial endocarditis. 3. Nephrotoxicity and ototoxicity have been the main drawbacks clinically for the aminoglycosides. 4. There has been an evolution in dosing strategies largely aimed at reducing toxicity. Therapeutic drug monitoring has been used extensively to assist dosing, and target concentrations have been advocated, such as peak concentrations of between 6 and 10 mg l-1 and through concentrations of < 2 mg l-1 for gentamicin, tobramycin and netilmicin. 5. Recently there has been a minor revolution in the approach to aminoglycoside dosing, with a change to larger doses, given less frequently. In its most convenient form this is 'Once-daily aminoglycoside dosing'. It offers the hope of better efficacy, less toxicity, and easier administration and monitoring. 6. This article summarises the background of aminoglycoside usage, leading up to the recent changes in dosing strategy.

Aminoglycosides↗
PubMed1994

[In vitro synergistic effects of tazobactam/piperacillin with various antibiotics].

We investigated in vitro synergistic effects of tazobactam/piperacillin (TAZ/PIPC), a combination drug of tazobactam (TAZ) and piperacillin (PIPC) in the ratio of 1:4, with several other antibiotics against Pseudomonas aeruginosa, Serratia marcescens and methicillin-resistant Staphylococcus aureus (MRSA). Synergistic effects of TAZ/PIPC with each of tobramycin (TOB), netilmicin (NTL), fosfomycin (FOM), ciprofloxacin, minocycline or cefoperazone were observed against all bacteria tested in the checkerboard dilution method. No antagonistic effect was observed in combination of TAZ/PIPC with other antibiotics. Against P. aeruginosa, a combination of TAZ/PIPC with NTL was the most effective, with an average fractional inhibitory concentration (FIC) index of 0.459. And a combination of TAZ/PIPC with FOM was the most the effective against S. marcescens and MRSA. TAZ/PIPC combined with TOB or FOM showed bactericidal effect against P. aeruginosa No. 11, S. marcescens No. 39 and S. aureus O-62 at concentrations of the drugs that showed only bacteriostatic activity individually. Phase-contrast micrographic observations of P. aeruginosa No. 11 and S. marcescens No. 39 demonstrated that the bacterial cells treated with TAZ/PIPC were in filamentous forms and those treated with TOB or FOM were nearly normal. The combination of TAZ/PIPC with TOB or FOM induced filamentous cells with spheroplast-like structures and lysis. Those results suggest that the combination of TAZ/PIPC with aminoglycosides or FOM were useful in the treatment of infections by P. aeruginosa, S. marcescens and MRSA, especially those caused by beta-lactamase-producing strains.

Drug Synergism↗
PubMed1994

[A study on MRSA infections and replacement of bacteria. Efficacy of vancomycin-ceftazidime combination therapy].

We analyzed the results of bacteriological tests on patients with MASA infections admitted to Osaka Prefectural Hospital, for the past 10 years. The conclusions obtained are as follows. 1. In our hospital, MRSA infections accounted for 50% or more of all Staphylococcus aureus infections in 1983 and 1984 (in the first half of the 1980's), markedly decreased to about 10% after 1988, because of the preventive measures taken against nosocomial infections and initiation of anti-MRSA treatment. During the latter period, use of antibiotics including third generation cephems was not especially restricted. 2. Glucose non-fermentative Gram-negative rods (GNF-GNR) or yeasts co-isolated with S. aureus were more frequent in MRSA infected patients, than those in MSSA infected patients. 70 to 80% of GNF-GNR were P. aeruginosa. 3. Sensitivities of MRSA to drugs were studied. VCM was most active, followed by arbekacin and rifampicin. Effectiveness against co-isolated GNF-GNR was high with ofloxacin, netilmicin and ceftazidime (CAZ). Therefore, is expected that, to prevent the replacement of opportunistic infections, combination therapies using vancomycin and CAZ would be effective.

Ceftazidime↗
PubMed1994

[Brachial plexus neuropathy following pyogenic cervical adenophlegmon].

BACKGROUND: Brachial plexopathy is rare in children; it may follow a non-specific respiratory infection or occur after a specific viral disease or immunization. CASE REPORT: An 8 year-old girl was admitted suffering from presuppurative acute cervical adenitis. She was given penicillin V, netilmicin and corticosteroids. The adenitis gradually resolved over a period of ten days. There was no evidence of a specific bacterial infection. The patient suffered from pain localized to her right shoulder 15 days after admission; this pain was resolved within 3-4 days but was followed by paralysis affecting the upper brachial roots without sensory signs. EMG performed 15 days later showed signs of denervation. Amyotrophy set in rapidly but recovery under physiotherapy was complete 5 months later. CONCLUSION: This plexopathy resembling the Parsonage-Turner syndrome could be allergic in pathogenesis although similar cases after bacterial, possibly streptococcal, infection remain to be confirmed.

Brachial Plexus↗
PubMed1994

[Neonatal herpes simplex hepatitis with favorable outcome after treatment with acyclovir].

BACKGROUND: Herpes simplex virus (HSV) may cause severe disease in the neonate with high mortality and devastating sequellae. This infection presents exceptionally as isolated fulminant hepatitis. CASE REPORT: An 8 day-old baby was admitted because of seizures, fever and vomiting. Initial investigations including CSF analysis were negative and the patient was given ampicillin plus netilmicin. Two skin vesicles were seen 5 days later containing HSV. A second CSF analysis was negative as was the brain scan. At that time, liver involvement was evident: ASAT 3700 IU/l; ALAT 1035 IU/l; prothrombin 37%; fibrinogen 1 g/l. Hemogram showed WBC: 2,500/mm3 and PNN: 702/mm3. The patient was given acyclovir 40 mg/kg/day IV. Blood and CSF culture remained negative; CSF interferon concentration was 4 IU/ml. Serologic investigations in both parents were inconclusive. The disease worsened rapidly with consumption coagulopathy requiring ventilation support. The dose of acyclovir was increased to 60 mg/kg/day, 9 days after admission. Improvement was noted on the 10th day and acyclovir was administered orally on the 21st day. The condition was completely normal 6 months later. CONCLUSION: Early administration of acyclovir may favor complete recovery of neonatal HSV hepatitis.

Acyclovir↗
PubMedDate not supplied

Antibiotics, biliary sepsis, and bile duct stones.

Bacteriologic studies of bile and blood cultures of 579 patients with ductal stones and infected bile revealed that 121 patients (21%) had associated bacteremia. Analysis of bile and stone cultures showed that Escherichia coli, Klebsiella sp, Enterobacter sp, Enterococcus sp, and Streptococcus sp were the most commonly isolated bacteria. Two-thirds of the patients with bacteremia had similar organisms isolated from blood and bile. Pharmacokinetic studies of the hepatic/biliary excretion profiles of ceftazidime, cefoperazone, imipenem, netilmicin, and ciprofloxacin were performed by ERCP and nasobiliary catheter drainage. The bile samples obtained immediately after cannulation from patients with complete biliary obstruction contained low or undetectable levels of the antibiotics administered--the exception being ciprofloxacin, which was present at a concentration of 20% of the serum level. In vitro determination of minimum inhibitory concentration of the aforementioned antibiotics against 199 isolates of biliary pathogens revealed imipenem and ciprofloxacin to have the highest antimicrobial activity. Based on pharmacokinetic studies and in vitro susceptibility findings, we conclude that ciprofloxacin is superior to the other tested antibiotics in prophylaxis and treatment of biliary sepsis.

Adolescent↗
PubMed1994

[Antibiotic sensitivity of gram negative bacilli isolated from urinary tract infections at NUHC of Cotonou (Benin) from March to December 1992].

Eleven antibiotics were tested against 1,194 Gram negative bacilli isolated from urinary tract infections at the National University Hospital Center at Cotonou. Among the betalactams tested, only cefotaxime remained active against most of the bacteria tested: 90% of the strains of Escherichia coli and 75% of the strains of Enterobacter cloacae were sensitive. Ampicilline, on the other hand, had lost its activity even on strains which are usually the most susceptible. Thirteen percent of the E. coli strains were sensitive. This reduction in antibiotic activity against bacterial strains in Cotonou, which concerned to various degrees the tetracyclines, chloramphenicol, cotrimoxazole, is less pronounced for the amino-sides (gentamicine and netilmicine), and the quinolones of which nalidixique acid was active against 83.9% of the strains of E. coli. The low frequency of isolation of wild type strains (sensitive to betalactams) is probably the consequence of strong selection pressure due to a massive, and uncontrolled use of antibiotics in Cotonou.

Aminoglycosides↗
PubMedDate not supplied

Tuberculous peritonitis in a child undergoing continuous ambulatory peritoneal dialysis.

We present a 13-year-old girl with Arnold-Chiari syndrome and uremia secondary to neurogenic bladder. She had been treated with continuous ambulatory peritoneal dialysis (CAPD) for 13 months prior to the development of peritonitis. The patient demonstrated no improvement with a 3-day therapy of intraperitoneal vancomycin and netilmicin. Meanwhile, smear of centrifuged dialysate revealed acid fast bacilli on two occasions. We, then, started anti-TB therapy with oral isoniazid (INAH), rifampin and ethambutal. The symptoms subsided within three days. In the first week, the patient lost her peritoneal ultrafiltration and needed daytime automatic peritoneal dialysis. At the last follow-up examination, 12 months after treatment, she remained well on standard CAPD.

Adolescent↗
PubMed1994

[Etiologic factors in acute inflammatory states of the abdominal cavity].

Three hundred and two samples of biological material from patients operated because of acute inflammatory states of abdominal cavity were investigated. Both aerobic and anaerobic bacteria were investigated. Among aerobic flora most frequently occurred enterococci, E. coli and Pseudomonas. Bacteroides and Peptostreptococcus were most frequently occurring anaerobes. Mixed flora was seen very often. Isolated microorganisms were tested for susceptibility to ciprofloxacin, cefoperazone, cefotaxime, gentamicin, netilmicin and in cases of anaerobes to metronidazole.

Abdomen, Acute↗
PubMed1994

[Septicemia due to Streptococcus milleri with pulmonary complications].

BACKGROUND: Streptococcus milleri can occasionally cause serious septicemia, that is often complicated by abscesses, particularly pulmonary. CASE REPORT: A 12.5 year-old boy was admitted because he had suffered from fever for 6 days. He also had headache, diffuse abdominal pain, chills and a cough. Laboratory investigations showed leukocytes: 9,300/mm3 (PMN: 6,700/mm3; lymphocytes: 1,400/mm3; monocytes: 1,200/mm3); hemoglobin: 12.5 g/dl; platelets: 106,000/mm3; sedimentation rate: 120 mm at 1 hour; blood fibrinogen: 5.6 g/l and C-reactive protein: 193 mg/l. His chest X-rays was normal. Four blood cultures showed Streptococcus milleri. The patient was given amoxicillin (150 mg/kg/d) plus gentamicin (3 mg/kg/d). Two foci of dental infection were found and treated by tooth extraction. Blood cultures remained positive 2, 3 and 6 days after onset of treatment and a second chest X-rays and CT scan showed several bilateral pulmonary abscesses. Cardiac ultrasonographs showed no valvular vegetations. The patient was then given ceftriaxone (100 mg/kg/d) plus rifampicin (20 mg/kg/d) and netilmicin (6 mg/kg/d). Blood culture was negative two days later, but the fever persisted and ceftriaxone was then successfully replaced by vancomycin (40 mg/kg/d) for three weeks. CONCLUSION: There are several reasons for the apparent resistance to treatment of this potentially severe infection; they are discussed by the authors.

Bacteremia↗
PubMed1994

[In vitro evaluation of susceptibility to selected antibiotics of strains of staphylococcus aureus isolated from purulent skin changes].

Resistance to antibiotics of Staphylococcus aureus strains isolated from purulent skin changes during the years 1987-1991 was investigated. The antibiogram was performed by the disc-diffusion method. Susceptibility to penicillin, ampicillin, cloxacillin, gentamicin, doxycycline, erythromycin, tetracycline, and lincomycin was determined. In investigated material during years 1987-1991 high percentage of resistant strains was found in the case of penicillin (from 70% to 66.2%), cloxacillin (66.6%-86.4%) and tetracycline (50%-66.2%). High and rising in time percentage of strains resistant to ampicillin, erythromycin and cephradine was also found. Increase of resistance was also observed with gentamicin (1987--7.1%, 1991--27%) and doxycycline++ (1987--12.7%, 1989--35.3%, 1991--17.6%), while resistance to lincomycin was keeping on a generally equal level within 20% (1987) to 26% (1991). In 1991 susceptibility of 42 strains of Staphylococcus aureus was tested to cefamandole, cefoperazone, cefotaxime, ceftriaxone, cefuroxime, amikacin and netilmicin. No resistant strains to these antibiotics were found.

Bacterial Typing Techniques↗
PubMed1994

[Infection of burn wound with Acinetobacter baumanii].

This paper describes infection of burn wound with participation of Acinetobacter baumanii in three out of five patients. Species classification of 23 strains of Acinetobacter was performed by application of API 20 NE tests. The profiles obtained through these tests permitted for selection of 8 biotypes. Biotype 00010703 was isolated most frequently. All tested strains of Acinetobacter sp. were susceptible only to netilmicin, norfloxacin, pefloxacin, ofloxacin, ciprofloxacin and imipenem. Out of tested antibiotics, imipenem only was active to all isolated species of bacteria.

Acinetobacter↗
PubMed1993

[Extended spectrum beta-lactamases].

At least 30 extended-spectrum beta-lactamases (ESB) have emerged responsible for resistance to indigestible beta-lactams (C3G) since their discovery in West Germany in 1983. Most of them are produced by enterobacteria and essentially K. pneumoniae which appeared susceptible to oxyimino-beta-lactams. A double-disk test was useful to detect such nosocomial isolates of enterobacteria (urines, blood, wound, sputum cultures) mostly recovered from patients in intensive care units. These have spread through hospital and outbreaks were described. Because plasmid-encoded this resistance mechanism was spreading among enterobacteria with other resistance markers (e.g. netilmicin, amikacin). It seems highly likely that the use of newer antibiotics favors the appearance of ESB obtained by selection of mutated genes coding for penicillinases (TEM, SHV). Treatment including a beta-lactam is still possible because of the stability of some beta-lactams e.g. cefamycins, carbapenems and the sensitivity to beta-lactam inhibitors. Digestive selective decontamination may overcome outbreak.

Adult↗