ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1988.tb04057.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Ciprofloxacin, considered a benchmark when comparing new fluoroquinolones, shares with these agents a common mechanism of action: inhibition of DNA gyrase. While ciprofloxacin demonstrated a fairly good activity against gram‐positive bacteria, it is against gram‐negative organisms that it proved to be more potent than other fluoroquinolones. It is the most active quinolone againstPseudomonas aeruginosa, with MIC90s on the order of 0.5 μg/ml. When given orally, ciprofloxacin exhibited 70% bioavailability and attained peak serum levels ranging between 1.5 and 2.9 μg/ml after a single 500‐mg dose. Nineteen percent of an oral dose was excreted as metabolites in both urine and feces. In most cases, body fluids and tissue concentrations equaled or exceeded those in concurrent serum samples. In clinical trials, oral and intravenous ciprofloxacin yielded similar clinical and bacteriologic results compared to standard therapy in a wide array of systemic infections, including lower and upper urinary tract infections; gonococcal urethritis; skin, skin structure, and bone infections; and respiratory tract and gastrointestinal tract infections. Major benefits with the oral form of this quinolone are expected in chronic pyelonephritis and bone infections, and in pulmonary exacerbations in patients with cystic fibrosis. Emergence of ciprofloxacin‐resistant microorganisms has been noted in clinical practice, primarilyPseudomonas aeruginosaandStaphylococcus aureus. The most frequent side effects are related to the gastrointestinal tract; but attention should be given to adverse central nervous syste

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1988.tb04058.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1988.tb04060.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1988.tb04061.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1988.tb04062.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Ofloxacin is a 4‐quinolone antibiotic with rapid bactericidal activity against a wide variety of organisms. Its proposed mechanism of activity is interference with DNA gyrase, an enzyme essential for the replication of bacterial DNA. In vitro activity of ofloxacin includes a variety of aerobic and anaerobic bacteria. Enteric gram‐negative bacilli and cocci are generally sensitive to ofloxacin; nonaeruginosa strains ofPseudomonasare less so. Numerous bacterial pathogens of the gastrointestinal tract are also sensitive to the drug. Although its MIC values for gram‐positive aerobic organisms are generally higher, ofloxacin's bactericidal activity against these organisms is considered by some to be adequate, and superior to that of most other fluoroquinolones. Ofloxacin is well absorbed after oral administration. Wide tissue and body fluid distribution is demonstrated. Urinary excretion is thought to be the primary route of elimination, with 80% of the dose recovered in the urine within 24 hours. The serum half‐life ranges between 2.9 and 9 hours in a dose‐dependent manner. Only modest accumulation is reported after multiple‐dose administration. Clinical trials using daily dosages of 100–800 mg/day in single or divided doses have been reported in the treatment of a variety of conditions such as skin and soft tissue infections, tonsillitis, sexually transmitted disease, respiratory tract infections, cystitis, and complicated and uncomplicated urinary tract infections. English reports of these trials, however, are generally limited to abstract form, making evaluation of trial design difficult. Side effects most frequently encountered include gastrointestinal and central nervous sys

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1988.tb04063.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1988.tb04064.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

We studied the circadian influences on cyclosporine pharmacokinetics in five recipients of pancreatic allografts. Results from these patients demonstrate a slightly increased area under the concentration‐time curve (p = 0.156) resulting from decreased apparent clearance during the resting (pm) versus activity (am) period (p = 0.199). A significant delay in mean residence time was observed after thepmdose (p = 0.039), and thepmarea under the moment curve was larger than theamvalue (p = 0.063). We propose three chronopharmacokinetic dosing methods that alter either thepmdose administration time or redistribute the daily dose to produce equal exposure to cyclosporine during the active and resting periods. These trends and differences suggest that more sophisticated time‐dependent cyclosporine dosing methods are needed to balanceamandpmdrug exposure and thereby improve immunosuppress

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1988.tb04065.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Herpes zoster is a cutaneous vesicular eruption resulting from recrudescence of the chickenpox virus. It is mainly a disease of adults, with a predisposition for the elderly or immunocompromised. Although usually localized, the disease can disseminate to visceral organs. Diagnosis is often made based on the characteristic pattern of the lesion and clinical features. Tzanck smear, viral isolation, seroconversion, antibody titers, and monoclonal antibodies may further aid or confirm the diagnosis. Clinical features of herpes zoster may follow a progression through 3 stages, prodromal, acute, and chronic. The prodromal and acute phases seldom require more than symptomatic management. The chronic pain syndrome, postherpetic neuralgia (PHN), demands a more aggressive approach. Pharmacologic intervention, neuroaugmentation, and/or surgery may prevent or alleviate PHN, but universal response to any of these therapeutic approaches is unlikely. Tricyclic antidepressants remain the first choice in treating this pain syndrome. A trial of antiviral therapy may be warranted in patients with disseminated disease or in immunocompromised patients with localized disease. Of the antiviral agents, acyclovir is considered the drug of choice by most clinicians.

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1988.tb04066.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Acute adrenal insufficiency is an unusual problem that may mimic overwhelming sepsis. Elevated cardiac output and low systemic vascular resistance in a patient with known risk factors should alert clinicians to the possibility of that condition.

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1988.tb04067.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY