摘要:

A multicenter comparative trial was conducted in 4 university hospitals to evaluate the efficacy of aztreonam, a new monobactam antibiotic. All patients enrolled in the study were admitted to the intensive-care unit with severe underlying conditions. A total of 167 infections were documented in 157 patients (78 pneumonia, 26 urinary tract infection, 23 peritonitis, and 40 septicemia). The study was performed in 2 phases. In phase 1, 49 patients receiving aztreonam were compared with 26 receiving amikacin. These two drugs were administered as the sole coverage against gram-negative bacilli. In phase 2, 48 patients treated with aztreonam were compared with 34 who received a synergistic combination of amikacin and a broad-spectrum β-lactam. The results suggest that aztreonam can be used as monotherapy in the treatment of systemic gram-negative infections with an efficacy comparable with that of standard antimicrobial therapy. Aztreonam is probably more effective than amikacin in treating respiratory tract infections and it is at least as effective as a β-lactam-aminoglycoside combination. An adequate standard dosage of aztreonam could be established as 3–4 g/day in compromised patients, and it should be combined with gram-positive coverage when used empirica

ISSN:0009-3157    

DOI:10.1159/000238713

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

Concomitant concentrations of monobactam antibiotics were measured in plasma and in prostatic tissue obtained by transurethral resection in 25 patients, 60–120 min after dosage. A 1-gram single intravenous injection of aztreonam or carumonam yielded mean prostatic concentrations of 6.0 mg/kg in 20 patients. Five patients who received a 2-gram dose of carumonam demonstrated average prostatic levels of 10 mg/kg. These concentrations significantly exceed MIC values for most common gram-negative urinary tract pathogen

ISSN:0009-3157    

DOI:10.1159/000238629

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

A multicenter trial involving several urologic units in Italy provided pooled data on 1,427 patients with urinary tract infections to evaluate the efficacy and safety of aztreonam, a new monobactam antibiotic. Microbiologic and clinical data were collected methodically in all cases. A majority of the patients (79.9%) were hospitalized during the study period, an associated pathology was noted in 29.1%, and 16.7% were receiving additional therapy. Aztreonam was administered by different routes and in different dosages according to the severity of the pathology. At the end of treatment, 93.6% of the patients showed a positive microbiologic response. Eradication percentages of the 6 main pathogens determined from cultures taken within the seventh day after the end of treatment were as follows: 93.9% for Escherichia coli (n = 415), 86.3% for Pseudomonas sp. (n = 207), 91.6% for Proteus sp. (n = 192), 89.8% for Providencia sp. (n = 59), 96.2% for Klebsiella sp. (n = 56), and 98.1 % for Serratia sp. (n = 56). Aztreonam was well tolerated. Of the 1,427 patients evaluated for safety, only 54 (3.8%) reported 55 adverse reactions, necessitating the withdraw al of therapy in 5 (0.2%) instances.

ISSN:0009-3157    

DOI:10.1159/000238714

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

Escherichia coli strains that were susceptible to multiple antibiotics were exposed to cefotetan and piperacillin. As with the majority of beta-lactam antibiotics, the growth curves showed an increase in optical density (OD) due to an increasing volume of cell-wall-deficient bacteria during the first hours before lysis. This increase in OD depended on the concentration of cefotetan and was less dependent on the concentration of piperacillin. A good correlation was found between the prelytic increase in OD and the killing curve. During the prelytic increase in OD, the number of CFU/ml remained more or less constant. The decrease in the number of CFU/ml depended on the concentration of cefotetan and was less dependent on the concentration of piperacillin.

ISSN:0009-3157    

DOI:10.1159/000238630

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

The combination aztreonam + cefotaxime (AZ + CE) was compared to amikacin + cefotaxime (AM + CE) in the treatment of nosocomial pneumonia acquired at the intensive-care unit. This study included a total of 33 patients fulfilling criteria for nosocomial pneumonia. 16 of them were randomly allocated to the AZ + CE group and 17 to the AM + CE group. The empirical treatment was effective for 78% of AZ + CE cases and 92% of AM + CE cases (p = NS). Clinical cure was observed in 77% of cases (10 out of 13 evaluable) in the AZ group and in 75% of the group treated with AM (12 cases out of 16 evaluable; p = NS). In the evaluable cases, treatment failure was associated with injections due to the following organisms: Acinetobacter calcoaceticus (1) and Pseudomonas aeruginosa (1) in the AZ group and A. calcoaceticus (1) in the AM group. Superinfections were observed only in the AM group P. aeruginosa, A. calcoaceticus, Streptococcus viridans, Candida albicans, Aspergillusfumigatus and Serratiamar-cescens. Both the peak and through serum concentrations of AZ and AM were maintained within normal ranges. Finally, an impairment of renal tubular function was observed in the group of patients treated with AM, as measured by urinary levels of N-ace-tyl-β-D-glucosaminidase and leucine aminopeptidase sequentially during the treatment. These changes in renal functions alterations mentioned were not observed in the AZ group. It is concluded that the AZ + CE combination is an effective empirical and active antibiotic treatment against severe nosocomial pneumonia. Aztreonam has no renal toxicity, which is an advantage to take into account in patients with altered renal function

ISSN:0009-3157    

DOI:10.1159/000238716

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

The interaction of ciprofloxacin and ofloxacin with the bactericidal capability of human polymorphonuclear leukocytes against staphylococci was investigated. Exposure of Staphylococcus aureus and Staphylococcus epidermidis to subinhibitory concentrations of ciprofloxacin and ofloxacin did not significantly affect the uptake and killing by human polymorphonuclear leukocytes. In our assay, ciprofloxacin and ofloxacin in concentrations of one time the minimal inhibitory concentration induced a significant reduction in viable intraphagocytic 5. aureus (percentages of survival: 43 and 51 %, respectively) compared to the controls without antibiotic (percentage of survival: 65%). In contrast, both antimicrobials failed to produce a reduction in viable intraphagocytic 5. epidermidis.

ISSN:0009-3157    

DOI:10.1159/000238631

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

Five antimicrobial drugs (ceftazidime, ciprofloxacin, imipenem, piperacillin and tobramycin) and two human, intravenously applicable, IgG immunoglobulin preparations (Psomaglobin®, Polyglobin N®) were examined alone and in various combinations for therapeutic efficacy in myelosuppressed as well as normal NMRI mice following systemic infection with 4 selected strains of Pseudomonas aeruginosa. Both IgG preparations alone invariably failed to passively protect neutropenic and normal mice, even though the preparations contained demonstrable antibodies against purified exotoxin A of P. aeruginosa and against numerous polypeptide and lipopolysaccharide constituents of the 4 test strains of P. aeruginosa. Among the antimicrobial drugs employed alone, ciprofloxacin and imipenem were the most effective. Tobramycin alone occupied an intermediate position, whereas monotherapy with ceftazidime and piperacillin invariably failed. All antimicrobial drug combinations were efficacious in myelosuppressed as well as normal mice. Both IgG preparations failed to enhance the activities of ceftazidime and piperacillin in neutropenic mice; the activity of tobramycin was augmented against 1 of 2 P. aeruginosa strains, as well as that of ciprofloxacin. Both IgG preparations enhanced the activities of ceftazidime and tobramycin in normal NMRI mice, as well as that of piperacillin against 1 of 2 test strains. It was concluded that the two IgG preparations were more beneficial for normal rather than neutropenic mice, provided that the animals were treated with appropriate antimicrobial drugs as wel

ISSN:0009-3157    

DOI:10.1159/000238632

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

Aztreonam was administered to 20 children diagnosed as having any of the following infections: urinary tract infection, pneumonia, meningitis, and abscess of the appendix. Haemophilus influenzae, Escherichia coli, and Klebsiellapneumoniae were isolated. The minimum inhibitory concentrations of aztreonam for these bacteria ranged from 0.03 to 0.5 μg/ml. All patients were clinically and bacteriologically cured within 5–16 days of treatment. Six months after completion of therapy, patients who had had meningitis appeared to be free of any neurologic sequelae. The antibiotic was well tolerated by all patien

ISSN:0009-3157    

DOI:10.1159/000238717

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

Ninety patients (41 males, 49 females) with a diagnosis of meningitis, urinary tract infection (UTI), gastroenteritis or other miscellaneous gram-negative infections were enrolled. Their ages ranged from 7 days to 10 years, with a mean age of 4 months. 58 (63%) patients had an etiology confirmed by either positive culture (52; 89%) or latex agglutination (6; 10%). 41 of these patients had meningitis diagnosed by positive CSF culture (38) or by positive CSF latex agglutination (3); 27/41 patients also had positive blood cultures. Aztreonam MIC100 for 27 isolates of Haemophilus influenzae, all ampicillin-sensitive, was 0.19 μg/ml; 4 Salmonella sp., 1 Neisseria meningitidis and 1 Serratia marcescens isolates were inhibited by 0.19 μg/ml, and the MIC100 for 2 Klebsiella pneumoniae, 1 Proteusvulgaris and 2 Pseudomonas aeruginosa isolates were 0.045 and 0.19, 0.022 and 12.5 ∣ig/ml, respectively. Bacteriologic cures were effected in 37/38 (97%) patients with meningitis, 8 (100%) with UTI and 6 (100%) with other gram-negative infections. Bacteriologic failure occurred in 1 patient with P. vulgaris (aztreonam MIC/MBC 0.006/0.011 μg/ml), who died. Bacteriologic relapse occurred in 3 patients: 1 with P. aeruginosa (aztreonam MIC/MBC 12.5/12.5 u, g/ml; corresponding aztreonam CSF level 5 μg/ml) was successfully treated with other antibiotics; 1 with H. influenzae (MIC/MBC aztreonam 0.022/0.045 μg/ml) relapsed after a course of aztreonam and a subsequent course of ampicillin and Chloromycetin, also experienced a relapse on ampicillin and chloramphenicol, had a negative CT head scan, mastoid, and long-bones film and was ultimately cured with another course of parenteral ampicillin; 1 with K. pneumoniae was malnourished (MIC/MBC aztreonam 0.19/0.19 μg/ml) and relapsed after a week off therapy despite initial CSF sterilization after 24 h of therapy. Additional clinical failures occurred in 2 patients with Salmonella sp. (aztreonam MIC 0.09 μg/ml) who died 3–5 days into treatment (they both were ill for more than 19 days prior to aztreonam treatment). Peak aztreonam serum levels ranged from 12.4–104 μg/ml (mean 44 μg/ml); CFS levels ranged from 3–52 μg/ml (mean 15.6 u.g/ ml). Overall, 52 (94%) patients were clinically cured, and of these, 48 (92%) were bacteri-ologic cures. There were no clinically significant adverse effects secondary to aztreonam use. Aztreonam appears safe and effective in the treatment of pediatric gram-ne

ISSN:0009-3157    

DOI:10.1159/000238718

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

The monobactam aztreonam was used to treat 22 young patients with meningitis caused by gram-negative bacilli. Haemophilus influenzae was isolated from the CSF of 21 patients and Salmonellaheidelberg from the CSF of 1. Dosages ranged from 100 to 200 mg/kg/day in 4 doses at 6-hour intervals. Minimal inhibitory concentrations were determined by the broth dilution method for all isolated strains, and values ranged from 0.05 to 2.0 μg/ml. Blood and CSF drug levels were determined by a microbiologic plate diffusion method, and mean values for CSF and blood were 1.4 and 14.9 μg/ml, respectively. The outcome was good in 21 patients; 1 patient died. Complications were mild: subdural effusion occurred in 6 cases and was managed clinically; asymptomatic hydrocephalus was seen in 4; seizure during the acute phase occurred in 6 cases; hypo-acusis was noted in 2, and motor impairment was detected at the follow-up in 1 case. Aztreonam achieved good blood and CSF penetration and performed well in the treatment of 20 cases of H. influenzae meningitis and in the one case of S. heidelberg meningiti

ISSN:0009-3157    

DOI:10.1159/000238719

出版商:S. Karger AG    

年代:1989

数据来源: Karger