Quimioterapia intraperitoneal en aerosol presurizado (PIPAC) / Pressurized intraperitoneal aerosol chemotherapy (PIPAC)

RESUMEN La técnica PIPAC se presenta como una variante de tratamiento para los pacientes con carcinomato sis peritoneal que no son candidatos a una resección. Se describen de manera detallada los pasos y el procedimiento quirúrgico para la administración de quimioterapia intraperitoneal presurizada con dispositivo PIPAC.

ABSTRACT Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a therapeutic option for patients with unresectable peritoneal carcinomatosis. The steps and the surgical technique of the PIPAC technique are thoroughly described.

Perianesthetic refractory anaphylactic shock with cefuroxime in a patient with history of penicillin allergy on multiple antihypertensive medications / Choque anafilático refratário perianestésico com cefuroxima em paciente com história de alergia à penicilina recebendo vários medicamentos anti-hipertensivos

Abstract We report a case of perianesthetic refractory anaphylactic shock with cefuroxime in a patient with history of penicillin allergy on regular therapy with atenolol, losartan, prazosin and nicardipine. Severe anaphylactic shock was only transiently responsive to 10 mL of (1:10,000) epinephrine and needed norepinephrine and dopamine infusion. Supportive therapy with vasopressors and inotropes along with mechanical ventilation for the next 24 hours resulted in complete recovery. She was successfully operated upon 2 weeks later with the same anesthetic drugs but intravenous ciprofloxacin as the alternative antibiotic for perioperative prophylaxis.

Resumo Relatamos um caso de choque anafilático refratário no período perianestésico com cefuroxima em paciente com história de alergia à penicilina em terapia regular com atenolol, losartan, prazosina e nicardipine. O choque anafilático grave foi apenas transitoriamente responsivo a 10 mL de epinefrina (1:10000) e precisou de infusão de norepinefrina e dopamina. A terapia de apoio com vasopressores e inotrópicos, juntamente com ventilação mecânica por 24 horas, resultou em recuperação completa. A paciente foi operada com sucesso duas semanas mais tarde, com os mesmos agentes anestésicos, mas com ciprofloxacina intravenosa como antibiótico opcional para a profilaxia perioperatória.

Use of cefuroxime for women with community-onset acute pyelonephritis caused by cefuroxime-susceptible or -resistant Escherichia coli

BACKGROUND/AIMS: Efforts to decrease the use of extended-spectrum cephalosporins are required to prevent the selection and transmission of multi-drug resistant pathogens, such as extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae. The objectives of this study were to assess the clinical efficacy of intravenous cefuroxime as an empirical antibiotic for the treatment of hospitalized women with acute pyelonephritis (APN) caused by Escherichia coli. METHODS: We analyzed the clinical and microbiologic database of 328 hospitalized women with community-onset APN. RESULTS: Of 328 women with APN, 22 patients had cefuroxime-resistant E. coli APN, and 306 patients had cefuroxime-susceptible E. coli APN. The early clinical success rates were significantly higher (p = 0.001) in the cefuroxime-susceptible group (90.8%, 278/306) than in the cefuroxime-resistant group (68.2%, 15/22) at 72 hours. The clinical cure rates at 4 to 14 days after completing antimicrobial therapy were not significantly different in the cefuroxime-resistant or -susceptible groups, with 88.2% (15/17) and 97.8% (223/228; p = 0.078), respectively. The microbiological cure rates were not significantly different and were 90.9% (10/11) and 93.4% (128/137), respectively (p =0.550). The median duration of hospitalization in the cefuroxime-resistant and -susceptible groups was 10 days (interquartile range [IQR], 8 to 13) and 10 days (IQR, 8 to 14), respectively (p =0.319). CONCLUSIONS: Cefuroxime, a second-generation cephalosporin, can be used for the initial empirical therapy of community-onset APN if tailored according to uropathogen identification and susceptibility results, especially in areas where the prevalence rate of ESBL-producing uropathogens is low.

Abordagem endovascular de paciente com fibrodisplasia de artéria renal bilateral associada a volumoso aneurisma renal / Endovascular approach of a patient with bilateral renal artery fibrodysplasia associated with a massive renal aneurysm

A fibrodisplasia muscular renal é de etiologia desconhecida, de origem não inflamatória e não aterosclerótica, estando associada ao desenvolvimento de estenoses e de aneurismas. Relatamos um caso de fibrodisplasia muscular renal bilateral associada a aneurisma volumoso de artéria renal tratado com angioplastia com balão e stent multicamadas.

Renal artery fibromuscular dysplasia is a condition of unknown etiology, with non-inflammatory, nonatheroscleroticorigin, associated to the development of stenosis and aneurysms. The authors report a case of bilateral renal artery fibromuscular dysplasia associated with a large renal artery aneurysm, treatedwith balloon angioplasty and a multilayer stent.

Comparison of Second- and Third-Generation Cephalosporin as Initial Therapy for Women with Community-Onset Uncomplicated Acute Pyelonephritis

PURPOSE: This study examined the clinical effectiveness of parenteral cefuroxime and cefotaxime as empirical antibiotics for treating hospitalized women with uncomplicated acute pyelonephritis (APN). MATERIALS AND METHODS: This study was based on the clinical and microbiologic data of 255 hospitalized women with APN. Of these 255 women, 144 patients received cefuroxime and 111 received cefotaxime. RESULTS: There were no marked differences in the demographic features, clinical characteristics, and treatment duration between the populations of the cefuroxime and cefotaxime groups. The rates of defervescence showed no significant differences in the two groups at 48, 72, 96, and 120 hours. The clinical cure rates observed at the follow-up visit 4 to 14 days after the completion of antimicrobial therapy were not statistically different between the cefuroxime and cefotaxime groups [94.9% (129 of 136) versus 98.0% (100 of 102), respectively; p=0.307], and the microbiological cure rates were also not significantly different [88.3% (91 of 103) versus 95.0% (76 of 80), respectively; p=0.186]. The median hospitalization periods in the cefuroxime and cefotaxime groups were 7 (6-8) and 7 (6-8) days (p=0.157), respectively. Microbiological success rates after 72-96 hours of initial antimicrobial therapy were also not statistically different in the cefuroxime and cefotaxime groups, 89.4% (110 of 123) versus 94.9% (93 of 98; p=0.140). CONCLUSION: Cefuroxime, a second-generation cephalosporin, is an appropriate antibiotic option for the initial treatment of uncomplicated APN and its efficacy does not differ from cefotaxime, a third-generation cephalosporin, in the initial parenteral therapy for community-onset APN.

Evaluación de efectividad y seguridad de cefaclor, cefprozil y cefuroxim a como primera línea para neumonía adquirida en la comunidad en menores de 5 años / Evaluation of effectiveness and safety of cefaclor, cefprozil and cefuroxim a as first line for community-acquired pneumonia in children under 5 years

Antecedentes: Descripción de la condición de salud de interés (indicación): La Neumonía Adquirida en la Comunidad (NAC), e s una enfermedad resultante de la inflamación del parénquima pulmonar generada por un agente infeccioso fuera del ambiente hospitalario. El cuadro clínico se caracteriza por tos, fiebre y signos de consolidación al examen físico, pero puede ser muy variable y mostrar otros síntomas locales como disnea, dolor torácico, expectoración, taquipnea, o generales como fiebre, escalofríos confusión y taquicardia. Información de la tecnología: La cefuroxima es muy activa frente a la mayoría de las bacterias gram-positivas (incluyendo las cepas productoras de penicilinasa) como los estafilococos (S. aureus, S. epidermis), estreptococos (a excepción de los enterococos) y algunas bacterias gram-positivas anaerobias. Entre las bacterias gram-negativas sensibles a la cefuroxima se encuentran los E.coli, Klebsiella, H.influenzae, Proteus mirabilis, N.meningitidis, y N.gonorrhoeae, incluyendo las cepas que son productoras de beta-lactamasas. Otros gérmenes sensibles son la Pasteurella multocida, Citrobacter, Salmonella, Shigella, y Yersinia. La cefuroxima tiene poca actividad frente a especies de Providencia, P. vulgaris, Serratia, o Pseudomonas. Tampoco es efectiva frente a la Listeria meningitis. Evaluación de efectividad y seguridad: ¿Cuál es la efectividad y seguridad de cefaclor, cefprozil y cefuroxima comparados con amoxicilina, amoxicilina/ácido clavulánico, eritromicina, claritromicina o azitromicina, como monoterapia ambulatoria de primera línea para NAC no complicada en niños menores de 5 años? La pregunta de evaluación fue refinada y validada con base en: autorización de mercadeo de las tecnologías para la indicación de interés (registro sanitario INVIMA), listado de medic\r\namentos vitales no disponibles, cobertura de las tecnologías en el Plan Obligatorio de Salud (POS) \r\n(Acuerdo 029 de 2011), revisión de grupos terapéuticos (clasificación ATC: Anatomical, Therapeutic, Chemical classification system), recomendaciones de guías de práctica clínica actualizadas, disponibilidad de evidencia sobre efectividad y seguridad (reportes de evaluación de tecnologías y revisiones sistemáticas de la literatura), uso de las tecnologías (listas nacionales de recobro, estadísticas de prescripc\r\nión, etc), estudios de carga de enfermedad. Población: Personas con diagnóstico de Neumonía Adquirida en la comunidad. Tecnología de interés: Amoxicilina, amoxicilina/ácido clavulánico, eritromicina, claritromicina o azitromicina. Metodología: Búsqueda de literatura, Búsqueda en bases de datos electrónica.Conclusiones: No existen diferencias estadísticamente significativas en cuanto a efectividad al comparar tasas de curación de cefuroxima con amoxicilina. No existen diferencias estadísticamente significativas en cuanto a efectividad al comparar tasas de curación de cefuroxima con claritromicina. No se encontraron comparaciones entre cefaclor, cefprozil con amoxicilina, amoxicilina/ácido, clavulánico, eritromicina, claritromicina y azitromicina. La revisión sistemática es de alta calidad, pero hacen falta estudios que permitan aclarar las diferencias entre cefuroxima y amoxicilina/ácido clavulánico, eritromicina, y azitromicina.

Efficacy and Safety of Fixed Dose Combination of Cefpodoxime Proxetil and Potassium Clavulanate (Cefchamp) in Comparison with Cefuroxime Axetil in Patients with Lower Respiratory Tract Infections.

Objectives: To evaluate the efficacy and safety of Fixed Dose Combination of Cefpodoxime Proxetil and Potassium Clavulanate (Cefchamp) in comparison with Cefuroxime Axetil in patients with Lower Respiratory Tract Infections.Methods:In this open, randomized, and controlled, parallel-group study of 7 days, 57 patients of both gender above 18 years of age with diagnosis of lower respiratory tract infection were randomized to receive Fixed Dose Combination (FDC) of Cefpodoxime Proxetil plus Potassium Clavulanate (Cefchamp), or Cefuroxime Axetil (CA) for a period of 7 days. Efficacy was assessed by symptoms of cough, dyspnoea, wheezing, Rhonchi, and chest pain based on 4-point scale as 0=none,1=mild, 2=moderate, 3=severe. Fever was recorded as the patient’s actual temperature. Safety assessment included adverse events and adverse drug reactions during the study period.Results: Three patients lost to follow up with CA.The improvement in all symptoms except cough was greater with CC as compared to CA group(p, >0.05). Fever improved from 37.18°C at baseline to 37.01 on day 3 with CC, whereas with CA the fever improved from 37.l5 at baseline to 37.05 on day 3 with CA. Fever subsided in all the patients in both treatments by day 5 of study therapy. Clinical cure was seen in 57.14% (16/28) patients on CC, whereas 42.3% patients (11/26) on CA had clinical cure.Conclusions:The fixed dose combination of Cefpodoxime Proxetil 200 mg and Potassium Clavulanate 125mg (Cefchamp) in comparison with Cefuroxime Axetil 500 mg showed improvement in the cure of respiratory tract infections in terms of decreasing the patient’s LRTI symptoms, improving the patient’s general health and with few adverse events and adverse drug reactions. However, further studies of greater sample size and blinded nature are needed to further substantiate this effect.

Comparison of single dose with multiple dose antibiotic prophylaxis with cefuroxime in open cholecystectomy

To compare single dose with multiple dose antibiotic prophylaxis with Cefuroxime in open cholecystectomy in terms of post operative surgical site infection, hospital stay and cost effectiveness. Study Design: Quasi experimental study. The study was conducted in the Surgical Unit of Punjab Employees Social Security Institution Islamabad and Ahmed Hospital Rawalpindi Teaching Hospitals of IMDC Islamabad, from 1st August 2010 to 30th September 2011. A total of one hundred and ten patients requiring elective open cholecystectomy were included. Patients with acute cholecystitis, jaundice, diabetes, malignancy, choledocholithiasis and co morbidity were excluded. Patients were divided in to two groups, 55 patients in each group, Group A received only single dose of Cefuroxime and Group B received multiple doses [six]. In this study, 97 [88%] patients were females and 13 [12%] were males. The mean age was 40.69 years. In Group A, 4 [5.5%] patients, and in Group B, 7 [12.7%] patients developed surgical site infection. Mean hospital stay in Group A was 2.18 days and in Group B 2.43 days. Cost of antibiotics in Group A was six times less than Group B. There is no difference in single dose and multiple doses prophylaxis with Cefuroxime in low risk patients for elective open cholecystectomy in terms of post operative surgical site infection and hospital stay however single dose is more cost effective

Perioperative cefuroxime pharmacokinetics in cardiac surgery

OBJECTIVE: The objective was to investigate the plasma levels and to compare the pharmacokinetics of cefuroxime during and after surgery in adult patients with elective indication for coronary artery bypass grafting. METHODS: Seventeen patients received three 1.5-g bolus IV doses of cefuroxime, one every 12 hrs. Serial blood samples (3 mL) were collected 1, 3, 6, 9, and 12 hrs after the first dose (given during the intervention) and after the second and third doses (postsurgery). Blood samples were centrifuged and stored frozen until being assayed. For assessment of the cefuroxime plasma levels by liquid chromatography, only 200 æL of plasma were required. Determination of cefuroxime plasma levels was followed by a pharmacokinetic (PK)-modeling using PK Solutions 2.0 software. RESULTS: The kinetic parameters obtained remained unchanged after the first, second, and the third dose as follows: elimination half-life: 1.8 h, 1.9 h, and 1.8 h; clearance: 1.4, 1.5, and 1.5 mL/min/kg, respectively. Additionally, the apparent volume of distribution did not change during and after the intervention: 0.19, 0.25, and 0.22 L/kg, after the first, second, and the third dose, respectively. Since the drug has a low volume of distribution, plasma levels obtained after a 1.5-g IV bolus injection of cefuroxime decreased rapidly due to the high plasma clearance, with a consequent short half-life. CONCLUSIONS: The kinetic disposition of cefuroxime remains unaltered in patients undergoing coronary artery bypass grafting; to reduce the fluctuation in plasma concentrations so that the antibiotic prophylaxis in the peri-operative period is guaranteed, the dose regimen should be reviewed.

OBJETIVO: Investigar os níveis plasmáticos e comparar a farmacocinética da cefuroxima durante e após cirurgia de revascularização do miocárdio. MÉTODOS: Dezessete pacientes receberam três doses intravenosas de 1,5 g de cefuroxima, a cada 12 horas. Foram coletadas amostras de sangue nos tempos de 1, 3, 6, 9 e 12 horas após a primeira dose (durante a cirurgia) e após a segunda e terceira dose (administradas após a cirurgia). As amostras de sangue foram centrifugadas e armazenadas congeladas até o momento da análise. Os níveis plasmáticos da cefuroxima foram determinados através de cromatografia líquida, utilizando-se apenas 200 mL de plasma. A determinação da farmacocinética da cefuroxima foi realizada utilizando o software PK-solutions 2.0. RESULTADOS: Todos os parâmetros cinéticos obtidos permaneceram inalterados após a adminstração da 1ª, 2ª e 3ª doses: meia vida de eliminação 1,8h, 1,9h and 1,8h, depuração 1,4, 1,5 and 1,5 mL/min/kg respectivamente. Adicionalmente, o volume aparente de distribuição, não se alterou durante ou após a intervenção: 0,19, 0,25 and 0,22 L/kg, após 1ª, 2ª e 3ª dose, respectivamente. Os níveis plasmáticos obtidos após administração da cefuroxima reduziram rapidamente devido à alta depuração plasmática com conseqüente curta meia-vida plasmática, atingindo valores abaixo da concentração inibitória mínima a partir da 9ª hora da administração. CONCLUSÕES: A disposição cinética da cefuroxima permanece inalterada em pacientes submetidos à cirurgia de revascularização do miocárdio, e com vistas à redução da flutuação no período perioperatório, o regime de dose para a antibioticoprofilaxia poderia ser revisto.

A bioequivalence study of the cefuroxime axetil in healthy volunteers.

The bioequivalence of 250-mg cefuroxime axetil was evaluated; Furoxime (by the Siam Bheasach Company, Thailand) as the test and Zinnat (GlaxoWellcome) as the reference. The two products were administered as a single dose according to a two-way crossover design, 1-week washout period to 12 healthy Thai male volunteers. Thereafter, serial blood samples were collected over a period of 15 hours. Plasma cefuroxime concentrations were measured by HPLC. The pharmacokinetic parameters were analyzed by noncompartmental analysis. Results: The Tmax [median (range, h)] of Furoxime and Zinnat were 1.5 (1.0-3.0) and 1.75 (1.0-3.5), respectively. The Tmax of Furoxime was faster than Zinnat with the mean (90% CI) of difference in Tmax of -0.5 [(-1.01)-0.01] h. Bioequivalence analysis showed that the AUC(0-infinity) and the Cmax of the two products were not significantly different. The point estimator (90% CI) for the ratio [Furoxime/Zinnat] of log transformed data of the AUC(0-infinity) and Cmax were 1.03 (0.98-1.20) and 1.09 (1.02-1.24), respectively and were within the bioequivalence range of 0.80-1.25.

Single dose intravenous regional antibiotic in clean orthopaedic procedures.

Patients undergoing clean orthopaedic operations with tourniquet in Orthopaedic Department of a tertiary level hospital in Dhaka during August 1999 to March 2002 were consecutively enrolled in a prospective clinical study to explore the efficacy and safety of regional prophylaxis with single dose antibiotic. Eighty two patients with 83 operations received 750-mg cefuroxime in 40 & 20 ml of distilled water, into a dorsal vein of the foot or hand respectively to be operated on immediately after the tourniquet was inflated. Patients with bilateral operation, regional administration of cefuroxime were also repeated for the operation on the other extremity. Follow up ranged from 3 weeks to 2 years & 7 months. None of the patients experienced local or systemic adverse effects following regional administration of cefuroxime. Also none developed early infection (superficial or deep) during the follow-up period. Infective complications at distant sites like UTI were observed in one case with bilateral corrective osteotomy for knocked knee deformity. It was probably due to catheterization in the immediate post-operative period, which was rapidly cured following antibiotic treatment and removal of catheter. Regional administration of single dose antibiotic appears to be a safe and effective prophylaxis for the control of early infection in clean orthopaedic procedures. Late infection is blood borne and that can not be controlled by prophylactic use of antibiotic.

Infección cervico vaginal en la pielonefritis aguda del embarazo: relación con los resultados del tratamiento antibiótico y con la contractilidad uterina anormal / Cervix-vaginal infection in acute pyelonephritis in pregnancy: it relation with the results of antibiotic treatment and with abnormal uterine contractility

Antecedentes. La embarazada desarrolla fácilmente infecciones de la vía urinaria por cambios funcionales y por ubicación del meato uretral. En la pielonefritis aguda del embarazo no es muy conocida la participación de la infección del tracto genital inferior en los resultados del tratamiento antibiótico y en la presencia de contracción uterina del aborto y parto prematuro. Objetivos. Conocer la microbiología de la vía uterina y del tracto genital en la pielonefritis aguda del embarazo y su relación con los resultados del tratamiento y con la existencia de contracción uterina. Diseño del estudio. Embarazada entre 12 y 34 semanas de gestación con el diagnóstico de pielonefritis aguda se enrolaron. Se tomaron muestras de orina y cervicovaginales para cultivo. Recibieron randomizadamente cefuroxima o cefradina. Se observó la contracción uterina. En el seguimiento se pidieron cultivos de orina como controles. Resultados. 97 mujeres cumplieron con los criterios de inclusión. Escherichia coli se aisló del urocultivo en el 94,8 por ciento de los casos. La vaginosis bacteriana se presentó en el 32,0 por ciento y la infección cervicovaginal en el 57,7 por ciento de las pacientes. En la infección cervicovaginal E. coli se aisló en el 65,2 por ciento. El fracaso en la erradicación de la bacteria de la vía urinaria, se asoció con infección cervicovaginal (76,9 por ciento vs 52,9 por ciento, p< 0.05) y con leucocitos aumentados en la muestra cervical (76,9 por ciento vs 47,1 por ciento, p< 0,01). La contracción uterina se asoció significativamente con: infección cervicovaginal (p < 0,01), vaginosis bacteriana (p < 0,001) y con hallazgo en la muestra cervical de : leucocitos aumentados (p < 0,01), flora polimicrobiana (p < 0,001), aislamiento de E. coli (p < 0.001) y disminución de Lactobacillus sp (p < 0.01). Conclusiones: La infección del tracto genital inferior existente en la pielonefritis aguda del embarazo se relaciona con el fracaso de la terapia antimicrobiana en la erradicación de la bacteria de la vía urinaria y con contracción uterina presente

Antibiotic prophylaxis in elective cholecystectomy: a randomized, double blinded study comparing ciprofloxacin and cefuroxime.

A prospective, randomised and double blind study was undertaken to compare the prophylactic efficacy of ciprofloxacin and cefuroxime in 155 patients undergoing elective cholecystectomy. Patients with past history of jaundice or presence of jaundice, diabetes mellitus, common bile duct stones and previous biliary tract surgery were excluded. Patients were allocated to the following groups: group A-no antibiotic (n = 30); group B-ciprofloxacin (200 mg i/v before surgical incision and a second dose after 12 hrs) (n + 45); group C-ciprofloxacin given only post operatively (200 mg i/v, 12 hourly X 2 days followed by oral 500 mg twice daily X 3 days) (n = 35); group D-cefuroxime (750 mg i/v before surgical incision and a second dose after 12 hrs) (n = 45). Efficacy of the antibiotic was defined as a patient being free of post operative wound infection. Maximum numbers of infection occurred in group A (26.67%) and group C (25.71%). The incidence of wound infection was significantly lower when ciprofloxacin was used as prophylaxis (group B) than when used post operatively (group C) only (P < 0.05). Patients who received ciprofloxacin (group B) and cefuroxime (group D) as prophylaxis had significantly reduced incidence of infection (4.44% and 6/67% respectively); no statistically significant difference was found between these groups. Ciprofloxacin could be used as prophylactic antimicrobial in elective cholecystectomy in developing countries because of its effectiveness, economy and ready availability.

Espectro clínico de las infecciones por chlamydia trachomatis en mujeres / Clinical spectrum of chlamydia trachomatis infection in women

Hoy en día es incierto el rol que tiene C. trachomatis como causa de efectos adversos durante el embarazo. Pero si está claramente establecido que es causa de EIP en mujer, uretritis y epididimitis en el hombre y conjuntivitis y neumonitis en los niños. La EIP aguda por C. trachomatis tiene un impacto enorme en la reproducción de la mujer: es causa de embarazo tubario e infertilidad por obstrucción tubaria. Por sus consecuencias y porque habitualmente la salpingitis por C. trachomatis es asintomática, es necesario desarrollar estrategias precisas para su control. Se recomienda la pesquisa regular de esta bacteria en la mujer menor de 35 años con factores de riesgo. Es necesario mantener registro de estas infecciones y tratar a la pareja y los contactos. De este modo se pueden prevenir las complicaciones más importantes secundarias a esta infección

Six months study of cases of severe pneumonia treated with inl: cefuroxime [zinacef]

All cases of 2 months to 5 years classified as severe pneumonia according to ARI programme were included in the study. 52 cases of severe pneumonia were treated with Inj: cefuroxime during the study period of G months Oct. 96 to March 97. The purpose of study was to 1] determine efficacy of cefurxime [ZINACEF] in the treatment of severe pneumonia and to compare ii] cost of treatment of cefuroxime with chloramphenicol mid third generation cephalosporins, iii] compare clinical efficacy of cefuroxime with chloramphenicol. 41/52 cases i.e. [78.84%] were below 1 year and 11/52 i.e. [21.15%] were between 1-3 yrs old. All cases were treated with inj: cefuroxime 100mg/kg in 3 divided doses. The response to treatment was good in 30/52 i.e. [57,69%] with recovery in 5 days, while slow clinical response was documented in 14/52 i.e. [26.92%] where treatment was continued for 7 days. In 6/52 cases [11.53%] antibiotic was changed due to lack of response within 48 hrs. Mortality rate was 2/52 i.e. [3.84%]. The study concludes that response of severe pneumonia to cefuroxime [84.61%] is comparable to that of chloramphenicol [89.70%] as reported in our previous study. The cost of cefuroxime is 4 time that of chloramphenicol therapy but it may be safer in so far as incidence of aplastie anaemia is concerned

Diagnóstico de neumonía por legionella pneumophila mediante inmunofluorescencia directa del lavado broncoalveolar / Diagnosis of legionella pneumophila pneumonia through direct immunofluorescence in bronchoalveolar lavage fluid

Investigamos retrospectivamente la presencia de Legionella pneumonophila mediante la técnica de inmunofluorescencia directa (IFD) para detección de antígenos polivalentes (Organon Teknika) en 50 muestras almacenadas de lavado broncoalveolar (LBA). La IFD fue realizada ignorando los datos clínicos de los pacientes, 64 porciento de los cuales habían tenido una neumonía, de acuerdo a criterios clínicos, radiológicos y microbiológicos. La IFD fue positiva en dos muestras. El primero fue un varon de 44 años, con un cuadro clínico de neumonía adquirida en la comunidad, tratada por tres días con penicilina sódica sin resultados. El estudio corriente de LBA no fue diagnóstico. Se trató con roxitromicina, con buena respuesta clínica y radiográfica. El segundo corresponde a un varón de 45 años, con rechazo agudo de transplante renal que desarrolló una neumonía fulminante que lo llevó a la muerte, pese a un tratamiento antimicrobiano de amplio espectro, que incluía eritromicina. Concluímos que en nuestro medio existen neumonías graves por L. pneumophila que pueden ser detectadas mediante IFD de LBA, método que es altamente específico

Profilaxis antibiótica en colecistectomía laparoscópica / Antibiotic prophilaxis in laparoscopic cholecistectomy

Trescientos cincuenta y siete pacientes sometidos a colecistectomía laparoscópica recibieron profilaxis antibiótica de 1,5 gramos de cefuroximo en dosis única en el momento de la inducción anestésica. Hubo infección leve de la herida umbilical en 4 casos (1,1%) y no se presentaron casos de complicaciones sépticas intraabdominales ni sepsis

Estudo comparativo cego com cefuroxima e cefaclor no tratamento das infecçöes das vias respiratórias inferiores / Blind comparative study with cefuroxime and ceflacor in the treatment of the inferior duct respiratory infections

A acetil cefuroxima foi comparada ao cefaclor no tratamento de infecçöes das vias respiratórias inferiores. Sessenta e um paciente foram distribuídos aleatoriamente em três grupos e se submeteram aos seguintes esquemas pososlógicos: (1) axetil cefuroxima, 250 mg por via oral cada 12 horas (21 pacientes); (2) axetil cefuroxima, 500 mg por via oral cada 12 horas (21 pacientes); 3 (3) cefaclor, 500 mg por via oral cada oito horas (19 pacientes). Desses 61 pacientes, 80 por cento eram homens, com idade média de 59,5 anos; 56 por cento apresentavam pneumonia aguda enquanto o restante tinha bronquite aguda. Os patógenos causais incluíram patógenos típicos do trato respiratório. Em suma 23 de 27 pacientes com bronquite estavam clinicamente curados ao se concluído o tratamento. Trinta e um dos 34 casos de pneumonia foram clinicamente curados ou melhoraram ao término da terapia; as três falhas terapêuticas em pacientes com pneumonia ocorreram nos grupos tratados com a menor dose cefuroxima (n=2) e de cefaclor (n=1). De modo geral, houve cura bacteriológica em 86 por cento dos pacientes tratados com 500mg de axetil cefuroxima em comparaçäo com 60 por cento dos pacientes que receberam tratamento com cefaclor. Os efeitos adversos foram raros. Baseando-se neste estudo, concluiu-se que a axetil cefuroxima, administrada cada 12 horas, é pelo menos, täo eficaz quanto o cefaclor em termos clínicos; trata-se de uma nova cefalosporina oral que, em comparaçäo com muitos outros agentes mais antigos, apresenta vantagens farmacológicas e de espectro antibacteriano