A randomised, multicentre study of ceftriaxone versus standard therapy in the treatment of lower respiratory tract infections.

In this study the efficacy and cost-effectiveness of i.v. ceftriaxone 1 g once daily (CTX) was compared with standard i.v. antibiotic treatment (STD) for lower respiratory tract infections (LRTI). STD was given according to the guidelines of the American Thoracic Society and consisted of either cefuroxime 1500 mg three times daily (q8h), amoxicillin/clavulanic acid 1200 mg q8h or ceftriaxone 2 g once daily; each with or without a macrolide. After a minimum of 5 days i.v. therapy, patients could be switched to oral therapy. One hundred patients were enrolled in the study; 52 patients received CTX and 48 STD. Groups were comparable with respect to demographic and baseline characteristics. Seventy patients had a confirmed diagnosis of pneumonia. Twenty-nine patients had a severe type I exacerbation of chronic bronchitis. In one patient the diagnosis of LRTI could not be confirmed. In approximately 50% of the patients a microbiological diagnosis could be made. The most important isolated pathogens from sputum and blood were (positive blood cultures in brackets): Streptococcus pneumoniae 14 (9) and Haemophilus influenzae 16. Mean duration of i.v. therapy was 7.4 days in both groups. Average duration of hospitalisation was 15.0 days for CTX patients and 15.9 days for STD patients. Overall cure and improvement rate at the end of treatment was 47 (90%) for patients receiving ceftriaxone 1 g compared to 37 (77%) for patients receiving standard therapy. Pathogens were eradicated or presumed to be eradicated in 84% of the CTX patients and in 76% of the STD patients. Mean total costs per treatment were lower for CTX than for STD treatment: NLG 169 versus 458. These results show, that i.v. ceftriaxone 1 g once daily is as effective as standard therapy in the treatment of LRTI and that its use reduces treatment costs, in view of the multiple daily dosing regimens of most standard therapies.

The stabilising function of the mm. iliocostales and the mm. multifidi during walking.

The myoelectric activity of the mm. multifidi and the mm. iliocostales lumborum of six subjects was recorded during walking. The subjects walked on a treadmill as well as on a fixed walkway. On the treadmill, recordings were made at two different speeds and with a varying loading of the spine. There was almost no difference in myoelectric activity time between the treadmill and the fixed walkway. Related to unloaded walking, both the multifidi and the iliocostales showed an increase in activity time when the subjects carried a load of 5 kg in front of the trunk and a decrease of activity time with a load of 5 kg on the back. A load on the lateral aspect of the body shortened the muscle activity time of the multifidi on the homolateral side. In three subjects the same pattern was found for the iliocostales, but in the other three subjects there was no activity registered at all. On the side contralateral to the load, the multifidi showed no increase of activity time while the iliocostales muscles demonstrated an increase. It is concluded that during walking the iliocostalis muscle has a more important function in lateral bending than the multifidus. It was remarkable that the multifidi muscles of the left side were active for longer periods than were those of the right side in all situations except during lateral loading.