[Comparative in vitro activity of ampicillin, cefoperazone, their combinations with sulbactam and other antibiotics with respect to staphylococci and pneumococci]. / Sravnitel'naia aktivnost' in vitro ampitsillina, tsefoperazona, ikh kombinatsii s sul'baktamom i drugikh antibiotikov v otnoshenii stafilokokkov i pnevmokokkov.

Antibiotic susceptibility of 225 Staphylococcus strains and 42 Pneumococcus strains was assayed with the method of serial microdilutions. Methicillin resistant Staphylococcus strains (S. aureus and coagulase negative strains) were characterized by high susceptibility to cephalosporins and ampicillin + sulbactam combination, as well as to ciprofloxacin, rifampicin and vancomycin (70 to 100 per cent of the susceptible strains). Less than 50 per cent of the strains was susceptible to erythromycin. The methicillin resistant Staphylococcus strains preserved their high susceptibility to vancomycin and rifampicin (the coagulase negative strains also preserved their susceptibility to ciprofloxacin). Four Pneumococcus strains with the intermediate resistance to benzylpenicillin were isolated (for 9.6 per cent of the strains the MIC was 0.12 to 1.0 micrograms/ml). The growth of 2 out of these 4 strains was inhibited by the ampicillin + sulbactam combination in a concentration of less than 0.5 micrograms/ml and by cefotaxime and the cefoperazone + sulbactam combination in a concentration of less than 1.0 micrograms/ml. The growth of the other 2 strains was inhibited by betalactams in concentrations higher than the above mentioned.

[Attempt to use cefpiramide (Tamicin) in patients with infectious destructive lung diseases]. / Opyt primeneniia tsefpiramida (Tamicin) u bol'nykh s infektsionnymi destruktivnymi zabolevaniiami legkikh.

The clinical efficacy and tolerance of cefpiramide were studied in 34 patients at the age of 15 to 79 years with infectious destructive lesions in the lungs. The clinical efficacy amounted to 88.2 per cent. Out of 39 strains of grampositive and gramnegative aerobes and anaerobes 85 per cent were sensitive to cefpiramide. The bacteriological efficacy of cefpiramide amounted to 71.4 per cent. In 11.7 per cent of the patients involved in the trial there were recorded adverse reactions to cefpiramide. The results of the study made it possible to recommend the drug for the treatment of patients with severe and complicated infectious destructive lesions in the lungs.

[Comparative in vitro activity ampicillin, cefoperazone, their combinations with sulbactam, as well as that of other antibiotics against aerobic gram-negative microorganisms]. / Sravnitel'naia aktivnost' in vitro ampitsillina, tsefoperazona, ikh kombinatsii s sul'baktamom, a takzhe drugikh antibiotikov v otnoshenii aérobnykh gramotritsatel'nykh mikroorganizmov.

The activity of 12 antibiotics against 849 strains of gram-negative aerobes isolated in special and general hospitals of Moscow and Smolensk in 1992-1993 was assayed with the method of serial microdilutions. By the criteria of the activity (percentage of the susceptible strains by the NSSLS criteria) against the isolates the antibiotics were arranged as follows: ciprofloxacin (89.8 per cent) > imipenem (89.6 per cent) > cefoperazone + sulbactam (86.1 per cent) > amikacin (83.8 per cent) > ceftazidime (81.8 per cent) > ceftriaxone (71.1 per cent) > cefoperazone (70.9 per cent) > cefotaxime (70.9 per cent) > gentamicin (60.8 per cent) > ampicillin + sulbactam (44.7 per cent) > cefazolin (37.5 per cent) > ampicillin (23.0 per cent). The frequency of the antibiotic susceptible isolates in the special hospitals was lower at the average by 20 per cent than that in the general hospitals with respect to all the antibiotics assayed.

[Characterization of microflora in pyo-destructive lung diseases]. / Kharakter mikroflory pri gnoino-destruktivnykh zabolevaniiakh legkikh.

The microflora pattern of the endobronchial secretion was investigated in 74 patients with purulent destructive diseases of the lungs. Specimens of the endobronchial secretion were collected by transtracheal aspiration and bronchoalveolar lavage. The anaerobic isolates were cultivated in anaerostats (OXOID, England) with the use of GasPacks. Bacteriological identification of the pathogens was carried out with respect to 67 patients (90.5 per cent). Non-sporulating anaerobic microflora was isolated from 51 patients (76.1 per cent). Anaerobic causative agents in the patients with complicated pulmonary destructions were detected in 54.3 per cent of the cases. Mono-infection represented by one species of the anaerobes was stated in 23 patients (34.4 per cent). Associations of aerobes and anaerobes were isolated from 28 patients (41.7 per cent). Associations of one strain of the anaerobic causative agents and aerobic microflora were detected in 17 patients (60.7 per cent). In 11 patients the microflora pattern was polymicrobial (89.3 per cent). A total of 66 strains of non-sporulating anaerobic pathogens were isolated. Gram-negative bacilli represented by Prevotella spp., Porphiromonas asaccharolitica and Bacteroides spp. were the most frequent isolates.

[Comparative clinical effectiveness and tolerance of azithromycin (sumamed) and erythromycin in patients with sinusitis]. / Sravnitel'naia klinicheskaia éffektivenost' i perenosimost' azitromitsina (sumamded) i éritromitsina u bol'nykh s sinusitami.

Clinical efficacy of azithromycin and erythromycin was compared in an open trial in 32 and 18 patients with acute sinusitis respectively. The following pathogens were isolated: Haemophilus influenzae (29.8 per cent), Streptococcus pneumoniae (19.1 per cent), Staphylococcus aureus (10.6 per cent), Streptococcus faecalis (8.5 per cent) and other microbes (8.5 per cent). Azithromycin was administered in a dose of 500 mg on day 1. During the following 4 days it was administered in a dose of 250 mg. Erythromycin was administered in a dose of 500 mg 4 times a day for 8 to 10 days. 91.2 per cent of the aerobic microflora were sensitive to azitromycin and 85.3 per cent were sensitive to erythromycin. One of 14 strains of H. influenzae proved to be resistant to azithromycin, 3 strains were resistant to erythromycin. Complete recovery was stated in 90.6 per cent of the cases treated with azithromycin and 66.7 per cent of the cases treated with erythromycin.

Use of gentamicin physiologically-based model for individual dosing.

A new approach to fixing initial doses of gentamicin (GM) for i.m. administration (that is most commonly used anyway) is discussed. This approach is based on a physiologically-based model allowing to reproduce individual patterns of GM concentration change in the patient's blood. This approach was used to reproduce the individual pattern of GM concentration change after the initial i.m. administration of 80 mg to 19 male patients (age-range 21 to 73 years, weight range 50-94 kg, creatinine concentration in the blood 0.4-1.6 mg/d). The GM concentration levels, obtained with the help of this model, were afterwards compared to the results of FPIA measurement of GM concentrations in the blood of the patients 0.5, 1, 2, 3, 5 and 7 h after administration. It proved that the average deviation of the predicted values from the actual was equal to 20 per cent for all the measuring time-points. For comparison we used individual patterns of GM distribution in blood calculated according to the one-compartment model from the same values of Vd, Cl and dose. In this case the error of pharmacokinetic prediction exceeded the 20 per cent and amounted to 43 per cent by 0.5 and 7 hours. Thus, the new approach with the physiologically-based model provides better accuracy for stable pharmacokinetic prediction for longer stretches of time upon administration, which is especially important for the correct establishment of dosing intervals.

[Use of a physiological model of gentamicin pharmacokinetics for individual dosage of the antibiotic]. / Ispol'zovanie fiziologicheskoi modeli farmakokinetiki gentamitsina dlia individual'nogo dozirovaniia antibiotika.

A new approach to fixing the initial doses of gentamicin (GM) for its intramuscular administration (the most commonly used anyway) is discussed. The approach is based on the physiological model reproducing the individual patterns of GM concentration change in patient's blood. Such parameters of the model as blood flow velocity and actual average volume of specific tissues as well as the tissue to the blood partition coefficient (Kp) are constant. They were used to calculate the volume of distribution in the body specific organs (Vs). The apparent distribution volume (Vd) and total clearance (Cl) are individual parameters. The Vd value was calculated individually for every particular patient depending on the body weight by the known equations. The difference between Vd and Vs was used to calculate the individual Kp for the organs and tissues which were not specially examined. When calculating Cl of GM, the patient's sex, age, weight and creatinine concentrations were taken into account. To evaluate the local velocity of blood flow after antibiotic intramuscular administration, it was important to consider the patient's sex and age. The approach was used to reproduce the individual patterns of GM concentration change after the initial administration of the antibiotic, 80 mg, to 19 male patients (age range, 21 to 73 years; weight range, 50 to 94 kg; blood creatinine concentration, 0.4 to 1.6 mg/dl). The GM concentrations attained with the use of the model were afterwards compared to the data on FPIA. (TDx, Abbott) by measuring the GM concentrations in the blood of the patients 0.5, 1, 5 and 7 hours after the administration.(ABSTRACT TRUNCATED AT 250 WORDS)

[The use of the carbon dioxide laser in acute surgical infection of the soft tissues]. / Ispol'zovanie uglekislotnogo lazera pri ostroi khirurgicheskoi infektsii miagkikh tkanei.

Clinico-laboratory studies were conducted in 46 patients with wound infection for the treatment of which carbon-dioxide laser was used, and in 78 patients who were operated on with a metal scalpel (control). It is shown that "excision" and "evaporation" of tissues took 15-45 minutes. Repeated interventions were performed in 15% of cases due to bleeding from vessels measuring 1.0-1.5 mm in diameter. After surgical debridement with a scalpel the number of microbes reduced from 10(7)-10(9) to 10(3)-10(4) per g. After exposure to the laser beam this value was 10(1) but on day 3-4 it was 10(5)-10(6). The extent of the zone of coagulation necrosis in the zone exposed to the laser beams measured up to 500 microns, and began diminishing only on day 7-9 of postoperation. Suppuration of the wounds in 56% of patients of the main group treated by operation was in conformity with the results of bacteriological and morphological studies. In the control group this index was 15.4%. It is concluded that the use of carbon-dioxide laser as a "light scalpel" with subsequent primary closure of the wound is inexpedient. Its use in preparing a wound for closure with secondary sutures has no advantages over radical surgical debridement.

[Characteristics of wound infection in long-term crush syndrome]. / Osobennosti ranevoi infektsii pri sindrome dlitel'nogo razdavli- vaniia.

Clinicobacteriological examination was carried out in 31 patients with the crush syndrome (CS) and extensive damage to the soft tissues in combination with bone fractures complicated by wound infection. Inadequate surgical treatment in the early periods after the trauma (complete closure of the wound, making small incisions of the involved skin and subcutaneous fat) is particularly hazardous in such cases because it leads to the development of severe wound infection. This disease is marked by a complex polymicrobial structure of the causative agents, massive dissemination of aerobic and opportunistic anaerobic bacteria in the purulent focus (10(7)-10(9) microbial bodies), and a high proportion (48.4%) of obligate anaerobic microflora. Wound infection in the CS takes a grave clinical course, but without profound microbiological study it is difficult to differentiate it into aerobic and anaerobic (clostridial and ++non-clostridial) forms. This is evidence of the need for emergency extended bacteriological diagnosis at all the stages of treatment. "Pure" aerobic infection was identified in half of the patients and mixed aerobic-anaerobic infection in the other half. The possibility of the involvement of asporogenic anaerobes is shown (35.5% of cases). The high risk of the development of gas gangrene is detected (9.7%) and its is concluded that early prevention is necessary by adequate surgical intervention, adequate intensive antibacterial and detoxification therapy, including hyperbaric therapy. The efficacy of current antigangrene immunization agents must be evaluated.

[Empirical antibiotic therapy of wounds complicated by anaerobic non-clostridial infection]. / Empiricheskaia antibiotikoterapiia ranevogo protsessa, oslozhnennogo anaérobnoi neklostridia'lnoi infektsiei.

Antibacterial activity of 14 drugs against clinical strains of asporogenic anaerobes causing wound infections in the soft tissues i. e. Bacteroides fragilis and Bacteroides melaninogenicus as well as anaerobic gram-positive++ cocci was assayed with the method of serial dilutions in agar. It was shown that among the investigated species B. fragilis had the most marked resistance since out of the 14 drugs only 8 were sufficiently active against it i.e. carbenicillin, levomycetin, lincomycin, dioxidine, metronidazole, thinidazole, nitrazole and erythromycin. The choice of drugs for treating infections caused by B. melaninogenicus and anaerobic grampositive cocci unlike those caused by B. fragilis offered no difficulty since practically++ all the investigated drugs were highly active against the causative agents. There was observed relationship between the frequency of asporogenic anaerobes and the wound genesis. The characteristic features of the species composition connected with localization of the suppurative foci were indicated. The detected specific antimicrobial profiles of the asporogenic anaerobes causing wound infections and the peculiarity of their participation in development of purulent infections of the soft tissues provided a differential approach to empirical antibacterial therapy prior to the pathogen bacteriological investigation and availability of the antibioticograms.