Potentiating effect of EDTA-Tris on the activity of antibiotics against resistant bacteria associated with otitis, dermatitis and cystitis.

Possible synergistic effects of the combination of EDTA-tromethamine (EDTA-Tris) and three antimicrobial agents (cephaloridine, kanendomycin and enrofloxacin) against resistant Gram-positive and Gram-negative bacteria are reported. Bacteria were isolated from eight cases of chronic otitis externa, five cases of chronic dermatitis and four cases of recurrent cystitis in dogs which had previously been treated with one of the three antibiotics without success. Animals exposed to EDTA-tromethamine plus the antibiotic recovered completely within 10 days, and were controlled clinically and bacteriologically for 180 days. Local irrigation with EDTA-tromethamine solution was well tolerated and no side effects were recorded.

Prevention of infection in children with acute leukaemia. No major difference between total and selective bowel decontamination.

To evaluate the effect of total bowel decontamination (TD) and selective bowel decontamination (SD) in a non-protective environment clinical and laboratory data of children treated for acute leukaemia between 1983 and 1991 were analysed retrospectively. From 1983 until 1989 34 patients [18 acute non-lymphoblastic leukaemia (ANLL) patients, 16 acute lymphoblastic leukaemia (ALL) patients] received TD and 31 patients (8 ANLL patients, 23 ALL patients) received SD from 1987 until 1991. TD consisted of colistin sulphate, neomycin, cephaloridine and amphotericin B orally as well as Orabase and sterilized food, while the patients were nursed in a single room. SD consisted of oral colistin sulphate, neomycin and amphotericin B. Those patients with ANLL were nursed in a single room; patients with ALL were nursed in a single room during remission induction therapy only. All patients except those with ANLL receiving TD received Pneumocystis carinii pneumonia prophylaxis with cotrimoxazole. Because the two groups were heterogeneous for diagnosis and chemotherapy the occurrence of fever (central body temperature at least 38.5 degrees C) and major infections (septicaemia of infections of the deep tissues or organs) were registered during periods of neutropenia (neutrophilic granulocytes < or = 500/mm3 for at least 8 days). Patients on TD had 55 periods of neutropenia, patients on SD 80. Patients on TD had 89.1 periods of fever/100 periods of neutropenia whereas patients on SD had 56.3. Also patients on TD had 27.3 major infections/100 periods of neutropenia whereas patients on SD had 11.3. Major infections predominantly consisted of septicaemia caused by gram-positive bacteria. We conclude that, in this study, TD in a non-protective environment does not offer better protection against major infections that SD in patients with ALL or ANLL.

[Acute renal failure caused by ceporin, kanamycin and gentamicin]. / Ostraia pochechnaia nedostatochnost', vyzvannaia tseporinom, kanamitsinom i gentamitsinom.

The use of aminoglycosides and cephalosporins is fairly often complicated by acute renal failure (ARF), particularly so if overdoses are used and baseline renal function is impaired. The course of ARF and outcome of treatment have been analyzed in 51 patients. ARF was caused by a nephrotoxic effect of aminoglycosides, cephalosporins or a combination thereof (ARF, type A) in 30 (58.8%) patients, and a combination with other factors (hypotension, arterial hypertension, sepsis) in 21 (41.2%) patients (ARF, type B). Nephrotoxic effect was more commonly produced by a ceporin-gentamicin combination (in 34 (66%) of 51 cases). Nineteen (55.8%) of the 34 patients died, in spite of extracorporeal detoxication treatment (peritoneal dialysis, hemodialysis), which way be attributed to a severe original condition (mostly, due to severe sepsis, original functional renal insufficiency, etc.) rather than the nephrotoxic effect of antibiotics. Hyperazotemia without marked oliguria is a specific feature of ARF, induced by nephrotoxic action of antibiotics. Preventive principles are proposed.

Bacterial corneal ulcers among Arabs in Kuwait.

A retrospective clinicomicrobiological study of 228 patients with bacterial corneal ulcers was performed. Positive cultures of corneal ulcer samples were obtained from 68% of all patients. A high incidence of Staphylococcus epidermidis was isolated from patients' ulcers, Staphylococcus aureus, Pseudomonas, Streptococcus pneumoniae, and Streptococcus were the next most frequent pathogens. Of some help in identifying the causative organism were the locations of the ulcer, the presence or absence of hypopyon and the frequency of perforation of the ulcer. Cephaloridine, gentamicin and polymyxin were found to be the most effective therapy. Gram strains of ulcer samples were positive for organisms in only 13% of patients and accordingly were not considered useful in determining initial therapy of ulcers. Since corneal and conjunctival cultures in the majority of the control group were negative, one can presume that most of the S. epidermidis isolated from patients' ulcers was exogenous in nature.

The cephalosporin antibiotics in pediatric therapy.

The cephalosporins have been available for clinical use for nearly 20 years and a large number is presently marketed, including drugs with a wide range of different pharmacokinetic and microbiologic properties. While some of these agents have certain specific uses in which they excel, the cephalosporins have not replaced older antibiotics but do provide the physician with a broader range of choices for the treatment of many infections, allowing greater individualization of therapy.

The role of muramyl dipeptide in the therapy of established experimental bacterial infection.

Muramyl dipeptide (MDP) actively potentiates host defences and confers protection when given before a bacterial challenge. Experiments were undertaken to characterize its actions when used alone or in combination with cephaloridine in a manner analogous to clinical therapy, i.e. after initiation of bacterial infection. MDP, alone or in combination, significantly decreased the systemic manifestations of infection compared with placebo when administered up to 6 h following bacterial contamination. Its effect on the primary lesion was less marked, but it may potentiate host defences sufficiently to have an impact on the decisive period. Benefits observed in this study were of lesser magnitude than those observed following administration of the dipeptide before bacterial inoculation.

Latamoxef for the prophylaxis of abdominal surgical wound infection: a controlled clinical trial.

In a series of 236 abdominal operations, patients were allocated at random to receive a single intravenous dose of either 1 g cephaloridine or 1 g latamoxef (at induction of anesthesia) for the prophylaxis of postoperative wound infection. Of the 116 patients given latamoxef, one developed major and seven minor wound infections, whereas five major and 21 minor infections occurred in the cephaloridine group (P less than 0.01). Latamoxef has now replaced cephaloridine as our prophylactic antibiotic of choice in potentially contaminated abdominal operations.

Results in the treatment of postoperative endophthalmitis.

A retrospective study of 40 cases of postoperative endophthalmitis was conducted between July 1979 and May 1981. Treatment consisted of topical, periocular, and systemic antibiotics, as well as the use of intraocular antibiotic injection in all cases. In addition, 22 cases had a diagnostic and therapeutic vitrectomy. The cases selected for vitrectomy included cases with worse presenting visual acuity, higher percentage of positive culture results, and more virulent organisms. Because of a poor clinical response to initial therapy, 13 cases had repeat intraocular cultures performed between 24 and 72 hours at the time of repeat intraocular antibiotic injection. All 13 repeat intraocular cultures were negative. Complications of the treatment included four retinal detachments (three in the vitrectomy group). In the culture-positive cases, a final visual acuity of 20/400 or better was achieved in 13 of 29 cases (45%), and complete loss of vision (NLP) resulted in 10 of the 29 cases (34%).

Prophylactic antibiotics in colon surgery.

One hundred twenty-three patients undergoing elective colon surgery were prospectively and randomly assigned to receive either three 1-g perioperative doses of intramuscular cephaloridine or three 1-g preoperative doses of both oral erythromycin base and neomycin sulfate. All patients had their bowels thoroughly cleansed mechanically. The groups were comparable in age and nutritional status. Eight wound infections occurred in the 65 patients receiving cephaloridine (12.3%) v one in the 58 receiving erythromycin and neomycin (1.7%). The difference was statistically significant. Eight of nine infected patients had only wound infections; the majority of cultures yielded Bacteroides fragilis. Serum and tissue antimicrobial concentrations were determined in the first 70 randomized patients at operation. Mean (+/- SD) cephaloridine levels were 14.7 +/- 10.2 and 10.5 +/- 10.0 mg/L in serum and tissue, respectively, compared with 1.98 +/- 1.58 and 0.699 +/- 1.146 mg/L for serum and tissue erythromycin levels.

Antibiotic prophylaxis in cystic fibrosis: inhaled cephaloridine as an adjunct to oral cloxacillin.

The effect of prophylactic antibiotics on bacterial colonization of the respiratory tract and on general progression of cystic fibrosis was studied in a two-year prospective study of 47 mildly to moderately affected patients. One group of patients received inhaled cephaloridine and the other received no inhaled antibiotic; both groups received cloxacillin orally. Carriage of Haemophilus influenzae was greater in the group not receiving inhaled antibiotic (55% vs 20%). Rates of carriage of Staphylococcus aureus (23%). Pseudomonas aeruginosa (greater than 90%). Pseudomonas cepacia (45%), and other organisms were similar in both groups. There were no significant differences between the two groups in incidence of respiratory tract infections or hospital admissions, clinical scores, radiologic scores, or rate of change of pulmonary function. Although continuous antistaphylococcal antibiotic prophylaxis may be successful in suppressing colonization with S. aureus, it may also contribute to the high rates of carriage of Ps. aeruginosa and Ps. cepacia observed in patients with cystic fibrosis.