Aztreonam in the treatment of urinary tract infections: a multicenter trial.

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 withdrawal of therapy in 5 (0.2%) instances.

[Crystalluria during prophylactic treatment of urinary lithiasis with allopurinol, hydrochlorothiazide, manganese oxide, diphosphonates and propionohydroxamic acid]. / Etude de la cristallurie lors du traitement prophylactique de la lithiase urinaire par l'allopurinol, l'hydrochlorothiazide, l'oxyde de manganèse, les diphosphonates et l'acide proprionohydroxamique.

The study of cristalluria was used as a method to evaluate the severity of nephrolithiasis and the efficacy of different drug therapies. The number and dimensions of urinary crystals as well as the number of crystal aggregates, were determined in patients with infected calcium or uric acid nephrolithiasis. Crystalluria was studied before therapy and at 6 and 12 months during treatment. Marked reduction of crystalluria in patients with uric acid stones treated with allopurinol and in patients with infected stones treated with antibiotics and propionohydroxamic acid (PHA) was observed. Reduction of crystalluria in the group of patients treated with antibiotics alone was lower. We stress usefulness of the study of crystalluria in stone formers, which is also relatively easy to carry out.

Acetohydroxamic acid therapy in infected renal stones.

The use of acetohydroxamic acid at different dosages is recommended in the treatment of renal lithiasis secondary to urease-producing bacteria. The effects of this drug are directed to urinary ammonium and urinary pH reduction and to potentiation of antibiotic therapy.

Urease inhibitor therapy in infected renal stones.

The strict dependence of struvite and carbonate apatite renal stones on the urease-producing germs confirm the need to combine bacterial urease inhibitor drugs with antibiotic treatment. Of the two antiurease drugs used the better results were obtained with acetohydroxamic acid, both for its minimum side effects and its more powerful urease-inhibitor capacity. Thus stone recurrence was avoided even in patients with urinary infection not responding to specific antibiotic treatment.