Penicillin as empirical therapy for patients hospitalised with community acquired pneumonia at a Danish hospital.

INTRODUCTION: We report on the outcome of a study of patients hospitalised with community acquired pneumonia (HCAP) at a Danish university hospital. METHODOLOGY: In a retrospective study of 243 consecutive patients with radiographically verified HCAP, data on clinical and laboratory findings and outcome parameters were collected. Three groups were established according to the initial choice of antibiotic(s): penicillin only (n = 160); non-allergic patients starting broader spectrum therapy (n = 54); and patients with suspected penicillin allergy (n = 29). RESULTS: The overall mortality within three months was 12% and the readmission rate within three months was 20%. The three treatment groups were comparable with respect to most demographic and clinical criteria at baseline. No significant differences in outcome between the groups were found: the mortality was 12.5%, 13.0%, and 10.3%, respectively, p = 0.94, and the readmission rate 20.3%, 24.0%, and 14.8%, respectively; p = 0.63. CONCLUSION: Patients treated for community-acquired pneumonia at a Danish university hospital had clinical outcomes fully at height with findings from other countries, and half of the patients were successfully treated with penicillin monotherapy. No differences in clinical outcomes were documented between patients treated empirically with broad-spectrum therapy and penicillin monotherapy. Therefore, penicillin seems to be a reasonable first choice for initial therapy of HCAP in Denmark as in other regions with similar patterns of microbial pathogens and resistance.

Cholecystokinin-stimulated and postprandial serum concentrations of bile acids in alcoholic liver cirrhosis.

This investigation was undertaken to examine the alterations in serum bile acid concentration after intravenous administration of cholecystokinin and a standard meal in 13 patients with alcoholic cirrhosis. Total 3 alpha-hydroxy bile acids in serum (SBA) were monitored for 2 h after injection of cholecystokinin and for 3 h after the standard meal. The median fasting value of SBA was 39.9 mumol/l (range, 3.2-148 mumol/l). The increase in SBA after cholecystokinin started earlier and lasted shorter than after standard meal stimulation (median, 30 min and 120 min, respectively). The appropriate relative peak levels of SBA were 173% and 212% of the fasting value. The increments were significant (P less than 0.01) within groups but insignificant between groups. Day-to-day variation of postprandial SBA was more pronounced than after cholecystokinin stimulation. The difference, however, was insignificant. An inverse correlation was detected between both fasting and stimulated peak levels of SBA and P-coagulation factors 2, 7, and 10.

Pharmacokinetics of topical gentamicin in total hip arthroplasty.

Two different ways of administering topical gentamicin were examined in patients undergoing total hip arthroplasty. 160 mg gentamicin, dissolved in isotonic saline, was instilled into the wounds of five out of ten patients. In the other five patients, the components of the prostheses were inserted by means of gentamicin-containing cement, 0.5 g per 40 g powder. Both the serum concentrations and the wound concentrations of gentamicin were determined constantly during the postoperative period. The average half-lives of gentamicin in the surgical wounds of the two groups of patients were found to be 3 1/2 and 25h, respectively. The average wound concentration was found to be higher than the minimum inhibitory concentration for staphylococci and aerobic Gram-negative rods for 18 and 11 h, respectively, in the group of patients treated with gentamicin solution compared with 160 and 67 h, respectively, in the group treated with the gentamicin-containing cement.