Levofloxacino frente a betalactámicos en el tratamiento de la neumonía adquirida en la comunidad con ingreso hospitalario / Levofloxacin versus betalactamic therapy in commu nity-acquired pneumonia that requires hospitaliza tion

Objetivo: Comparar la eficacia y seguridad de levofloxacino frente al tratamiento estándar con betalactámicos en pacientes con Neumonía Adquirida en la Comunidad que cumplen criterios de ingreso hospitalario (NACH). Pacientes y métodos: Estudio prospectivo de un año de duración de 49 pacientes (ptes.) ingresados en el Servicio de Medicina Interna, diagnosticados de NACH con asignación aleatoria a recibir.- I: cefotaxima o ceftriaxona, II: amoxicilina-clavulánico, (las dos previas asociadas o no a un macrólido) o, III: levofloxacino. Se realizó Rx. tórax a los 7 -10 días, al mes y, posteriormente si era necesario. Resultados: 29 ptes. recibieron pauta estándar (I o II) y 20 ptes. levofloxacino. Eran varones el 84%, con edad media de 70,9 años, 57% con enfermedad de base moderada o grave, y 55% con criterios de gravedad inicial. En el 47% de los casos se llegó a diagnóstico etiológico, siendo en un tercio de los casos bacilos gramnegativos. Se produjo la curación en el 94% de los pacientes y éxitus en 2 pacientes (5%). No se observaron diferencias entre los dos grupos en las características demográficas, enfermedad de base ni gravedad inicial. No se detectaron diferencias en los efectos secundarios, complicaciones, estancia hospitalaria o porcentaje de curaciones. La necesidad de prolongar el tratamiento fue mayor en el grupo estándar que en el tratado con levofloxacino (52 vs 15%, p: 0,02). Conclusiones: En población mayor y con gravedad inicial el tratamiento con levofloxacino puede ser una alternativa válida al tratamiento estándar (AU)

Objective: To compare the effectiveness and security of levofloxacin treatment in front betalactamic therapy in patient with community-acquired pneumonia that require hospitalization (CAPH). Patient and methods: A prospective and randomized study along a year from 49 patients diagnosed of (CAPH) that were admitted in the Internal Medicine Service. The patients were assigned randomly to receive.- I: cefotaxime or ceftriaxone, II: amoxicillin/ clavulanate (both could be associated or not with a macrolide) or III: levofloxacin. It was accomplished Rx. thorax to 7 -10 days, to the month and, other reviews if was necessary. Results: 29 cases were in standard therapy (I or II) and 20 cases received levofloxacin therapy. Male 84 %, half age 70,9 years old, 57 % with moderate or severe underlying disease, and 55 % with approaches of initial severity criteria. In 47 % of the cases we arrived to etiologic diagnosis, in the third of the cases were BGN. The cure took place in 94 % of the patients and 2 patients died (5%). No differences were observed regarding demographic characteristics, underlying disease and severity. No differences were detected in: the secondary effects, complications, hospital stay or, mean stay or percentage of cures. The necessity to prolong the therapy was bigger in the standard group in front of the group tried with levofloxacin (52 % vs. 15 %, p:0.02). Conclusions: In bigger population and with initial severity the treatment with levofloxacin can be a valid alternative to the standard therapy (AU)

[Levofloxacin versus beta-lactamic therapy in community acquired pneumonia that requires hospitalization]. / Levofloxacino frente a betalactámicos en el tratamiento de la neumonía adquirida en la comunidad con ingreso hospitalario.

OBJECTIVE: To compare the effectiveness and security of levofloxacin treatment in front betalactamic therapy in patient with community-acquired pneumonia that require hospitalization (CAPH). PATIENT AND METHODS: A prospective and randomized study along a year from 49 patients diagnosed of (CAPH) that were admitted in the Internal Medicine Service. The patients were assigned randomly to receive.-I: cefotaxime or ceftriaxone, II: amoxicillin/clavulanate (both could be associated or not with a macrolide) or III: levofloxacin. It was accomplished Rx. thorax to 7-10 days, to the month and, other reviews if was necessary. RESULTS: 29 cases were in standard therapy (I or II) and 20 cases received levofloxacin therapy. Male 84%, half age 70.9 years old, 57% with moderate or severe underlying disease, and 55% with approaches of initial severity criteria. In 47% of the cases we arrived to etiologic diagnosis, in the third of the cases were BGN. The cure took place in 94% of the patients and 2 patients died (5%). No differences were observed regarding demographic characteristics, underlying disease and severity. No differences were detected in: the secondary effects, complications, hospital stay or, mean stay or percentage of cures. The necessity to prolong the therapy was bigger in the standard group in front of the group tried with levofloxacin (52% vs. 15%, p:0.02). CONCLUSIONS: In bigger population and with initial severity the treatment with levofloxacin can be a valid alternative to the standard therapy.

A replica plating technique for in vitro study of susceptibility of Candida albicans to miconazole, econazole and ketoconazole: some data for standardization.

We report our studies in vitro on the activity of ketoconazole (KZ), econazole and miconazole on 115 isolates of Candida albicans of clinical origin tested by an agar dilution method with three different culture media: yeast morphology agar, Sabouraud maltose agar and Casitone agar (CA). The antifungal effects of the imidazole compounds (IC) were strongest in CA. Eighty percent of the strains were inhibited by 0.1 micrograms/ml of KZ, the most active drug. The frequent appearance of "veil growth" at higher concentrations of the IC made the exact determination of the minimal inhibitory concentration (MIC) difficult. Microscopic examination of the growth on plates at the highest drug dilutions was performed and the results compared with a replica plating technique of IC plates on other plates with antibiotic-free media. The following were observed: a) a residual capacity of cell division of Candida strains even in the presence of high antifungal concentrations to which they are considered sensitive; and b) a certain viability (7% of the cases) of some fungal cells in the residual growth, particularly in those strains with higher conventional MIC. A standardized methodology is needed for the clinical evaluation of the susceptibility tests of Candida to the imidazolic compounds.

Susceptibility of Candida spp. of clinical origin to lucknomycin, a new polyenic antibiotic.

Lucknomycin is a new polyenic derivative antifungal agent obtained from a Streptomyces diastatochromogenes culture. The in vitro activity of the compound was tested against 403 strains of different Candida species of clinical origin by the Sabouraud Agar dilution method. The mean geometrical value of the minimal inhibitory concentrations (MIC) for Candida albicans was 0.85 microgram/ml, 6 times lower than the corresponding value of nystatin (5.29 micrograms/ml) and very close to that of amphotericin B (0.56 microgram/ml). Lucknomycin was also 4-10 times more active than nystatin on other Candida species, with an MIC similar to those obtained with amphotericin B.