[The clinical efficacy of ticarcillin/clavulanate in severe pneumonia]. / Klinicheskaia éffektivnost' tikartsillin/klavulanata pri tiazheloi pnevmonii.

Efficacy of ticarcillin/clavulanate was studied in the treatment of 11 patients with severe community- and hospital-acquired pneumonia in an open controlled trial. The drug was administered in a dose of 3.1 g every 4 or 6 hours depending on the infection severity. When pneumonia was due to Pseudomonas aeruginosa, amikacin was additionally used. The positive clinical effect of ticarcillin/clavulanate was stated in 73 per cent of the patients. The pathogen eradication was stated in all the patients. However, in 2 cases superinfection due to P.aeruginosa developed. Mild adverse effects were observed in 2 cases. It is concluded that ticarcillin/clavulanate is highly efficient in the treatment of patients with severe or complicated pneumonia. In cases with ventilator-associated pneumonia it is advisable to use ticarcillin/clavulanate in combination with an aminoglycoside.

[Program of empirical antibacterial therapy of community-acquired pneumonia]. / Razrabotka programmy émpiricheskoi antibakterial'noi terapii vnebol'nichnoi pnevmonii.

Clinical and bacteriological efficacies of some antibacterial agents were estimated with their differential use in the management of various groups of patients with community-acquired pneumonia. Group 1 included young and middle-aged patients with mild pneumonia. Group 2 included young and middle-aged patients with moderate pneumonia. Group 3 included elderly patients with pneumonia and/or patients with concomitant diseases or certain factors complicating the main process. The patients of group 1 were treated with roxithromycin and spiramycin and showed a rapid clinical effect in 100 and 86 per cent of the cases and a rapid bacteriological effect in 84 and 75 per cent of the cases respectively. The patients of group 2 were treated with parenteral cefuroxime with positive clinical and bacteriological effects in 68 and 78 per cent of the cases respectively. The patients of group 3 were treated with ceftibuten and pefloxacin which provided a clinical effect in 91 and 70 per cent of the cases and a bacteriological effect in 72 and 100 per cent of the cases respectively. The results of the treatment with an account of the differences in the pathogen spectra made it possible to recommend as the 1st order agents for the empirical therapy of community-acquired pneumonia (1) macrolide antibiotics for young and middle-aged patients with mild pneumonia without concomitant diseases, (2) 2nd generation cephalosporins for patients with moderate pneumonia without severe concomitant diseases and (3) 3rd generation cephalosporins or fluoroquinolones for elderly patients with pneumonia and the patients with complicating factors.

[Stepwise therapy of community-acquired pneumonia. Results of cefuroxime and cefuroxime axetil study]. / Stupenchataia terapiia vnebol'nichnoi pnevmonii. Rezul'taty issledovaniia tsefuroksima i tsefuroksim aksetila.

The efficacy of a 7-day switch therapy with parenteral cefuroxime in a dose of 750 mg for 3-5 days followed by the use of oral cefuroxime axetil in a dose of 500 mg every 12 hours was compared with that of a 7-day therapy with parenteral cefuroxime in a dose of 750 mg every 8 hours in hospitalized patients with community-acquired pneumonia. The clinical and bacteriological efficacies and pharmacokinetic properties of both the dosage forms were estimated. It was shown that the clinical and bacteriological effects did not significantly differ in the patients under the parenteral regimen with cefuroxime and under the parenteral-to-oral regimen with cefuroxime and cefuroxime axetil: the cure in 75 and 83 per cent of the patients and the bacteriological response in 100 and 86 per cent of the cases respectively. The results indicated that the cost of the switch therapy was much lower while the efficacy did not decrease.

[Use of piperacillin/tazobactam as empirical monotherapy in the treatment of bacterial infections in a resuscitation department]. / Primenenie piperatsillin/tazobaktama v kachestve émpiricheskoi monoterapii pri lechenii bakterial'nykh infektsii v reanimatsionnom otdelenii.

Fifteen patients with severe bacterial infection (12 with pneumonia) that developed in the resuscitation unit were subjected to the empirical monotherapy with piperacillin/tazobactam (P/T) or tazocin under an open randomized controlled experiment. P/T was administered intravenously in a dose of 4.5 g every 8 hours for 5 to 12 days (9.3 days on the average). When the monotherapy was not sufficiently efficient the patients were additionally treated with amikacin administered intravenously in a dose of 0.5 g every 8-12 hours. The favourable effect was observed in 14 patients (93 per cent). 7 of them were treated with P/T alone and 7 were treated with P/T in combination with amikacin. The primary pathogens were eradicated in 8 (73 per cent) out of the 11 patients treated with P/T alone. Before the treatment 34 microbial strains were isolated from the patients. 77 per cent of them were susceptible to P/T. The treatment with P/T resulted in eradication of 27 bacterial strains (79 per cent) including 67 per cent of gram-positive organisms and 86 per cent of gram-negative organisms. The adverse effects were recorded in 1 patient on the 6th day of the treatment: skin eruption and pruritus that required the treatment discontinuation. The results showed that the use of P/T in the initial empirical monotherapy of infections in patients under resuscitation conditions could be efficient.

[Clinical trials of ofloxacin in sequential use (intravenous and oral) in patients with serious hospital infection]. / Klinicheskoe izuchenie ofloksatsina pri posledovatel'nom primenenii (vnutrivenno i vnutr') u bol'nykh s ser'eznymi gospital'nymi infektsiiami.

Fifteen patients with severe hospital infections such as postoperative pneumonia or intraabdominal sepsis were treated with ofloxacin in a dose of 400 mg once a day for 7 to 14 days (11 days at the average). The drug was administered intravenously for the first 3-5 days and then orally till the end of the treatment course. The clinical effect was observed in 14 patients (93 per cent) and the positive bacteriological effect was stated in 11 out of 13 patients (85 per cent). Before the treatment 18 microbial cultures were isolated from the patients. 94 per cent of them was susceptible to ofloxacin. The isolates of Escherichia coli, Staphylococcus aureus and Pseudomonas aeruginosa were the most frequent. The treatment resulted in the eradication of 15 cultures (83 per cent). The adverse reactions were observed in 3 patients but only in 1 of them they were for certain due to the drug use. All the adverse reactions were insignificant or moderate and did not require the treatment discontinuation. The trials showed that ofloxacin was a highly efficient agent useful in the empirical monotherapy of patients with severe hospital infection.

[Cefpirome--a fourth generation antibiotic for the treatment of severe hospital infections]. / Tsefpirom--tsefalosporinovyi antibiotik IV pokoleniia dlia lecheniia tiazhelykh gospital'nykh infektsii.

The efficacy of cefpirome was estimated in the treatment of 12 patients with severe hospital infection in the Municipal Hospital No. 7. The positive clinical effect at the background of the cefpirome use was recorded in 11 patients. The eradication of the primary pathogens was stated in 10 patients. 116 isolates were tested for their susceptibility to cefpirome. 92 per cent of the isolates from outpatients and 79 per cent of the isolates from inpatients proved to be susceptible to the antibiotic. The results of the cefpirome use in the treatment of patients with various infections in 6 hospitals of Moscow were analyzed. The positive clinical effect was observed in 103 out of 111 patients (93 per cent). The eradication of the primary pathogens was recorded in 90 out of 102 patients (88 per cent). In the treatment of the lower respiratory tract infection, urinary tract infection and surgical infection the positive clinical results were stated in 91, 95 and 96 per cent of the cases respectively. Insignificant or moderate side effects of the drug were observed in 17 patients. Discontinuation of the drug use because of the side effects was required in 2 of them. The results showed that the use of cefpirome in the monotherapy of various severe hospital infections was efficient and safe.

[Preparation and properties of acid proteinase from Aspergillus awamori]. / Preparat kisloi proteinazy Aspergillus awamori i nekotorye ee svoistva.

From the culture liquid filtrate of Aspergillus awamori 78-2 a preparation of acid proteinase was isolated and its properties were described. This producer was shown to have a peculiar capacity of synthesizing under submerged conditions extracellular acid proteinase as the sole proteolytic enzyme. The preparation of acid proteinase showed a comparatively high hydrolyzing capacity. Under optimal conditions the enzyme degraded hemoglobin and albumin almost completely. The possibility of purifying and concentrating acid proteinase on the ion-exchange resin KB 51 X 2 was explored.