Clinical efficacy and safety of teicoplanin.

This was an open efficacy and safety study in 310 hospitalized patients (187 male and 123 female) with infection by Gram-positive bacteria. The age range was 12-88 years (mean 49.8 years), and 80 of the patients were older than 65 years. Teicoplanin was given either by fast iv or by im injection, in most cases at a dose of 200 or 400 mg every 24 h with an initial dose of 400 mg. For both routes of administration the mean total daily dose was 286 +/- 5 mg/day. The mean duration of treatment was 8.2 days (range 1-37 days). The infections comprised 133 skin or soft tissue, 53 joint or bone, 40 urinary tract, 39 upper respiratory tract, 21 lower respiratory tract, nine septicaemia, four gastro-intestinal tract and 11 miscellaneous. All Gram-positive bacteria isolated were sensitive to teicoplanin. Teicoplanin was the sole antimicrobial agent given in 269 of the 310 patients. Clinical cure occurred in 79.7%, and improvement in 13.6%. Adverse events related to teicoplanin occurred in 7.7% of the patients. Most were minor and in only six patients was treatment discontinued because of adverse events (three allergy, two bronchospasm, one tremor). The laboratory values and audiometry indices in 67 patients showed no significant changes. Teicoplanin was considered an effective and well-tolerated treatment for Gram-positive infections in this study.

Pharmacokinetics of erythromycin in patients with different degrees of renal impairment.

The kinetics of erythromycin (E.) was studied in 16 patients with different degrees of impairment of renal function after a single intravenous dose. Renal clearance of E. was found to be significantly correlated to the creatinine clearance. Total recovery in urine did not exceed 7.5%. As expected from the small fraction excreted via the kidneys, the elimination half-life and the total clearance of E. did not depend on renal function. We conclude that impairment of renal function does not justify a dose adjustment of E. Hearing acuity should, however, be monitored during treatment since transient deafness predominantly in patients with renal failure has been reported by various authors.

[The pharmacokinetics of 1,000 mg erythromycin lactobionate i. v. in patients with respiratory tract infections (author's transl)]. / Pharmakokinetik von 1000 mg Erythromycin-Lactobionat i. v. bei Patienten mit Atemwegsinfektionen.

Pharmacokinetic data were determined in 16 patients with respiratory tract infections who had received 1,000 mg erythromycin lactobionate i. v. The infusion lasted 60 or 30 minutes. The peak concentrations were 33.3 mg/l (60 min group) and 34.4 mg/l (30 min group). The elimination half-lives were 2.0 h and 1.9 h. The concentrations are considerably higher than those found following the peroral administration of erythromycin. We did not find a cumulative effect after four administrations at 12-hour intervals. The clinical efficacy was good.

[Typing of Escherichia coli O and K antigens in patients with urinary tract infections (author's transl)]. / Typisierung von Escherichia-coli-O- und -K-Antigenen bei Patienten mit Harnwegsinfektionen.

In a long-term investigation in children and adult patients with urinary tract infection, 1403 Escherichia coli strains were serotyped and 266 strains were subjected to serological investigation. The most frequently occurring O groups were O6, O8, O2, O18, O4, O75, O1, O22, O7 and O9. L type antigens were predominant among the K antigens. Infants in whom pyelonephritis manifested itself for the first time exhibited an above average rate of infection with O2, O4 and O75. A reinfection rate of 84 to 91% was observed in children in follow-up investigations.

["Removing of infection" through nephrectomy of the pyelonephritic atrophic kidney]. / "Infektsanierung" durch Nephrektomie pyelonephritischer Schrumpfnieren?

On the basis of own examinations is shown: 1. In female patients with non-obstructive infections of the urinary tract and unilateral pyelonephritic cirrhosis of the kidney the recidivations of the infections are in general not to be traced back to the flaring up of old germinal areas in them. 2. For this reason the removal of the diseased kidney also does not in general effect a sanation of the infection. In most cases it is not necessary, occasionally even harmful. 3. The nephrectomy with the aim of the sanation of the infection is indicated only then, when was proved that kidney is focus of the germ. This is possible only with the help of an exact localisation diagnostics and identification of the germs.

[Occult reflux (author's transl)]. / Der okkulte Reflux.

Level diagnosis repeatedly performed in patients without roentgenologically demonstrable reflux demonstrated bladder bacteriuria in 80% of the cases. The remaining 20% had supravesical bacteriuria. We called this occult reflux, if reinfection was demonstrated. Contamination of the upper tract by occult reflux can, but must not induce pyelonephritis. Bilateral antireflux surgery frequently eliminates occult reflux of bacteria, so this seems a debatable method of treatment.

[Localizationstudies in female patients with recurrent urinary tract infection. I. Patients without ureterovesical reflux (author's transl)]. / Lokalisationsdiagnostische Untersuchungen bei Patientinnen mit rekurrierenden Harnwegsinfekten. I. Patientinnen ohne vesiko-ureteralen Reflux.

In 16 girls and 12 women with recurrent urinary tract infection without ureterovesical reflux we performed 75 bladder washout-tests. 52 (72%) tests indicated a vesical, 19 (27%) of supravesical bacteriuria. The 16 girls had less often (18%) supravesical bacteriurias than the 12 women (58%). If follows that in the absence of reflux, ascension of bacteria from the bladder to the upper tract is a relatively frequent phenomenon, the pathogenic importance of which is not yet clear. Clinical manifestations and urographic aspect correlated rather poorly with the results of the bladder-washout-test.

[Change of pathogeus and pathogen persistence in chronic urinary tract infections in childhood. E. coli-O-serotypes in follow-up]. / Erregerwechsel und Erregerpersistenz bei der chronischen Harnwegsinfektion im Kindesalter. E. coli-O-Serotypen bei Verlaufsuntersuchungen

In 171 children with urinary tract infections, all strains of E. coli O isolated from the urine in the course of two years were serotyped. The serogroups 06, 02, 08 and 01 were predominant. Follow-up examinations revealed a 78% incidence of reinfection, while relapses (= identical E. coli serotypes or pathogen species) only occurred in 22% of all new episodes. Two thirds of all reinfections by E. coli occurred within two months of the previous E. coli infection.

[Bacteriological studies in outpatients with acute urinary tract infections with particular reference to the resistance spectrum (author's transl)]. / Bakteriologische Untersuchungen bei ambulanten Patienten mit akuten Harnwegsinfektionen unter besonderer Berücksichtigung des Resistenzspektrums

Bacteriological investigation of urinary samples from 1,926 non-hospitalised patients with documented or suspected acute urinary tract infection revealed organisms pathogenic for the urinary tract in 56.4% of the patients, who came from various parts of West Germany. Prevalent pathogens were E. coli (69%) and Proteus mirabilis (14%). E. coli and P. mirabilis demonstrated a low rate of resistance against ampicillin, the cephalosporines, gentamicin, tobramycin, and also against nitrofurantoin, nalidixine acid and trimethoprimsulfamethoxazole. The situation was more unfavourable in the case of Klebsiella and indolpositive Proteus species however, there being a noticeably high proportion of strains resistant to gentamicin and tobramycin.

[Long-term follow-up of children with urinary tract infection: bacterial spectrum, E. coli-serotypes 0, relapse, and reinfection (author's transl)]. / Langzeituntersuchungen bei Kindern mit Harnwegsinfektionen. I. Erregerspecktrum, E.-coli-0-Serotypen, Rezidive und Reinfektionen.

Within 4 years 1400 children were investigated for urinary-tract infection in a long-term study. Children with manifest infection were treated and followed-up. In 59 children with chronic pyelonephritis 159 recurrences were observed: 146 were reinfections (change of organism) and 13 relapses (organism unchanged). Serotyping of 0-antigens showed differences between children with chronic pyelonephritis and children with a single exacerbation within the observation period. Reinfection with resistant bacteria mainly occurred shortly after cessation of therapy.