Piperacillin/tazobactam in the treatment of hospitalized patients with urinary tract infections: an open non-comparative and multicentered trial.

The aim of this multicentered, prospective and open study was to determine the clinical and bacteriological efficacy and safety of piperacillin/tazobactam (4g/500 mg IV tid) in the treatment of 79 adult patients with complicated urinary tract infections (UTI) requiring hospitalization. Forty-seven women and 32 men (mean age 54.2 years, and range 21-91) from 4 Argentinean and 6 Mexican hospitals were enrolled. Sixty-one clinically and bacteriologically evaluable patients were treated for a mean of 9.1 days (range 5-15). A favorable clinical response was seen in 83.6% and 80% at early and late assessment, respectively. Bacteriological eradication was achieved in 85.3% and 80% at early and late estimation, respectively. Escherichia coli was isolated in 33 cases, Klebsiella pneumoniae in 8, Enterococcus spp. in 7, Proteus mirabilis in 6, Pseudomonas aeruginosa in 3, Enterobacter spp. and Morganella morganii in 2. While 21% of all the clinical isolates were resistant to piperacillin, none of them was initially resistant to piperacillin/tazobactam. However, one female patient with a persistent UTI caused by E. coli developed resistance to piperacillin/tazobactam during treatment. A 64-year-old man with frontal meningioma developed purulent meningitis due to Enterobacter cloacae after neurosurgery. He was initially treated with ciprofloxacin, rifampin and amikacin and because of persistence of fever, he was moved to piperacillin/tazobactam. After 5 days of therapy, he developed coma secondary to intracranial hemorrhage and died. By then, the platelet count was normal (220,000/microliters), but the prothrombin time (19.5 seconds) and the partial thromboplastin time (63 seconds) were significantly prolonged. Our data suggest that piperacillin/tazobactam is a reliable therapy for complicated, non-complicated, community or hospital-acquired UTI.

Randomized comparative study of fleroxacin and chloramphenicol in typhoid fever.

This study compared fleroxacin, 400 mg daily for 7 or 14 days, with chloramphenicol, 50 mg/kg per day for 14 days, for the treatment of patients with typhoid fever in a multicenter study. A total of 184 patients were randomly assigned to the three treatment groups. Efficacy was determined by culture of blood and stool, overall clinical response, and time to defervescence. Safety was assessed by occurrence of adverse events and laboratory abnormalities. A total of 97 patients were evaluable for efficacy, 28 in the fleroxacin 7-day group, 35 in the fleroxacin 14-day group, and 34 in the chloramphenicol group. All showed rapid defervescence with high cure rates. Bacteriologic cure rates were 96% in the fleroxacin 7-day group, 97% in the fleroxacin 14-day group, and 85% in the chloramphenicol group. Clinical cure rates were 83-100% with fleroxacin and 82% with chloramphenicol. The time to defervescence was shorter for patients treated with fleroxacin than for those treated with chloramphenicol. All three treatment regimens were well tolerated. Fleroxacin, 400 mg daily for 7 days, appears to be satisfactory for the treatment of typhoid fever and compares favorably with the standard 14-day therapy with chloramphenicol.

Fluoroquinolones in the treatment of typhoid fever and the carrier state.

Typhoid fever remains an important public health problem throughout the world with a higher morbidity and mortality rate in the developing countries. Early establishment of the diagnosis and prompt initiation of treatment with chloramphenicol, ampicillin or trimethoprim-sulfamethoxazole is not necessarily followed by complete resolution of the infection. Between 1% and 6% of patients with typhoid fever become chronic biliary carriers of Salmonella typhi. These carriers are potential factors in the continued transmission of the disease. The increasing emergence worldwide of strains showing multiple resistance to the agents traditionally used in therapy has encouraged investigators to seek alternatives such as third generation cephalosporins and recently the new 4-quinolones, which have greater activity against Salmonella typhi including multi-resistant strains. The fluoroquinolones seem to be the treatment of choice in those regions where resistant strains of Salmonella typhi are prevalent.

Diclofenac potasico como coadyuvante en el tratamiento de la bronquitis aguda. / Potassium diclofenac as adjuvant in the treatment of acute bronchitis

Se valoro con el metodo doble ciego la respuesta sintomatica de 90 pacientes adultos con bronquitis infecciosa aguda a la administracion de diclofenac potasico, metoxipropiocin sodico y placebo en los tres grupos se asocio ampicilina. Los resultados obtenidos permiten concluir que ambos preparados activos ejercen efecto sintomatico sobre la fiebre e inflamacion, que fue mas notable con la administracion de diclofenac potasico. Una vez mas se comprobo la conveniencia del tratamiento sintomatico en este tipo de procesos agudos

Evaluacion de cefadroxil en el tratamiento de infeccion aguda no complicada del tracto urinario. / Evaluation of cefadroxil in the treatment of the non complicated acute urinary tract infection

El monohidrato de cefadroxil 1.000 mg cada 12 horas, via oral, fue evaluado en el tratamiento de 20 pacientes ambulatorios con infeccion aguda no complicada del tracto urinario.La duracion del tratamiento fue de 5 a 10 dias (promedio 7.5 dias).A 17 pacientes (85%) se les aislo E. coli y en el 15% restante se logro aislar P.mirabilis 2 y A. anitratus 1. La respuesta al monohidrato de cefadroxil fue uniformemente satisfatoria. Se observaron efectos secundarios de la terapeutica con cefadroxil en 3 pacientes (15%), consistieron en: nausea y vomito en 2 y exantema generalizado en uno. Los estudios de sensibilidad mostraron que todos los organismos eran sensibles. El monohidrato de cefadroxil parece ser un antibiotico de gran valor en el tratamiento de infeccion aguda no complicada del tracto urinario, causada por bacilos gramnegativos

Evaluacion clinica de amikacina el el tratamiento de infecciones causadas por bacilos gramnegativos. / Clinical evaluation of amikacin in the treatment of infections caused by gram-negative bacilli

Fue evaluada en 20 pacientes la eficacia y seguridad de la amikacina en el tratamiento de pacientes con infecciones causadas por bacilos gramnegativos. Se utilizo una dosis de 15 mg/kg/dia administrada por via endovenosa a 9 pacientes y por via muscular a 11, en dos dosis divididas con intervalos de 12 horas. La duracion del tratamiento fue de 8 a 10 dias (promedio 9 dias). De los 20 pacientes, 5 tuvieron neumonia, 4 infeccion del tracto urinario, 3 infeccion pelvica aguda, 5 septicemias, 1 infeccion quirurgica, 1 absceso de pared abdominal y 1 endocarditis. De los dieferentes sitios involucrados se logro aislar los siguientes organismos: E. coli 4, K. pneumoniae 4, Klebsiella-Enterobacter 8, P. aeruginosa 4, S. marcescens 1, P. mirabilis 2, Enterococo 1 y A. anitratus 1. La respuesta al tratamiento con amikacina fue excelente; no se observaron efectos colaterales serios