The Journal of antimicrobial chemotherapy
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J. Antimicrob. Chemother. · Jul 1992
Randomized Controlled Trial Clinical TrialA controlled trial of selective decontamination of the digestive tract in intensive care and its effect on nosocomial infection.
Nosocomial infection is a major problem in intensive therapy units (ITUs) and a significant cause of mortality. Selective decontamination of the digestive tract (SDD) has been advocated as a means to reduce ITU morbidity and mortality. Ninety-one patients in a general ITU underwent SDD, consisting of topical polymyxin E, tobramycin and amphotericin B administered throughout the unit stay together with parenteral ceftazidime for the first three days, and were compared with 84 historical and 92 contemporaneous control patients who were treated conventionally. ⋯ Screening specimens revealed a significantly higher rate of colonization with resistant Acinetobacter spp. in the contemporaneous control than in the other two groups of patients; infection caused by resistant bacteria did not occur. SDD did not lead to a significant reduction in the use of systemically-administered antibiotics when compared with either control group. SDD may be used selectively in an ITU without ill effects on those patients not receiving SDD; nevertheless, microbiological monitoring is needed to detect emergence of resistant bacteria in the unit.
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J. Antimicrob. Chemother. · Apr 1992
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialCefpirome versus ceftazidime in the treatment of urinary tract infections.
In an open, randomized multiclinic trial, hospitalized patients with upper or complicated lower urinary tract infections requiring treatment with a parenteral antibiotic were randomized to receive 1 g doses of cefpirome (594 patients) or ceftazidime (303 patients) 12 hourly for at least five days. Cefpirome was considerably more active in vitro than ceftazidime against Gram-positive pathogens isolated from the urine samples. At the early follow-up, 2-15 days after treatment, clinical cure was achieved in 86% and 82% of the patients in the cefpirome and ceftazidime groups respectively. ⋯ No specific type of adverse reaction accounted for this difference. Treatment was discontinued because of adverse events in 2.5% and 1.7% of the patients respectively. Cefpirome was found to be safe and at least as effective as ceftazidime for the treatment of urinary tract infections in hospitalized patients.
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J. Antimicrob. Chemother. · Nov 1991
Randomized Controlled Trial Comparative Study Clinical TrialThree-day treatment of typhoid fever with two different doses of ceftriaxone, compared to 14-day therapy with chloramphenicol: a randomized trial.
Fifty-nine adult Filipino patients suffering from typhoid fever documented by blood culture were randomly allocated to one of three different drug regimens. Nineteen patients received 3 g ceftriaxone iv once daily for three days. Twenty patients received 4 g ceftriaxone iv once daily for three days and 20 patients received oral chloramphenicol 3 g daily in divided doses for two days followed by 2 g daily for 12 days. ⋯ Three patients relapsed within 15 to 17 days in the chloramphenicol group. Fever subsided in most patients between six and eight days, with three patients having a prolonged and moderate fever for 11 days in the ceftriaxone groups. This study suggests that a short treatment of three days of typhoid fever with ceftriaxone (3 or 4 g once daily) is adequate and not hazardous as far as relapses are concerned.
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J. Antimicrob. Chemother. · May 1991
Randomized Controlled Trial Comparative Study Clinical TrialThe pharmacokinetic of amikacin in critically ill adult and paediatric patients: comparison of once- versus twice-daily dosing regimens.
The pharmacokinetic profile of amikacin was analysed by a two-compartment model in 100 critically-ill adult and paediatric patients with normal renal function. In addition the serum amikacin levels in 200 patients randomized to receive a once- or twice-daily dosing regimen are reported. The mean volume of distribution (Vdt) was 0.33 l/kg in the adult patients, 0.50 l/kg in patients 6 to 12 months of age and 0.58 l/kg in patients less than 6 months old. ⋯ In comparison, therapeutic concentrations were achieved in only 48% of adult and 44% of the paediatric patients receiving the twice-daily dosing regimen. Furthermore the amikacin trough concentrations were significantly higher in the patients who received a divided daily dose. As a consequence of the pharmacokinetic profile of amikacin in critically ill patients a once-daily dosing regimen may be more effective and less toxic than the conventional twice-daily dosing regimen.
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J. Antimicrob. Chemother. · Oct 1990
Comparative Study Clinical TrialPefloxacin in the treatment of septicaemia: three years' experience.
Sixty cases of septicaemia treated with pefloxacin, alone (30) or in combination with other antibiotics (30) were analysed retrospectively. A satisfactory outcome was achieved in 33 (87%) of 38 evaluable Gram-negative septicaemias (including success in 25 of 29 treated with pefloxacin alone) and in 15 of 21 staphylococcal septicaemias, mainly treated with combinations of antibiotics. Failures and relapses were associated with a variety of local or systemic underlying conditions.