The Journal of antimicrobial chemotherapy
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J. Antimicrob. Chemother. · Sep 1990
Randomized Controlled Trial Clinical Trial Controlled Clinical TrialPrevention of bacterial colonization of the respiratory tract and stomach of mechanically ventilated patients by a novel regimen of selective decontamination in combination with initial systemic cefotaxime.
A novel regimen of selective decontamination (SDD) with initial systemic cefotaxime prevented bacterial colonization of the oropharynx and stomach in mechanically ventilated patients. In a three-group study of all patients receiving prolonged mechanical ventilation, patients in control groups A and B received antibiotics only when infection was present. In group A, antibiotics that disturb colonization resistance (CR) were used. ⋯ In group C, only 12% and 24% of the patients acquired colonization of the oropharynx and stomach respectively (P less than 0.001). The oropharynx and stomach were the major sources of microorganisms causing lower respiratory tract infection in both control groups. In group C, elimination of oropharyngeal and gastric colonization completely prevented lower respiratory tract infection from these sources.
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Meropenem and comparative antibiotics were evaluated in five models of infection. All antibiotics were administered parenterally; imipenem was used in combination with cilastatin but meropenem and other agents were given alone. Generalized infections in mice caused by Staphylococcus aureus, Streptococcus pneumoniae, Escherichia coli, Serratia marcescens, Proteus mirabilis or Pseudomonas aeruginosa all responded to low doses of meropenem or imipenem. ⋯ Infection with Ps. (Xanthomonas) maltophilia localized to the subcutaneous neck tissue of guinea pigs was also treated successfully. Lung infections caused by Ps. aeruginosa in guinea pigs were treated effectively by meropenem, imipenem, and ceftazidime at the dose of 10 mg/kg but only meropenem eradicated bacteria from all the tissues examined. These results demonstrate that meropenem has excellent antibacterial activity in vivo in both normal and immunocompromised animals and in some models of infection is superior to imipenem.
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J. Antimicrob. Chemother. · Mar 1989
Effect of Bacteroides fragilis on mortality induced by Escherichia coli in an experimental infection treated with cefotaxime, aztreonam or gentamicin.
The possibility that beta-lactamase-producing strains of Bacteroides fragilis can protect Escherichia coli from cefotaxime was studied in an in-vivo model of peritoneal infection in rats. The protective effect of cefotaxime, aztreonam and gentamicin in peritonitis induced by E. coli alone or combined with B. fragilis was evaluated by analysing mortality at 24 and 48 h after bacterial inoculation and treating the animals with two doses of each antibiotic. ⋯ Infections by mixed flora or E. coli alone treated with aztreonam or gentamicin did not show any significant difference in mortality rate analysed at 24 or 48 h. These in-vivo results confirm previous in-vitro studies and suggest that cefotaxime could be inactivated in mixed infections if a beta-lactamase-producing strain, such as B. fragilis, is involved in a clinical infection.
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J. Antimicrob. Chemother. · May 1988
Treatment of bacterial meningitis with once daily ceftriaxone therapy.
Ceftriaxone, a cephalosporin with an extended half-life and excellent antibacterial activity was used to treat bacterial meningitis, given as a single daily intravenous dose of 100 mg/kg on day one, followed by 80 mg/kg daily. A total of 22 patients were treated, of whom 14 had Haemophilus influenzae type b, five had Streptococcus pneumoniae and three Neisseria meningitidis isolated from their CSF. ⋯ Side effects encountered included mild diarrhoea (32%), thrombocytosis (77%) and neutropenia (9%), but none caused therapy to be stopped. Ceftriaxone is a safe and effective antibiotic for the treatment of bacterial meningitis when administered once daily.
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J. Antimicrob. Chemother. · Sep 1983
Review Randomized Controlled Trial Comparative Study Clinical TrialInterim summary of mortality in herpes simplex encephalitis and neonatal herpes simplex virus infections: vidarabine versus acyclovir.
Herpes simplex encephalitis and neonatal herpes simplex virus infections are important consequences of herpes simplex virus infections of humans. The association of both diseases with significant mortality and morbidity has prompted intensive therapeutic trials designed to improve outcome. The NIAID Collaborative Antiviral Study Group has been able to demonstrate that vidarabine therapy decreases the mortality and improves morbidity for both herpes simplex encephalitis and neonatal herpes simplex virus infections. ⋯ Because adequate numbers of patients for definitive statistical analyses have not been entered into the trial, data were assessed according to outcome for the entire group, irrespective of drug administered. The mortality of herpes simplex encephalitis and neonatal herpes simplex virus infections has been reduced to 34 and 30%, respectively, a decrease of approximately 10% for each disease. Further analyses await completion of the trials.