The American journal of medicine
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The third-generation cephalosporins are useful for empiric therapy of most of the severe infections in adults as a result of their broad spectrum of antimicrobial activity (particularly against clinically important gram-negative bacteria), good tissue penetration, and lack of serious adverse effects. This review examines their use in respiratory tract infections, bacterial meningitis, skin-structure infections, and urinary tract infections in adult patients. Penicillin G remains the optimal therapy for severe community-acquired pneumonia, since Streptococcus pneumoniae still accounts for the majority of cases. ⋯ However, in meningitis in which gram-negative bacilli are suspected and where specific problems include antibiotic resistance among these organisms and the inadequate penetration of many antibiotics into the cerebrospinal fluid, third-generation cephalosporins are the drugs of choice, and they have markedly improved the clinical outcome. Most skin-structure infections are due to S. aureus and are best treated by an anti-staphylococcal penicillin or an older cephalosporin. Nevertheless, the third-generation cephalosporins have proved to be highly effective agents for infections of skin and soft-tissue infections associated with both gram-positive and gram-negative pathogens in patients at risk from these organisms or in the elderly.
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Inappropriate administration of intravenous verapamil to patients with wide QRS complex tachycardia due to ventricular tachycardia or atrial fibrillation with Wolff-Parkinson-White syndrome occurs frequently because of misdiagnosis, and may precipitate a cardiac arrest. We evaluated the safety and the diagnostic and therapeutic utility of adenosine triphosphate administered to a consecutive series of 34 patients during wide QRS complex tachycardia due to a variety of mechanisms. ⋯ In the setting of electrophysiology testing, adenosine triphosphate is a safe agent, even when administered inappropriately during arrhythmias for which it is relatively ineffective, such as ventricular tachycardia, and Wolff-Parkinson-White syndrome with atrial fibrillation. It is an effective agent in terminating supraventricular tachycardia involving the AV node. Tachycardia termination following adenosine triphosphate, when used as a diagnostic test to indicate obligatory participation of the AV node, had a sensitivity of 70%, specificity of 92%, and a positive predictive accuracy of 85%. Thus, adenosine triphosphate also has diagnostic utility, but should be used after the appropriate arrhythmia diagnosis has been made based on the clinical history and analysis of the 12-lead electrocardiogram.