Antimicrobial agents and chemotherapy
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Antimicrob. Agents Chemother. · Aug 1989
Efficacy of mupirocin in methicillin-resistant Staphylococcus aureus burn wound infection.
Methicillin-resistant Staphylococcus aureus strains (MRSA) have become increasingly prevalent as nosocomial pathogens, especially in burn wounds. MRSA constituted 38% of all S. aureus isolates in our 25-bed burns unit despite the utilization of a combination of 1% silver sulfadiazine and 0.2% chlorhexidine as topical therapy. Mupirocin, a new antibiotic, has proved in vitro and in vivo to be highly effective in the treatment of MRSA infections. ⋯ Treatment was well tolerated by all children. We recommend that mupirocin in its present polyethylene glycol base should be used only on a selective basis, when current prophylactic topical therapy has failed to control MRSA infection in burns of less than 20% of the total body surface area, and that it should be applied only for a limited period of 5 days. The safety and the efficacy of mupirocin in burns exceeding 20% of the total body surface area need to be established.
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Antimicrob. Agents Chemother. · Jun 1988
Randomized Controlled Trial Comparative Study Clinical TrialRandomized clinical trial of rifampin-trimethoprim and sulfamethoxazole-trimethoprim in the treatment of localized urinary tract infections.
To investigate whether 10 days of rifampin-trimethoprim (RIF-TMP) or 6 weeks of sulfamethoxazole-trimethoprim (SMX-TMP) would decrease the relapse rate in patients with acute uncomplicated upper urinary tract infections in comparison with 10 days of SMX-TMP, we randomized 189 patients to receive RIF-TMP or SMX-TMP in a ratio of 1:2. After the site of infection was established by the antibody-coated bacterium (ACB) test, patients with upper-tract infections who received SMX-TMP were again randomized and received either a total of 6 weeks or 10 days of therapy. All patients who received RIF-TMP were treated for 10 days. ⋯ This 6% relapse rate was not different from the 4% relapse rate observed in patients with upper-tract infections who received 10 days of SMX-TMP. The number of patients who discontinued treatment because of an adverse effect in the 6-week SMX-TMP treatment group was significantly greater than those in the 10-day SMX-TMP treatment group (P=0.003) and the RIF-TMP treatment group (P=0.05). Ten days of SMX-TMP was as effective as 6 weeks of SMP-TMP or 10 days of RIF-TMP in the treatment of uncomplicated upper urinary tract infections and caused the fewest untoward effects.
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Antimicrob. Agents Chemother. · May 1988
Effect of cardiopulmonary bypass on vancomycin and netilmicin disposition.
The effect of cardiopulmonary bypass (CPB) on the disposition of vancomycin (15 mg/kg) and of netilmicin (3 mg/kg) was studied in 10 adults. The concentration-time profile of the drug in serum and renal clearance were characterized pre-CPB, during CPB, and post-CPB. Vancomycin and netilmicin exhibited initial decreases in mean concentrations in serum of 4.0 mg/liter (16.8%) and 2.2 mg/liter (29.1%), respectively, upon initiation of CPB. ⋯ Vancomycin concentrations in serum demonstrated a rebound increase of 2.3 mg/liter (23.5%) at the end of CPB when the aorta was unclamped. Mean renal clearance throughout CPB was decreased for vancomycin (58.4 to 43.4 ml/min per m2) and netilmicin (53.4 to 31.5 ml/min per m2). The rebound in vancomycin concentration in serum strongly correlated with the length of time between unclamping the aorta and coming off CPB (r = 0.94), as well as with the increase in temperature upon rewarming (r = 0.92).
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Antimicrob. Agents Chemother. · May 1988
Comparative StudyComparison of dosages, intervals, and drugs in the prevention of Pneumocystis carinii pneumonia.
The efficacies of trimethoprim (TMP)-sulfamethoxazole (SMZ), TMP-dapsone, dapsone, and pentamidine were compared for the prevention of Pneumocystis carinii pneumonia in the corticosteroid-treated-rat model. While 11 (73%) of 15 untreated control animals had P. carinii pneumonia after 10 weeks of immunosuppression, none of the animals given 125 mg of dapsone per kg daily, weekly, biweekly, or monthly had evidence of infection. Of the 10 rats given a single dose of dapsone 23 and 50 days after immunosuppression was started, 5 (50%) had P. carinii pneumonia. ⋯ The experiments showed that dapsone is highly effective in chemoprophylaxis for P. carinii pneumonia when given at monthly intervals or more frequently and that dapsone and TMP-dapsone are more effective than is TMP-SMZ when given at biweekly intervals. It seems reasonable to expect that biweekly doses of dapsone or TMP-dapsone would provide an effective and reasonably safe chemoprophylaxis regimen for patients at high risk for P. carinii pneumonia, and studies to test such a scheme are justifiable. Biweekly doses are preferred over monthly doses to allow for occasional inadvertent omission of doses expected from patients.
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Antimicrob. Agents Chemother. · Sep 1986
Antimicrobial therapy of experimental endocarditis caused by nutritionally variant viridans group streptococci.
Rabbits with nutritionally variant viridans group streptococcal experimental endocarditis were treated three times daily for 3 days with procaine penicillin (1.2 X 10(6) U) alone or together with low-dose streptomycin (2 mg/kg), high-dose streptomycin (8 mg/kg), low-dose gentamicin (0.32 mg/kg), or high-dose gentamicin (1.05 mg/kg). The mean 0.5-h serum concentrations of streptomycin were 5.3 and 22.5 micrograms/ml in the low- and high-dose group, respectively, and the concentrations of gentamicin were 0.7 and 2.5 micrograms in the low- and high-dose groups, respectively. ⋯ The higher dose of streptomycin was not significantly more effective than either dose of gentamicin. The results of treatment with the high or low dose of gentamicin were virtually identical.