International journal of antimicrobial agents
-
Int. J. Antimicrob. Agents · Sep 2006
Review Meta Analysis Comparative StudyCiprofloxacin/metronidazole versus beta-lactam-based treatment of intra-abdominal infections: a meta-analysis of comparative trials.
Intra-abdominal infections are polymicrobial and result in substantial morbidity and mortality. The combination of ciprofloxacin/metronidazole as well as several beta-lactam-based regimens are among the commonly used regimens for the treatment of patients with such infections. Thus, we sought to review the evidence from available comparative clinical trials studying ciprofloxacin/metronidazole versus broad-spectrum beta-lactam-based regimens in the treatment of intra-abdominal infections. ⋯ There was a statistically significant difference between the compared arms with regard to cure in favour of the ciprofloxacin/metronidazole combination (odds ratio (OR)=1.69, 95% confidence interval (CI) 1.20-2.39). There was no statistically significant difference between the compared arms with regard to total mortality (OR=1.10, 95% CI 0.71-1.69), mortality attributable to infection (OR=1.42, 95% CI 0.66-3.06) and toxicity (OR=1.25, 95% CI 0.66-2.35). In conclusion, pooled data from the available comparative trials suggest that the ciprofloxacin/metronidazole combination may be superior to beta-lactam-based therapeutic regimens in the treatment of intra-abdominal infections with regard to cure of infections, although no difference in mortality was found.
-
Int. J. Antimicrob. Agents · Sep 2006
Clinical TrialIncreased amikacin dosage requirements in burn patients receiving a once-daily regimen.
Altered pharmacokinetics in burn patients may affect antibiotic plasma concentrations. Typical once-daily dosing (ODD) of 15 mg/kg amikacin (AMK) in burn patients does not always produce peak concentrations (C(max)) reaching the therapeutic objective of six to eight times the minimal inhibitory concentration (MIC). We recorded plasma concentrations following administration of 20 mg/kg AMK in burn patients and studied factors affecting pharmacokinetics. ⋯ Statistical analysis demonstrated a relationship between C(max) and the area of the burn and Unit Burn Standard, and between AMK clearance and creatinine clearance (Cl(CR)). We conclude that ODD regimens of AMK in patients with burns >15% body surface area and/or with Cl(CR) >120 mL/min could require doses >20 mg/kg to reach adequate C(max). In all cases, patient therapeutic drug monitoring is essential to ensure the safe usage of these dosing recommendations.
-
Int. J. Antimicrob. Agents · Aug 2006
Randomized Controlled Trial Comparative StudyClinical efficacy of continuous infusion of piperacillin compared with intermittent dosing in septic critically ill patients.
Since the bactericidal effects of beta-lactam antibiotics are time dependent, the optimum strategy for their administration could be continuous infusion. In this prospective, randomised controlled trial to evaluate the clinical efficacy of continuous infusion therapy, we evaluated the outcomes for 40 septic critically ill patients who received piperacillin either continuously (2 g intravenously (i.v.) over 0.5 h as a loading dose followed by 8 g i.v. daily over 24 h (n=20)) or as an intermittent infusion (3 g i.v. every 6h over 0.5 h (n=20)). Results from our study demonstrated that the clinical efficacy of piperacillin as a continuous infusion is superior to intermittent administration in critically ill patients. ⋯ There was a significant relationship between clinical results and laboratory data. It was shown that the superiority of the clinical efficacy of continuous infusion could be related to piperacillin pharmacodynamics. Continuous infusion significantly reduced the severity of illness as demonstrated by APACHE II scores during therapy.
-
Int. J. Antimicrob. Agents · Aug 2006
Incidence of nosocomial urinary tract infections on a surgical intensive care unit and implications for management.
The incidence of nosocomial infections (NIs) in our surgical intensive care unit was evaluated with special consideration of nosocomial urinary tract infections (NUTIs). The trial was a prospective, single-centre, 6-month cohort study. Infections according to CDC criteria, pathogens, devices, APACHE II scores, infection parameters and urinalysis were noted. ⋯ UTIs accounted for 28% of the NIs, lower respiratory tract infections for 21%, pneumonia for 12% and bloodstream infections for 11%. The rates of urinary-catheter-associated UTIs varied between 4.2 (symptomatic UTI) and 14.0 (asymptomatic UTI). Although asymptomatic NUTI usually deserves no therapy, it needs to be considered carefully in terms of its environmental impact on the emergence of bacterial resistance.
-
This review will summarise the relevant pathophysiology of sepsis, the rationale for treatment with recombinant human activated protein C and the evidence for and against its use, and will provide evidence-based recommendations for its administration.