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Several anti-inflammatory, including nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and other drugs, have been implicated as a cause of upper gastrointestinal bleeding. Although there is extensive anecdotal evidence to support this link, only a very few studies involving a very small number of subjects have been performed with adequate control conditions to draw firm conclusions. To further investigate the relationship between anti-inflammatory drugs (aspirin as well as others) and gastrointestinal (GI) bleeding, a study was carried out with 161 patients (102 men and 59 women) who were being treated for either hematemesis (vomiting blood) or melena (blood in stool), and an age-matched control group of patients who were being treated for non-gastrointestinal maladies. There was significantly more use of both non-aspirin NSAIDs and aspirin in the gastrointestinal treatment group. There were no differences between the groups in the extent to which they used other drugs, including acetaminophen, corticosteroids, tobacco, and alcohol. When patient characteristics were calculated for users and non-users of the various drugs, NSAID users were found to be older, more likely to be female, and to have a higher mortality rate than non-users. Among those patients who were found to be suffering from bleeding peptic ulcer disease, NSAID users were equally likely to have reported previous symptoms of ulcer compared with non-users, and did not have a higher frequency of multiple gastric or duodenal ulcers. The increased risk of developing gastrointestinal bleeding attributable to non-aspirin NSAID use was higher than that attributable to the use of aspirin. (Consumer Summary produced by Reliance Medical Information, Inc.)

Aztreonam, the first monomcyclic beta-lactam antibiotic with pure anti-Gram-negative activity, combined with flucloxacillin, a penicillinase resistant penicillin, was given as empirical treatment of 53 serious infections in very elderly people. Eighteen of the cases had positiove blood cultures and 11 had a clinical picture of sepsis without positive blood cultures: Of 49 evaluable infections, 45 (92%) were cured. In 40% of the infections, antibiotic treatment could be narrowed after 72 hours to one antibiotic. Diarrhoea, mostly transaction, was the only side-effects. Aztreonam-flucloxacilin combination is a safe and effective empirical treatment regimen for series. infection in very elderly patients.

Objectives: There is paucity of data on the capacity of fetal membranes to repair surgical defects following trauma. We aimed at developing an in vitro model using monolayers of human amnion epithelial cells to study fetal membrane healing. Methods: Term (n = 6) and preterm (n = 3) fetal membranes were collected at caesarean section. The amnion was digested twice in a trypsin solution. Amniocytes were seeded (250,000-750,000/ml) and incubated at 37°C and 5% CO2 and 21 or 5% O2. A microsurgical injury was made centrally in the monolayers and the cultures were incubated for 48 h. Every 6 h, slides were fixed and immunohistochemical staining was performed to quantify proliferation at the site of the defect and centrally in the monolayer. The closure rate was evaluated by measuring the defect size every 6 h. Results: The closure rate of the defects was higher in preterm versus term cultures. Proliferation was significantly higher in the defect zone versus the peripheral zone, and also higher in the preterm group. Conclusion: We describe a new model for the study of fetal membrane healing and observed gestational age-dependent repair capacity of the amnion. Copyright © 2009 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

MICs of 16 non-β-lactams were determined by agar dilution for 283 penicillin-susceptible, 122 intermediate and 23 fully penicillin-resistant isolates of pneumococci. Penicillin-resistant pneumococci were more likely to be resistant to tetracyclines, macrolides and related compounds. In the latter group, quinupristin/dalfopristin was the only compound whose activity was not influenced by penicillin resistance. Among the fluoroquinolones, clinafloxacin and trovafloxacin showed excellent activity. Strains resistant to macrolides, tetracycline and penicillin were concentrated in serogroups 6, 9, 14, 19 and 23. [ABSTRACT FROM PUBLISHER]

The comparative activities of piperacillin/tazobactam and other antibiotics against 5625 Gram-negative and Gram-positive bacteria freshly isolated from hospitalized patients was examined. The percentage of Enterobacteriaceae susceptible to piperacillin/tazobactam, ceftazidime, imipenem and ciprofloxacin was very similar and varied from 81% to 84% in the Enterobacteriaceae with inducible type 1 beta-lactamases and from 93 to 97% in the non-inducible organisms. Piperacillin/tazobactam was similar in activity to ceftazidime against Pseudomonas aeruginosa and more active than imipenem or ciprofloxacin. Piperacillin/tazobactam is more active than ceftazidime against Gram-positive bacteria (staphylococci, enterococci) and seems to be a promising antibiotic for nosocomial infections. [ABSTRACT FROM AUTHOR]

Fusidic acid, a fusidane that interferes with protein synthesis via the translocase enzyme, is mainly notable for its activity against staphylococci, coagulase-positive and negative, whether or not they are resistant to methicillin and related penicillins. It is also active against corynebacteria and against many genera of strict anaerobes and microaerophiles. Mutants showing resistance, by more than one mechanism, may readily be selected in vitro. Combination of fusidic acid with other antibiotics generally gives addition or indifference, but also delays emergence of resistant mutants. [ABSTRACT FROM PUBLISHER]

The in-vitro activity of Ro 23-6240, a new quinolone, was tested in comparison with that of other quinolones against 486 recent clinical isolates. Ro 23-6240 displayed the typical features of the new quinolones: highest activity against Gram-negative bacilli, MBCs close to the MICs, minimum inoculum effect and rapid killing. Against Gram-negative organisms (Enterobacteriaceae, non-fermenters, Haemophilus influenzae and gonococci) the activity of Ro 23-6240 was between that of ofloxacin and norfloxacin; against staphylococci its activity was between that of ciprofloxacin and ofloxacin, and against streptococci it was similar to that of norfloxacin. [ABSTRACT FROM AUTHOR]

The in-vitro activity of BRL-36650, a novel beta-lactamase-stable penicillin was tested in comparison with that of cefotaxime, ceftazidime, aztreonam and imipenem against 559 multiply resistant Gram-negative organisms, some of which were also resistant to third generation cephalosporins. BRL-36650 and imipenem were the most active antibiotics. Against 342 Enterobacteriaceae the MICs90 were: imipenem 2 mg/l, BRL-36650 4 mg/l, aztreonam 8 mg/l and cefotaxime 32 mg/l. Against 122 Pseudomonas aeruginosa the MICs90 were: BRL-36650 4 mg/l, imipenem 8 mg/l, aztreonam and ceftazidime 64 mg/l. [ABSTRACT FROM AUTHOR]

The activity of ampicillin, of mecillinam and of combinations of ampicillin with mecillinam, clavulanic acid or 6β-bromopenicillanic acid has been studied against 126 Enterobacteriaceae resistant to ampicillin. The combination of ampicillin with mecillinam showed synergy or addition in 60% of the combinations tested. Synergy was seen especially when the strains were resistant to mecillinam, indifference when they were susceptible to mecillinam. The combination of ampicillin with mecillinam was more active than the combination with clavulanic acid against and , but not against and . The combination of ampicillin with clavulanic acid was more active than the combination with 6β-bromopenicillanic acid in and strains. [ABSTRACT FROM PUBLISHER]

The pharmacokinetics of a single 4 g intravenous bolus dose of piperacillin were investigated in 5 normal subjects and 13 patients with moderate, severe or end-stage renal function impairment. Parameters were calculated using a two-compartment open model.In normal subjects the following mean (±S.E.M.) values were found: Tl©2β 1.02±0.05 h, AEC0–∞ 250.3±l2.5 mg©1.h, Vdss l8.6±1.1 1©1.73 m2, total body clearance 258.4 ± 6.2 ml©min, renal clearance 213.8 ± 19.6 ml©min and non-renal clearance 61.1±7 ml©min. Urinary recovery was 79.8% of the dose in 24 h.In patients, Vdss did not change but T4©2β and AUC increased, proportionally with the degree of renal insufficiency, to values 5–6 times those in control subjects. Total body and renal clearance decreased linearly with the endogenous creatinine clearance. Non-renal clearance did not change.During haemodialysis T 1©2β decreased from 5.6 to 2.4 h in end-stage renal insufficiency.Liver function impairment associated with renal insufficiency in one patient further prolongs piperacillin half-life. [ABSTRACT FROM PUBLISHER]

The susceptibility to 8 aminoglycosides of 146 clinical isolates of from 4 different hospitals, has been determined. Most isolates were multiply resistant: namely 62% to carbenicillin, 79% to kanamycin, 59% to streptomycin, 56% to gentamicin and sisomicin, and 5% to tobramycin. All strains were susceptible to amikacin and netilmicin. The predominant profile of resistance to aminoglycosides was simultaneous resistance to streptomicin-kanamycin-paromomycin and sisomicin. Transfer experiments confirmed that the resistance to these drugs was plasmid-mediated. [ABSTRACT FROM PUBLISHER]

The antibiotic imipenum (thienamycin-formamidine) is partially hydrolyzed during excretion by a renal brush border dehydropeptidase. The co-administration of imipenum with the renal dehydropeptidase inhibitor cilastatin results in an increase of the urinary recovery of the antibiotic, both in animals and humans. To study the pharmacokinetics of imipenem and cilastatin, subjects with normal renal function and patients with different degrees of renal insufficiency received intravenously 250 mg imipenum alone and 250 mg imipenem with 250 mg cilastatin. The mean plasma half-life of imipenem varied from 52 min in subjects with normal renal function to 173 min in subjects with end-stage renal failure studied while off-dialysis. The plasma half- life of imipenem was not affected by the co-administration of cilastatin. The mean plasma half-life of cilastatin varied from 54 min in normals to 798 min in patients with end-stage renal failure. The co- administration of cilastatin resulted in an increase of the urinary concentration and in the urinary recovery of imipenem, the effect being more pronounced in the subjects with normal or only mildly impaired renal function. The plasma clearance of imipenem was decreased when cilastatin was co-administered, possibly due to inhibition of tubular secretion of imipenem. Elimination studies performed during haemodialysis indicated efficient removal of both imipenem and cilastatin during a 4 h session. In view of the important increase in half-life of cilastatin as a function of increasing renal failure, a dosage reduction is proposed in patients with severe renal failure. It is recommended that the maximum dose of imipenem/cilastatin would be limited to either 1000/1000 mg twice daily or 500/500 mg four times daily in patients with a creatinine clearance of less than 15 ml/min. Also, a supplementary dose of imipenem and cilastatin after dialysis is recommended. [ABSTRACT FROM AUTHOR]

MICs of 21 beta-lactams were determined by agar dilution against 283 penicillin-susceptible (pen-S), 122 intermediate (pen-I) and 23 fully penicillin-resistant (pen-R) pneumococci. MICs of all beta-lactams increased with increasing MICs of penicillin. Clometocillin was the most active penicillin against pen-I or pen-R pneumococci. All oral cephalosporins except cefuroxime and cefpodoxime were less active than penicillin and none was satisfactory against pen-I or pen-R pneumococci. The parenteral third- and fourth-generation cephalosporins (except ceftazidime) were similar in activity to penicillin against pen-S isolates. Cefpirome showed the lowest mean MICs against pen-I and pen-R strains. [ABSTRACT FROM AUTHOR]

MICs of 21 β-lactams were determined by agar dilution against 283 penicillin-susceptible (pen-S), 122 intermediate (pen-I) and 23 fully penicillin-resistant (pen-R) pneumococci. MICs of all β-lactams increased with increasing MICs of penicillin. Clometocillin was the most active penicillin against pen-I or pen-R pneumococci. All oral cephalosporins except cefuroxime and cefpodoxime were less active than penicillin and none was satisfactory against pen-I or pen-R pneumococci. The parenteral third- and fourth-generation cephalosporins (except ceftazidime) were similar in activity to penicillin against pen-S isolates. Cefpirome showed the lowest mean MICs against pen-I and pen-R strains. [ABSTRACT FROM PUBLISHER]

Between 1991 and 1995 the Belgian National Program for Surveillance of Hospital Infections (NSIH) collected data on perioperative antibiotic prophylaxis in 72 acute care hospitals. From the costs of prophylactic antibiotics for six categories of surgical procedure and from discharge summaries for hospitalization episodes nationwide, annual drug costs were estimated for 73% of Belgian surgical activity. Costs of antibiotics used in these surgical activities were estimated at 386-410 million Belgian francs (Bf) per year (us$12.1-12.9 million). After agreeing recommendations for best practice, the hypothetical costs of `optimal' antimicrobial prophylaxis were calculated for the same selection of surgical procedures. It was calculated that savings of at least 194 million BF (US$6.1 million) could be made if recommendations were followed closely. Only the costs borne by the National Health Insurance Institute for reimbursement of the dispensed drugs were considered in this study. Other direct costs, such as those related to drug storage, dispensing and administration, were not included. [ABSTRACT FROM PUBLISHER]

Trichosporon beigelii (Trichosporon cutaneum) was identified as the causative agent of chronic meningitis in a 15-year-old boy with acute lymphocytic leukaemia. After a neutropenic episode following cytostatic treatment and itraconazole therapy as prophylaxis, cerebrospinal fluid (CSF) samples yielded growth of Trichosporon beigelii. Treatment with amphotericin B, flucytosine and high doses of fluconazole was followed by clinical improvement, although CSF pleocytosis remained. The cross-reactivity between Cryptococcus neoformans and Trichosporon beigelii in a cryptococcal antigen latex test was used as a means of diagnosis in CSF and serum samples. [ABSTRACT FROM AUTHOR]

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