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Biomedical subjects

A J Weinstein

Publications and source records attributed to A J Weinstein.

At least 91 records · Page 5Linked to original sources
PubMed1977

Principles of concomitant antibiotic therapy.

There are five major disadvantages of the combined use of antibiotics: (i) antibiotic antagonism; (ii) a "false sense of security"; (iii) increased toxicity; (iv) suprainfection; and (v) increased cost. Four situations clearly require the use of antibiotic combinations: (i) to produce antibiotic synergism; (ii) to prevent the emergence of resistant organisms; (iii) to treat mixed infections, such as brain abscess, peritonitis, and pelvic infections; and (iv) to institute therapy for severe infections.

Animals↗
PubMed1977

Systemic absorption of neomycin irrigating solution.

Systemic absorption of neomycin sulfate occurred in ten patients in whom neomycin wound irrigating solutions were used during total hip replacement. The use of neomycin in this manner may be associated with the risk of ototoxicity and nephrotoxicity.

Adult↗
PubMed1977

Listeria monocytogenes endophthalmitis.

Listeria monocytogenes and a staphylococcus organism caused a catastrophic endophthalmitis in a patient despite appropriate local and systemic antimicrobial chemotherapy. Although L monocytogenes is widespread in nature and has produced a variety of clinical illnesses, it has only one previously been reported to cause endophthalmitis. If appropriate microbiologic techniques are not employed, the organism may go unrecognized as an ocular pathogen.

Ampicillin↗
PubMed1977

Penicillinase-resistant penicillins plus gentamicin in experimental enterococcal endocarditis.

Previous in vitro studies demonstrating that the penicillinase-resistant penicillins act synergistically in combination with gentamicin against some enterococci have suggested that these combinations might be effective therapy for enterococcal infections in vivo. To determine the in vivo effectiveness of such combinations, we treated rabbits with enterococcal endocarditis with gentamicin and either nafcillin, oxacillin, or methicillin. Despite doses of the penicillins equivalent to 12 or 24 g/day in a 70-kg patient, the percentage of animals in each treatment group with sterile valves at autopsy after spontaneous death or sacrifice after 21 days of therapy was low. High-dose therapy with the penicillins did not significantly increase survival over the low-dose treatment groups. Thus, it seems prudent to include penicillin with a penicillinase-resistant penicillin and gentamicin as the initial therapy of patients with endocarditis possibly caused by enterococci.

Animals↗
PubMed1977

CT detection and aspiration of abdominal abscesses.

Computed tomography (CT) is effective in detecting intraabdominal abscesses. Loculations of fluid and extraluminal gas are clearly localized in relation to other organs. Of 22 abscess in this series, CT successfully detected 20; comparative information with gallium, techneticum, and ultrasound scans is presented. In addition to localizing these collections, CT can be used to guide needle aspiration and drainage procedures. Three sizes of needles were used to aspirate specimens and/or provide drainage. This was accomplished successfully in 12 of 14 CT-guided procedures.

Abdomen↗
PubMed1977

Therapeutic use of gentamicin in horses: concentrations in serum, urine, and synovial fluid and evaluation of renal function.

Serum, synovial fluid, and urine concentrations of gentamicin were measured in normal mature horses which had been given a single dose of the drug. Mean peak serum concentration (16.8 microgram/ml) occurred in horses 30 minutes after they were given a single intramuscular dose of 4.4 mg of gentamicin/kg of body weight. In horses given a smaller dose of gentamicin (1.7 mg/kg), mean peak serum concentrations of gentamicin (10.2 microgram/ml) appeared at 1 hour. Synovial fluid concentration was maximum at 2 hours for both doses; in horses given the larger dose, mean peak concentration was 6.4 microgram/ml, and in those given the smaller dose (1.7 mg/kg), 3.4 microgram/ml. Measurable concentrations of gentamicin in serum and synovial fluid persisted 8 hours. During the first 8 hours, percentages of gentamicin excreted in the urine were between 3.9 and 32.8% of the larger dose and between 3.3 and 13.4% of the smaller dose. Serum creatinine concentrations were serially measured in 10 hospitalized horses intramuscularly given 1.7 to 4.4 mg of gentamicin/kg 4 times a day' significant increase in creatinine concentration was not found.

Animals↗
PubMed1976

Routine blood cultures from febrile outpatients. Use in detecting bacteremia.

Of 565 febrile patients examined in the emergency room of a metropolitan hospital, 210 had blood samples cultured (37.1%). Bacteremia was present in 9 of 86 patients who were admitted to the hospital but in only one of 124 patients who were not admitted (P less than .005). Thus, approximately 5% of febrile adult outpatients had bacteremia, and these patients were usually admitted before the results of the culture were known. Since positive cultures were found so infrequently in patients not admitted and were, therefore, of little value in guiding the treatment of these patients, we conclude that use of routine blood cultures to screen for bacteremia in unnecessary for febrile adult outpatients who are not admitted to the hospital.

Adult↗
PubMed1976

Bacteriologic effects of prophylactic antibiotics in cesarean section.

An eight-hour course of prophylactic clindamycin and gentamicin was given to 54 service patients undergoing cesarean section. Aerobic and anaerobic endometrial cultures obtained from eight patients who developed endometritis after prophylaxis revealed major changes in flora. Compared to infected patients who had received no prophylaxis, the clindamycin-gentamicin group had marked decreases in aerobic and anaerobic cocci and Bacteroides but increases in E. coli and enterococci. However, this regimen was found to be no more effective than the previously reported regimen of ampicillin and kanamycin.

Ampicillin↗
PubMed1976

Placental transfer of clindamycin and gentamicin in term pregnancy.

The pharmacokinetics of clindamycin and gentamicin were studied in women given these antibiotics prior to cesarean section. Maternal clindamycin levels were within the normal range and cord levels were within the therapeutic range for this antibiotic. For gentamicin, however, maternal levels were depressed, with a concurrent depression of cord levels. This may have significant implications for the use of gentamicin in maternal and fetomaternal infections.

Bacterial Infections↗
PubMed1976

Puerperal infection in the antibiotic era.

Developments in etiology and treatment of puerperal infection in the last 20 years are reviewed. Emphasis is placed upon predisposing factors, microbiology and antibiotics, unusual sources of severe infection, special complications, and prophylactic antibiotics.

Anti-Bacterial Agents↗
PubMed1976

Newer antibiotics: guidelines for use.

The number of antimicrobial agents available for use has increased significantly since the introduction of penicillin in the mid 1940s. Consequently, choosing among them has become an increasingly complex problem. In selecting an antibiotic, careful consideration must be given to the status of the patient and to the organism isolated. In addition, the physician must have detailed knowledge about the specific characteristics of each agent and must apply basic guidelines of antimicrobial therapy in order to make a rational choice.

Amoxicillin↗
PubMed1976

Cephalosporin-aminoglycoside synergism in experimental enterococcal endocarditis.

Despite in vitro demonstrations of synergism against enterococci, combinations of cephalosporin and aminoglycoside antibodies have been ineffective in the therapy of enterococcal endocarditis. Penicillin-gentamicin, cephalothin-gentamicin, and cefazolin-gentamicin were used to treat enterococcal endocarditis in rabbits. A direct relation was observed between the rate of cure and the degree by which the peak serum concentration of penicillin and the cephalosporins exceeded the minimal inhibitory concentration of the enterococcus. Thus, cephalosporin doses which produce serum concentrations which exceed the minimal inhibitory concentration of the enterococcus by several orders of magnitude may, in combination with aminoglycosides, be effective in treating human enterococcal endocarditis.

Aminoglycosides↗
PubMed1975

Studies of cephalothin: aminoglycoside synergism against enterococci.

Combinations of cephalothin and aminoglycoside antibiotics are not currently used in the therapy of serious enterococcal infections, because clinical trials of these combinations have been unsuccessful. Studies of 28 enterococci isolated from patients with enterococcal bacteremia suggested three possible mechanisms for this in vivo antibiotic failure: (i) a relatively high level of resistance to cephalothin among all enterococci and especially those characterized as Streptococcus faecium, (ii) a significant incidence of high-level resistance to the aminoglycosides among certain strains of enterococci, and (iii) a failure of synergism to occur when cephalothin concentrations fall below the minimal inhibitory concentration of the enterococcus, as occurs during the in vivo metabolism and excretion of this antibiotic when given in standard doses for endocarditis.

Aminoglycosides↗
PubMed1975

Disseminated mycobacterium kansasii infection presenting as cellulitis in a recipient of a renal homograft.

A recipient of a renal homograft developed disseminated infection caused by Mycobacterium kansaii. He initially presented with cellulitis and abscesses in one foot, and was thought to have a pyogenic bacterial infection. The daily administration of prednisone and azathioprine appears to have prevented the typical cell-mediated granulomatous reaction to mycobacterial infection and to have contributed to the patient's atypical inflammatory response. A switch to alternate-day prednisone combined with antimycobacterial medication resulted in rapid healing without rejection of the homograft.

Adult↗