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Biomedical subjects

A M Geddes

Publications and source records attributed to A M Geddes.

At least 55 records · Page 3Linked to original sources
PubMed1985

Multiply resistant Salmonella typhimurium septicaemia in an immunocompromised patient successfully treated with ciprofloxacin.

A patient with acute lymphoblastic leukaemia developed a septicaemia due to a multiply resistant strain of Salmonella typhimurium probably contracted in Pakistan. This was associated with splenic abscesses and proved resistant to treatment with a succession of beta-lactam antibiotics--ceftazidime, imipenem, and mecillinam despite in-vitro sensitivity. The infection resolved completely with ciprofloxacin therapy--a new 4-quinolone antibiotic which may have an important role in the treatment of systemic salmonella infections.

Adult↗
PubMed1985

Infection in immunocompromised patients.

Infection is a common cause of morbidity and mortality in immunocompromised patients for whom diagnosis and management require scrupulous attention to detail and a continuing awareness of the micro-organisms causing infection in a particular environment in different groups of patients. Although uncommon and relatively non-pathogenic organisms may be the cause of infection in these patients most are caused by recognised pathogens. The present review concentrates on infection in the immunocompromised as seen in the United Kingdom.

Aminoglycosides↗
PubMed1984

Comparison of methods for estimating gentamicin clearance and retrospective analysis of changes in clearance with emphasis on patients with normal renal function.

The subjects were 29 general medical and surgical patients with apparently normal renal function at the start of treatment with gentamicin. Nine methods of estimating gentamicin clearance (CL) were compared as means of calculating gentamicin dosage. In 23 of the 29 patients CL was measured twice during treatment. The first measurement was based on 10 blood samples taken around a dose early in treatment. CL calculated from the area under the serum concentration-time curve using all 10 samples was designated a reference method for comparison with other methods. There was considerable inter-individual variation in CL. Serum creatinine and body weight gave poor estimates of an individual's CL. A good estimate of CL was obtained from four blood samples taken immediately before and 2, 3 and 4 h after dosing. Prediction of serum levels is not a good method for checking CL estimations. A significant decrease in CL was found during treatment. This was probably due to a reduction in glomerular filtration rate.

Adult↗
PubMed1984

Pneumococcal bacteraemia--a continuing challenge.

In a retrospective study of pneumococcal bacteraemia in a large district hospital over an eight-year period 103 cases were identified. Although all age groups were represented, an unexpectedly large number of cases occurred among elderly males. The overall case fatality rate was 34 per cent, ranging from 13 per cent in children to 42 per cent in the elderly. Most children had preexisting disease and did have pneumonia. Pre-existing diseases were of three main types: (i) disorders of the respiratory system; (ii) disorders of metabolism; (iii) disorders of the immune system. Six patients had no spleen. Almost all patients received appropriate antibiotics. Most deaths occurred during the first 48 h of treatment. The prospects for the prevention of fatal pneumococcal bacteraemia are reviewed in the light of these findings.

Adolescent↗
PubMed1983

Q fever.

Explore the source record for details and available documents.

Endocarditis, Bacterial↗
PubMed1983

Management of enteric fever with amdinocillin.

Twenty-six patients with enteric fever treated with amdinocillin and/or its pivaloyloxymethyl ester in 1975 to 1978 were compared with 21 patients with enteric fever treated with trimethoprim-sulfamethoxazole in 1972 to 1974. Diagnosis was based on clinical illness and isolation of Salmonella typhi or S. paratyphi A/B from blood cultures or stool cultures. The dosage of pivamdinocillin in adults was 400 to 800 mg, every 6 hours, for 10 to 16 days; dosage in children was half this amount for 11 to 15 days. Of the 21 patients treated with trimethoprim-sulfamethoxazole, 18 (86 percent) showed a satisfactory clinical response; 13 of these 18 had negative stools immediately after therapy, and two more were negative at the time of discharge (total: 83 percent). Mean hospital stay of these patients was 34.5 days. Of the 26 patients treated with amdinocillin, 23 showed a satisfactory clinical response; 20 of those responding clinically were still excreting the causative organism at the end of therapy; seven of the group remained as convalescent patients who continued to excrete the causative organism in feces at the time of discharge. Mean hospital stay was 43 days. The results of initial trials of amdinocillin and ampicillin in combination suggest that such therapy may be preferable to use of amdinocillin alone, although the excretion of the causative organism during convalescence has not been adequately assessed.

Adolescent↗
PubMed1983

A controlled study of the reliability of pure tone audiometry for the detection of gentamicin auditory toxicity.

Hearing changes in patients treated with gentamicin have been prospectively investigated. A group of patients who had a similar spectrum of clinical conditions but did not receive gentamicin have been studied as a control group. The audiometric technique was first validated by recording audiograms from healthy volunteers, once in an anechoic chamber and twice in a ward. It was concluded that changes in threshold less than 20 db. should not be regarded as significant when measured in a ward. In the gentamicin-treated group an initial audiogram was not a reliable measure of the patients' normal hearing because of the influence of their clinical condition. Twenty-one of the control patients were elective admissions to hospital and had their hearing first tested when they were clinically well. There was a 24 per cent incidence of unexplained hearing abnormalities--similar to the incidence of hearing loss in the gentamicin-treated group at follow-up. It was concluded that aminoglycoside auditory toxicity should not be assessed retrospectively. The incidence of hearing changes in the control and gentamicin-treated groups were similar. Possible causes of hearing loss in surgical patients are discussed and recommendations are made for the conduct of future studies of drug-induced auditory toxicity.

Adult↗
PubMed1983

Study of alanine aminopeptidase excretion as a test of gentamicin nephrotoxicity.

We studied the urinary excretion of the proximal tubular enzyme alanine aminopeptidase (AAP) by 38 patients who received gentamicin and by 45 similar control patients. AAP excretion by the control patients was highly variable. The pattern of AAP excretion distinguished patients with pre-renal and renal causes for increases in serum creatinine (SCr) but this can be done more simply with the urine to serum creatinine ratio. Peak AAP excretion did not reflect renal damage in oliguric patients and di not identify gentamicin patients with a renal cause for increases in SCr. The level of AAP excretion in the first three days of gentamicin treatment did identify the three patients with renal causes for an increase in SCr and was highest in a patient with symptomatic hypomagnesaemia due to impairment of proximal tubular function. We concluded that study of AAP excretion in normal volunteers receiving three-day courses of aminoglycosides is a valid screening test for nephrotoxicity but that AAP excretion is too non-specific to use in clinical practice.

Aminopeptidases↗
PubMed1983

Clinical experience with a method for adjusting gentamicin dose from measured drug clearance.

Gentamicin clearance was measured in 26 patients by a method which requires four blood samples. Clearance was used to calculate mean steady state serum concentrations [Css] with the aim of maintaining Css within the range 2.5-3.0 mg/l. All of the patients who failed to respond to antibiotic treatment had adequate Css and peak levels; all of these patients had serious underlying problems to explain their poor response. In contrast some patients responded satisfactorily despite being apparently underdosed. In two patients poor clinical response was associated with low Css levels despite adequate doses and peak levels; both patients responded to increased doses. In patients with stable renal function doses calculated from initial clearance measurements did result in Css within the desired range. In patients with unstable renal function measurement of clearance gave a better indication of the severity of renal impairment than measurement of serum creatinine or peak and trough levels but the bioassay used was too slow to allow adequate dose adjustment.

Adult↗
PubMed1982

Ceftazidime--a new extended-spectrum cephalosporin.

65 patients with serious infections, including 25 with septicaemia, were treated with ceftazidime, a new extended-spectrum cephalosporin. 80% of the infection were cured by the antibiotic. 11 of 12 infected patients who had malignant disease or were otherwise immunocompromised responded satisfactorily to ceftazidime; 7 of these 12 had infections caused by Pseudomonas aeruginosa. The serum half-life of ceftazidime was 1.9 h in a patient with normal renal function. After a 1 g intravenous dose the antibiotic was present in pus, sputum, and bile in therapeutic concentrations. The antibiotics should prove a useful and non-toxic alternative to the aminoglycosides.

Adolescent↗
PubMed1982

Acute osteomyelitis in a district general hospital.

A survey of the 58 patients with acute osteomyelitis seen in one general hospital between 1969 and 1979 has shown that, although the condition is less common now than in the pre-antibiotic era, it remains a serious disease. Bone pain and tenderness are still the commonest symptoms, but the source of the infection is less apparent now than it used to be, and this may lead to delay in diagnosis. The antecedent trauma experienced by nearly half the patients probably predisposes to infection by causing local bone damage and thus a focus for secondary infection. The pattern of infecting organisms has not changed much over the past 11 years, but Haemophilus influenzae must be considered in children aged under 5 years. Treatment was the use of antibiotics, with surgical drainage if necessary. The commonest antibiotic used was clindamycin, and chronic osteomyelitis did not develop in patients treated with this antibiotic, whereas all 9 patients who had chronic sequelae necessitating sequestrectomy had received cloxacillin either alone or in combination with another antibiotic.

Acute Disease↗
PubMed1982

Chloramphenicol in the treatment of enteric fever.

Chloramphenicol is still very effective for acute enteric fever. A literature survey does not confirm the repeated claims of decreasing efficacy over the past 20 years (not taking into account the R factor mediated resistance noted since 1972/73). However, there have been regional variations in the time needed to achieve defervescence under chloramphenicol treatment since the early 1950s. When comparing alternative antimicrobials with chloramphenicol other criteria apart from clinical efficacy have to be considered, namely, influence on the rate of excretion of the organisms and the relapse rate, ease of administration parenterally, toxicity, cost, and the possible occurrence of resistance to Salmonella typhi or S. paratyphi A/B.

Chloramphenicol↗
PubMed1982

Bacterial meningitis--ten years experience.

Between January 1968 and December 1977, 635 cases of acute bacterial meningitis were admitted to hospitals in the Birmingham Area Health Authority. The epidemiology of these cases was analysed and compared with the 270 cases which were admitted to the regional infectious diseases unit at East Birmingham Hospital (E.B.H.). In children and young adults the meningococcus was the commonest causative organism while over the age of 25 pneumococcal meningitis predominated. Although Haemophilus influenzae was the second commonest infecting organism it was a rare cause of meningitis in school children and adults, only four cases presenting in these age groups in the Birmingham Area. A detailed analysis was made of the symptoms, signs, laboratory investigations and clinical course of the 270 cases treated at E.B.H. The mortality in the patients with pneumococcal meningitis was 30%. In the meningococcal group it was 3.5% and in the haemophilus groups 7.7%. An analysis of the various treatment regimes employed in the 270 E.B.H. patients supports the view that a single antibiotic is sufficient for the therapy of most forms of bacterial meningitis. Intrathecal antibiotic administration is unnecessary in pyogenic meningitis caused by meningococci, pneumococci or H. influenzae.

Adolescent↗