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Biomedical subjects

B I Davies

Publications and source records attributed to B I Davies.

At least 19 recordsLinked to original sources
PubMed1992

Clinical and bacteriological experience with cefodizime in acute purulent exacerbations of chronic bronchitis.

1 or 2 g doses of cefodizime i.m. were studied in 287 patients admitted to hospital with acute purulent exacerbations of chronic bronchitis, mostly associated with Haemophilus influenzae, Streptococcus pneumoniae or Moraxella catarrhalis. Pharmacokinetic studies in serum and sputum on the first treatment day yielded mean peak serum concentrations of 50 to 100 mg/l, with corresponding sputum concentrations of 1.4 and 2.7 mg/l, after the two respective doses. No great differences were found between the clinical and microbiological results in the various dosage groups, and no corresponding improvement was noted with the highest dosages studied. In general, infection was eliminated in 90 to 95% of patients at the end of treatment, and in approximately 70 to 80% after a follow-up week. Some infections associated with beta-lactamase producing M. catarrhalis persisted or relapsed after treatment. Unwanted drug effects were recorded in five patients, leading to discontinuation in two. It is concluded that a single daily intramuscular dose of 1 g cefodizime for seven days produces satisfactory results in most patients.

Aged↗
PubMed1991

Meningococcal chest infections in a general hospital.

In the course of one calendar year (1989-1990), 46 specimens of respiratory secretions (from 44 patients) cultured in the microbiology department of a large district general hospital in The Netherlands were found to yield Neisseria meningitidis. Twenty-eight of the 46 samples yielded pure cultures of meningococci and 18 yielded other recognised respiratory pathogens as well. Only one patient had pneumonia, whereas 19 had acute respiratory infections and 18 acute purulent exacerbations of chronic bronchitis. The remaining patients, who had a variety of symptoms, all had purulent sputum. Only 8 of the 44 patients were under 40 years of age; 21 were aged more than 60 years. Serological grouping and subtyping showed a predominance of group B strains (in 24 of 44 patients) and 13 strains were non-groupable. The importance of recognising or overlooking meningococci in cultures of respiratory secretions is discussed.

Acute Disease↗
PubMed1990

Cefodizime and cefotaxime in acute exacerbations of chronic bronchitis: a randomized double-blind prospective study in 180 patients.

In a double-blind prospective study, 180 patients admitted to hospital with acute purulent exacerbations of chronic bronchitis were treated for seven days with twice daily 1 g intramuscular injections of either cefodizime or cefotaxime. Sputum cultures performed before, during and immediately after treatment showed complete eradication of the infection in 89/90 given cefodizime and 86/90 receiving cefotaxime. Some symptomatic Pseudomonas aeruginosa superinfections occurred with each agent. During the follow-up week, recurrences or reinfections after apparent clearance occurred in 15 patients given cefodizime and in 21 receiving cefotaxime. Pharmacokinetic studies in blood showed mean Cmax values of 50.8 mg/l for cefodizime and 36.5 mg/l for cefotaxime, corresponding values in the sputum being 1.61 and 0.62 mg/l. Mean AUC values in both blood and sputum were 2 1/2- to 3-fold higher for cefodizime. Some features suggested better performance by cefodizime than by cefotaxime, but the clinical results were not statistically significantly different.

Acute Disease↗
PubMed1990

Temafloxacin in acute purulent exacerbations of chronic bronchitis.

Temafloxacin hydrochloride, a new fluoroquinolone, was given orally in doses of 300 or 600 mg twice daily for ten days to 36 patients, all hospitalized because of severe acute purulent exacerbations of chronic bronchitis. Sputum cultures before, during and after treatment showed that the infection was eliminated in 12/18 evaluable patients given 300 mg and in 13/16 receiving the 600 mg doses. Haemophilus influenzae, Branhamella catarrhalis and Streptococcus pneumoniae were effectively eliminated, but only half the Pseudomonas aeruginosa infections were eradicated. MICs for most pathogens were 1 mg/l or less (including the majority of the pneumococci) but the MICs for Ps. aeruginosa ranged from 0.5 to greater than 16 mg/l, those for 10 of the 22 strains being greater than 2 mg/l. Pharmacokinetic studies on serum and sputum specimens showed serum Cmax values of 3.5 and 6.0 mg/l, the sputum Cmax being 2.35 and 4.17 mg/l after the different doses. No interaction with concomitant theophylline could be found. Two patients complained of moderate nausea or water-brash. Temafloxacin can be considered safe and effective at these dosages, but for Ps. aeruginosa infections higher dosages need to be investigated.

4-Quinolones↗
PubMed1989

Doxycycline and minocycline in the treatment of respiratory infections: a double-blind comparative clinical, microbiological and pharmacokinetic study.

A group of 41 patients, all admitted to hospital because of acute purulent exacerbations of chronic respiratory disease, were treated with either doxycycline or minocycline in a double-blind randomized study. Drug dosage was one 100 mg capsule twice daily for seven days. Bacteriological and clinical assessment before and immediately after treatment showed no significant differences between the doxycycline and the minocycline groups, nor did further evaluation after seven days follow-up. Pharmacokinetic studies showed that the Cmax and 0-11 h AUC values in blood were higher for doxycycline, whereas the sputum Cmax was, on average, higher for minocycline because of the greater penetration of the latter. The MIC values for the two antibiotics differed slightly, usually, but not always, in favour of minocycline. Problems were experienced with both agents in the eradication of Haemophilus influenzae. The net clinical results with the two drugs were identical.

Adult↗
PubMed1989

Azithromycin (CP-62,993) in acute exacerbations of chronic bronchitis: an open clinical, microbiological and pharmacokinetic study.

A group of 21 patients admitted to hospital with acute purulent exacerbations of chronic bronchitis was treated for five days with a new oral macrolide azithromycin. They received one dose of 500 mg on the first day, followed by 250 mg once daily thereafter. Pre-treatment sputum cultures were typical for this district, but the cultures during and after treatment showed many Haemophilus influenzae infections persisting. Geometric mean MICs of azithromycin for these organisms rose from 1.23 mg/l (pre-treatment) to 4.87 mg/l, a week after the end of treatment. The mean MICs for erythromycin also rose four-fold. Streptococcus pneumoniae and Branhamella catarrhalis strains were effectively eradicated. Pharmacokinetic studies on serum and sputum from the first treatment day showed relatively low serum Cmax values, averaging 0.63 mg/l, but with considerable individual variation. However, peak sputum concentrations averaged 3.7 mg/l. Nevertheless, the clinical and microbiological results were not encouraging because of the failure to eradicate H. influenzae with the drug dosage used in this study.

Acute Disease↗
PubMed1989

A prospective study of ofloxacin in acute exacerbations of chronic respiratory disease associated with Pseudomonas aeruginosa.

Forty patients (32 inpatients and 8 outpatients) with acute purulent exacerbations of obstructive respiratory disease associated with Pseudomonas aeruginosa were treated orally with 800 mg ofloxacin twice daily for seven days. Sputum was cultured before, during and after treatment. The drug was extremely well tolerated, only one patient discontinuing because of alleged nausea. The infection was completely eradicated, with excellent clinical results and negative sputum cultures, in 23 patients. In six others the Ps. aeruginosa infection was cleared although reinfection with different organisms followed. Five patients showed recurrence of the infection after apparent initial eradication, but Ps. aeruginosa persisted in three others. Three patients were not evaluable because of death, transfer elsewhere, or discontinuation. There was a slight tendency for the mean MICs to rise during treatment, owing to eradication of all highly sensitive strains. Resistance did not develop. These results suggest that purulent exacerbations of chronic respiratory disease caused by Ps. aeruginosa can safely be treated orally with 800 mg ofloxacin twice daily, but that further studies in outpatients should be performed.

Adolescent↗
PubMed1988

Cefodizime in acute purulent exacerbations of chronic respiratory disease.

Clinical, microbiological and pharmacokinetic studies were carried out after 1 or 2 g intramuscular injections bd of cefodizime (HR 221), a new aminothiazolyl cephalosporin, in 41 patients hospitalized for acute purulent exacerbations of chronic respiratory disease. Treatment was for 10 days. Serum Cmax values of 54.8 and 84.7 mg/l were recorded approximately 2 hours after the injections, the corresponding sputum values averaging 1.01 and 2.58 mg/l. Penetration from blood to sputum was 2 to 3.6%. The elimination phase half-life in serum was approximately 4.5 h. Clinical, microbiological and pharmacokinetic studies were carried out after 1 or 2 g intramuscular injections bd of cefodizime (HR 221), a new aminothiazolyl cephalosporin, in 41 patients hospitalized for acute purulent exacerbations of chronic respirators disease. Treatment was for 10 days. Serum Cmax values of 54.8 and 84.7 mg/l were recorded approximately 2 hours after the injections, the corresponding sputum values averaging 1.01 and 2.58 mg/l. Penetration from blood to sputum was 2 to 3.6%. The elimination phase half-life in serum was approximately 4.5 h.

Adult↗
PubMed1988

Microbial flora and bile acid metabolism in patients with an ileal reservoir.

Bacterial flora of ileum effluent and bile acid metabolism were investigated in 11 patients 11-44 months after construction of a Kock's continent ileostomy. Bacteriologic investigation showed significantly more microorganisms per millilitre (p less than 0.01) and a more colon-like flora--that is, anaerobic microorganisms (p less than 0.001)--in ileum effluent of continent ileostomy patients than in ileum effluent of patients with a conventional ileostomy. The reabsorptive capacity of the reservoir mucosa was tested by direct introduction of a radioactively labelled conjugated bile acid, 23-75Se-25-homotaurocholic acid (SeHCAT), into the ileal pouch. After 4 h, 90% of the SeHCAT activity had been reabsorbed from the reservoir. Quantitative and differential analysis of bile acids in the ileum effluent showed unconjugated and predominantly primary (88%) bile acids, suggesting a minimal influence of bacterial flora on bile acid metabolism. Moreover, total bile acid loss appeared to be within normal limits.

Adult↗
PubMed1988

The epidemiology of respiratory tract pathogens in southern Netherlands.

Results of sputum cultures and susceptibility tests have been reviewed for the years 1977-1986, with approximately 1,700 positive cultures per year. Haemophilus influenzae always occupied the first place, being grown in 65% of positive specimens in 1977 and 37% in 1986. Streptococcus pneumoniae occupied the second place, rising from 17 to 27% in the same period, during which Branhamella catarrhalis rose from 5 to 26%. Based on the frequency of occurrence of individual bacterial species in the sputum cultures and on the percentage of strains resistant to ampicillin, cotrimoxazole, doxycycline, erythromycin and ofloxacin, theoretical chances of failure of blind therapy were calculated and found to be most advantageous for ofloxacin and cotrimoxazole. No explanation could be given for the increase in beta-lactamase production by B. catarrhalis, but the disappearance of Haemophilus parainfluenzae may have been due to improvements in the identification procedure.

Anti-Bacterial Agents↗
PubMed1987

Respiratory infections: clinical experiences with the new quinolones.

Nearly 300 patients, admitted to hospital with acute purulent exacerbations of chronic respiratory disease, have been treated with various newer quinolones: 26 patients received enoxacin, 50 pefloxacin, 80 ciprofloxacin and 143 ofloxacin. Dosages varied from 400 mg once daily to 1000 mg twice daily. orally for five to 10 days. Patients were evaluated bacteriologically and clinically before, during and after treatment. Nearly all infections associated with Haemophilus influenzae and/or Branhamella catarrhalis were successfully eradicated. Some Streptococcus pneumoniae infections relapsed, some could not be eradicated, and a number of patients developed new infections with these organisms. Approximately half of the Pseudomonas aeruginosa infections were eradicated. Nearly all patients received concomitant theophylline but this only caused serious problems in those given 600 mg doses of enoxacin twice daily. Five patients given ciprofloxacin had to discontinue because of unwanted effects (mostly hallucinations), one patient given pefloxacin had gastric pain and two patients given ofloxacin developed a skin rash. Apart from the theophylline interaction, the unwanted effects did not appear to be dose-related. The best overall clinical results were noted after 800 mg doses of ofloxacin once daily for seven days.

Adolescent↗
PubMed1987

Amoxycillin/clavulanate in acute purulent exacerbations of chronic bronchitis.

Twenty patients, all admitted to hospital with acute purulent exacerbations of chronic bronchitis associated with Haemophilus influenzae, Streptococcus pneumoniae or beta-lactamase producing Branhamella catarrhalis were treated twice daily for ten days with amoxycillin/clavulanate. Ten patients were first given 1000 mg amoxycillin with 200 mg potassium clavulanate intravenously bd for three days, before crossing to the standard oral regimen of 1000 mg amoxycillin + 250 mg potassium clavulanate bd. Clinical results on day 10 were excellent in 16/20 patients, but 14 patients developed recurrences or reinfections within a week of the end-of-treatment, five of them with beta-lactamase producing B. catarrhalis. Bacteriological and kinetic studies showed that the branhamella beta-lactamases were inhibited by 0.25 mg/l clavulanic acid and that the mean sputum concentration of clavulanic acid was 0.16 mg/l, that of amoxycillin being 0.92 mg/l. The importance of the follow-up of such infections is stressed.

Aged↗