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Biomedical subjects

C A Ramirez

Publications and source records attributed to C A Ramirez.

5 recordsLinked to original sources
PubMed1989

Intravenous ciprofloxacin or ceftazidime in selected infections. A prospective, randomized, controlled study.

In a prospective, randomized, controlled study, the effectiveness and safety of intravenous ciprofloxacin was compared with those of ceftazidime in the treatment of tissue infections. A total of 52 patients received intravenous ciprofloxacin 200 mg twice daily (26 patients) or ceftazidime 1 to 2 g every eight to 12 hours (26 patients). This was followed, respectively, by oral ciprofloxacin or another suitable drug when improvement was seen. Informed consent was obtained from all patients. Cultures and laboratory determinations were performed initially and repeated periodically as indicated. Both groups were comparable in age, sex, number of infected sites, and instance of nosocomial infections (27 total). Severe infections occurred in six ciprofloxacin and 12 ceftazidime patients (p = 0.056). There were 13 patients in the ciprofloxacin group and six in the ceftazidime group with accompanying diseases (p = 0.032). Patients were treated with ciprofloxacin or ceftazidime for infections of the urinary tract (eight and two patients, respectively), skin or soft tissues (15 and 17 patients), pelvis (one and zero patients), lower respiratory tract (one and one patients), intra-abdominal (zero and three patients), and bacteremia (three and five patients). Two patients in each group had two sites of infection. Causative organisms were as follows: 15 gram-positive cocci (90 percent minimal inhibitory concentration: ciprofloxacin, 0.5; ceftazidime, 16.0 micrograms/ml) and 55 gram-negative rods (44 Enterobacteriaceae, nine Pseudomonas aeruginosa; 90 percent minimal inhibitory concentration: ciprofloxacin, 0.25; ceftazidime, 8.0 micrograms/ml). Resistance emerged in one patient treated with ciprofloxacin (Acinetobacter sp.) and 12 treated with ceftazidime (four Enterococcus, two Staphylococcus aureus, six other). Intravenous treatment was longer with ceftazidime (11.5 days versus 5.6 days for the ciprofloxacin group, p less than 0.0005), but the total duration of therapy was similar (12.9 versus 14.1 days, p value not significant). Resolution or improvement occurred in 23 ciprofloxacin and 26 ceftazidime sites of infection (p value not significant). Death occurred in two ceftazidime-treated patients (due to bacterial infection) and one ciprofloxacin-treated patient (at the induction of anesthesia). Adverse experiences were more common in the ceftazidime group as compared with the ciprofloxacin group (22 versus 15 patients, p = 0.026). Ciprofloxacin eradicated 25 of 31 causative organisms, whereas ceftazidime eradicated 30 of 41 (p value not significant). Intravenous ciprofloxacin was at least as effective as ceftazidime. Patients treated with ciprofloxacin may need added coverage for anaerobes, but the drug's excellent activity against nosocomial pathogens and its availability in oral form allow for an early change to oral therapy without compromising effectiveness coupled with added savings and convenience.

Adult↗
PubMed1985

Open, prospective study of the clinical efficacy of ciprofloxacin.

One hundred patients with infections mostly outside of the urinary tract were studied in a prospective, open manner to ascertain the effectiveness and safety of ciprofloxacin in a variety of clinical situations. There were 41 instances of bacteremia, including 38 with Salmonella typhi, and 21 respiratory, 17 skin and skin structure, 11 bone or joint, 6 gastrointestinal, and 4 urinary tract infections. The patients were given 500 mg of ciprofloxacin orally every 12 h for 2 to 107 days (mean, 15.1 days). Microorganisms isolated disclosed susceptibilities comparable to those reported previously, with a MIC for 90% of the strains of 0.25 microgram/ml. For Streptococcus pneumoniae the MIC for 90% of the strains was 0.03 microgram/ml, and it was higher for Pseudomonas aeruginosa (0.5 microgram/ml), although still in the therapeutic range. Levels in blood were lower than those reported in other series, and no accumulation of the drug during treatment was detected. In 88 instances there was resolution of the infectious process, in 7 there was improvement, in 3 there was a failure to respond, and in 2 the clinical response was indeterminate. Bacteriological eradication was documented in 87 infections. Despite extensive clinical and laboratory examinations before, during, and after therapy, no major abnormalities related to therapy were seen; only one patient required discontinuation of ciprofloxacin due to gastrointestinal intolerance. Ciprofloxacin is an effective and safe therapeutic alternative in many tissue infections caused by susceptible microorganisms.

Adolescent↗
PubMed1981

Clinical efficacy of moxalactam with emphasis on infections due to multidrug-resistant organisms in patients with renal insufficiency.

The efficacy of moxalactam, a new beta-lactam antibiotic with an expanded spectrum of in vitro activity, was evaluated in 22 patients with 27 sites of infection. The pathogens included six strains of multidrug-resistant Serratia marcescens and one of Pseudomonas aeruginosa. The minimal inhibitory concentration of moxalactam for the study isolates ranged from less thant 0.12 to 32 microgram/ml. Peak serum levels exceeded the minimal inhibitory concentration of the pathogen in every instance with mean peak serum levels of 43.0, 65.0 and 123 microgram/ml for doses of 0.5, 1.0 and 2.0 g, respectively. Pharmacokinetic data was obtained in patients with normal and abnormal renal function and during hemodialysis. Moxalactam was found to have excellent penetration into synovial, peritoneal, pleural and cerebrospinal fluids. 23 of the 27 infections were cured, There were six episodes of recurrent infections at the 4-week follow-up among the 12 patients treated for urinary tract infections. Drug toxicity was not a major problem. There were nine instances of superinfection noted (three each due to Candida spp., enterococci and P. aeruginosa), only of which was clinically significant.

Adult↗
PubMedDate not supplied

Transport of 125I-albumin across normal and deendothelialized rabbit thoracic aorta in vivo.

Transmural concentration profiles of 125I-albumin in vivo were measured across the normal and balloon catheter-deendothelialized rabbit descending thoracic aorta as a function of time following intravenous injection. A tracer was injected 5 or 60 minutes after deendothelialization, and the animals were sacrificed after circulation times of 10, 30 or 60 minutes. The aorta was immediately excised and frozen flat between glass slides. Samples were serially sectioned parallel to the intimal surface in a refrigerated microtome, washed with trichloroacetic acid (TCA), and counted. Relative tissue concentration profiles of TCA-precipitable radioactivity from the media of control animals showed entry from both luminal and adventitial sides, as previously found with conscious normal rabbits, but spatial gradients at both luminal and medial-adventitial borders were less steep. Relative concentration levels in ballooned animals were 10- to 40-fold higher than in controls, and the profiles were flatter. Uptake rates at equivalent circulation times were greater in experiments initiated 60 minutes, as compared with 5 minutes, after deendothelialization, suggesting that progressive medial edema may have occurred following balloon injury. These results show that the intact endothelium is the dominant mass transfer resistance for 125I-albumin transport across the aortic wall. The data also suggest that the incomplete monolayer of platelets adherent to the subendothelium after balloon deendothelialization is not a substantial resistance to transport, as compared to that of the media, and that convection plays a more important role than diffusion for 125I-albumin transport across the deendothelialized aortic wall.

Animals↗