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Biomedical subjects

C G Cobbs

Publications and source records attributed to C G Cobbs.

16 recordsLinked to original sources
PubMed1992

In vitro activity of sparfloxacin and three other fluoroquinolones against methicillin-resistant Staphylococcus aureus and Staphylococcus epidermidis.

Fluoroquinolones are variably active against methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant Staphylococcus epidermidis (MRSE). The purpose of this study was to test the in vitro susceptibility of 50 isolates each of MRSA and MRSE to four of the new fluoroquinolones--sparfloxacin, ciprofloxacin, ofloxacin and norfloxacin--and to see if resistance could be induced in five susceptible strains of each species by serial passages with increasing concentrations of drug. A standard microdilution technique was used to determine minimal inhibitory concentrations (MICs) and minimal bactericidal concentrations (MBCs) of each drug for each isolate. Agar dilution plates were also prepared containing concentrations of drug varying from one-half of the reported MIC to 128 times the reported MIC, and microorganisms persisting were serially passaged. Initially, 98% of the strains of MRSA were susceptible to the fluoroquinolones. MBCs were essentially identical to MICs. Similarly, 96% of the strains of MRSE were susceptible. Following exposure to increasing concentrations of each fluoroquinolone, resistance appeared to emerge less rapidly to sparfloxacin and ofloxacin than to norfloxacin and ciprofloxacin.

Anti-Infective Agents↗
PubMed1991

In vitro comparison of cilofungin alone and in combination with other antifungal agents against clinical isolates of Candida species.

Cilofungin, a lipopeptide antifungal agent, was tested for in vitro activity alone and in combination with ketoconazole, itraconazole, flucytosine and amphotericin B against 102 clinical isolates of Candida species. At 48 hours all isolates of Candida albicans, Candida tropicalis, Candida paratropicalis and Candida glabrata were inhibited by less than or equal to 5 meg/ml of cilofungin. In contrast, the MIC90 for Candida krusei was 10 mcg/ml and for Candida parapsilosis greater than 40 mcg/ml. The interaction of combinations of cilofungin with amphotericin B, itraconazole, ketoconazole and flucytosine was additive or indifferent at 48 hours for 100%, 88%, 78% and 70% of all Candida species isolates, respectively. Overall, cilofungin demonstrated good activity in vitro against most Candida species isolates.

Amphotericin B↗
PubMed1990

Comparison of cilofungin and amphotericin B for therapy of murine candidiasis.

We compared the efficacies of cilofungin and amphotericin B treatment in a murine model of disseminated candidiasis. Three different dosages of each drug plus controls were evaluated. Statistically improved survival was noted only among mice treated with 1 mg of amphotericin B per kg of body weight (P less than 0.05). While all amphotericin B regimens and the two lower-dosage cilofungin regimens significantly reduced yeast cell counts in kidneys compared with the controls, the amphotericin B-treated mice had a significantly higher percentage of sterile kidneys following therapy compared with those treated with cilofungin (P = 0.0001).

Amphotericin B↗
PubMed1989

Diseases that mimic herpes simplex encephalitis. Diagnosis, presentation, and outcome. NIAD Collaborative Antiviral Study Group.

A total of 432 patients underwent brain biopsy for presumptive herpes simplex encephalitis. Three patient groups were identified. The first group, 195 patients (45%), had herpes simplex encephalitis confirmed by the isolation of herpes simplex virus from brain tissue at biopsy (193 patients) or autopsy (2 patients). The second group, 95 patients (22%), had diseases that were identified but that were not caused by herpes simplex virus. Three subgroups were recognized: (1) 38 patients (9%) with treatable disease, (2) 40 patients (9%) with nontreatable but diagnosed viral infection, and (3) 17 patients (4%) with identified diseases neither of viral etiology nor treatable. The third group, 142 patients (33%), remained without a diagnosis. Clinical presentation of patients in the second group was similar to that of those with herpes simplex encephalitis and those without a diagnosis. Patients in the subgroup with nontreatable but diagnosed viral infections had the greatest likelihood of returning to normal.

Adolescent↗
PubMed1989

Bacteriostatic versus bactericidal activity.

Antibiotics alone or in combination may either inhibit or kill bacteria. Laboratory methods are available to determine the activity of various antimicrobial agents and can aid the physician in selecting appropriate antimicrobial therapy for specific infectious disease disorders. A few infectious processes appear to require bactericidal antimicrobial therapy for cure. Additional multicenter trials of the ability of a standardized SBT to predict therapeutic outcome in specific bacterial diseases are required.

Animals↗
PubMed1979

A comparison of amphotericin B alone and combined with flucytosine in the treatment of cryptoccal meningitis.

We compared amphotericin B therapy for cryptococcal meningitis with a newer regimen containing both amphotericin B and flucytosine. In 50 patients with 51 courses of therapy adherent to the protocol, 27 courses were with amphotericin B and 24 with the combination. Even though the combination regimen was given for only six weeks and amphotericin B for 10 weeks, the combination cured or improved more patients (16 vs 11), produced fewer failures or relapses (three vs. 11), more rapid sterilization of the cerebrospinal fluid (P less than 0.001) and less nephrotoxicity (P less than 0.05) than did amphotericin B alone. The number of deaths was the same (five) with each regimen. Adverse reactions to flucytosine occurred in 11 of 34 patients but were not life threatening. We conclude that combined flucytosine-amphoericin B therapy is the regimen of choice in cryptococcal meningitis.

Adolescent↗
PubMed1979

Clinical and laboratory evaluation of cefamandole in the therapy of Haemophilus spp. Bronchopulmonary infections.

A prospective, randomized, single-blind comparison of parenteral cefamandole and ampicillin was conducted in 27 hospitalized adult patients with pneumonia or purulent tracheobronchitis due to Haemophilus spp. Patients received either parenteral cefamandole or ampicillin in a dose of 1 g every 6 h. Cefamandole was as effective and safe as ampicillin. Of the 14 patients treated with cefamandole, 13 were considered cured, as were 12 of the 13 treated with ampicillin. One patient in each treatment group improved clinically but did not clear his sputum of Haemophilus spp. One patient treated with cefamandole had a recurrence of Haemophilus spp. bronchitis 9 days after cure. Adverse effects were more common in the cefamandole-treated group (50% versus 15%), but were mild and did not require discontinuation of therapy in any patient. The in vitro susceptibilities of 64 clinical isolates of Haemophilus spp. to 10 antibiotics were determined. Cefamandole was the most active of the cephalosporin-cephamycin antibiotics tested, inhibiting 98% of 61 non-beta-lactamase-producing isolates at 2 mug/ml and 100% at 4 mug/ml. Cefamandole inhibited the three ampicillin-resistant isolates at 2 mug/ml or less. Cephapirin, cefoxitin, and cephalothin were the next most active, whereas cefazolin and cephradine were the least active.

Adult↗
PubMed1979

Correlation of aminoglycoside dosages with serum concentrations during therapy of serious gram-negative bacillary disease.

We prospectively evaluated serum aminoglycoside (AMG) concentrations in 120 patients who received gentamicin or tobramycin for serious gram-negative bacillary disease. AMG serum concentrations were assayed by microbiological and radioimmunoassay techniques. Correlation between the two assay methods was good. When AMG doses were based on total body weight, there was no significant correlation between AMG dosage administered and serum concentrations in patients with either normal or abnormal renal function. The use of ideal body weight for calculation of AMG dosage improved this correlation significantly except in hemodialysis patients. AMG-induced nephrotoxicity occurred in 13 patients. No significant association was noted between the occurrence of toxicity and the specific AMG given or with other commonly recognized risk factors. Among study groups, peak AMG serum concentrations failed to exceed the minimal inhibitory concentration of the infecting organism in 17 to 33% of the cases. Serum inhibitory levels of greater than or equal to 1:8 were not associated with improved survival. There was no significant difference in mortality between the gentamicin- and tobramycin-treated groups. We advise base-line serum AMG levels in seriously ill patients with gram-negative bacillary disease and additional bacteriological studies in selected situations.

Aminoglycosides↗
PubMed1979

In vitro activity of LY127935, a new 1-oxa cephalosporin, against aerobic gram-negative bacilli.

A total of 434 clinical aerobic gram-negative bacillary isolates were tested against LY127935, a new 1-oxa cephalosporin, and compared with other cephalosporins, penicillins, and aminoglycosides by a broth microdilution technique. Cefotaxime (HR756), a new semisynthetic cephalosporin, and LY127935 were more active, and showed lower minimum inhibitory concentrations (ranges, less than or equal to 0.12 to 2.0 micrograms/ml), than cefamandole, cefoxitin, and cefazolin against Escherichia coli, Klebsiella spp., Enterobacter spp., Proteus mirabilis, indole-positive Proteus spp., Serratia marcescens, Providencia spp., and Citrobacter spp. Against P. aeruginosa, pepercillin, azlocillin, and mezlocillin were the most active beta-lactam agents; 64 micrograms/ml inhibited 99, 93, and 87% of the isolates, respectively. LY127935 and cefotaxime at 16 micrograms/ml inhibited 71% of Pseudomonas isolates, whereas the aminoglycosides gentamicin, tobramycin, and amikacin at a concentration of 4 micrograms/ml inhibited 84, 88, and 93%, respectively. Minimum bactericidal concentrations were determined for all isolates and were generally the same as the minimum inhibitory concentrations.

Aminoglycosides↗
PubMed1978

Persistent bacteremia in staphylococcal endocarditis.

We treated five patients with persistent Staphylococcus aureus bacteremia and endocarditis. Surgical intervention or a "second-line" antistaphylococcal agent was required for bacteriologic cure in each. Special bacteriologic evaluation failed to demonstrate methicillin resistance or antibiotic "tolerance" among the strains of Staphylococcus tested. Cephalosporin agents were noted to be more susceptible to inoculum effect than either methicillin or nafcillin. All patients survived; the explanation for their atypical course is obscure. We present an approach to patients with persistent Staph. aureus bacteremia and endocarditis.

Adult↗
PubMed1978

Recent experience with tetanus in Alabama.

In recent years, all cases of tetanus reported in the United States have occurred either in unimmunized persons, partially immunized persons, or persons whose immunization history was uncertain. We present our experience with three unimmunized individuals who acquired this disease. One patient became ill after a "clean, minor wound." Present guidelines do not encourage immediate protection with human tetanus immune globulin (TIG) for unimmunized patients with this type of injury. We believe serious consideration should be given to modification of current recommendations to include the more liberal use of TIG, especially in nonimmune persons.

Aged↗
PubMed1975

Gram-negative bacillus pneumonia.

Our experience with gram-negativebacillus pneumonia (GNBP) was examined to assist us in the diagnosis and treatment of this serious condition. The patients were divided into three categories: those with primary GNBP, those with primary nosocomial GNBP, and those with superinfection GNBP. Mortality correlated highly with the severity of underlying disorders. Aspiration occurred or was suspected before most instances of primary GNBP. Tracheostomy, inhalation therapy, and aspiration were common events before development of primary nosocomial GNBP and superinfection GNBP. Half the patients survived the two primary varieties of GNBP. A striking leukocytosis developed at the onset of most cases of primary nosocomial GNBP and superinfection GNBP.

Adult↗
PubMed1975

Treatment of end-stage renal disease by transplantation: clinical results with 111 cases.

The efficacy of renal transplantation for patients with end-stage renal disease was reviewed in 108 patients receiving 111 transplants followed for an average of two and one-half years after transplantation. Overall patient survival decreased 10 per cent per year from 90 per cent after the first year to 70 per cent at three years. Kidney survival was slightly less, with a similar pattern. Patients with better tissue matches and living related donor allografts had fewer and less severe rejections and better ultimate function than did patients with poor tissue matches and cadaver allografts. However, a significant number of patients with poor tissue matches and cadaver allografts had excellent results. Eighty-six per cent of all survivors with functioning kidneys had serum creatinines of 2.0 mg./100 ml. or below. Mortality was associated primarily with sepsis from a variety of bacterial, fungal, viral and protozoan organisms often associated with other complications such as rejection or gastrointestinal bleeding. Recipients over the age of 40 were in a higher risk group. Rejection per se, however, played a minor role. Urological and skeletal complications were a major source of morbidity but were not associated with mortality.

Adolescent↗