PubMed Health⌕ Search

Biomedical subjects

C J Wilkowske

Publications and source records attributed to C J Wilkowske.

At least 19 recordsLinked to original sources
PubMed1992

Prophylactic use of antimicrobial agents in adult patients.

The prophylactic use of antimicrobial agents is recommended for prevention of numerous infections, including tuberculosis, endocarditis, rheumatic fever, recurrent cellulitis and lymphangitis in patients with lymphedema, meningococcal meningitis, and bite wounds. In addition, the prophylactic use of antimicrobial agents has proved effective in certain surgical procedures such as various abdominal operations, hysterectomy, and major operations that involve the head and neck. Except for oral bowel preparations, antimicrobial prophylaxis should be limited, in general, to the operative period. Prolonged perioperative prophylaxis has not been shown to enhance effectiveness and may result in increased toxicity, resistant superinfections, and inflated costs. The investigation of antimicrobial prophylaxis necessitates adequate evaluation of the potential advantages and disadvantages in a prospective, double-blind fashion.

Adult↗
PubMed1992

Isolated antral narrowing associated with gastrointestinal cryptosporidiosis in acquired immunodeficiency syndrome.

A 33-year-old man with human immunodeficiency virus infection had severe protracted diarrhea. Radiologic assessment disclosed narrowing of the gastric antrum. Biopsy specimens revealed diffuse Cryptosporidium infection of the antral mucosa. Isolated antral narrowing due to Cryptosporidium gastritis should be added to the list of gastrointestinal complications associated with acquired immunodeficiency syndrome (AIDS).

AIDS-Related Opportunistic Infections↗
PubMed1992

Antituberculous agents.

Antituberculous agents have radically improved the prognosis of patients with active tuberculosis. Generally, 6-month and 9-month antituberculous regimens have been successful, and surgical therapy is rarely needed. Extrapulmonary tuberculosis should be managed with the same drug regimens as pulmonary tuberculosis. The major cause of therapeutic failure is poor compliance of the patient in taking the prescribed medication regularly. A second cause of failure of treatment is resistance of tubercule bacilli to antimicrobial agents used. When failure of treatment is apparent, careful reassessment by physicians experienced in the treatment of tuberculosis is indicated. A single drug should never be added to a failing regimen. Isoniazid administered prophylactically for 6 to 12 months is effective in most cases.

Antitubercular Agents↗
PubMed1991

General principles of antimicrobial therapy.

Treatment with antimicrobial agents must be tailored to the individual patient, the site of infection, and the etiologic organism involved. Effectiveness, toxicity, and cost are the basic considerations in choosing a drug. Because initiation of therapy often cannot be delayed until microbiologic studies have been performed, empiric treatment should be sufficiently broad to cover the most likely pathogens, based on the site of infection and the type of host. Definitive therapy may differ from initial therapy and should be instituted as soon as specific laboratory and clinical data are available. Information about allergic reactions to drugs should be elicited; because of the numerous families of antimicrobial agents currently available, most infections in patients with drug allergies can be treated with adequate substitutes. Cautious conservatism is advocated in the use of new antimicrobial agents. The effects of new agents on the microbial ecology and the hospital environment should be considered.

Anti-Bacterial Agents↗
PubMed1991

The penicillins.

The penicillin family of antibiotics remains an important part of our antimicrobial armamentarium. In general, these agents have bactericidal activity, excellent distribution throughout the body, low toxicity, and efficacy against infections caused by susceptible bacteria. The initial introduction of aqueous penicillin G for treatment of streptococcal and staphylococcal infections was an important pharmacologic landmark. The emergence of penicillinase-producing Staphylococcus aureus prompted the development of the penicillinase-resistant penicillins (for example, methicillin, oxacillin, and nafcillin), in which an acyl side chain prevented disruption of the beta-lactam [corrected] ring. Subsequently, the aminopenicillins (such as ampicillin and amoxicillin) were developed because of the need for gram-negative antimicrobial activity. Their spectrum included Escherichia coli, Proteus mirabilis, Shigella Salmonella, Listeria, Haemophilus, and Neisseria. The search for a penicillin with additional antimicrobial activity against the Enterobacteriaceae and Pseudomonas aeruginosa led to the development of the carboxypenicillins (carbenicillin, ticarcillin, and temocillin) and the ureidopenicillins (mezlocillin, azlocillin, piperacillin, and apalcillin). Finally, the combination of a beta-lactamase inhibitor (clavulanic acid or sulbactam) and an aminopenicillin or ticarcillin has further extended their antibacterial spectra. The development of an ideal penicillin that is rapidly bactericidal, nonsensitizing, nontoxic, bioavailable, resistant to beta-lactamase, and without inoculum effect and that has a high affinity for penicillin-binding proteins remains the goal.

Humans↗
PubMed1988

Efficacy of ganciclovir in liver and kidney transplant recipients with severe cytomegalovirus infection.

Twelve liver and 5 kidney transplant recipients with severe cytomegalovirus infection were treated with Ganciclovir (7.5 mg/kg/day, intravenously). Ten were evaluable (compatible clinical picture, organ involvement shown histopathologically or by culture, viremia, and absence of concomitant infection). All 17 patients were studied for adverse drug side effects. A total of 9 evaluable patients survived the infection; 1 died during treatment due to infection or drug toxicity. A death 19 days after completion of treatment was due to unrelated causes. Patients became afebrile after 2-9 days (mean, 5.3 days) of treatment. Liver function improved, pulmonary infiltrates cleared, and hypoxemia reversed during therapy. Viremia ceased during therapy in 9 patients; asymptomatic viruria persisted or recurred in 6 of 7 patients studied. No relapses occurred during follow-up (7-17 months; mean, 13 months). Transient neutropenia and thrombocytopenia occurred in 3 and 1 patients, respectively. Ganciclovir appears promising for treatment of severe CMV infection in patients with kidney or liver transplants.

Acyclovir↗
PubMed1987

General principles of antimicrobial therapy.

Use of antimicrobial agents must be tailored to the individual patient, site of infection, and etiologic organism. The choice of drug should be based on efficacy, safety, low toxicity, and acceptable cost. Empiric therapy should be broad enough to cover the pathogens that are suspected of causing the infection, based on the site of infection and the type of host. Definitive therapy may differ from initial therapy and should be started as soon as specific laboratory and clinical data are available. Cautious conservatism is advocated with regard to the use of new antimicrobial agents. The effects of the agents on the microbial ecology and hospital environment should be considered. Judicious use is necessary to prevent antimicrobial pollution.

Anti-Bacterial Agents↗
PubMed1987

The penicillins.

The penicillin family of antibiotics is ever expanding and remains an important part of our antimicrobial armamentarium. These medications generally have bactericidal activity, excellent distribution throughout the body, low toxicity, and efficacy against infections due to susceptible organisms. The clinical introduction of aqueous penicillin G for treatment of streptococcal and staphylococcal infections was an important pharmacologic landmark. The emergence of penicillinase-producing staphylococci prompted the development of the penicillinase-resistant penicillins (methicillin, oxacillin, nafcillin, and others), in which the acyl side chain prevented disruption of the beta-lactamase ring. The aminopenicillins (ampicillin, amoxicillin, and others) were later developed because of the need for gram-negative antimicrobial activity. Their spectrum included Escherichia coli, Proteus mirabilis, Shigella, Salmonella, Listeria, and Haemophilus. The search for a penicillin with even further antimicrobial activity against the Enterobacteriaceae and Pseudomonas aeruginosa led to the development of the carboxypenicillins, ureidopenicillins, and piperazine penicillins. Recently, the combination of a beta-lactamase inhibitor (clavulanic acid or sulbactam) and an amino-penicillin or ticarcillin has resulted in further extension of their antibacterial spectra. The development of an ideal penicillin that is nonsensitizing, bioavailable, beta-lactamase-resistant, rapidly bactericidal, nontoxic, and inexpensive and that has high affinity to penicillin-binding proteins and no inoculum effect remains the goal.

Bacterial Infections↗
PubMed1987

Antituberculous agents.

Antituberculous agents have radically improved the prognosis of patients with active tuberculosis. Generally, 6-month and 9-month regimens have been successful, and surgical therapy is rarely necessary. Extrapulmonary tuberculosis should be managed with the drug regimens outlined for pulmonary tuberculosis. The major cause of therapeutic failure is poor compliance of the patient in taking the medication regularly. The second major cause of treatment failure is resistance of tubercle bacilli to the antimicrobial agents used. When treatment failure is apparent, careful reassessment by physicians experienced in the treatment of tuberculosis is indicated. A single drug should never be added to a failing regimen. For prophylaxis, isoniazid, given for 6 to 12 months, is effective in most cases.

Antitubercular Agents↗
PubMed1987

Prophylactic use of antimicrobial agents in adult patients.

Prophylactic antimicrobial agents are recommended for prevention of a variety of conditions, including tuberculosis, endocarditis, rheumatic fever, recurrent cellulitis and lymphangitis in patients with lymphedema, meningococcal meningitis, bite wounds, and herpes virus infections. In addition, prophylactic antimicrobial agents have proved effective in certain surgical procedures such as a variety of abdominal operations, hysterectomy, and head and neck operations for cancer. Except for oral bowel preparations, administration of antimicrobial agents for prophylaxis should be limited, in general, to the perioperative time period. Doses given more than an hour before or 3 hours after a surgical procedure have not been shown to increase effectiveness, and such an approach increases the cost and the probability of toxicity and superinfection. Investigation of antimicrobial prophylaxis necessitates adequate evaluation of potential advantages and disadvantages in prospective double-blind fashion.

Adult↗
PubMed1979

Pseudospirochetes, a cause of erroneous diagnoses of leptospirosis.

Motile filaments of varying lengths and thicknesses were observed by darkfield microscopy in a blood culture of a specimen from a patient who had fever of unknown origin. Similar structures were also seen in cultures inoculated with donor blood from healthy controls. Since the movement and configuration of the structures were not characteristic for spirochetes, the morphologic features were further examined by electron microscopy. The filaments observed were identical in appearance to pseudospirochetes described more than 50 years ago. The authors' observations indicate that they are derived from erythrocytes. Because of possible confusion of these pseudospirochetes with living organisms, the diagnosis of leptospirosis by darkfield microscopy should be confirmed by cultural or serologic tests.

Adult↗
PubMed1979

Severe infection due to Streptococcus pneumoniae in asplenic renal transplant patients.

The medical records of 293 patients who underwent renal transplantation were analyzed for the occurrence of Streptococcus pneumoniae and Haemophilus influenzae infections in relation to splenectomy. Splenectomy was done in 236 (81%) graft recipients before or concomitant with transplantation. Bacteremia developed in five and fulminant sepsis in two from 3 to 32 months after splenectomy. No serious infections with these organisms occurred in the nonsplenectomy group. These results suggest that asplenia may be an additional factor predisposing transplant patients to serious infection. Prevention of these serious pneumococcal infections may be possible with polyvalent pneumococcal vaccine.

Adult↗
PubMed1978

Short-term intramuscular therapy with procaine penicillin plus streptomycin for infective endocarditis due to viridans streptococci.

Thirty-three patients with viridans streptococcal infective endocarditis were treated for two weeks with intramuscular procaine pencillin, 1.2 million units every 6 hours, plus streptomycin, 500 mg intramuscularly every 12 hours. Nine patients (27%) had infections with relatively penicillin-resistant microorganisms (MIC greater than 0.1 microgram/ml or MBC greater than or equal 3.12 microgram/ml). Follow-up ranged from 2 months to 3.5 years. There were no relapses; Mild vestibular toxicity developed in one patient. One patient died two months after completion of antimicrobial therapy from sudden onset of severe congestive heart failure; Seven patients required cardiac valve replacement after completion of antimicrobial therapy. None died. We believe that this therapeutic regimen is effective antimicrobial therapy for infective endocarditis caused by viridans streptococci, irrespective of in vitro microbiologic data.

Adolescent↗
PubMed1978

Cardiobacterium hominis endocarditis. Four cases with clinical and laboratory observations.

The clinical and microbiologic features of Cardiobacterium hominis endocarditis in four patients seen at the Mayo Clinic from 1971 through 1976 are described. All four were men ranging in age from 39 to 60 years. The precipitating factor in three was a dental procedure, and the illness was a prolonged, chronic one, with symptoms having been present 10 to 18 months before diagnosis. The other patient had a late prosthetic valve endocarditis and had had symptoms for only 3 months. Three patients were cured; the fourth died after 32 days of adequate therapy and what was considered a bacteriologic cure. Because of the pronounced fastidiousness of these bacteria, in vitro susceptibility tests could be done in only two of the four; the minimum inhibitory concentration for penicillin G was 0.07 microgram/ml in both. The therapeutic regimens were penicillin G plus streptomycin in the first case, predominantly penicillin G alone in the second, penicillin G for 2 weeks in the third, and ampicillin for 4 weeks in the fourth (prosthetic valve case) in addition to valve replacement. Clinical and laboratory experiences in the total reported cases lead us to believe that 3 weeks of therapy with penicillin G or ampicillin alone is adequate therapy for C. hominis endocarditis of natural valves.

Adult↗
PubMed1977

The penicillins.

The penicillins as a group are the most frequently and widely used of the antimicrobial agents because they are effective, low in toxicity, and relatively inexpensive. Effectiveness is due to the bactericidal action, the excellent distribution throughout the body spaces, and the wide spectrum of activity. Knowledge of the variation in spectrum of activity of the various types of penicillins is needed for effective use of the proper drug against individual infections. Allergenicity is the most frequent and serious problem associated with the use of penicillins. However, individual penicillin drugs do have other toxic side effects. The older penicillins are so inexpensive that the cost of their use need hardly be considered, whereas the newer penicillins are expensive and should be used only when they are clearly more effective for treatment than are drugs such as penicillin G.

Bacteria↗
PubMed1977

Haemophilus endocarditis. Report of 14 patients.

From 1963 through December 1976, 14 patients with Haemophilus endocarditis were seen, 10 since January 1972. Four different species representing 15 isolates were cultured from the 14 patients: H. influenzae (1), H. aphrophilus (5), H. PARAPHROPHILUS (5), and H. parainfluenzae (4). One patient had infection with both H. aphrophilus and H. paraphrophilus. Minimal inhibitory concentrations of 12 of the tested 14 strains with ampicillin were 1.25 mug/ml or less. Tube dilution tests were not possible for minimal bactericidal concentrations (7 times) or serum bactericidal titers (5 times) of the 12 tested strains. The clinical picture varied from an insidious onset and mild uncomplicated disease to abrupt onset with severe multisystem disease. Twelve patients had murmurs on admission; congestive heart failure was absent in all 14 but embolization occurred in 6. Treatment periods of 3 to 7 weeks consisted of penicillin G or ampicillin plus aminoglycoside in nine patients and ampicillin alone in five. All 14 patients were cured; no relapses occurred. Value surgery was not needed for bacteriologic cure but was necessary 15 days after therapy in one patient and in four others from 12 to 22 months after therapy. We believe that ampicillin, 12 g/day alone for 3 weeks, is adequate treatment for Haemophilus endocarditis.

Adolescent↗
PubMed1975

Bactericidal activity of combinations of gentamicin with penicillin or clindamycin against Streptococcus mutans.

Data derived from testing the bactericidal activity of combinations of penicillin with gentamicin or streptomycin and of clindamycin with gentamicin on nine isolates of Streptococcus mutans were analyzed by preparing isobolograms to determine the presence of additive, synergistic, or antagonistic effects. Synergy with penicillin-aminoglycoside combinations was found in two strains; additive effects occurred in seven instances with penicillin-gentamicin combinations; and antagonism occurred in eight instances with clindamycin-gentamicin combinations.

Clindamycin↗