[Penetration of norfloxacin in aqueous humor: preliminary study].
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Biomedical subjects
Publications and source records attributed to D Talon.
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The authors have studied the penetration of Ofloxacin in the aqueous humour in 30 patients (30 eyes). Six hours after a single oral dose of 200 mg, the concentration in the anterior chamber reached 0.6 microgram/ml which is 23% of the average serum level. It is over the minimal inhibitory concentration necessary for many bacterial agents found in endophthalmitis (except Streptococcus) because the MIC of Ofloxacin are the lowest among quinolones. Side effects and association with other antibiotics are precise.
Authors have studied the intraocular penetration of a new antibiotic, pefloxacin in 35 patients (35 eyes). This study emphasizes the three main qualities of this recent quinolone in ophthalmology: wide spectrum adequate for the most pathogens commonly found in endophthalmitis. Very large penetration in the aqueous humour flow with an average level of 0.95 mu/ml, which is over the minimal inhibitory concentration for many bacterial infections and is equal to 25% of average serum level.
Analysis of 20 cases of staphylococcal septicemia, observed over 1 1/2 months in a general hospital, confirms that these infections are frequent and severe. They occurred in compromised hosts and were nosocomial infections in 2/3 of cases. An intravenous device (particularly a central venous catheter) was associated with 70% of staphylococcal septicemia. Study of bacterial susceptibility to antibiotics and clinical course leads to advocate that high risk patients with fever be initially given rifampin combined with netilmicin.
A virulent phage specific for Pseudomonas testosteroni is described. This phage have a regular icosahedral head (52 nm between opposite angles) and a contractile tail (165 X 8 nm) but no fibers on. The buoyant density is 1,51 +/- 0,01 g/ml. The nucleic acid is an desoxyribonucleic acid with a density of 1,696 +/- 0,03 g/ml and a GC% between 33,7 and 39,7.
The authors report the tobramycin minimal inhibitory concentration (MIC) of 264 strains (dilution in Mueller-Hinton agar). Staphylococcus aureus (96 strains) have a MIC of 0.02 mcg/ml, 80 % being inhibited by 0.07 mcg/ml. Most Enterobacteriaceae (70 strains) are sensitive to 0.7 mcg/ml ; Providencia are the most resistant (MIC 11.88 mcg/ml). Among Pseudomonas aeruginosa (98 strains, MIC : 11.57 mcg/ml) 50 % are inhibited by 0.30 mcg/ml, 80 % by 18.8 mcg/ml. Relationships of MIC to zone diameters with the use of 10 mcg (D 10) and 30 mcg (D 30) tobramycin discs allow to draw the regression line which is respectively : y = -- 0,331 x + 6,64 and y = -- 0.263 x + 7,68. The strains are sensitive with an inhibition diameter greater than or equal to 16 mm (D 10) or greater than or equal to 18.5 mm (D 30).
The intraocular penetration of Ciprofloxacin in man: authors have studied the penetration of Ciprofloxacin in the aqueous humor of 30 patients (30 eyes). The concentration in the anterior chamber was on average 0.73 mg/l which is 33% of serum level, from 1.30 hours after a single oral dose of 1000 mg till the 4th hour after this dose. The samples were assessed by a microbiological method. These results are over the minimal inhibitory concentration for many bacterial agents found in endophthalmitis. So this antibiotic may be proposed in the treatment of endophthalmitis. Anyway further investigation is mandatory to assess the safety on efficacy of these antibiotics.
Currently, the systemic antibiotics intraocular penetration's rate is low and we have to perform intraocular antibiotics injections to reach levels above the minimal inhibitory concentration of the bacterial agents found commonly in endophthalmitis. Authors try to specify a rational strategy based on pharmacokinetics and bacteriological aspects of a new class of antibiotics, the fluoroquinolones, using their own studies and those from other teams about the intraocular distribution of these antibiotics. Further investigation is mandatory to assess the safety and efficacy of our first clinical results.
This study included 44 children undergoing autologous marrow transplantation for leukemia between August 1979 and June 1987. Three of them received a second transplant. In the phase of neutropenia, 38 children presented with fever. Nineteen septicemia occurred (13 Gram positive cocci, 6 Gram negative bacteria), and 2 interstitial pneumonitis were observed. All children with documented infection or a fever of unknown origin recovered after treatment, except 3, who died from infection. The latest antimicrobial therapy used was a combination of an aminoglycoside and a third generation cephalosporin. When necessary, vancomycin or amphotericin B were added. After engraftment (granulocyte count greater than 0.5 X 10(9)/l) 14 septicemia (which recovered) and 10 herpes zoster infections were observed. Only one patient died of infection (herpes zoster with encephalitis).
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OBJECTIVES: The prognosis of septicaemia due to Pseudomonas aeruginosa is severe with mortality ranging from 32 to 73%. We retrospectively studied 82 episodes in order to determine whether risk factors could be identified. METHODS: Eighty-two episodes of Pseudomonas aeruginosa septicaemia, observed between 1986 and 1991, were analyzed. Risk of death within 2 days of the first positive blood culture (mortality = 19.5%) were assessed with univariate and multivariate analyses. RESULTS: Patient age ranged from 1 to 92 years. Most had been hospitalized in medical wards (49%) or intensive care units (28%) (NS). The type of septicaemia (several bacteria in 21%), the source of the infection (nosocomial in 78%), portal, predisposing factors (cancer, haematologic disease: 54%) and MacCabe index were not significantly correlated with risk of death at two days following first positive blood culture. With univariate analysis body temperature below 38,5 degrees C was significant (p = 0.007) for death at day 2 and appropriate antibiotic treatment after diagnosis was significant (p < 0.001) for absence of death on day 2. For multivariate analysis, chemotherapy and shock syndrome were significant (p = 0.005 and 0.09 respectively) for death at day 2 and appropriate antibiotic treatment was significant (p = 0.005) for absence of death on day 2. CONCLUSION: Antibiotic prescription appears to be the most easily controlled significant factor predictive of outcome in Pseudomonas aeruginosa septicaemia.