[Prevention of endocarditis with antibiotics].
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Biomedical subjects
Publications and source records attributed to F Nordbring.
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Pseudomonas aeruginosa has emerged into the limelight mainly as a result of compromised host problems and the development of resistance leading to serious treatment difficulties. The organism possesses virulence factor that produce an effect in certain clinical situations. Changes in local anatomy, often with the presence of foreign bodies, are important (bladder and intravenous catheters, tracheostomy, burns, wounds, and injuries). Deficiencies in immune defense, particularly granulocytopenia, are almost a prerequisite for development of Pseudomonas septicemia and meningitis. The toxic factors of Pseudomonas organisms in combination with a disturbed defense mechanism produce characteristic necrotic skin lesions. A mucoid form of P aeruginosa is a characteristic feature of cystic fibrosis. Resistance of P aeruginosa to antibiotics is very definitely associated with overuse of broad-spectrum antibiotics in hospitals. New and more effective antibiotics may be needed.
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23 infants and children, aged 1 month - 15 years, were treated with piperacillin, a new semi-synthetic penicillin with a broad spectrum of activity. The indications were perforated appendicitis with peritonitis or abscess formation (12 patients), urinary tract infection due to congenital anomalies (3 patients), miscellaneous infections (3 patients) and peroperative prophylactic treatment (5 patients). The clinical response was good. Few adverse reactions were noted. The drug seems to be effective and safe.
A review is given of current antibiotic treatment of anaerobic infections. It is emphasized that infections with Bacteroides fragilis constitute the main problem, virtually all other anaerobe organisms of clinical significance are sensitive to penicillin. Particularly useful antibiotics for infections with B. fragilis are cefoxitin, chloramphenicol, clindamycin and the nitroimidazoles. Vancomycin is the drug of choice for pseudomembranous colitis provoked by Clostridium difficile.
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Fatal progressive vaccinia developed in two infants, a girl and a boy, vaccinated at the age of 2 months. Immunodeficiencies comprised both humoral and cell-mediated immunity. In the girl low levels of immunoglobulins and a defect function of lymphocytes was demonstrated. The boy had hypogammaglobulinemia and lack of T-lymphocytes. There was a marked hypoplasia of thymus and lymphoid organs in both infants. Both infants had the haplotype A3, B8 and in the boy a crossing over had taken place within the HLA region. No effect was achieved with antivaccinia immunoglobulin and concomitant antiviral therapy (thiosemicarbazone, adenine arabinoside). Interferon therapy gave no clinical improvement, nor did transfer factor.
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Side-effects of aminopenicillin therapy are reviewed on the basis of nine comparative studies of ampicillin and bacampicillin, and available literature data from investigations with talampicillin, pivampicillin, bacampicillin and amoxycillin. Diarrhoea is more common with ampicillin than with newer aminopenicillins. Exanthema do not appear more frequently with newer aminopenicillins. The frequency of upper gastrointestinal complaints in association with some of the newer aminopenicillins (amoxycillin, bacampicillin) is not more frequent than with ampicillin. All current evidence speaks in favour of a change from ampicillin to modern aminopenicillins for oral therapy.
During a small epidemic of infectious hepatitis, a fulminant infection with fatal outcome occurred in a 54-year-old woman. IgM antibody to hepatitis A virus was demonstrated in the serum and large amounts of hepatitis A virus were found in the liver. It is suggested that the pathogenesis may be different for fulminant hepatitis A and B infection.