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Biomedical subjects

H Lode

Publications and source records attributed to H Lode.

At least 235 records · Page 13Linked to original sources
PubMed1989

[Bioequivalence of an optimized doxycycline preparation].

The galenically optimized and pharmaceutically balanced doxycycline preparation Sigadoxin was compared with a reference preparation according to the new "Criteria for testing of the bioavailability and bioequivalence of doxycycline-containing products" recommended by the Central Laboratory of German Pharmacists. The statistical evaluation of the AUC and Cmax of the trial preparations and the urinary excretion rates from commercial production batches, which were of good quality in accordance with the present state of pharmaceutical knowledge, showed the comparable bioavailability of the two preparations, which can thus be considered as bioequivalent. The AUC and Cmax for the trial preparation were 44.9 mg/l and 2.87 mg/l, respectively. For the reference preparation the values for these parameters were 50.3 mg/l and 3.19 mg/l, respectively. The relative bioavailability, based on the AUC, was 89.3%.

Adult↗
PubMed1989

The pharmacokinetics of sultamicillin.

Sultamicillin is a mutual prodrug of ampicillin and sulbactam, a beta-lactamase inhibitor. When administered orally, sultamicillin is readily absorbed and rapidly hydrolyzed to provide high levels of its two constituents in the peripheral circulation. Peak serum concentrations of ampicillin are achieved that are approximately three and one-half times those obtained with an equivalent amount of oral ampicillin. Equimolar concentrations of sulbactam are also provided, with both ampicillin and sulbactam being widely distributed among various body fluids and tissues. The pharmacokinetic parameters of the two components are similar, both being eliminated primarily by renal excretion. Although the elimination half-lives of ampicillin and sulbactam are each approximately 1 hour, the high serum concentrations achieved coupled with their synergistic bactericidal activity permit twice-daily dosing.

Amoxicillin↗
PubMed1988

[Quinolones].

New quinolones are notable for their high level of antibacterial activity, especially against gram-negative pathogens, and also for their specific pharmacokinetics involving good bioavailability after oral administration, high distribution volumes and a long elimination time. In view of these properties the more recent quinolones can be regarded as on a par with the modern beta-lactam antibiotics and aminoglycosides, which, especially through the possibility of oral administration in infections with problem organisms such as Pseudomonas aeruginosa or Serratia, represent a therapeutic advance. To maintain this advance the indications for therapy must be approached in a restrictive and critical spirit; the newer quinolones are only rarely the drugs of choice and should be held in reserve for complicated infections of the respiratory tract, the intestinal tract, the urinary tract and the bones. In regard to tolerance, particular consideration should be given to the specific CNS intolerance reaction.

4-Quinolones↗
PubMed1988

[Pulmonary complications in acquired immunodeficiency syndrome. Results of a prospective study].

Between 1983 and 1987, a stepwise diagnostic programme was undertaken prospectively in 37 of 100 HIV-positive patients with 40 bronchopulmonary infections. It consisted chiefly of flexible bronchoscopy combined with lavage, transbronchial biopsy and/or removal of bronchial brush cells. Taking into account all examinations performed in life and at autopsy, 25 of the 37 patients had Pneumocystis carinii pneumonia (67.5%), 13 had bacterial pneumonia, six of these were mycobacterial infections (atypical mycobacteria in four), eight had neoplasms (pulmonary Kaposi's sarcoma in five, squamous-cell carcinoma in two, and Hodgkin's disease in one), and four patients had cytomegalovirus infection. Total diagnostic success of bronchoscopy was 78%; related to Pneumocystis pneumonia it was 91%.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Microbiological and clinical aspects of aspiration pneumonia.

Aspiration pneumonia is characterized by a pneumonitis in a dependent segment of the lung with typical necrosis or abscess-formation in the parenchyma. Observed aspiration or predisposition to aspiration, cavitation or abscess formation, with or without empyema fluid and isolation of distinctive micro-organisms are important clues to the diagnosis. Diagnostic procedures to collect anaerobic uncontaminated secretions are transtracheal aspiration, blood cultures, pleural fluid aspiration, fibreoptic bronchoscopic protected investigations and percutaneous transthoracic aspiration. Leading pathogens in more than 90% are anaerobic bacteria, mostly species of Bacteroides, Fusobacterium, Peptococcus and Peptostreptococcus; aerobic bacteria include Staphylococcus aureus and Gram-negative bacilli, mainly Klebsiella spp. and Pseudomonas aeruginosa. Treatment depends on bacteriological results; penicillin G and clindamycin are the most useful antibiotics against anaerobes and should be administered over a long period of time (4-12 weeks), adjusted to the clinical course of the individual patient.

Humans↗
PubMed1988

Comparative pharmacokinetics of intravenous ofloxacin and ciprofloxacin.

In ten volunteers the pharmacokinetics of ofloxacin and ciprofloxacin were determined after crossover administration of 100 and 200 mg intravenously (30 min constant infusion). Concentrations in serum and urine were measured by HPLC. Concentrations in serum following parenteral ofloxacin dosages demonstrated dose dependency with long biological half-lives. Pharmacokinetic parameters were calculated on the basis of an open three-compartment model, which resulted in a high volume of distribution for both substances (166-246 1 for ofloxacin, 178-2611 for ciprofloxacin). AUC for ofloxacin was three times higher than that for ciprofloxacin. Approximately 80% of ofloxacin and 57% of ciprofloxacin were eliminated through the kidneys. Ciprofloxacin had a considerable amount of extrarenal clearance, whereas only 19% of ofloxacin were eliminated by extrarenal mechanisms. Only 4.3% of ofloxacin after iv dosing could be detected as metabolites in urine.

Adult↗
PubMed1988

Pharmacokinetics and serum bactericidal activity of vancomycin alone and in combination with ceftazidime in healthy volunteers.

The pharmacokinetics and serum bactericidal activity of vancomycin alone and in combination with ceftazidime were investigated in 10 healthy volunteers. The pharmacokinetic parameters showed no significant differences (P less than 0.05) between single and combined administration. No antagonistic effects were observed in serum bactericidal activity with the combination against 20 gram-positive and 20 gram-negative locally isolated bacteria. A titer of greater than or equal to 1:8 was generated by the combination against all test strains except enterococci. Seven of ten volunteers developed a typical "red man's syndrome" during the administration of 1.0 g of vancomycin.

Adult↗
PubMed1988

Comparative pharmacokinetics of sulbactam/ampicillin and clavulanic acid/amoxycillin in human volunteers.

In this study, the pharmacokinetic parameters of 2 different beta-lactamase inhibitors (sulbactam and clavulanic acid) in combination with 2 different aminobenzylpenicillins (ampicillin and amoxycillin) were compared. The study involved 10 healthy volunteers who received sulbactam 250 mg plus ampicillin 500 mg intravenously, clavulanic acid 100 mg plus amoxycillin 500 mg intravenously, sultamicillin equivalent to sulbactam 294 mg plus ampicillin 440 mg orally, and clavulanic acid 125 mg plus amoxycillin 500 mg orally in a crossover, randomised trial. Serum and urine concentrations of ampicillin, amoxycillin and clavulanic acid were assayed by agar diffusion test, and the concentrations of sulbactam by gas chromatography with mass spectrometry. Pharmacokinetic parameters were calculated according to open 1- and 2-compartment models. Test results showed that the addition of sulbactam significantly increases the bioavailability of oral ampicillin when the 2 drugs are administered in the form of the prodrug sultamicillin. Also, sulbactam does not interfere with the kinetics of intravenous ampicillin but increases the absorption of oral ampicillin.

Administration, Oral↗
PubMed1987

Significance of non-pneumophila Legionella species in adult community-acquired and nosocomial pneumonias.

The number of different Legionella species is increasing at an impressive rate. In two prospective studies, one involving 110 intensive-care unit (ICU) patients with mainly nosocomial pneumonias and the other 105 patients with community-acquired pneumonias, we investigated the incidence and significance of Legionella pneumophila and non-pneumophila pneumonias on the basis of 17 different main serogroups. In the first study, 14 ICU patients had 15 (13.6%) Legionella pneumonias, which, in 5 cases (33%), were of non-pneumophila etiology. In the second study, 9 patients with community-acquired pneumonias had 10 (9.5%) Legionella pneumonias. Leading this study were 6 L. gormanii infections, followed by 2 L. dumoffii and only 1 L. pneumophila and 1 L. longbeachae pneumonia. Of the total, 22 of 23 patients with Legionnaires' disease suffered from severe basic diseases and complications (acute renal failure, respiratory insufficiency, etc.) predominant among the nosocomial pneumonias. The mortality rate was significant in these patients at 33% (5 patients) in the ICU group and 10% (1 patient) in the group with community-acquired pneumonias. We conclude that non-pneumophila Legionella species should receive more diagnostic and therapeutic consideration in patients with nosocomial or community-acquired pneumonias.

Adolescent↗
PubMed1987

Therapeutic aminoglycoside monitoring in renal failure patients.

In patients with normal renal function, defined peak (5-10 mg/L) and trough levels (less than 2 mg/L) for gentamicin, tobramicin, and netilmicin are considered therapeutic. Netilmicin peak and trough levels were investigated in 50 patients requiring hemodialysis due to acute (70%) or permanent (30%) renal failure. Netilmicin was given at a dosage interval of 24 h, with a loading dose on the first day (1.5 mg/kg) and a reduced daily maintenance dose (0.5 mg/kg) supplemented to the posthemodialysis dosage (1.3 mg/kg) after each hemodialysis. As compared with studies on patients not requiring hemodialysis, mortality (44%) was higher, mainly due to uncontrolled infection, whereas ototoxicity (17%) was not. Peak (5.9 +/- 1.7 mg/L) and trough plasma levels (3.0 +/- 0.9 mg/L) were significantly lower in patients who did not respond and died than were peak (8.2 +/- 2.5 mg/L) and trough (3.8 +/- 1.2 mg/L) levels in patients responding to aminoglycoside treatment. In renal failure patients, there is obviously not only the risk of overdosing and toxic side effects but also the risk of insufficient bactericidal effect as a result of underdosing. Consequently, by use of an aminoglycoside dosage similar to the present schedule, peak levels (5-10 mg/L) as desired in normal subjects but trough levels (2.5-5 mg/L) that are considerably higher than in normal subjects should be the target concentrations for patients with advanced renal failure.

Acute Kidney Injury↗
PubMed1987

Prospective randomized controlled study of ciprofloxacin versus imipenem-cilastatin in severe clinical infections.

In a randomized prospective study, 66 patients with serious bacterial infections--mainly lower respiratory tract infections--were treated with either imipenem plus cilastatin (32 patients) or ciprofloxacin (34 patients); 30 patients in each group were evaluable for efficacy. Substantial underlying disease was present in most of the patients; pathogens isolated prior to treatment (77 isolates) consisted mainly of members of the family Enterobacteriaceae, Pseudomonas aeruginosa, Staphylococcus aureus, Haemophilus influenzae, and streptococci. Of the etiologic bacteria, 67% were eradicated by ciprofloxacin treatment and 79% by imipenem therapy; however, two patients (6.7%) failed in the ciprofloxacin group, and six patients (20%) did not respond to imipenem treatment (P = 0.25). All patients with therapeutic failures suffered from severe fatal underlying diseases, which had substantial impact on the outcome of treatment. Therapeutic drug monitoring in the ciprofloxacin patients revealed higher concentrations in serum at days 4 and 8 in comparison with day 1 of treatment, indicating that steady-state conditions were reached between days 1 and 4. The total number of side effects was relatively high--eight imipenem patients (25%) and six ciprofloxacin patients (18%) had reactions. Treatment had to be discontinued due to adverse reactions for three ciprofloxacin patients and two imipenem patients. Major side effects in both groups were gastrointestinal and central nervous system-related symptoms. In terms of clinical and bacteriological efficacy and safety, there was no statistical difference between the two groups, and both groups gave good to excellent results for bacterial infections that were difficult to treat.

Adolescent↗