Biomedical subjects

H Thadepalli

Publications and source records attributed to H Thadepalli.

At least 37 records · Page 2Linked to original sources

PubMed1991

Ciprofloxacin monotherapy for acute pelvic infections: a comparison with clindamycin plus gentamicin.

This prospective, randomized controlled study compared the efficacy and safety of ciprofloxacin alone versus a conventional two-drug regimen, clindamycin with gentamicin. The study group included 71 patients hospitalized for pelvic infections such as acute (N = 33) and chronic (N = 8) salpingitis, tubo-ovarian abscesses (N = 11), endometritis (N = 9), septic abortion (N = 3), and other categories (N = 7). Twenty-two of 35 patients on ciprofloxacin and 20 of 36 on clindamycin plus gentamicin had culturable pathogens: gonococci in 28, anaerobes in six, chlamydia in four, and associated pathogens in 19. Complete clinical and bacteriologic cure was achieved in 21 of 22 (95%) in the ciprofloxacin group and 19 of 20 (95%) in the clindamycin plus gentamicin group. The mean duration of intravenous/oral ciprofloxacin therapy was 3.7/7.2 days, and it was 3/6.6 days for clindamycin plus gentamicin. Ciprofloxacin, a new quinolone, appears to be safe as a single-drug therapy and was as effective as the combination of clindamycin plus gentamicin for the treatment of severe pelvic infections requiring hospitalization.

Acute Disease↗

PubMed1991

Bacteriology of the appendix and the ileum in health and in appendicitis.

The bacteriology of the ileum and the appendix in appendicitis patients with or without perforation and compared with patients who had "incidental appendectomy" was studied. Of 42 appendicitis patients, 24 (57%) of them had anaerobic bacteria in the appendix compared with two of eight (25%) with normal appendix. Anaerobes were found in the ileal aspirates of 20 of 42 (47.6%) appendicitis patients and two of eight (25%) in normal persons. This suggests that anaerobic bacteria increasingly colonize the appendix and the ileum in cases of appendicitis.

Adolescent↗

PubMed1990

Human intestinal tissue antibiotic concentrations. Clindamycin, gentamicin, and mezlocillin.

An antibiotic, to be effective for prophylaxis in abdominal trauma, should quickly achieve high concentrations in the intestinal wall and at enough inhibitory levels to kill most aerobic and anaerobic bacteria that are potential contaminants at the site of surgical incision. Therefore, we studied the intestinal tissue levels of clindamycin, gentamicin, and mezlocillin to see whether the tissue levels achieved by these antibiotics in the intestinal tissue were adequate. A single dose of mezlocillin, 4 grams; clindamycin, 600 mg and gentamicin, 80 mg; quickly reached the desired concentrations, i.e., 52.3, 9.69 and 6.1 micrograms/gram of intestinal tissue respectively. These levels were high enough to inhibit the growth of most isolates of E. coli and B. fragilis, common pathogens involved in intra-abdominal abscess.

Adult↗

PubMed1989

Ciprofloxacin versus ceftazidime in skin and soft tissue infections.

Intravenous ciprofloxacin therapy was evaluated in comparison with i.v. ceftazidime in the treatment of skin and soft tissue infections and were found to be comparable. Intravenous or peroral forms of ciprofloxacin may be used instead of intravenously given third generation cephalosporins or aminoglycosides in the treatment of even severe infections of the skin and soft tissue.

Administration, Oral↗

PubMed1989

Influence of environmental factors on the in vitro efficacy of ciprofloxacin against anaerobic bacteria.

The effects of alterations in pH, size of inoculum, addition of human serum, and repeated exposure to sub-minimum inhibitory concentration of ciprofloxacin against anaerobic bacteria were assessed. Increase in the size of the inoculum and human serum had no effect on the minimum inhibitory concentration, whereas decrease in pH and exposure to sub-MIC decreased the activity of ciprofloxacin against Bacteroides fragilis. We tested for synergism of ciprofloxacin with cefoxitin, clindamycin and metronidazole against B. fragilis.

Anti-Bacterial Agents↗

PubMed1989

Oral ciprofloxacin vs parenteral cefotaxime in the treatment of difficult skin and skin structure infections. A multicenter trial.

A prospective, randomized, double-blind, multicenter study was conducted of hospitalized patients to compare the efficacy and safety of oral ciprofloxacin (dosage, 750 mg every 12 hours) with intravenous cefotaxime (dosage, 2.0 g every 8 hours) as monotherapy for difficult skin and skin structure infections requiring hospitalization. Five hundred seventy patients were assessed for an analysis of safety and 461 patients were assessed for an analysis of efficacy. The most common infections were infected ulcers and abscesses. At the end of therapy, there was a higher incidence of recurrent or persistent organisms in the cefotaxime group compared with ciprofloxacin. Adverse reactions related to either therapy were rare. By pathogens, there were no differences in activity, except the higher rate of recurrent or persistent Pseudomonas aeruginosa infection in the cefotaxime group. By diagnosis, the two drugs had comparable efficacy, except for the higher incidence of bacteriologic failure in patients with polymicrobial infected ulcers in the cefotaxime group. Larger studies are needed to evaluate emergence of resistance to ciprofloxacin. Oral ciprofloxacin therapy is as safe and effective as parenteral cefotaxime in the treatment of difficult infections of the skin and skin structure, and affords the prospect of early discharge from the hospital and significant cost savings.

Administration, Oral↗

PubMed1988

Safety and efficacy of mezlocillin: a single-drug therapy for penetrating abdominal trauma.

This study was done to determine if a single drug, mezlocillin (Mezlo), is as safe and as effective as combined clindamycin (Clind) and gentamicin (Gent) in the treatment of penetrating abdominal wounds. One hundred seventy-three patients received either Mezlo or Clind/Gent combined therapy as assigned by computer-generated randomization. Of these, 147 patients were evaluable. Of 73 patients treated with Clind/Gent the mean duration of hospital stay was 8.9 +/- 4.0 days. Infectious complications developed in 18 patients of whom five failed to respond promptly, but only one required change in therapy. Of 74 patients treated with Mezlo, the mean duration of hospital stay was 9.1 +/- 5.0 days. Infectious complications occurred in 17, in whom four patients failed to eliminate their infections, and two needed changes in antibiotic therapy. None of the patients in either antibiotic group failed because of Enterococcus or Pseudomonas infections. There were no deaths. Twelve isolates of Bacteroides were found in peritoneal fluid cultures and all these patients had colon injuries. The overall therapeutic response was excellent to good in 94% on Clind/Gent and 93% on Mezlo. Azotemia developed in one patient on Clind/Genet and one on Mezlo but no other adverse reactions occurred. The differences shown between the two groups were not statistically significant. We conclude that a single drug mezlocillin is as safe and as effective in the treatment of abdominal trauma as combined clindamycin and gentamicin.

Abdominal Injuries↗

PubMed1988

Use of lymphokines in treatment of experimental intra-abdominal abscess caused by Bacteroides fragilis.

The role of cell-free soluble factors (lymphokines) derived from mitogen-activated splenic cells of mice previously immunized against Bacteroides fragilis was evaluated in the treatment of B. fragilis intra-abdominal abscess (IAA). Neither clindamycin nor lymphokines alone were effective against an established B. fragilis IAA, but the combination of clindamycin and lymphokines decreased the abscess size and bacterial counts in the majority of animals. This suggests that the synergy of lymphokines with clindamycin effects cure of IAA caused by B. fragilis and that lymphokines might have an application as adjuncts to conventional antimicrobial therapy in this setting.

Abdomen↗

PubMed1988

Effect of K+ channel blockers on anti-immunoglobulin-induced murine B cell proliferation.

Ion channels play an important role in the transmission of signals across cell membrane in a variety of cell types. Recent studies indicate that normal murine splenic B lymphocytes express voltage gated K+ channels. In the present study, we examined the influence of K+ channel blockers 4 aminopyridine (4 AP) and tetraethyl ammonium, and Ca++ activated K+ channel blocker quinine on anti-immunoglobulin (anti-Ig)-induced B cell proliferation. The results show that ion channel blockers inhibited DNA synthesis in B cells induced by anti-Ig. 4 AP also inhibited protein synthesis but had no effect on the expression of surface immunoglobulin. 4 AP exerted its maximum suppressive effects on DNA synthesis when added within the first 24 hours after the onset of culture with anti-Ig. The inhibition of DNA synthesis by 4 AP was reversible upon its removal from culture. These studies show a role of K+ channels in B cell DNA and protein synthesis.

4-Aminopyridine↗

PubMed1988

The effect of human bile on Bacteroides fragilis in health and disease.

Bacteroides fragilis is generally believed to be stimulated by bile. Although B. fragilis is rarely found in the human duodenum, it is relatively frequent in gall bladder infections. To investigate this paradox, the growth of B. fragilis in the human bile in both health and disease was studied, and compared with the effect of bovine and porcine bile. B. fragilis was stimulated by the bovine bile and inhibited by the porcine bile. The normal human bile was either bacteriostatic or inhibitory whereas bile from cholelithiatic patients, in 50% of cases, stimulated the growth of B. fragilis. This explains the relative prevalence of B. fragilis in cholelithiatic cholecystitis patients although it is not a resident flora of the duodenum.

Acute Disease↗

PubMed1988

Anatomic basis of head and neck infections.

The head is the portal for all infections acquired by ingestion and inhalation. The oropharynx, with its fine microbiologic niches around the teeth, serves as a source for endogenous pyogenic infections of the head and neck. The anatomic connections of the head with the mediastinum through extensions of the deep cervical fascia, and the intracranial venous sinuses connected through emissary veins to the facial veins, make infections of this region the most dreaded. Perhaps no other set of lymph nodes in the human body is challenged as frequently by microbiologic insults as the cervical lymph nodes.

Head↗

PubMed1988

Contribution of intestinal flora to surgical infections.

Postoperative septic complications related to intestinal injury are regulated by a complex group of factors, including intestinal microflora, site of injury, surgical procedures used, and the type of antimicrobial therapy; however, a large number of yet-to-be understood factors also exist that influence septic morbidity associated with intestinal surgery. The authors present an overview of this serious complication of surgery.

Digestive System Surgical Procedures↗

PubMed1987

Activity of difloxacin (A-56619) and A-56620 against clinical anaerobic bacteria in vitro.

We determined the MICs of difloxacin (A-56619) and A-56620 against anaerobic bacteria and assessed the effects of alterations in pH, size of inoculum, addition of human serum, and repeated exposure to subinhibitory levels of antibiotics. We tested for synergism of these drugs with cefoxitin against Bacteroides spp. We found that difloxacin and A-56620 were as active as ciprofloxacin, inhibiting about 90% of B. fragilis (4 micrograms/ml) and other Bacteroides spp. (8 micrograms/ml), A-56620 being more active than difloxacin against several isolates. Increased inoculum size and changes in pH did not alter their MICs much, but human serum and exposure to sub-MICs of antibiotic effected increases in their MICs against Bacteroides spp. Cefoxitin was not synergistic with either difloxacin or A-56620 against B. fragilis.

Anti-Infective Agents↗

PubMed1987

In vitro synergy of ciprofloxacin and three other antibiotics against Bacteroides fragilis.

The potential in vitro synergistic effect of ciprofloxacin associated with mezlocillin, cefoxitin and clindamycin was evaluated against 30 strains of Bacteroides fragilis. All bacteria were clinical isolates, identified by gas chromatography and fermentation of carbohydrates. MICs of the drugs were determined by a miniaturized dilution broth method. Resistance or susceptibility to the drugs was not a criterion for the selection of the strains. Antibacterial combinations were tested by a checkerboard method utilizing brain hearth infusion broth and a bacterial inoculum of 10(6) CFU/ml. Microtitre plates were incubated at 37 degrees C for 48 h in anaerobic jars (BBL). Prereduced chopped meat carbohydrate broth was used to store and culture the strains. The effect of antimicrobial combinations was defined on the basis of the fractionary inhibitory concentration (FIC) indexes. We considered: synergistic effect FIC less than or equal to 0.5; additive effect FIC = 0.5-0.75; indifferent effect FIC = 0.76-2.0; antagonism FIC greater than or equal to 2. Ciprofloxacin + clindamycin showed synergistic activity against 10 strains out of 26 (38%); ciprofloxacin + mezlocillin against 9 strains out of 30 (30%); and ciprofloxacin + cefoxitin against 8 out of 29 strains (28%). Each antibiotic combination showed an additive or indifferent effect against all remaining bacteria. The synergistic effect of ciprofloxacin represents an important advantage in allowing the reduction of the dosage of associated drugs such as aminoglycosides or beta-lactams that can potentially be responsible for damage or side-effects.

Anti-Bacterial Agents↗

PubMed1987

Treatment of spontaneous bacterial empyema thoracis.

The need for decortication to cure primary bacterial (nontuberculous) empyema was evaluated in 112 consecutive patients. Twenty-eight patients (25%) were cured by thoracentesis alone. Intercostal chest tube drainage was required in 43 (39%) and decortication in 41 (36%). Although hospital stay was shortened by 5 days for those who had decortication, the difference was statistically insignificant. Penicillin failed to eradicate infection in nine of 17 patients, four of whom had Bacteroides organisms. There were no therapeutic failures among 46 patients treated with clindamycin and gentamicin. We conclude that conservative therapy, such as thoracentesis, antibiotics directed against anaerobic bacteria, and intercostal tube drainage (thoracostomy), was adequate to achieve clinical and physiologic resolution in about two thirds of all patients with primary bacterial empyema. The remaining one third required decortication. Rib resection and Eloesser flap procedures seem to be unnecessary in the treatment of primary bacterial empyema.

Adult↗

PubMed1986

Activity of penicillin or ticarcillin in combination with clavulanic acid in the treatment of experimental intra-abdominal abscess.

The combination of clavulanic acid (CA) with penicillin or ticarcillin was evaluated in a rat intra-abdominal abscess model. Gelatin capsules filled with a mixture of Bacteroides fragilis and Escherichia coli were implanted intraperitoneally in male Wistar rats. Four different groups of animals with appropriate controls were treated with penicillin or ticarcillin alone or in combination with CA. The treatment was started either immediately or delayed for 48 h after peritoneal inoculation. The therapeutic regimen was given for ten days at 8-hourly intervals. The mortality rate decreased to almost one-half when antibiotic therapy was started within 6 h. Seventy-nine to 89% of animals were cured when treated with ticarcillin in combination with CA showing that ticarcillin + CA was the most effective regimen of those tested in the treatment of experimental intra-abdominal abscess of rats caused by Bact. fragilis and E. coli.

Abdomen↗

PubMed1986

Effect of ciprofloxacin on mitogen-stimulated lymphocyte proliferation.

Ciprofloxacin was tested for its inhibitory or stimulatory effects on concanavalin A- and phytohemagglutinin-stimulated proliferation (measured by [3H]thymidine uptake) of human peripheral blood mononuclear cells and murine splenocytes. Ciprofloxacin did not diminish or enhance mononuclear cell proliferation at concentrations of 5 to 125 micrograms/ml. Further, the proliferative response of splenocytes of mice previously treated with ciprofloxacin (40 mg/kg, twice daily for 5 days) was essentially similar to that of untreated controls.

Animals↗

PubMed1986

Aryl-fluoroquinolone derivatives A-56619 (difloxacin) and A-56620 inhibit mitogen-induced human mononuclear cell proliferation.

Aryl-fluoroquinolone derivatives A-56619 (difloxacin) and A-56620 were found to inhibit human peripheral blood mononuclear cell (MNC) proliferation (measured by [3H]thymidine uptake) that was induced by concanavalin A or monoclonal antibody OKT3. These antimicrobial agents exert their maximum suppressive effect when added within the first 24 h after the onset of culture with concanavalin A. No increase in the concentration of mitogen or the duration of incubation of MNC cultures reversed this inhibitory effect, but the removal of the drug from cultures reversed the suppression of DNA synthesis. A-56619 appeared not to interfere with the triggering of MNC activation by mitogen because it did not inhibit mitogen-induced increase in protein synthesis (measured by [3H]leucine incorporation), interleukin-2 receptor expression (measured by the binding of fluorescein-conjugated monoclonal antibody against interleukin-2 receptor), and cell volume. These findings are considered in terms of possible interference of aryl-fluoroquinolones with mammalian topoisomerase and DNA polymerases.

Anti-Infective Agents↗