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Biomedical subjects

I M Gould

Publications and source records attributed to I M Gould.

At least 19 recordsLinked to original sources
PubMed1992

Prevention of endocarditis: communication between doctors and dentists.

Successful implementation of guidelines to prevent infective endocarditis (IE) depends upon the dental practitioner being aware of which of his patients are at risk. This was studied by sending a questionnaire to at risk patients and their dentists in the Grampian area. Of 145 respondents (53% response rate) with predisposing cardiac disorders, only 63 reported having seen their dentist in the past 2 years, although for dentate patients 47/61 had seen a dentist in the past 2 years. The dentists of 59 of these cases were then surveyed and replies received in 53 cases. Nineteen had no record of the patient having a cardiac disorder. In only 17 of the remaining cases was information on the cardiac disorder well enough recorded to warrant prophylaxis for at risk procedures. The dentist was usually told of the disorder only by the patient. Sixty-three per cent of dentists felt that communication between them and the patient's doctor was unsatisfactory. It is necessary to improve doctor/patient/dentist communication so that current recommendations on prophylaxis can be implemented to the full. This should be done through the patient's GP or consultant, who should communicate directly with the dentist. Details could also be inserted on warfarin cards and 'cardiac alert cards' expanded.

Anti-Bacterial Agents↗
PubMed1992

Diagnosis of bacterial vaginosis in a routine diagnostic laboratory.

Vaginal swabs from 299 hospital and general practitioners' patients were examined for Gardnerella vaginalis by Gram film and by culture, G. vaginalis was isolated in 12% of cultures. Comparison between the 'clue' cell and culture methods suggested that the former is a rapid, acceptable routine screening method for the detection of G. vaginalis. The value of the traditional method of identifying G. vaginalis by sensitivity testing is questioned. All specimens were also examined by Gram film and culture, for the presence of Mobiluncus spp, which was detected in 8.4% of specimens by Gram film but only 0.7% by culture. From a questionnaire returned by 84% of clinicians, metronidazole was found to be the most commonly used antimicrobial agent for the treatment of G. vaginalis, and in all but one case appeared to be clinically effective.

Bacteria, Anaerobic↗
PubMed1991

Determination of teicoplanin in plasma using microbore high-performance liquid chromatography and injection-generated gradients.

A reversed-phase isocratic high-performance liquid chromatographic method for the determination of total teicoplanin in plasma is reported. The method developed uses a bracketing injection technique in conjunction with large injection volumes on a 1 mm diameter column to form a limited injection-generated gradient. The chromatography yields adequate resolution among all the major components for individual quantitation and also allows quantitation of total teicoplanin in plasma using ultraviolet detection. Pretreatment is by solid-phase extraction which uses C8 Bond Elut cartridges and gives effective clean up from endogenous materials. The method offers a faster and simplified means to determine total teicoplanin in plasma than those previously reported, and has a detection limit of 50 ng/ml.

Anti-Bacterial Agents↗
PubMed1991

An open study of teicoplanin in the treatment of gram-positive infections.

Teicoplanin, a new glycopeptide antibiotic similar to vancomycin, was evaluated in treating 36 hospitalized patients suffering from various Gram-positive infections. The 36 patients received teicoplanin once daily as a mean intravenous injection of 550 mg/day (range 200-800 mg/day). Previous antimicrobial therapy was used in 28% of patients. The mean duration of therapy was 7.5 days (range 3-38 days). The overall clinical success rate was 94%. 24/36 patients (66%) had positive microbiology. Elimination of the pathogens was seen in 75% of all evaluable cases. Four patients with early prosthetic valve endocarditis due to coagulase negative Staphylococcus (3 patients) and Propionibacterium acnes (1 patient) had a favorable clinical and microbiological outcome. No adverse drug reactions were observed. Teicoplanin is safe and effective in the therapy of many different infections caused by Gram-positive bacteria.

Adult↗
PubMed1991

Ionic binding, adaptive resistance and post-antibiotic effect of netilmicin and ciprofloxacin.

Ionic binding, post-antibiotic effect (PAE) and adaptive resistance to netilmicin and ciprofloxacin were investigated in 11 distinct clinical isolates. Both netilmicin and ciprofloxacin showed concentration dependent kill and PAE when bacteria were exposed to these antibiotics at 37 degrees C. The effects of netilmicin were maintained at 4 degrees C, when there is no energy dependent cell uptake of antibiotic, but were partially inhibited by exposure to NaCl and EDTA although not by Ca++. This supports the concept that ionic binding to the bacterial cell wall is important in the initial uptake of netilmicin. Ciprofloxacin showed no such effects at 4 degrees C. Adaptive resistance (reduced bacterial kill on second exposure) occurred with both netilmicin and ciprofloxacin but was seen more frequently with netilmicin. It persisted longer than classical PAE but, even after continuous exposure, was not enough to suggest a loss of kill with a twice daily dosing regimen of netilmicin or ciprofloxacin.

Ciprofloxacin↗
PubMed1991

Interaction of imipenem with erythromycin and tetracycline assessed by microdilution checkerboard techniques.

Microdilution methodology was used to study the interaction of imipenem with erythromycin and tetracycline, a combination therapy that might be used for the treatment of serious pelvic inflammatory disease. The combination of imipenem and erythromycin showed no antagonism for Escherichia coli and Haemophilus influenzae but was antagonistic for Staphylococcus aureus, Enterococcus faecalis, and group B streptococci; the combination of imipenem and tetracycline was antagonistic for all strains except H. influenzae. Correlation between the results of kill curves and the measurement of fractional bactericidal concentration (FBC) indices was good, although FBC indices showed less antagonism than kill curves. Fractional inhibitory concentration indices showed poor correlation, rarely showing antagonism, and indeed showed synergy in three cases. If erythromycin or tetracycline is considered necessary in addition to imipenem in the treatment of pelvic inflammatory disease, it is probably more effective when given after the course of imipenem has been completed.

Bacteria↗
PubMed1991

Piperacillin/tazobactam in the treatment of serious acute soft tissue infection.

Twenty-five consecutive patients admitted to hospital with severe soft tissue infection were entered into an open trial designed to evaluate safety and efficacy of the drug combination tazobactam/piperacillin. The dosage regimen was 4 g piperacillin/500 mg tazobactam Q8H. There were twenty cases of uncomplicated cellulitis and five cases with associated abscess formation. These five cases required adjunctive surgical drainage. Mean duration of therapy was 7.6 days. No other antibiotics were administered unless treatment with the study drug failed. There were eight treatment failures, six related to the trial drug. Four patients developed an allergic response to the trial drug, necessitating a change of therapy. Three patients failed to respond; all three had acute cellulitis in association with peripheral vascular disease. Significant bacterial isolates were grown in thirteen patients; Group A streptococci in three, S. aureus in five, other pathogenic streptococci in four and coliforms or Ps. aeruginosa in five. The majority of isolates except the streptococci were resistant to piperacillin but all isolates except one strain of Ps. aeruginosa were susceptible to the combination. The combination is suitable for the treatment of serious soft tissue infection, but increased doses may be appropriate in infection at poorly perfused sites.

Adolescent↗
PubMed1990

Current prophylaxis for prevention of infective endocarditis.

A nationwide postal survey of dental and medical practitioners was undertaken to ascertain the degree of acceptance of the British Society for Antimicrobial Chemotherapy guidelines on prophylaxis for infective endocarditis. Questionnaires were circulated to 21,050 individuals. The overall response rate was 17%. Prophylaxis for infective endocarditis is widely practiced (99% of respondents) and the recommendations are generally accepted but there is still room for improvement in practice, particularly in drug dosing, timing and duration of prophylaxis. There is a disappointing lack of use of local policies, topical antibiotics and cardiac alert cards.

Anti-Bacterial Agents↗
PubMed1990

Severe salmonellosis related to oral administration of anti-diarrhoeal drugs.

Infection with non-typhoidal Salmonellae usually causes a self-limiting dysenteric illness. Several factors are known to increase the propensity to invasive disease--with its related sequelae. We present four previously healthy patients who had none of the recognised risk factors but developed Salmonella infection with a severe and protracted illness. Common to each of these patients was the pre-hospital oral administration of anti-diarrhoeal drugs.

Adolescent↗
PubMed1990

Concentration-dependent bacterial killing, adaptive resistance and post-antibiotic effect of ciprofloxacin alone and in combination with gentamicin.

The clinical relevance of in vitro tests of antimicrobial activity, other than simple MIC and MBC observations, is increasingly recognised. Such tests include bacterial time-kill studies and post-antibiotic effect (PAE). The authors have studied these parameters in 11 Gram-negative and Gram-positive strains, all clinical isolates. Viable counts were done at 0, 2, 4, 6 and 24 h by a new microtitre method, and PAE was studied by both conventional methodology and by use of the Malthus Microbial Growth Analyser. Bacterial kill was inoculum-dependent and kill at high inocula concentration-dependent. No paradoxical reduction in kill was seen at high concentrations of ciprofloxacin (200 x MBC). PAE was concentration-dependent and addition of gentamicin can prolong PAE. Reduced sensitivity to further antibiotic exposure in the PAE period (adaptive resistance) was noticed and was dependent on antibiotic concentration in the first exposure. The significance of these findings to new dosage schemes is discussed. To optimise therapy in seriously ill patients, it may be relevant to increase the dose of ciprofloxacin currently used for treating serious infection.

Ciprofloxacin↗
PubMed1990

Selective parenteral and enteral antisepsis regimen (SPEAR).

With infection rates approaching 80% for patients staying in ICU for more than 5 days there is clearly a need for effective prophylaxis. SPEAR is a system of antimicrobial prophylaxis which extends the regimen of selective digestive tract decontamination to encompass systemic antimicrobial prophylaxis and includes oral non-absorbable antibacterial and antifungal agents with initial use of a broad-spectrum systemic antibacterial.

Anti-Bacterial Agents↗
PubMed1989

Use of the Malthus Microbial Growth Analyser to study the post antibiotic effect of antibiotics.

The post antibiotic effect (PAE) of ceftazidime, ciprofloxacin, mecillinam and imipenem alone and in combination against Gram-negative bacteria was assessed by a new technique using a Malthus Microbial Growth Analyser. Ciprofloxacin gave the most prolonged and consistent PAE (1.3-2.9 h) and imipenem also gave a significant PAE against some bacterial strains (up to 1.3 h). The PAE of both antibiotics was dependent on concentration. The PAE of combinations of ciprofloxacin and imipenem often showed less PAE than was present with either agent alone. Ceftazidime gave no significant PAE (-1.5-0.4 h), though mecillinam consistently gave a short PAE (approximately 0.5 h) against Escherichia coli. The new method allows for the rapid and labour saving evaluation of PAE. We believe that further studies on PAE of antibiotic combinations are desirable.

Amdinocillin↗