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Biomedical subjects

J M Ehret

Publications and source records attributed to J M Ehret.

At least 19 recordsLinked to original sources
PubMed1991

A comparison of single-dose cefixime with ceftriaxone as treatment for uncomplicated gonorrhea. The Gonorrhea Treatment Study Group.

BACKGROUND: Because of the widespread existence of Neisseria gonorrhoeae resistant to penicillin or tetracycline, ceftriaxone is now recommended for the treatment of gonorrhea. There is, however, a need for effective antibiotics that can be administered orally as an alternative to ceftriaxone, which requires intramuscular administration. Cefixime is an orally absorbed cephalosporin that is active against resistant gonococci and has pharmacokinetic activity suitable for single-dose administration. METHODS AND RESULTS: In a randomized, unblinded multicenter study of 209 men and 124 women with uncomplicated gonorrhea, we compared three single-dose treatment regimens: 400 mg or 800 mg of cefixime, administered orally, and 250 mg of ceftriaxone administered intramuscularly. The overall cure rates were 96 percent for the 400-mg dose of cefixime (89 of 93 patients) (95 percent confidence interval, 93.5 percent to 97.8 percent); 98 percent for the 800-mg dose of cefixime (86 of 88 patients) (95 percent confidence interval, 94.6 percent to 100 percent); and 98 percent for ceftriaxone (92 of 94 patients) (95 percent confidence interval, 94.9 to 100 percent). The cure rates were similar in men and women, and pharyngeal infection was eradicated in 20 of 22 patients (91 percent). Thirty-nine percent of 303 pretreatment gonococcal isolates had one or more types of antimicrobial resistance; the efficacy of all three regimens was independent of the resistance pattern. Chlamydia trachomatis infection persisted in at least half the patients infected in each treatment group. All three regimens were well tolerated. CONCLUSIONS: In the treatment of uncomplicated gonorrhea, a single dose of cefixime (400 or 800 mg) given orally appears to be as effective as the currently recommended regimen of ceftriaxone (250 mg given intramuscularly).

Administration, Oral↗
PubMed1989

Gonorrhea.

Laboratory methods for the isolation and identification of Neisseria gonorrhoeae are updated. The antimicrobial susceptibility patterns of the gonococcus are changing and becoming less predictable. Methods for monitoring susceptibility are presented. The use of serotyping, auxotyping, and molecular techniques to characterize gonococcal isolates and the epidemiological applications are reviewed.

Gonorrhea↗
PubMed1989

Genital Chlamydia infections.

The past decade has seen a breakthrough in laboratory methods for the diagnosis of chlamydial infections. Antigen detection methods have made screening for C. trachomatis available in most clinical laboratories. These methods are highlighted and evaluated. Current culture methods and the antibiotic susceptibility of C. trachomatis are also discussed.

Antibodies, Bacterial↗
PubMed1988

Factors related to genital Chlamydia trachomatis and its diagnosis by culture in a sexually transmitted disease clinic.

The authors cultured 2,320 patients who attended the Denver Metro Health Clinic for Sexually Transmitted Diseases from September 1981 to June 1983 to determine clinical and epidemiologic factors associated with genital chlamydial infection. Among consecutive heterosexual men with urethral discharge, 226 of 849 (27%) had positive urethral cultures, with rates significantly lower among those with profuse (18%) or purulent (19%) discharges, and higher (37%) among those with symptoms for more than seven days. In a subgroup of men without gonococci, those who had polymorphonuclear leukocytes on smear had higher isolation rates (33%) than those who did not (3%). Among consecutive female patients, 172 of 1,031 (17%) had positive cervical cultures, with rates significantly lower in those who were white (13%), married (7%), or using a diaphragm (0 of 77), and higher in those who were positive for Neisseria gonorrhoeae (38%). There was a marginally significant increased rate of chlamydial isolation among oral contraceptive users only for women aged 20 years or younger. Younger age was significantly associated with chlamydial isolation in both men and women after controlling for sexual activity and other factors. Various patient characteristics can be combined to define subgroups of men and women, with rates of isolation ranging from under 4% to over 60%. These results can be useful in deciding whom to test and whom to treat presumptively in a public health setting.

Adult↗
PubMed1988

Treatment of uncomplicated gonorrhea with single-dose imipenem-cilastatin.

Single 500-mg intramuscular doses of imipenem-cilastatin cured 116 (95%) of 122 men and 9 of 9 women with uncomplicated gonorrhea due to beta-lactamase-negative Neisseria gonorrhoeae. Most co-existing Chlamydia trachomatis infections persisted. Imipenem-cilastatin is effective for uncomplicated gonorrhea in men but has no advantages over other available regimens.

Adult↗
PubMed1987

Fluorescent monoclonal antibody for confirmation of Neisseria gonorrhoeae cultures.

We evaluated a monoclonal fluorescent-antibody (FA) reagent (Neisseria gonorrhoeae Culture Confirmation Test; Syva Co., Palo Alto, Calif.) for confirmation of N. gonorrhoeae isolates obtained from clinics for sexually transmitted diseases in four cities. The FA test was performed in parallel with established confirmation procedures on all organisms growing on 773 primary culture plates of modified Thayer-Martin agar. All N. gonorrhoeae isolates reacted with the FA reagent and produced a bright, easily interpretable fluorescence. The FA test correctly identified 533 N. gonorrhoeae isolates from 474 patients and did not react with 90 N. meningitidis or with 213 non-Neisseria isolates. In one city (Baltimore), Gonochek II (Du Pont Co., Wilmington, Del.) failed to identify four N. gonorrhoeae isolates reactive with the FA reagent and confirmed as N. gonorrhoeae by Phadebact (Pharmacia Inc., Piscataway, N.J.) and acid production from sugars. The FA test was rapid and specific and could be performed directly from primary isolation plates. The test requires 1 h to perform and is applicable to mixed-flora cultures.

Antibodies, Monoclonal↗
PubMed1986

Comparative study of cefoperazone and spectinomycin for treatment of uncomplicated gonorrhea in men.

Beta-lactamase-negative Neisseria gonorrhoeae infections were treated with single-dose cefoperazone (0.5 or 1.0 g) or spectinomycin (2.0 g). Anogenital infections were cured in 36 (83%) of 43 volunteers given 0.5 g of cefoperazone, 61 of 61 volunteers given 1.0 g of cefoperazone, and 99 of 100 volunteers given spectinomycin. The cefoperazone geometric mean MIC for 242 isolates was 0.028 microgram/ml. Cefoperazone (1.0 g) and spectinomycin (2.0 g) are comparable for the therapy of anogenital gonorrhea in men.

Adolescent↗
PubMed1985

Comparative study of ceftriaxone and spectinomycin for treatment of pharyngeal and anorectal gonorrhea.

Of the currently recommended regimens for treatment of uncomplicated gonorrhea, only aqueous penicillin G procaine is effective against infections at all sites. However, procaine penicillin is not effective against penicillinase-producing Neisseria gonorrhoeae and suffers from poor patient acceptability owing to the 10-mL volume of injection and allergic and toxic procaine reactions. Ceftriaxone is a new extended-spectrum cephalosporin with a long serum half-life and is many times more active than penicillin G against both beta-lactamase-positive or -negative strains of N gonorrhoeae. Ceftriaxone was compared as a single, 125-mg, 0.5-mL injection with a single 2-g injection of spectinomycin in difficult to treat pharyngeal gonorrhea in men and women and anorectal gonorrhea of men. Ceftriaxone cured 30/32 (94%) pharyngeal and 52/52 anorectal infections, compared with 6/14 (43%) and 9/9, respectively, for spectinomycin. Both regimens were well tolerated. Ceftriaxone may prove to be a drug of choice for uncomplicated gonorrhea, particularly where homosexual men are treated and/or penicillinase-producing N gonorrhoeae is prevalent.

Adult↗
PubMed1979

In vitro comparison of rosamicin and erythromycin against urinary tract pathogens.

The in vitro activity of rosamicin and erythromycin was compared at various pH values against 311 strains of bacteria representing common urinary tract pathogens. Alkalinization of the media consistently and significantly increased the antibacterial activity of rosamicin against all of the organisms tested. This was also true for erythromycin except when tested against strains of Proteus. At pH 8, rosamicin was two- to sixfold more active than erythromycin against Enterobacteriaceae. The activity of both antibiotics against Pseudomonas aeruginosa was very similar when tested at pH 8. Erythromycin was twice as active as rosamicin at pH 8 against group D streptococci. The activity of both antibiotics was bacteriostatic and inoculum size dependent, regardless of the organism tested or the pH of the test media. The greater activity of rosamicin against Enterobacteriaceae warrants clinical investigation.

Anti-Bacterial Agents↗
PubMed1978

Anogenital infection with Neisseria meningitidis in homosexual men.

Among monosexual men anal infection with Neisseria meningitidis was more prevalent (15 of 731 men) than expected and significantly more prevalent than urethral infection with N. meningitidis (three of 669 men, P less than 0.01). Anal infection was also significantly more prevalent among homosexual men than among heterosexual women (two of 1,197 women, P less than 0.001). These differences in rates of prevalence may be best explained by a preference of meningococci for anal mucosa and by the common homosexual practice of oral-anal sexual contact. Serogrouping of the 17 anal and three urethral isolates revealed a broad representation of serogroups often found in meningococcal pharyngeal carriage in the community. Of 14 patients who returned for a test-of-cure culture within seven days of treatment with an antibiotic regimen recommended for anogenital gonococcal infection, each was culture-negative for N. meningitidis. Minor and symptoms in three men and profuse urethral discharges in two men resolved with treatment.

Ampicillin↗
PubMed1977

In vitro activity of netilmicin compared with gentamicin, tobramycin, amikacin, and kanamycin.

The in vitro activity of netilmicin was compared with that of gentamicin, tobramycin, amikacin, and kanamycin against 636 strains of bacteria recently isolated from clinical sources. Gentamicin was the most active antibiotic, but netilmicin and tobramycin closely paralleled it. Netilmicin was generally four-to eightfold less active than gentamicin against Serratia and group A streptococci, and was twofold less active against Pseudomonas aeruginosa. When effects of inoculum size and concentration of divalent cations in the media were evaluated, netilmicin was shown to be similar to gentamicin in vitro. Minimum inhibitory concentrations for P. aeruginosa were increased as much as 18-fold when the Mg(2+) and Ca(2+) concentrations were increased to physiological levels in Mueller-Hinton broth.

Amikacin↗
PubMed1976

Comparative activity in vitro of ticarcillin, BL-P1654, and carbenicillin.

The activity of ticarcillin, BL-P1654, and carbenicillin was compared in vitro using a microtiter tube dilution test in Mueller-Hinton broth against 50 recent clinical isolates each of Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, Klebsiella species, Enterobacter species, Proteus species, and Pseudomonas aeruginosa. Bactericidal end points were determined using a modified Steers replicator. Ticarcillin was generally two to four times more active against all organisms tested except S. epidermidis against which BL-P1654 was most active. Median minimum inhibitory concentrations in micrograms per milliliter were for S. aureus: ticarcillin (6.2), carbenicillin (12.5), BL-P1654 (25); for S. epidermidis: BL-P1654 (1.6), ticarcillin (3.2), carbenicillin (3.2); for E. coli: ticarcillin (3.2), BL-P1654 (6.2), carbenicillin (6.2); for Klebsiella sp.: >100 for all three drugs; for Enterobacter sp.: ticarcillin (3.2), carbenicillin (6.2), BL-P1654 (12.5); for Proteus sp.: ticarcillin (1.6), carbenicillin (1.6), BL-P1654 (3.2); for P. aeruginosa: ticarcillin (31), BL-P1654 (62), carbenicillin (125). Bactericidal end points were dependent on both the drug and the species but were in general no more than twofold more than the minimum inhibitory concentration with the exception of BL-P1654 against P. aeruginosa. BL-P1654 was bactericidal for only 60% of the strains tested at a concentration of 500 mug/ml.

Bacteria↗
PubMed1976

Characterization of an ampicillin-resistant Haemophilus influenzae type B.

A 28-year-old female in Denver was found in early 1974 to have frontal sinusitis, osteomyelitis, and bacteremia due to Haemophilus influenzae, type B. The minimal inhibitory concentration of ampicillin for this organism was 100 mug/ml and the minimal bactericidal concentration was >100 mug/ml. It was inhibited by chloramphenicol at 0.4 mug/ml. Further studies demonstrated that ampicillin and methicillin were synergistic against this organism. It was shown to produce a diffusible beta-lactamase. Transferase of resistance from this organism to a susceptible Haemophilus parainfluenzae and a reciprocal transfer were accomplished. A test for transformation was negative as was a test for reversal of resistance by ethylenediaminetetraacetic acid.

Adult↗
PubMed1976

In vitro comparison of cefoxitin, cefamandole, cephalexin, and cephalothin.

The in vitro effect of cefoxitin, cefamandole, cephalexin, and cephalothin was tested against 645 strains of bacteria recently isolated from clinical sources. Against gram-positive organisms cephalothin and cefamandole were the most effective, generally being three- to fourfold more active than cephalexin or cefoxitin. Enterococci were not inhibited by less than 25 mug of any of the antibiotics per ml. Against Enterobacteriaceae, cefoxitin and cefamandole were the most active. An exception was the Enterobacter strains, against which cefoxitin was the least effective. None of the Pseudomonas aeruginosa strains were susceptible to 100 mug of any of the cephalosporins per ml. Cefamandole was the most active agent against Neisseria meningitidis and Neisseria gonorrhoeae. It was also the most effective agent against Haemophilus influenzae, even when taking into account a threefold inoculum effect.

Bacteria↗
PubMed1976

Immunofluorescence of yeast in urine.

A study of immunofluorescence of yeast in the urine was carried out in 18 patients with funguria in an effort to correlate gamma globulin coating with evidence of tissue invasion or as an indicator for institution of therapy. Positive immunofluorescence of yeast in urine is common but is neither indicative of upper urinary tract yeast invasion nor a useful guideline for beginning treatment.

Adult↗
PubMedDate not supplied

Auxotype/serovar diversity and antimicrobial resistance of Neisseria gonorrhoeae in two mid-sized American cities.

To characterize the prevalence and heterogeneity of Neisseria gonorrhoeae with chromosomally mediated resistance to penicillin G or tetracycline.HCl in Seattle, Washington, and Denver, Colorado, we auxotyped, serotyped, and determined the MICs of penicillin G and tetracycline for gonococcal isolates collected in both cities during 1984. In Seattle 37 (18%) and ten (5%) of 205 isolates had MICs for penicillin G of greater than or equal to 1.0 and greater than or equal to 2.0 micrograms/ml, respectively; in Denver eight (3%) of 240 isolates had MICs for penicillin of 1.0 microgram/ml, and none had MICs of greater than 1.0 microgram/ml. For tetracycline.HCl, 107 (52%) and 38 (19%) of Seattle isolates had MICs of greater than or equal to 1.0 and greater than or equal to 2.0 micrograms/ml, respectively, while in Denver the respective figures were 111 (46%) and 48 (20%). In each city, antimicrobial resistance was present in a number of auxotype/serovar (A/S) classes: isolates with MICs for penicillin G of greater than or equal to 1.0 microgram/ml were identified in 15 of 49 A/S classes in Seattle and in five of 49 A/S classes in Denver. These data indicate that chromosomal resistance to penicillin G and tetracycline.HCl varies geographically in prevalence and is a heterogeneous phenomenon involving multiple gonococcal strains.

Colorado↗