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Biomedical subjects

J Modai

Publications and source records attributed to J Modai.

At least 55 records · Page 3Linked to original sources
PubMed1986

[Antibiotic therapy of Pseudomonas aeruginosa infections].

Antibiotics active against Pseudomonas aeruginosa are carboxy- and ureidopenicillins, some cephalosporins, aztreonam, imipenem, aminoglycosides, fluoroquinolones and, in some special circumstances, polymyxins and fosfomycin. The choice of the antibiotic should be based not only on minimal inhibitory concentrations in vitro, but also on the inoculum effect, on the speed with which bacteria are killed, on natural or acquired resistance and on data obtained from experimental infections in animals. Antibiotics used against P. aeruginosa infections must be rapidly bactericidal. Since the prognosis is severe, the initial treatment given before the sensitivity of the strain is known must combine a beta-lactam antibiotic and an aminoglycoside, both being selected among the most regularly active.

Anti-Bacterial Agents↗
PubMed1986

Penetration of aztreonam into cerebrospinal fluid of patients with bacterial meningitis.

The penetration of aztreonam into the cerebrospinal fluid was determined in 16 patients with bacterial meningitis undergoing treatment with other antibiotics. Three aztreonam doses of 30 mg/kg were infused intravenously over 30 to 45 min at 8-h intervals, first between days 2 and 4 and again between days 11 and 20 after onset of the disease. Concentrations of aztreonam in serum and cerebrospinal fluid samples obtained at 60, 90, 120, and 240 min after the third aztreonam dose were measured by high-pressure liquid chromatography. The concentrations of aztreonam in cerebrospinal fluid ranged from 3.5 to 62 micrograms/ml, depending on the sampling time and the time elapsed since the onset of the disease. These concentrations were equal to or higher than the MICs for most of the gram-negative bacilli (including Pseudomonas aeruginosa).

Adult↗
PubMed1986

[Pharmacokinetics of ofloxacin in the elderly (65-85 years) with normal renal function after a single oral dose of 200 mg].

Ofloxacin is a fluoroquinolone that is mainly eliminated through the kidneys. We studied ofloxacin pharmacokinetics following administration of a single oral 200 mg dose to each of 16 elderly patients (77 +/- 2.4 years). Serum and urine concentrations were assayed using high performance liquid chromatography. Peak serum ofloxacin concentrations were 3.60 (+/- 0.36) micrograms/ml; residual concentrations were 1.33 (+/- 0.15) and 0.62 (+/- 0.10) micrograms/ml at 12 and 24 hours respectively. Urine concentrations approximating 100 micrograms/ml were found up to the 12th hour. As compared to healthy adults, in elderly subjects ofloxacin distribution volume (85.3 +/- 6.3 l) was decreased by 34%, apparent clearance (4.97 +/- 0.53 l/h) was divided by 2.6 and elimination half life (13.3 +/- 1.2 h) was almost doubled. A linear correlation was found between individual apparent ofloxacin clearances and creatinine clearances. In view of these significant changes in ofloxacin pharmacokinetics found in elderly subjects, we advocate reducing the usual dosage by half.

Administration, Oral↗
PubMed1986

[Pharmacokinetics of cefmenoxime in the aged subject (60 to 90 years of age) after an intravenous injection of 1 g].

A pharmacokinetic study of Cefmenoxime (CMX) has been carried out in 17 patients, 60 to 90 years old, following IV injection of 1 gram. Plasma concentrations of CMX were determined in 15 blood samples drawn between 0.25-12th hour by a specific high pressure liquid chromatography. The apparent terminal half lives calculated by regression analysis ranged from 0.94 to 3.8 h. We observed an increase of apparent elimination half life and a decrease of total clearance with aging as compared to that of healthy young subjects. Apparent volume of distribution seemed not to differ from those observed in young adults. There is a correlation between renal function and elimination kinetics of Cefmenoxime. In spite of kinetics modifications, it seems that it is not necessary to modify the dosage regimen in elderly.

Aged↗
PubMed1986

Role of third-generation cephalosporins in the treatment of bacterial meningitis.

The third generation cephalosporins are very active against Haemophilus influenzae, including betalactamase producing strains, Neisseria meningitidis and against gram-negative bacilli. Considering that a CSF level at least 10 times the MIC for the causative agent must be achieved, some cephalosporins are limited in their use in meningitis. Randomized controlled studies are sparse and it is difficult to compare objectively the clinical efficacy of cephalosporins with that of commonly used regimens. Moxalactam, cefotaxime, ceftazidime and ceftriaxone were revealed as being at least as effective as standard antibiotics in the treatment of meningitis. Although the outcome from bacterial meningitis has not appreciably changed in a 14-year period from 1969 to 1982, when newer generation beta-lactam drugs were available, it is obvious that these drugs will be very useful in special situations, particularly where multiply resistant pathogens are involved. Finally, the role of third-generation cephalosporins in the treatment of bacterial meningitis is best approached by analysis based on age group and clinical setting.

Cephalosporins↗
PubMed1985

Penetration of imipenem and cilastatin into cerebrospinal fluid of patients with bacterial meningitis.

The penetration of imipenem and cilastatin into the cerebrospinal fluid (CSF) was determined in patients with bacterial meningitis. Four 1000 mg doses [corrected] of both imipenem and cilastatin were infused intravenously over 20-30 min at 6 h intervals, first between days 2 and 4, and again, whenever possible, between days 11 to 20, in 12 patients with bacterial meningitis undergoing treatment with other antibiotics. Concentrations of imipenem and cilastatin in serum and cerebrospinal fluid samples obtained either at 60, 90 or 120 min following the fourth dose were measured by high pressure liquid chromatography. Concentrations of imipenem in CSF ranged from 0.5 to 11 mg/1 and concentrations of cilastatin ranged from 1.1 to 10.5 mg/1, depending on the sampling time and the time elapsed since the onset of the disease.

Adult↗
PubMed1985

Pharmacokinetics of cefotiam in humans.

After intravenous bolus injections of 0.5, 1, and 2 g of cefotiam to three healthy volunteers, the mean (+/- standard deviation) total plasma clearances measured for each dose were, respectively, 26.8 +/- 2.7, 22.8 +/- 0.8, and 17.8 +/- 0.9 liters/h; the terminal elimination half-lives were 54.0 +/- 0.1, 68 +/- 15, and 98 +/- 36 min; and the renal clearances were 16.0 +/- 2.9, 13.3 +/- 1.4, and 11.3 +/- 2.6 liters/h. The 24-h urinary recovery was independent of the dose and averaged 53% of the dose. After intramuscular administration of 1 g of cefotiam to three healthy volunteers, a mean (+/- standard deviation) peak concentration of 16.6 +/- 5.1 micrograms/ml was reached at 0.75 to 1 h post dosing. The concurrent intramuscular administration of lidocaine and cefotiam did not modify the kinetics of cefotiam. During a constant-rate infusion, the steady-state plasma clearance decreased slightly when the infusion rate was increased. There was no trend towards accumulation of cefotiam in plasma during chronic treatment with 1 g intravenously every 12 h for 10 days.

Adult↗
PubMed1985

[Antibiotic management in oral medicine].

Although antibiotic therapy cannot replace surgical drainage of pus and ablation of necrotic tissue, it plays an essential role in the treatment of buccodental infections by preventing vascular dissemination responsible for bacterial endocarditis and infection of cardiovascular and hip prostheses. It also prevents complications due to local spread of infection (sinus cavernosus thrombosis, osteomyelitis, maxillary sinusitis, Ludwig's angina). Bacteriology of stomatologic infections of dental origin is complex and usually reflects buccal endogenous flora. Infections due to anaerobic germs are increasing in frequency in line with streptococcal affections. The choice of effective antibacterial treatment is complicated by the difficulty in isolating responsible germs and the need for diffusion of the antibiotic into bone and tonsillar tissues. Penicillin G, ampicillin and amoxicillin, possibly combined with a betalactamase inhibitor, macrolide and imidaxole derivative, are products responding best to bacteriologic and pharmacokinetic criteria for treatment of buccodental infections.

Anti-Bacterial Agents↗
PubMed1984

[Peri-anal ulceration. Tuberculosis should not be overlooked].

Two cases of peri-anal ulceration of tuberculous origin are reported: one revealed an active pulmonary and ileo-caecal tuberculosis, the other complicated a chronic pulmonary tuberculosis of several years' duration. Cutaneous manifestations of tuberculosis are exceptional. In patients with protracted peri-anal ulceration, a biopsy should be performed that will show a typical tuberculoid granuloma. The most frequently encountered anorectal tuberculous lesions are suppurations and fistulae. The main differential diagnosis is Crohn's disease with anorectal manifestations.

Adult↗
PubMed1984

[Current therapeutic indications of aminoglycosides].

Aminoglycosides still play a major role int e treatment of severe infections, especially those due to Gram-negative bacilli. They are usually administered together with a beta-lactam antibiotic, either to cover a wide antibacterial spectrum, or to obtain a better bactericidal effect, or to prevent the emergence of resistant mutants. They are mainly used in severe urinary tract infections and/or in those due to multiresistant organisms and in Gram-negative pneumonia and meningitis (intrathecally, since they poorly diffuse into the CSF). Combined with cephalosporins they constitute the first-line treatment of severe, life-threatening infections caused by Gram-negative aerobes. Given simultaneously with penicillinase-resistant semi-synthetic penicillins or with vancomycin they act synergistically against staphylococci and can be used initially for a few days in the treatment of severe staphylococcal infections. It is also for this synergistic action that they are combined with penicillin G or ampicillin in the treatment of endocarditis. The ototoxic or nephrotoxic effects common to all aminoglycosides can be avoided by adjusting the doses to the degree of renal function, by limiting their use to about a fortnight (except for endocarditis) and by monitoring blood levels.

Aminoglycosides↗
PubMed1984

[Penetration of piperacillin into the cerebrospinal fluid of patients with purulent meningitis].

Ten patients with purulent meningitis received 3 intravenous injections of 4 g piperacillin at intervals of 8 hours, in addition to the usual antimicrobial treatment. Piperacillin was assayed in serum and CSF by high performance liquid chromatography. The mean CSF concentration of the drug was 9.2 micrograms/ml and its mean percentage of penetration was 22,7%. There were no significant differences in CSF concentrations between days 2 to 4 (inflamed meninges) and days 10 to 20 (patient cured). It is concluded that piperacillin shows good CSF penetration and could be useful to treat selected cases of meningitis due to Gram-negative bacilli.

Adolescent↗