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Biomedical subjects

L A Mandell

Publications and source records attributed to L A Mandell.

At least 19 recordsLinked to original sources
PubMed2000

Comparative in vitro activities of ciprofloxacin, gemifloxacin, grepafloxacin, moxifloxacin, ofloxacin, sparfloxacin, trovafloxacin, and other antimicrobial agents against bloodstream isolates of gram-positive cocci.

The in vitro activity of gemifloxacin against 316 bloodstream isolates of staphylococci, pneumococci, and enterococci was compared with the activities of six fluoroquinolones and three other antimicrobial agents. Of the antimicrobial agents tested, gemifloxacin was the most potent against penicillin-intermediate and -resistant pneumococci, methicillin-susceptible and -resistant Staphylococcus epidermidis isolates, and coagulase-negative staphylococci.

Anti-Bacterial Agents↗
PubMed1999

Antibiotic therapy for community-acquired pneumonia.

This article takes a broad perspective of community-acquired pneumonia (CAP). The arguments and data that support or refute the current approaches to initial antimicrobial treatment of CAP as outlined in the American Thoracic Society and Infectious Disease Society of America documents are provided. The complex issues involved in the decision of how to properly treat CAP are addressed.

Anti-Bacterial Agents↗
PubMed1999

[The role of trovafloxacin in the treatment of nosocomial pneumonia].

In order to understand the role of trovafloxacin in the treatment of nosocomial pneumonia, the nature and characteristics of this infection have to be first reviewed. During the first part of this revision the principal aspects of the epidemiology are reviewed, some concepts which take part in the pathogenia of the illness and the immunology of these patients are analysed and the microbiological characteristics of nosocomial pneumonia are evaluated. In the second part of the revision the bacterial resistance to the main groups of antibiotics is considered, listing the different mechanisms used by the bacteria to develop this resistance. They are: production of enzymes which inactivate the antibiotic, access reduction of the drug to the target site, increase of the antibiotic efflux or changes in the target site. Current controversies concerning diagnostic methods and some controversial issues regarding this pathology are here discussed. Finally, the proposed guidelines for the treating hospital acquired pneumonia are revised as well as the role of special new antibiotics. In this sense special reference is made to trovafloxacin, listing its principal characteristics, as its broad spectrum of activity, its excellent pharmacokinetic properties, its availability in i.v. and oral formulations and its good tolerance, which makes trovafloxacin a very interesting option for treatment of hospital acquired pneumonia.

Anti-Infective Agents↗
PubMed1998

Community-acquired pneumonia in adults: guidelines for management. The Infectious Diseases Society of America.

This is part of the series of practice guidelines commissioned by the Infectious Diseases Society of America through its Practice Guidelines Committee. The purpose of this guideline is to provide assistance to clinicians in the diagnosis and treatment of community-acquired pneumonia. The targeted providers are internists and family practitioners. The targeted groups are immunocompetent adult patients. Criteria are specified for determining whether the inpatient or outpatient setting is appropriate for treatment. Differences from other guidelines written on this topic include use of laboratory criteria for diagnosis and approach to antimicrobial therapy. Panel members and consultants are experts in adult infectious diseases. The guidelines are evidence based where possible. A standard ranking system is used for the strength of the recommendations and the quality of the evidence cited in the literature reviewed. The document has been subjected to external review by peer reviewers as well as by the Practice Guidelines Committee and was approved by the IDSA Council. An executive summary and tables highlight the major recommendations. The guidelines will be listed on the IDSA home page at http://www.idsociety.org.

Adult↗
PubMed1998

Nosocomial pneumonia guidelines: an international perspective.

Hospital-acquired pneumonia is a serious illness with substantial morbidity and mortality. Management of this illness is challenging for the physician and a number of diverse issues must be considered when initiating therapy. Guidelines for the treatment of hospital-acquired pneumonia have been developed in Canada and the United States. A questionnaire sent to infectious disease physicians or clinical microbiologists in 29 countries showed that Australia, Sweden, and France had national guidelines in addition to Canada and the United States, while Hong Kong and France had single hospital-based guidelines. These guidelines are reviewed and some of the controversial issues relating to nosocomial pneumonia are discussed.

Canada↗
PubMed1996

Quinolone-based antibacterial chemoprophylaxis in neutropenic patients: effect of augmented gram-positive activity on infectious morbidity. National Cancer Institute of Canada Clinical Trials Group.

OBJECTIVE: To determine whether augmented quinolone-based antibacterial prophylaxis in neutropenic patients with cancer reduces infections caused by gram-positive cocci and preserves the protective effect against aerobic gram-negative bacilli. DESIGN: Open, randomized, controlled, multicenter clinical trial. SETTING: Centers participating in the National Cancer Institute of Canada Clinical Trials Group. PATIENTS: 111 eligible and evaluable patients hospitalized for severe neutropenia (neutrophil count < 0.5 x 10(9)/L lasting at least 14 days) who were receiving cytotoxic therapy for acute leukemia or bone marrow autografting. INTERVENTION: One of three oral antibacterial prophylactic regimens (norfloxacin, 400 mg every 12 hours; ofloxacin, 400 mg every 12 hours; or ofloxacin, 400 mg, plus rifampin, 300 mg every 12 hours) beginning with cytotoxic therapy. MEASUREMENTS: Incidence and cause of suspected or proven infection. RESULTS: Microbiologically documented overall infection rates for norfloxacin, ofloxacin, and ofloxacin plus rifampin were 47%, 24%, and 9%, respectively (P < 0.001). Corresponding rates were 24%, 13%, and 3%, respectively for staphylococcal bacteremia (P = 0.03) and, 21%, 3%, and 3%, respectively for streptococcal bacteremia (P < 0.01). The pattern of bacteremia suggested that rifampin played a role in suppressing staphylococcal infection. Both ofloxacin alone and ofloxacin plus rifampin had a clinically significant antistreptococcal effect. Aerobic gram-negative rods were cleared from rectal surveillance cultures in all patients after a median of 5.5 days and caused infection in only one patient (0.9%). The reductions in the number of microbiologically documented infections among ofloxacin recipients and ofloxacin plus rifampin recipients were offset by concomitant increases in the number of unexplained fevers (24% of norfloxacin recipients, 53% of ofloxacin recipients, and 49% of ofloxacin plus rifampin recipients; P = 0.02). No statistically significant difference was found among the treatment arms with respect to the overall incidence of febrile neutropenic episodes as defined for this trial (79% for the norfloxacin group, 82% for the ofloxacin group, and 77% for the ofloxacin plus rifampin group). CONCLUSIONS: Quinolone-based antibacterial chemoprophylaxis protected patients from aerobic gram-negative bacillary infections. Augmentation of the gram-positive activity reduced the incidence of gram-positive infections but did not influence the overall incidence of febrile neutropenic episodes.

Adult↗
PubMed1996

Antimicrobial approaches to therapy for pneumonia.

Pneumonia remains a serious illness with significant associated morbidity and mortality. Parallelling our increased understanding of the etiology, epidemiology, and pathogenesis of pneumonia and the development of new antibiotics has been the frightening increase in the rate and extent of bacterial resistance. The prevalence of resistance has reached unprecedented levels in many countries, and we are facing the specter of infection by pathogens for which we have no effective treatment. To better understand some of the newer developments in this field, the discussion centers around the interactive triad of the host, pathogen, and drug. Pertinent developments relevant to each of these three areas are considered, along with a discussion of their clinical impact.

Anti-Bacterial Agents↗
PubMed1994

Antibiotics for pneumonia therapy.

When treating any infectious disease, a physician selects an antimicrobial based on the following considerations: the in vitro activity of the drug, its pharmacokinetic properties, the efficacy data based on properly designed and conducted clinical trials, and finally the adverse effects. In this article, all of these factors, with the exception of adverse effects, were discussed. It was neither my intent nor my purpose to deal with side effects or adverse drug reactions because these are well covered in standard texts or physician references such as the Physicians' Desk Reference and the American Hospital Formulary Service (United States) and the Compendium of Pharmaceuticals and Specialties (Canada).

Anti-Infective Agents↗
PubMed1993

In vitro activity of sparfloxacin, ciprofloxacin, ofloxacin, and other antibiotics against bloodstream isolates of gram-positive cocci.

The in vitro activity of sparfloxacin was compared with the activities of ciprofloxacin, ofloxacin, and six other antimicrobial agents against 323 bloodstream isolates of staphylococci (both oxacillin susceptible and resistant) enterococci, and pneumococci. Sparfloxacin was more active than both ciprofloxacin and ofloxacin against all the isolates tested. Its activity (MIC for 90% of strains tested < or = 0.10 microgram/ml) against oxacillin-susceptible staphylococci was superior to that of ciprofloxacin and ofloxacin by at least fourfold. Sparfloxacin was also more potent against pneumococci. However, fluoroquinolone resistance was noted among oxacillin-resistant strains of Staphylococcus aureus and coagulase-negative staphylococci.

Anti-Bacterial Agents↗
PubMed1992

Effect of acidified enteral feedings on gastric colonization in the critically ill patient.

OBJECTIVE: To evaluate the effect of acidified enteral nutritional formulas (feedings) on gastric colonization and pH in critically ill patients. DESIGN: Randomized, double-blind trial of three groups: a) regular feedings into the stomach; b) regular feedings into the duodenum; and c) acidified feedings into the stomach. Nasogastric aspirates for gastric pH and microbiological determinations were obtained daily for a mean of 5 days after feeding began. SETTING: ICU at a tertiary care hospital. PATIENTS: Thirty-one patients indicated to receive enteral feedings before day 4 in the ICU were randomized. Seven patients had their feedings discontinued because of intolerance, accidental extubation, or tolerance of oral supplementation. One patient received the wrong feedings and was dropped from the study. A total of 23 patients finished the study. They were mostly trauma (n = 15) or neurosurgical (n = 6) patients. The average age was 40 yrs (range 15 to 71). INTERVENTIONS: An enteral formula with a pH of 6.5 was used as the control feeding. Hydrochloric acid was added to the control feeding to titrate the pH to 3.5 and this acidified enteral formula was given to the experimental group. All patients received continuous enteral feedings via an 8-Fr feeding tube. MAIN RESULTS: Seven of eight patients receiving the acidified feedings were sterile (no microbial growth) on receiving feedings compared with five of 15 of those patients receiving regular feedings (p = .027). For those patients initially colonized, four of four patients receiving acidified feedings immediately became sterile and remained so. Only two of ten patients receiving regular feedings remained sterile (p = .021). The mean gastric pH of the acidified group was 3.2 compared with the group receiving regular feedings into the stomach (pH = 4.7) and the group receiving regular feedings into the duodenum (pH = 3.8) (p < .01). There was no evidence of gastrointestinal bleeding in any patient. CONCLUSIONS: Acidified enteral feedings are effective in eliminating and preventing gastric colonization in critically ill patients. Further investigation is needed to assess its effect on nosocomial infection rates.

Acidosis, Lactic↗
PubMed1992

Gastric colonization by gram-negative bacilli and nosocomial pneumonia in the intensive care unit patient. Evidence for causation.

The purpose of this article is to assess critically the evidence for a causal relationship between gastric colonization by Gram-negative bacilli and nosocomial pneumonia in the intensive care unit. Articles were found using MEDLINE search and citations in relevant articles. Nine diagnostic tests of causation were applied and analysis showed that the major tests were satisfied. The strongest evidence comes from randomized controlled trials of selective gut decontamination and stress ulcer prophylaxis in intensive care units. These studies confirm that the incidence of nosocomial pneumonia correlates directly with the rate of gastric colonization by Gram-negative bacilli. Further support comes from other tests of causation such as strength and consistency of association, temporal relationship, and dose-response gradient. The data reviewed suggest that gastric colonization with Gram-negative bacilli plays a causal role in the development of nosocomial pneumonia in the intensive care unit patient. This relationship impacts on future studies of pathogenesis and prevention of this potentially lethal infection.

Causality↗
PubMed1991

Role of quinolones in surgical prophylaxis.

The general principles involved in the use of chemoprophylaxis in surgery, the selection of patients at risk, and the choice of antibiotic agents are reasonably well established. While a good deal of data exist regarding commonly used prophylactic regimens, very little data are available on the role of quinolones in surgical prophylaxis. The literature dealing with this area is reviewed, and studies on the use of quinolones in biliary, colorectal, urologic, orthopedic and vascular surgery are discussed. The data suggest that generally the quinolones are as efficacious as the other antibiotics with which they were compared, and in the case of urologic surgery the results using quinolones were better than those in non-treated controls. Single-dose prophylaxis was regularly shown to be as effective as multiple dose regimens. Further clinical trial data are necessary before any firm conclusions can be drawn regarding the role of quinolones in surgical prophylaxis.

4-Quinolones↗
PubMed1991

Synergistic killing of gram-negative bacilli by cefotaxime, its desacetyl metabolite and human polymorphonuclear neutrophils.

Using an in-vitro model the effects of sub-MIC cefotaxime and its desacetyl metabolite singly and in combination on killing of E. coli by PMNs were studied. Our purpose was to determine if the parent compound and its metabolite had a synergistic effect on killing of E. coli by PMNs. Thymidine-labelled serum resistant Escherichia coli 018:K1:H7 were incubated during log phase growth with varying sub-MICs (1/2, 1/8, 1/32) of cefotaxime, its desacetyl metabolite and both agents together, or phosphate buffered saline (PBS) as a control for 90 min at 37 degrees C. The bacteria were then washed and a series of opsonization experiments was performed using intact and sonicated PMNs. Killing of bacteria was determined at 3, 10 and 20 min. Uptake and killing of bacteria by PMNs were measured using standard techniques. Pre-treatment of E. coli with cefotaxime alone and desacetyl cefotaxime and cefotaxime together resulted in significantly enhanced bacterial killing by PMNs at all three exposure times to PMNs. Pre-treatment of the bacteria with sub-MICs of desacetyl cefotaxime alone showed enhanced killing only after exposure for three minutes. In all cases, any increased killing was independent of ingestion by the phagocytes. The opsonization experiments demonstrated that contact between bacteria and PMNs was necessary for optimal killing to occur. The enhanced killing of the sub-MIC antibiotic pre-treated bacteria was seen even when sonicated PMNs were used. The extent of bacterial killing, however, was less than that seen with intact PMNs.

Cefotaxime↗