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Biomedical subjects

L O Gentry

Publications and source records attributed to L O Gentry.

At least 37 records · Page 2Linked to original sources
PubMed1992

Oral ofloxacin therapy for lower respiratory tract infection.

We made an open, noncomparative evaluation of ofloxacin, 400 mg orally bid for 10 days, in 98 subjects with community-acquired pneumonia or pathogen-confirmed bronchitis. Thirty-nine (40%) of the subjects were treated in the hospital and 59 (60%) were treated as outpatients. The mean age of those treated was 56.2 years; 73 (74%) of the subjects either were more than 60 years old or had a history of chronic obstructive pulmonary disease, or both. There were 95 organisms initially isolated in sputum, aspirate, or lavage fluid; all were susceptible to ofloxacin, and none acquired resistance during therapy. Haemophilus influenzae was the most common pathogen (19 isolates), followed by Streptococcus pneumoniae (18) and Staphylococcus aureus (10). Clinical responses included cure in 70 patients (71%), improvement in 26 (27%), and failure in two (2%). After 10 days of therapy, pathogens persisted in two cases; in one case, Streptococcus salivarius was isolated, though it remained susceptible to ofloxacin, and in the other, Klebsiella pneumoniae was accompanied by superinfection due to a resistant strain of Serratia marcescens. We included in this study three confirmed cases of atypical pneumonia successfully treated with ofloxacin, two of them due to Mycoplasma pneumonia and one to Legionella pneumophila. Ofloxacin was well tolerated. Our data indicate that ofloxacin is effective and safe as specific and empiric treatment for many lower respiratory tract infections.

Administration, Oral↗
PubMed1992

Parenteral followed by oral ofloxacin for nosocomial pneumonia and community-acquired pneumonia requiring hospitalization.

We report a multicentric, open trial of intravenous followed by oral ofloxacin, 400 mg every 12 h, as therapy for 100 cases of nosocomial pneumonia and community-acquired pneumonia requiring hospitalization. The typical subject was 57 yr old, and underlying diseases, such as chronic obstructive pulmonary diseases (COPD), diabetes mellitus, and congestive heart failure, were common. For 10 subjects previous therapy had failed. There were 118 pathogens isolated in blood or sputum; S. pneumoniae was the most common (42), followed by H. influenzae (13), Klebsiella spp. (11), and S. aureus (10). Ofloxacin was administered for an average of 5.7 days intravenously followed by 6.9 days orally. Response to therapy was judged to be cure in 71 subjects, improvement in 24, and failure in 5. Among the more seriously ill subjects, ofloxacin therapy was successful for four of five immunocompromised subjects, for 12 of 12 subjects with nosocomial pneumonia, three of whom were on the ventilator, and for nine of 10 subjects with community-acquired pneumonia and bacteremia, including seven of eight cases due to S. pneumoniae. Univariate risk factor analysis revealed underlying COPD and/or tachypnea upon admission to be associated with failure of ofloxacin therapy, with bacteremia suggestive of failure. Conversely, ofloxacin was equally effective in cases in whom previous therapy failed and in cases of nosocomial pneumonia, multilobar pneumonia, and/or pneumonia due to S. pneumoniae. Results for P. aeruginosa were inconclusive. Intravenous followed by oral ofloxacin was highly effective in many difficult cases of pneumonia.

Administration, Oral↗
PubMed1992

Cefuroxime prophylaxis in cardiovascular surgery: clinical, microbiological, and ecological impact.

To determine the efficacy of cefuroxime as a prophylactic agent against infection, we retrospectively evaluated patients who had undergone cefuroxime therapy for cardiovascular surgery procedures in the years 1987 and 1990. In the 403 evaluable patients (203 in 1987 and 200 in 1990), we noted a postoperative surgical wound infection rate of 3% and a nosocomial infection rate of 3%. These rates have remained constant in 1987 and 1990. Despite more than a 6-fold increase in cefuroxime consumption during this same period, we have not observed a selection for staphylococcal infections in cardiovascular surgery patients, nor have we detected a selection for resistant staphylococci in our institution. Our original criteria that caused us to select cefuroxime for routine prophylaxis-notably its equivalent efficacy and safety as compared with other cephalosporins, and its lack of an adverse impact on the hospital flora-remain valid.

Journal Article↗
PubMed1992

Toxoplasmosis in pregnancy: an emerging concern for family physicians.

Toxoplasmosis is usually asymptomatic in pregnant women but poses a risk of severe effects on the fetus. One to eight of every 1,000 pregnant women become infected, and the infection is transmitted to the fetus in approximately 40 percent of these cases. The risk of transmission rises with increasing gestational age at the time of initial infection. Congenital infection with toxoplasmosis may lead to serious sequelae, such as blindness, mental retardation, neurologic deficits and deafness. Prevention of morbidity from toxoplasmosis depends on prevention of the infection in pregnant women, plus early recognition and aggressive treatment of maternal infections.

Female↗
PubMed1991

Review of quinolones in the treatment of infections of the skin and skin structure.

The oral fluoroquinolones ciprofloxacin, ofloxacin and temafloxacin are active against staphylococci, Enterobacteriaceae and Pseudomonas aeruginosa. Ciprofloxacin has been extensively studied, and is as effective as parenteral third-generation cephalosporins in many difficult infections of the skin and skin structure. Ofloxacin has been less extensively studied, yet is probably more effective than ciprofloxacin against Staphylococcus aureus, while less effective against P. aeruginosa. Temafloxacin is an oral quinolone, and appears to be a promising agent for skin and soft tissue infections due to its extended spectrum of activity, including anaerobic pathogens. Oral fluoroquinolone monotherapy, when combined with surgical debridement and local management, may be effective in many difficult infections of the skin and skin structure previously treated with parenteral antibiotics.

4-Quinolones↗
PubMed1991

Randomized comparison of cefepime and ceftazidime for treatment of skin, surgical wound, and complicated urinary tract infections in hospitalized subjects.

We undertook a prospective, randomized open comparison of the broad-spectrum cephalosporins cefepime and ceftazidime in treatment of hospitalized subjects with skin or wound infections and complicated nosocomial urinary tract infections. Cefepime treatment (dosage, 2.0 g intravenously twice daily for 4 to 28 days) was successful in 36 (90%) of 40 infections of the skin and skin structure or wounds and in 16 (84%) of 19 nosocomial urinary tract infections. Ceftazidime treatment, 2.0 g every 8 h, was successful in 34 (96%) of 36 infections of the skin and skin structure and in 15 (88%) of 17 urinary tract infections. Microbiological eradication rates of each agent overall and for Pseudomonas aeruginosa were greater than 90%. In the cefepime group, one death occurred, contributed to by an enterococcal superinfection acquired during study drug therapy, and there were two mild and transient adverse experiences observed. Cefepime was comparable to ceftazidime in treatment of infections of the skin and skin structure requiring hospitalization and of complicated nosocomial urinary tract infections.

Adult↗
PubMed1991

Ofloxacin versus parenteral therapy for chronic osteomyelitis.

We conducted a randomized comparison of oral ofloxacin (400 mg twice a day) and parenteral agents (cefazolin, 1.0 g intravenously every 8 h, or ceftazidime, 2.0 g intravenously every 12 h) in biopsy-confirmed, nonprosthesis osteomyelitis. A total of 19 subjects received ofloxacin for an average of 8 weeks, and 14 received parenteral antibiotics for an average of 4 weeks; both therapies were well tolerated. Infections were due to Staphylococcus aureus (40%), Enterococcus spp. (3%), Pseudomonas aeruginosa (15%), and other gram-negative organisms (42%). At the completion of therapy, one P. aeruginosa infection in the ofloxacin group persisted and the organism acquired resistance, accompanied by a resistant Acinetobacter superinfection. In the parenteral group, one S. aureus infection persisted, and there was a resolved superinfection due to S. aureus as well. Eighteen-month follow-up data have been obtained. Among those treated with ofloxacin, four subjects whose initial response to therapy was successful suffered relapses of infection, three due to S. aureus and one due to P. aeruginosa, while in the parenteral group, one subject with a P. aeruginosa infection relapsed. Long-term response to therapy was successful for 14 of 19 (74%) subjects who received ofloxacin and 12 of 14 (86%) who received parenteral antibiotics; the difference was not significant. Oral ofloxacin appears comparable to parenteral antibiotics in chronic osteomyelitis due to susceptible organisms, and oral ofloxacin offers advantages in economics and convenience.

Administration, Oral↗
PubMed1991

Bacterial resistance.

Pathogenic bacteria remain adaptable to an increasingly hostile environment and a wider variety of more potent antibiotics. Organisms not intrinsically prepared for defense have been able to acquire resistance to newer antimicrobial agents. Chromosomal mutations alone cannot account for the rapid emergence and spread of antibiotic resistance. It has been established that plasmids and transposons are particularly important in the evolution of antibiotic-resistant bacteria. Plasmid- or transposon-mediated resistance provides the bacteria with pre-evolved genes refined to express high-level resistance. In particular, transposons can transfer these resistance determinants in diverse bacterial species, and nature provides in humans and animals large intestinal reservoirs in which such communications are facilitated. Antibiotic therapy exerts selection pressures on bacteria. Eradication or marked reduction in the populations of susceptible organisms promotes the overgrowth of intrinsically resistant strains and favors those resistant as a result of favorable chromosomal mutations or via plasmids or transposons. In our hospitals, where antibiotic consumption continues to increase, the nosocomial flora consists of many resistant bacteria, and infections acquired in the nosocomial setting are now far more severe than their community-acquired counterparts. There is convincing evidence that infection control measures must take into further consideration the contribution of the hospital worker as carrier and mediator of antibiotic resistance.

Anti-Bacterial Agents↗
PubMed1990

Cefotaxime and prophylaxis. New approaches with a proven agent.

Cefotaxime, a third-generation cephalosporin, is active against many troublesome gram-negative organisms and anaerobes that now more frequently cause nosocomial infection. Single-dose cefotaxime, 1 g or 2 g administered 30 minutes prior to surgery, has been proven to be effective as prophylaxis for infection following gastrointestinal, biliary, obstetric, gynecologic, and genito-urinary procedures. When published trials are compiled, single-dose cefotaxime is more effective than multiple-dose cefazolin (p less than 0.01) in these types of surgery. Unfortunately, the dramatic increase in cephalosporin use has been accompanied by the emergence of resistant organisms such as enterococci and fungi. In Europe, some centers successfully prevent nosocomial pneumonia in intubated patients by decontaminating gastric contents with a combination of nonabsorbable antimicrobial agents including cefotaxime. Further trials may validate this concept for use in the United States.

Bacterial Infections↗
PubMed1990

Oral ciprofloxacin compared with parenteral antibiotics in the treatment of osteomyelitis.

We undertook a prospective, randomized comparison of oral ciprofloxacin with standard parenteral therapies for the treatment of biopsy-proven osteomyelitis caused by susceptible organisms. Following surgical debridement, the ciprofloxacin patients received 750 mg twice a day, and the other patients received a broad-spectrum cephalosporin or a nafcillin-aminoglycoside combination intravenously (i.v.). There were 31 evaluable patients in the ciprofloxacin group, treated an average of 56 days, and 28 in the i.v. group, treated an average of 47 days. Clinical success rates were 24 of 31 (77%) for the ciprofloxacin group and 22 of 28 (79%) for the i.v. group. Of the seven failures in the ciprofloxacin group, one was due to a persistent Klebsiella pneumoniae infection and six were due to relapse of the infection within 1 year of therapy. Of the six failures in the i.v. group, one was due to an Enterobacter aerogenes strain which emerged resistant and five were due to relapse. The most troublesome etiology was polymicrobial osteomyelitis involving Pseudomonas aeruginosa, in which five of six (83%) regimens failed. Adverse reactions occurred infrequently, i.e., in 1 of 31 (3%) of the ciprofloxacin patients and in 4 of 28 (14%) of the i.v. patients, yet all reactions responded to therapy and none required protocol deviation. Our data indicate that oral ciprofloxacin monotherapy is as safe and effective as conventional parenteral therapy in cases of osteomyelitis caused by susceptible organisms.

Administration, Oral↗
PubMed1990

Antibiotic therapy for osteomyelitis.

Antibiotic therapy for osteomyelitis has dramatically changed within the past twenty years. The diagnostic criteria for osteomyelitis remain confusing to practicing physicians. Bone biopsy culture is now the standard for determining specific antimicrobial therapy. Many of the newest and most potent antimicrobials are now used to treat the increasingly broad bacterial spectrum of etiologies of osteomyelitis. There are tremendous economic incentives for outpatient and/or oral therapy. The third-generation cephalosporins and the new fluoroquinolones have replaced older, more toxic regimens, especially those containing aminoglycoside used to treat gram-negative osteomyelitis due to susceptible organisms.

Anti-Bacterial Agents↗
PubMed1990

Newer concepts in antimicrobial therapy.

Advances in the treatment of infection have continued to increase both the length and quality of life. Unfortunately, many bacteria can readily adapt to their environment and develop a tolerance to the antimicrobial agents in widespread use. During the recent past, the consumption of cephalosporins has increased so dramatically as to parallel the initial acceptance of penicillin. Organisms that are resistant to the cephalosporins will no doubt continue to thrive, especially within the susceptible host. It is essential for the clinician to become familiar with the newest antimicrobial agents to more effectively treat modern infections.

Bacterial Infections↗
PubMed1989

A comparative evaluation of oral ofloxacin versus intravenous cefotaxime therapy for serious skin and skin structure infections.

In a single-blind, placebo-controlled randomized trial, 100 successive patients were enrolled with serious skin and soft-tissue infections, whose illnesses had precipitated an initial hospital admission or an extension of inpatient care. There were 93 evaluable patients who received either ofloxacin, 400 mg orally every 12 hours plus an intravenously administered placebo every eight hours, or cefotaxime, 2.0 g intravenously every eight hours plus an orally administered placebo every 12 hours. The average length of therapy was 12 days. Both patient groups had similar demographics and underlying conditions. Wound infection was the most common diagnosis, followed by abscess, cellulitis, and trophic ulcer. Multiple pathogens were commonly isolated from infected sites (1.4 pathogens/patient). The most common pathogen was Staphylococcus aureus, followed by Escherichia coli, Klebsiella spp., Pseudomonas aeruginosa, Serratia marcescens, Proteus/Providencia spp., and Enterobacter spp. Persistence of the initial pathogen at the end of therapy was observed in 22.5 percent of the cefotaxime-treated group, but in only 10 percent of the ofloxacin-treated group. There was one clinical failure in the cefotaxime group, caused by a susceptible strain of Enterobacter cloacae, and there was one clinical failure in the ofloxacin group, in which the patient had an Acinetobacter calcoaceticus var. anitratus wound infection and subsequently developed a P. aeruginosa superinfection. Adverse experiences, including rash, insomnia, and nausea, occurred in 16 percent of the patients in each group. It was concluded that oral ofloxacin is as safe and efficacious as parenteral cefotaxime in the treatment of serious skin and skin structure infections.

Administration, Oral↗
PubMed1989

Intravenous/oral ciprofloxacin versus intravenous ceftazidime in the treatment of serious gram-negative infections of the skin and skin structure.

A prospective, randomized, non-blind comparison of sequential intravenous/oral ciprofloxacin with parenteral ceftazidime as treatment for serious infections of the skin and skin structure caused by susceptible gram-negative organisms was conducted. For mixed gram-positive or anaerobic infections, concurrent therapy with vancomycin or anti-anaerobic agents was used. The mean duration of therapy was 25 days for the 32 evaluable ciprofloxacin-treated patients and 19 days for the 19 evaluable ceftazidime-treated patients. Overall response was "cure" in 24 of 32 (75 percent) ciprofloxacin-treated patients and 11 of 19 (58 percent) ceftazidime-treated patients (0.01 less than p less than 0.05). Ciprofloxacin eradicated 36 of 46 (78 percent) pathogens and ceftazidime 21 of 29 (72 percent) pathogens. Superinfections occurred in nine of 32 (28 percent) ciprofloxacin patients and in two of 19 (11 percent) ceftazidime patients (0.01 less than p less than 0.05). Adverse reactions requiring cessation of therapy occurred in two of 32 (6 percent) ciprofloxacin patients and in one of 19 (5 percent) ceftazidime patients. There was one death in each group; neither was due to the infection or antimicrobial therapy. Chronic infection was a significant risk factor for failure in both groups. Ciprofloxacin was as effective and safe as ceftazidime for serious infections of the skin and skin structure.

Administration, Oral↗