Trends in zidovudine prescription since 1987 in AIDS-free HIV-positive French patients attending university hospitals.
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Biomedical subjects
Publications and source records attributed to M Armengaud.
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From 1/87 to 12/89, the French Registry of HIV-associated tumors recorded 131 cases of intermediate- and high-grade non-Hodgkin's lymphomas (NHL). There were 47 small non-cleaved Burkitt-type lymphomas (SNCL), 32 immunoblastic lymphomas (IL) and 52 diffuse large-cell or predominantly large-cell lymphomas (LCL). There were differences in the clinical patterns of the histological subtypes. Isolated extranodal presentation was less frequent in SNCL (2/47) than in IL (13/32) and LCL (17/49) (p less than 0.0001). In the latter two groups, the central nervous system was the principal site of extranodal involvement (16/30), 87% of SNCL, patients had no previous manifestations of AIDS whereas 40% of IL and LCL patients presented full-blown AIDS (p less than 0.01). At the time of NHL diagnosis, the median blood CD4 lymphocyte count was higher in SNCL (266/microL) than in LCL (125/microL, p less than 0.05) and IL (80/microL, p less than 0.01), 69% of stages I/II patients, 31% of stages III/IV, and 33% of stage ie patients achieved complete remission (CR), p less than 0.05. Overall median survival time was 5 months. There was no statistical difference in CR and survival rates among histological types. The two-year actuarial survival rate was 25% (median 8 months) for initially asymptomatic patients or those with persistent generalized lymphadenopathy (PGL) and 9% (median 3 months) for those previously with AIDS-related complex (ARC) and AIDS patients (p less than 0.001). Response to treatment was the other predictor factor. The two-year survival rate was 42% (median 16 months) for patients who achieved CR, and 5% (median 3 months) for those who did not.(ABSTRACT TRUNCATED AT 250 WORDS)
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A multicentre open trial was conducted in 31 centres to evaluate the therapeutic and ecological impact of imipenem-cilastatin on patients admitted to infectious pathology departments. Two-hundred patients (mean age: 58 +/- 19.4 years) were included in the study. The predominant infections were septicaemia, severe urinary tract infections and lower respiratory tract infections. Most of the patients treated (188/200) had associated severity factors. The acute infectious episode had been present for 9.3 +/- 12.2 days before the drug was prescribed. In the majority of patients the infection was hospital-acquired. Two-hundred and fifteen out of the 298 initial bacterial isolates were Gram-negative bacilli. Imipenem-cilastatin was administered alone in 74.5 per cent of the patients during 14.1 days on average in doses of 30 mg/kg/day. The drug was given as first-choice treatment in 60 per cent of the cases and after failure of another antibiotic therapy in 40 per cent. Clinical cure was obtained in 180 of the 198 assessable patients. Among therapeutic failures, 4 were due to the emergence during treatment of an imipenem-resistant Pseudomonas aeruginosa, but 30 of the 42 strains of Pseudomonas isolated before treatment were eradicated. The therapeutic success rates were 100 per cent in intra-abdominal infections, 94 per cent in septicaemias, 97 per cent in urinary tract infections and 82 per cent in lower respiratory tract infections, this last figure being one of the highest recorded in clinical trials. Frequent colonization or superinfection were not encountered in this study. The incidence of phlebitis at the site of injection was 14 per cent.
A multicenter study including 10 outpatient private laboratories (hospital laboratories excluded) was carried out in France. 1,611 urines samples from patients with UTI were collected during the forth trimester of 1987. The most frequently recovered pathogens were: E. coli (71%), Proteus mirabilis (9%), Staphylococcus coagulase (6%), Klebsiella (6%), Enterobacter (2%). Other sorts (Streptococcus D, Proteus sp, Pseudomonas aeruginosa, Enterobacter sp) were infrequent (less than 1%). The sensitivity of the aerobic Gram-negative bacteria to ampicillin, clavulanic acid-amoxicillin, cephalothin, gentamicin, pipemidic acid, norfloxacin and co-trimoxazole was tested.
In an open study, twenty cases of meningococcal meningitis have been treated by ceftriaxone for five days. Therapeutic results presented in this study are consistent with findings reported in similar conditions, and agree for shortened treatment of meningococcal meningitis with ceftriaxone.
Thirty-two patients were included in this trial: 22 with staphylococcal meningitis (including 5 methicillin-resistant) and 10 with enterobacterial meningitis. Mean duration of treatment was 14.5 and 15.9 days respectively. The combination was synergistic in vitro against 10 of the 12 strains of Staphylococcus and 5 of the 6 strains of Enterobacteriaceae studied. Bacteriological sterilization occurred in all cases which could be evaluated, and clinical recovery was obtained in 95.2% of patients with staphylococcal meningitis (4 unrelated deaths) and 100% of patients with enterobacterial meningitis (2 deaths). Bactericidal power of the cerebro-spinal fluid, often less than 1/8, was not correlated with effectiveness against Staphylococci. Mean CSF concentrations of cefotaxime, desacetylcefotaxime and fosfomycin on the 2nd and 15th days of treatment were 4, 3.5 and 39.8 mg/l and 2.2, 2.1 and 28.0 mg/l, respectively. Clinical and biological acceptability was satisfactory. There were three cases of superinfection or colonization, by Pseudomonas and Enterobacter.
Seventeen Caucasian patients with acquired immunodeficiency syndrome (AIDS) contracted after long stays in Africa are reported. Central Africa was concerned in all cases. Men are particularly exposed to AIDS whatever their occupation. This study suggests that the risk of contracting AIDS in Africa is high; the transmission of the virus was related to sexual contact, particularly with prostitutes, in Africa in most of the cases. It suggests also that Caucasians who travel in Africa spread the virus throughout the world by means of their heterosexual relations.
One hundred one nosocomial septicemias (NS) were studied among 461 cases of septicemias (22%) collected by French Septicemia Expert System Group during 1985. The mean-age of the patients was 58 +/- 23 years while it was 56 +/- 23 years in the 360 community acquired septicemias (CAS). The source of septicemia was found more frequently in NS than in CAS (79/101 versus 223/360; p less than 0.002): mainly urinary tract and intravenous therapy in NS, urinary tract, gastrointestinal and biliary origin in CAS. Invasive procedures (except surgical procedures) were more frequent in NS than in CAS (13/101 vs 14/360; p less than 0.0001). Underlying diseases were more often associated with NS than with CAS (96/101 vs 276/360; p less than 0.0001). Many pathogens were involved in these NS but the frequency of S. aureus meti-S and meti-R, S. epidermidis, Enterobacter, Klebsiella, Serratia, Proteus indol + and Pseudomonas carbeni-R was significantly greater in NS than in CAS. There was no significant difference between NS and CAS for septic localizations, respiratory distress syndrome and septic shock. Two antibiotics (and possibly 3 antibiotics for polymicrobial septicemias) were more often used in NS than in CAS (61/101 vs 135/360; p = 0.002). If the duration of hospitalization was not significantly greater in NS than in CAS (26 +/- 29 days vs 23 +/- 33 days), the overall mortality was significantly more important (25.6% vs 14.9%; p less than 0.05).
Following a brief review of the main bacteriological and pharmacokinetic properties of ceftriaxone, the authors present a therapeutic evaluation of this new cephalosporin antibiotic. The effects of ceftriaxone in severe infections, such as septicaemia, bacterial meningitis, urinary tract infections, typhoid, bone infections and sexually transmitted diseases, are described on the basis of recent publications. Mention is also made of the adverse reactions to, and benign side-effects of the drug. Finally, the advantages of ceftriaxone in the treatment of some infections are envisaged: the single daily dose and short therapeutic courses may modify therapeutic habits and exert a beneficial effect on costs in some cases.
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In managing bacterial meningitis, the essential rule, stated by Chabbert, is to achieved antibiotic concentrations in the CSF which exceed the minimal bactericidal concentration (MBC) Several factors must be considered, related either to the microorganism itself (virulence, sensitivity, density of the cultured sample, resistance to metabolites, inactivation of the antibiotic by purulent CSF) or to the patient (initial site of infection, immunologic deficiency, csf clearance). As to the antibiotic liposolubility, free plasma fraction, and route of administration, are the factors which affect it's passage towards the CSF.
Sixty patients including forty two males and eighteen females, age range: 18-87 years, received antibacterial single drug treatment with latamoxef for septicemia. Forty nine patients had underlying conditions including multiple trauma, neoplasm, cardiovascular, metabolic and respiratory tract diseases. Causative pathogens were isolated in all cases. The predominant isolates were E. coli (thirty), Klebsiella pneumoniae (tent) and Enterobacter (seven). A single organism was isolated in fifty seven cases; in the other three cases two organisms were isolated from blood cultures. Mean daily dosage was 46.6 +/- 6.1 mg . kg-1 (range: 14-113 mg . kg-1). In the majority of cases (fifty two) dosage was 3 g . d-1 or less; in thirty cases it was no higher than 2 g . d-1. Duration of therapy ranged from six to thirty eight days. Serum titer was measured in many cases and latamoxef blood levels were assayed in nine patients. A satisfactory clinical response was achieved in fifty eight cases and fifty eight bacteriological cures were also obtained. There was no statistically significant difference in therapeutic response between the 2 g and 3 g daily dosage groups. Tolerance was very good; untoward effects were few and required drug discontinuation in one case only.
Cefotaxime was administered as sole treatment (49 cases) or after failure of another previous antibiotic (17 cases) to 66 patients suffering from infectious diseases. The 78 infections thus treated included urinary tract infections (35), septicaemia or endocarditis (25), respiratory tract infections (7), osteitis (5), meningitis (4), biliary infection (1), and skin infection (1). The pathogens identified were more often enterobacteria: Serratia: 23, E. coli: 15, Klebsiella: 7, Proteus: 7, Enterobacter: 1, Providentia: 1, Pseudomonas: 5, Staphylococcus: 7, Pneumococcus: 4, Streptococcus: 2, Branhamella: 1. Cefotaxime was given either intravenously (2/3 of cases) or intramuscularly, at an average daily dose of 3.75 g (mean: 1.5-8 g). It was administered alone to 49 patients suffering from septicaemia and urinary tract infections caused by E. coli, Klebsiella and especially Serratia, and it was combined in 17 cases, particularly in meningitis and bone infections. The overall results of cefotaxime given in serious diseases were especially favourable in debilitated patients (88% therapeutic success). The local tolerance was good and side effects were not observed in any patient. Cefotaxime seems to be an active antibiotic, indicated in many severe septicemic or not septicemic infections, more particularly in diseases with multiresistant Gram negative pathogens.
The therapy of gram-negative bacillary meningitis is less than adequate to date; the agents recommended do not achieve bactericidal levels in purulent cerebrospinal fluid. Because optimal antibiotic therapy of meningitis occurs when the cerebrospinal fluid level of an antibiotic is above the concentration needed to kill the offending pathogen, another group of agents needs to be considered. The newer cephalosporins or cehalosporin-type antibiotics (cefotaxime, moxalactam), by virtue of their marked activity against gram-negative bacilli and their ability to achieve significant CSF levels, merit serious consideration as therapy for gram-negative bacillary meningitis. Investigators in Europe and the United States have developed preliminary data demonstrating the efficacy of these agents in a growing number of cases. In the group presented herein, of the 35 cases in which gram-negative bacillary meningitis was treated with the newer cephalosporins, there were only four failures.
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