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Biomedical subjects

M Vergnaud

Publications and source records attributed to M Vergnaud.

35 records · Page 2Linked to original sources
PubMed1989

[Use of an antibioprophylaxis with pefloxacin and fosfomycin in cardiac surgery in patients with beta-lactam hypersensitivity].

An association of pefloxacin plus fosfomycin was used as antibioprophylaxis in beta lactam allergic patients who underwent cardiac surgery with cardiovascular-bypass. Pefloxacin (800 mg), was administered orally, one hour before anesthetic induction and fosfomycin (60 mg/kg) was injected at the time of induction. The whole course of prophylaxis wat 24 hours. Antibiotic concentrations were measured in serum before (P1, P2) during (C1, C2, C3, C4) and after cardiovascular-bypass (P3) and in bone, endocardiac and pleural tissues. The efficacy was evaluated on clinical and biological data. Antibiotic levels of pefloxacin were measured by HPLC and those of fosfomycin by bacteriological method. Antibiotic concentrations are high in blood and tissues, without evidence of cardiovascular-bypass influence. The tissue penetration of both drugs is excellent. Two patients have presented serious post-operative infections. The pharmacokinetic of pefloxacin associated with fosfomycin is appropriate during cardiovascular-bypass and the local antibiotic concentrations are above the MIC of the strains commonly responsible of post operative infections in cardiovascular surgery. The clinical efficacy of this prophylaxis must be studied in a large population of patients.

Aged↗
PubMed1987

[Diffusion, in the bronchial mucus, of enoxacin administered by oral route in man].

The diffusion of Enoxacin into the bronchial mucus was studied in 34 patients admitted because of an acute infectious episode over chronic bronchopathy. They received via the oral route 400 mg of Enoxacin twice daily. The antibiotic concentrations were measured in sputum and serum by microbiological assay and HPLC. The patients were divided into 5 groups according with the timing of sampling: 1, 3, 6, 12 hours after dosing at day 3 (group I, II, III, IV), 3 hours after dosing at day 1, 2 and 3 (group V). Serum concentrations of Enoxacin were low (2.46 mg/l at 3rd hour). Bronchial concentrations exceed blood levels (mean 3.06 mg/l at 3rd hour). The bronchial levels of Enoxacin were above the mean MIC of many respiratory bacterial pathogens.

Aged↗
PubMed1986

[Effectiveness of piperacillin in the antibacterial treatment of intra-abdominal infections in children].

The effectiveness of piperacillin was investigated in 30 children operated upon for peritonitis: 13 had acute appendicitis with puriform peritoneal reaction, or a recently perforated appendix; 5 had generalized peritonitis of appendicular origin, and 13 had intraperitoneal abscess. In the 12 children who underwent right iliac appendicectomy (with post-operative drainage in 3), piperacillin was administered alone during 5 days; clinical and bacteriological cure was obtained in all cases; the mean duration of stay in hospital was 7 days. The 5 cases of generalized peritonitis required drainage; piperacillin was given alone in 4 of them and combined with an aminoglycoside and metronidazole in one who was in poor general condition. Bacteriology showed a predominance of Escherichia coli alone or associated with other organisms. Clinical and bacteriological cure was obtained in 3 patients; the mean duration of stay in hospital was 12 days. Seven of the 13 cases of intraperitoneal abscess needed drainage. Piperacillin was administered alone for 7 days on average in 10 cases and combined with an aminoglycoside and metronidazole in 2 cases. Eight patients had a favourable course, 5 developed complications. In all 3 groups piperacillin was tell tolerated. A patch of urticaria was noted in 2 cases and a transient skin rash in 2 other cases. No neutropenia was observed in these children whose treatment never exceeded 10 days.

Abscess↗
PubMed1986

[Pharmacokinetics of ceftazidime injected peritoneally in continuous ambulatory peritoneal dialysis].

Peritonitis is the most frequent complication in patients under continuous ambulatory peritoneal dialysis. Intraperitoneal administration of ceftazidime in a dose of 125 mg per liter dialysate achieved serum concentrations higher than the minimal inhibitory concentrations of most organisms in spite of low peritoneal clearance. Serum concentration was stable up to the 120th hour. Dialysate osmolarity had no influence on serum concentration, peritoneal absorption or clearance of ceftazidime. Peritoneal inflammation did not cause changes in ceftazidime pharmacokinetics. Ceftazidime used alone as the first choice treatment was successful in 85%, of cases.

Absorption↗
PubMed1986

[Diffusion of an orally administered single dose of ofloxacin into human bronchial mucus].

As part of a systematic investigation of the penetration of antibiotics into human bronchial mucus, we assayed ofloxacin concentrations following ingestion of a single dose. 25 patients with acute superinfection of a chronic lower respiratory tract disease were studied. Each patient had single drug therapy with ofloxacin in a daily dosage of 200 mg taken in the morning on an empty stomach. Patients were divided into five groups according to the time interval between ingestion of ofloxacin and collection of samples (bronchial mucus and serum): 1 hour, 3 hours, 6 hours, 12 hours or 24 hours. Duplicate determinations of ofloxacin on individual samples were done using a microbiologic method. Mean serum concentrations were 1.85, 1.64, 1.32, 0.75 and 0.20 mg/l respectively, with a half-life of 6.7 hours; the corresponding concentrations in mucus were 1.83, 1.51, 1.20, 0.66 and 0.19. These results demonstrate ofloxacin's outstanding penetration into bronchial mucus.

Administration, Oral↗
PubMed1985

[Aztreonam. Diffusion into bronchial mucus].

In a prospective study of antibiotics' diffusion into human bronchial mucus, we compared serum and mucus concentrations of aztreonam, a new beta lactam belonging to the monobactam group. Twenty patients were given aztreonam (1 g twice a day) for an acute purulent exacerbation of chronic bronchitis and divided into four groups according to the time of sampling (0.5, 1, 1.5 or 3 h). Samples were taken on the first and third treatment days. Antibiotic concentrations were assayed using agar diffusion and HPLC. Aztreonam concentrations were low, similar to those achieved with other beta lactams. According to the time sampling, levels ranged from 0.27 to 1 mg/l and 0.4 to 1.15 mg/l on the first and third treatment days respectively. Corresponding serum levels were 90 mg/l and 30 mg/l, respectively 30 mn and 3 h after dose ingestion.

Aztreonam↗
PubMed1985

[Pleuropulmonary localizations of non-typhoid Salmonella infections].

Non-typhoid salmonella infections are extremely common, usually taking the form of a benign toxi-infection. In the context of the rare extra-digestive manifestations, the authors report 3 cases of pleuro-pulmonary involvement, in infections due to Salmonella Dublin. In 2 cases, the organism was identified from blood cultures, whilst in the 3rd case it was isolated from pleural fluid. As with other extra-digestive sites, pleuro-pulmonary involvement is favored by underlying pathology, accounting for the grave nature of the problem (amongst the 3 cases, gastrectomy and acute myeloblastic leukemia in one case and obliterative arterial disease in another case). Non-typhoid salmonella infections are sensitive to Sulfamethoxazole-trimethoprim which diffuses well in the respiratory system. They are also sensitive to Amoxicillin and to Chloramphenicol.

Aged↗
PubMed1984

[Pefloxacine: diffusion into bronchial mucus].

Pefloxacin is a new quinolone with significant in vitro antibacterial activity and a broad spectrum. It was included in an extensive study of antibiotic diffusion into bronchial mucus. Pefloxacin was given to 35 patients divided into five groups according to the timing of sputum sampling. Plasma specimens were taken simultaneously. Pefloxacin was measured by microbiological assay. Mean pefloxacin concentrations in bronchial mucus was high, exceeding 5 mg/l. Concentrations on the first and third days were similar. The ratio of mucus concentrations to plasma concentrations was high in each case, around or often above 1. These findings show that diffusion of pefloxacin into bronchial mucus is outstanding.

Anti-Infective Agents↗
PubMed1983

Cefotetan: comparative study in vitro against 226 Gram-negative clinical isolates.

The activity in vitro of the new cephamycin, cefotetan, was compared with that of cephalothin, cefoxitin, cefuroxime and cefotaxime against 226 recently isolated Gram-negative pathogens (207 Enterobacteriaceae and 19 Acinetobacter). Cefotetan was consistently more potent than cephalothin, cefoxitin and cefuroxime. Cefotaxime and cefotetan were essentially similar in activity against the Enterobacteriaceae with the singular exception of Enterobacter spp. which were markedly more susceptible to the former drug. None of the five agents was especially active against acinetobacter but cefotaxime was the best. Limited tests of bactericidal activity showed that the MBC differed from the MIC by a factor of 4 at most. Increasing the inoculum tested from 10(2) to 10(8) per ml had little adverse effect on the MIC of cefotetan. If the recommendations of the National Committee for Clinical Laboratory Standards for susceptibility to cephalosporins are applicable to cefotetan and the breakpoint criteria of less than or equal to 10 mg/l (sensitive) and greater than or equal to 32 mg/l (resistant) are acceptable, then only a few of the Enterobacteriaceae in this study were resistant. These resistant organisms were amongst Enterobacter spp. and Citrobacter spp.

Anti-Bacterial Agents↗
PubMed1982

[Dibekacin: diffusion in bronchial mucus].

The study of the bronchial concentration of dibekacin has shown a different degree of activity than that of gentamicin. This activity resembles that of amikacin with a three hour time lag from the appearance of the bronchial peak in relationship to the serum peak. In addition there seems to be a special passage mechanism for the antibiotic from the blood into the bronchial secretions since we observed an increase in the mucus/serum ratio through time.

Adult↗
PubMed1982

[Penetration of mezlocillin into bronchial secretions (author's transl)].

The penetration of mezlocillin into bronchial secretions collected by fiberoscopy was determined in 18 hospital patients with acute-on-chronic bronchial infection. Samples of blood and bronchial mucus were collected simultaneously 3 hours after each 12-hourly intramuscular injection of 1 g mezlocillin. Antibiotic concentrations were measured by the microbiological method. Mezlocillin concentrations in bronchial secretions averaged 50 % of concomitant serum concentrations. The rate of penetration of the drug was higher than that observed with ampicillin in similar conditions. The mean bronchial level of 3 micrograms/ml was indicative of a high therapeutic index in relation to the MICs of the pathogens isolated in these patients. It is concluded that intramuscular mezlocillin is indicated for the treatment of acute exacerbations of chronic bronchial infections due to highly sensitive organisms.

Bronchi↗
PubMed1982

[Lung tissue diffusion of intravenous trimethoprim-sulfamethoxazole combination (author's transl)].

In 13 cases of pneumonectomy, we have studied the concentration of TMP-SMZ in tissue and serum, after three days of treatment. Four hours after TMP-SMZ injection, the tissue's samples obtained from crushed and mixed ; the dosages were performed by a microbiological assay. As we previously described in bronchial secretions : the lung penetration of TMP is important ; the tissue concentrations were higher than in serum ; the diffusion of SMZ is low. The ratio of TMP to SMZ were diffusion of SMZ is low. The ratio of TMP to SMZ were different in serum and tissue, but the antibacterial activity is not affected in vitro by the value's modification.

Adult↗
PubMed1979

[Detection of rubella specific IgM on gel filtration through Sephadex G 200: use of dithiothreitol and limits with MnCl2-heparine pretreatment (author's transl)].

The detection of rubella haemagglutination inhibiting antibody, in the IgM fraction of the serum, on gel filtration through Sephadex G 200, needs precautions to exclude false results. Treatment with dithiothreitol is a satisfactory method for confirming the content of rubella IgM antibody. The failure of MnCl2-heparin pretreatment to remove non specific inhibitors of rubella hemagglutinin is unfrequent (7/108) and so do be repeated. Rarely (1/108) aggregated IgG fractionates with IgM and yield false positive results.

Antibodies, Viral↗
PubMedDate not supplied

[Antibiotic prophylaxis using a combination of pefloxacin and fosfomycin in heart surgery with CEC (extracorporeal circulation) in patients allergic to beta-lactams].

This study conducted for 15 months, was carried out in 34 patients with beta-lactam allergy scheduled for open heart surgery. In the study, pefloxacin was given orally an hour before the induction of anaesthesia and then as a short infusion following induction. When the bypass was stopped, pefloxacin (400 mg) and fosfomycin (60 mg.kg-1) were given in association by two separate slow intravenous infusions just before sternal closure and repeated in intensive care unit postoperatively. The antibiotic kinetics was observed in blood and cellular concentrations (atria, sternum and mediastinal part of pleura). The antibiotic level analysis showed a good diffusion during the surgical procedure, particularly during the bypass. The pefloxacin given orally was found to achieve satisfactory plasma levels of 5.4 to 6.9 mg.l-1 during sternotomy and always higher than 3 mg.l-1 during bypass. At the sternal closure, the residual plasma level was about 2.8 mg.l-1 before the reinfusion. The kinetic evaluation of fosfomycin has also shown same effective levels. Hence, the clinical potency of these antibiotics was confirmed as predicted by their excellent tissue diffusion. Thus, clinical evaluation was in favour of this antibiotic-association in most cases, except the two following ones. The first case had a lethal bronchiolar and lung reinfection with Pseudomonas aeruginosa and Candida albicans germs which appeared at the 6th postoperative day. The second patient is a case of antibiotic prophylaxis failure. He had developed an acute suppurating mediastinal infection at the seventh postoperative day with a methicillin resistant Staphylococcus aureus which had become pefloxacin fosfomycin resistant. However, the evolution was ultimately good after surgical disinfection of sternotomy and 30 days of drainage and irrigation with antiseptic solution associated with well adapted antibiotic treatment: vancomycin, pristinamycin and rifamycin. In fact, the choice of pefloxacin and fosfomycin for prophylaxis against staphylococcus in cardiac surgery is the right choice for patients having beta-lactam allergy. Their spectral activity and pharmacokinetics give us satisfactory results. But it is not the absolute solution as the bacteria responsible for nosocomial infection (hospital borne infection) may be found resistant to this association.

Adult↗