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Biomedical subjects

N C Klein

Publications and source records attributed to N C Klein.

At least 19 recordsLinked to original sources
PubMed1998

Treatment of legionnaires' disease.

Erythromycin has been the most commonly used drug for the treatment of legionnaires' disease; however, failures have occurred and adverse effects are common. Doxycycline intravenously is preferred and is less expensive. The newer macrolides/azalides, clarithromycin and azithromycin, have excellent in vitro activity against Legionella and fewer adverse effects than erythromycin. The fluoroquinolones, particularly levofloxacin, are the most active anti-Legionella antibiotics available. Other agents with activity against Legionella pneumophila include minocycline, rifampin, and trimethoprim-sulfamethoxazole. The preferred therapy of legionellosis in immunocompromised patients are quinolone/macrolide combinations, eg, levofloxacin plus azithromycin.

Anti-Bacterial Agents↗
PubMed1997

Pasteurella multocida pneumonia.

Pasteurella multocida, a gram-negative coccobacillus which colonizes the nasopharynx and gastrointestinal tract of many animals, is a well known cause of soft tissue infection after animal bites. Human infection can also occur after non-bite animal exposure, usually via inhalation of contaminated secretions. The respiratory tract is the second most common site of Pasteurella infection after soft tissue infection. Most patients with Pasteurella pulmonary infection are elderly with underlying lung disease, either COPD, bronchiectasis, or malignancy. The spectrum of disease includes pneumonia, tracheobronchitis, lung abscess, and empyema. Clinical features of Pasteurella respiratory tract infections are indistinguishable from other pathogens. A history of cat or dog exposure should alert the clinician to consider Pasteurella as a potential pulmonary pathogen in an elderly patient with chronic lung disease. The preferred drug for the treatment of Pasteurella infections is penicillin. Alternately, doxycycline is highly effective against P multocida.

Animals↗
PubMed1996

Treatment of fever.

Fever is an important indicator of disease and should not be routinely suppressed by antipyretics. There is considerable evidence that fever may actually benefit the host defense mechanism. In most patients, fever is short-lived and causes only minor discomfort. Antipyretic agents are effective in lowering temperature, but have significant side effects. Routine antipyretic therapy should be avoided but may be necessary in individual patients with underlying cardiovascular or neurologic disorders.

Fever↗
PubMed1995

Third-generation cephalosporins.

Third-generation cephalosporins are broad-spectrum antimicrobial agents useful in a variety of clinical situations. No one cephalosporin is appropriate for all infectious disease problems. Cefotaxime and ceftizoxime have the best gram-positive coverage of the third-generation agents. Ceftazidime and cefoperazone are the only third-generation drugs that provide antipseudomonal coverage. Ceftriaxone's long half-life allows for once-daily dosing, making ceftriaxone an excellent drug for outpatient antibiotic therapy of community-acquired infections. Ceftriaxone is also useful for the treatment of Lyme disease and sexually transmitted diseases. The third-generation cephalosporins except for cefoperazone penetrate cerebrospinal fluid and are indicated for the treatment of bacterial meningitis. Their proven record of clinical efficacy, favorable pharmacokinetics, and low frequency of adverse effects make third-generation cephalosporins the preferred antibiotic in many clinical situations.

Bacterial Infections↗
PubMed1995

Tetracyclines.

Tetracyclines are relatively safe drugs with a broad antimicrobial spectrum. Doxycycline remains the preferred tetracycline agent for most indications. Doxycycline has a long half-life, which makes convenient twice-a-day dosing possible. It is well absorbed orally even in the presence of food, has excellent tissue penetration, and does not require a dose adjustment in renal insufficiency. Doxycycline is a useful agent for the treatment of atypical pneumonias, sexually transmitted diseases, traveler's diarrhea, rickettsial infections, and Lyme disease. Minocycline is the preferred drug for MRSA colonization/infection.

Bacterial Infections↗
PubMed1992

Trimethoprim-sulfamethoxazole versus pentamidine for Pneumocystis carinii pneumonia in AIDS patients: results of a large prospective randomized treatment trial.

OBJECTIVE: To compare the clinical efficacy and safety of trimethoprim-sulfamethoxazole (TMP-SMX) with pentamidine in the therapy of Pneumocystis carinii pneumonia (PCP) in patients with AIDS. PATIENTS, PARTICIPANTS: TMP-SMX (TMP, 20 mg/kg/day plus SMX, 100 mg/kg/day) was compared with pentamidine (4 mg/kg/day), both administered intravenously for 21 days in a prospective randomized treatment trial of 163 patients diagnosed with PCP between November 1984 and May 1988. RESULTS: Ninety-two evaluable patients received TMP-SMX as initial therapy; 68 received pentamidine. Failure to complete therapy was common. Of those receiving TMP-SMX, 39 (42%) required change in therapy because of failure to respond, and an additional 31 (34%) because of drug toxicity. This compared with 27 (40%; P = 0.733) and 17 (25%; P = 0.235), respectively, in the pentamidine-treated group. The overall survival rates were similar in the two groups, 62 out of 92 (67%) initially administered TMP-SMX versus 50 out of 68 (74%) initially administered pentamidine (P = 0.402). The survival rates for patients requiring a change in therapy because of failure to respond was 46% (18 out of 39) for the TMP-SMX group compared with 56% (15 out of 27) for the pentamidine group. When a change in therapy was made because of toxicity, survival rates were 97% (30 out of 31) for those receiving TMP-SMX versus 94% (16 out of 17) for those receiving pentamidine. CONCLUSION: TMP-SMX and pentamidine are of equivalent efficacy as initial therapies for PCP in patients with AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Postoperative Serratia marcescens endophthalmitis.

Endophthalmitis after ophthalmic surgery is a rare but serious complication. Postoperative endophthalmitis presents clinically with conjunctival erythema and lid edema with eye pain and decrease in visual acuity. Diagnosis requires invasive culture techniques because postoperative external eye cultures are not reflective of intraocular organisms. The most common pathogens causing postoperative endophthalmitis are staphylococci and streptococci. Less common organisms associated with exogenous endophthalmitis include gram-negative aerobic bacilli and fungi. We report a case of Serratia marcescens postoperative endophthalmitis in a normal host.

Aged↗
PubMed1991

Listeria.

Explore the source record for details and available documents.

Adult↗
PubMed1991

Fluoroquinolones in respiratory infections.

The fluoroquinolones have excellent activity against a number of respiratory pathogens, especially gram-negative bacteria, including beta-lactamase-producing Hemophilus influenzae and Moraxella catarrhalis. Several studies have shown ciprofloxacin to be effective in the treatment of acute exacerbations of chronic bronchitis, some community-acquired and nosocomial pneumonia, and acute exacerbations of bronchopulmonary infections in cystic fibrosis. The fluoroquinolones have less activity against Streptococcus pneumoniae and limited anaerobic activity, which should limit the use of these drugs in empiric therapy of community-acquired pneumonia where the pneumococcus or anaerobes play a predominant role.

4-Quinolones↗
PubMed1990

The psychologist as admitting clinician. A single case example.

An experiential view of significant issues associated with independent hospital practice for psychologists is offered through a case presentation. The example is a model of practice in effect at a 90-bed, free-standing, inpatient facility opened in 1985, that gives psychologists full professional staff privileges.

Hospitalization↗
PubMed1990

Listeria monocytogenes meningitis in a human immunodeficiency virus-positive patient undergoing hemodialysis.

Listeria monocytogenes bacteremia without meningitis has been reported in patients who have undergone long-term hemodialysis and have transfusional iron overload. On the other hand, cases of Listeria bacteremia without meningitis have occurred sporadically among the acquired immunodeficiency syndrome population, mostly homosexuals. There have been no reports of Listeria meningitis occurring among persons who are antibody positive to human immunodeficiency virus or are intravenous drug abusers having chronic renal failure and undergoing hemodialysis. This patient represents the first case of Listeria bacteremia and meningitis to occur in an intravenous drug abuser who is human immunodeficient antibody positive, is receiving hemodialysis, and has transfusional iron overload.

Acute Kidney Injury↗