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Biomedical subjects

N Lambert-Zechovsky

Publications and source records attributed to N Lambert-Zechovsky.

At least 73 records · Page 4Linked to original sources
PubMed1988

[Comparison of in vitro activity of 4 oral beta-lactams on microorganisms responsible for broncho-pulmonary infections in children].

MIC 90 and MBC 90 of amoxicillin, cefaclor, cefadroxil and cefuroxime axetil have been determined by the microdilution method against 48 organisms responsible of acute respiratory tract infections in children: 17 E. coli, 15 K. pneumoniae, 16 H. influenzae. An inoculum effect and an inhibitory index in blood and bronchial secretions were determined. An inoculum effect was more important for amoxicillin and cefadroxil than for cefuroxime axetil and cefaclor. Against H. influenzae, cefuroxime axetil and cefaclor have a similar activity. Against Enterobacteria, cefuroxime axetil has the lowest MIC 90 and MBC 90 and the highest inhibitory index.

Administration, Oral↗
PubMed1988

[Choice of first-line antibiotic therapy in the treatment of bone and joint infections in children].

Because of the frequency of Haemophilus influenzae and Staphylococcus aureus in joint and bone sepsis in children, a prospective study of first line antibiotic therapy was performed. In a series of 23 cases, including 8 osteomyelitis and 15 arthritis, Gram stain on joint fluid or antigen detection was helpful in reaching a decision about initial therapy in only 3 cases (Haemophilus influenzae). In 20 of the 23 patients, the first line antibiotic therapy was cefotaxime (100 mg/kg/day) and fosfomycin (100 mg/kg/day) in combination. In 6 of them, the bacteriologic culture was positive (3 Staphylococcus aureus, 1 Haemophilus influenzae and 2 Streptococcus pneumoniae) and the initial antibiotic therapy was changed according to the antibiotic susceptibility testing. In the others 14 cases, from whom no agent was isolated, this combination was continued during about 15 days, then followed by pristinamycin and amoxicillin-clavulanic acid in combination during one month. The C. reactive protein dosage was performed in each patient. All children cured. In view of these first results, cefotaxime and fosfomycin in combination seems to us to be interesting in first line antibiotic treatment without initial orientation.

Adolescent↗
PubMed1988

[Contribution of bactericidal rate in the initial treatment of severe staphylococcal infections in children].

Rapid bactericidal effect is essential for therapy of severe Staphylococcus aureus infections in children. The in vitro activity of clinically achievable levels of vancomycin and its combinations with gentamicin, amikacin and rifampin plus amikacin was studied with the time-kill curve method at 2.5, 4, 6, 24 and 48 hours against 20 strains of Staphylococcus aureus isolated from children with severe staphylococcal infection. Vancomycin alone exerted a bactericidal effect at 48 hours. However, with the combinations vancomycin plus gentamicin, vancomycin plus amikacin and vancomycin plus amikacin plus rifampin a bactericidal effect was respectively observed at 24, 6 and 4 hours. Most rapid killing was achieved with vancomycin plus rifampin plus amikacin. Thus this antibiotic combination seems the most appropriate for initial treatment of severe staphylococcal infections in children.

Anti-Bacterial Agents↗
PubMed1987

[Evaluation of the bactericidal curves of beta-lactam and aminoglycoside combinations at the concentrations obtained in the cerebrospinal fluid in Haemophilus influenzae meningitis].

The prognosis and sequelae of patients with Haemophilus influenzae meningitis were related to concentrations of bacteria in the cerebrospinal fluid (CSF). Rapid bacterial killing and rapid reduction of organisms in vivo in CSF are critical to the outcome. In our patients colony counts of Haemophilus influenzae in CSF were 10(2)/ml - 10(9)/ml (mean 10(5)/ml). Killing kinetics were determined for amoxicillin and cefotaxime, alone and in combination with amikacin, against 35 clinical strains of Haemophilus influenzae (43% beta-lactamase-positive) at concentrations of these antibiotics comparable to those attained in the CSF following systemic administration. Antibiotics concentrations were: amoxicillin: 5 mg/ml, cefotaxime: 3.8 mg/l, amikacin: 1.8 mg/l. Mean killing curves with beta-lactamase-negative strains showed that a bactericidal effect was observed at 18 h for amoxicillin, at 5 h for cefotaxime, at 5 h for amoxicillin plus amikacin and at 2 h 30 for cefotaxime plus amikacin. Against beta-lactamase-positive strains a bactericidal effect was observed at 5 h for cefotaxime, at 2 h 30 for cefotaxime plus amikacin and at 18 h for amoxicillin plus amikacin. The finding of significantly increased killing rates of Haemophilus influenzae by amikacin at low concentration in the presence of either ampicillin or cefotaxime suggests that combined therapy may be beneficial in the treatment of meningitis caused by Haemophilus influenzae.

Amikacin↗
PubMed1987

[Effects of loperamide on the fecal flora in children in severe diarrheas].

Loperamide has been recently indicated in the management of infants with severe protracted diarrhea. The purpose of this study was to determine the effect of loperamide on fecal flora in severe protracted diarrheas. 19 children aged 1 to 36 months, with severe protracted diarrhea were studied: 14 received loperamide (0.5 mg/kg/d) and 5 were without loperamide treatment. Criteria analysed were: clinical tolerance (vomiting and abdominal distention); efficacy (number of stools, transit time and Na+/K+ in stools) and effect on fecal flora, with differential qualitative and quantitative analysis method (complete identification and counts of aerobic and strict anaerobic bacteria in fresh fecal samples before and 4 to 8 days after the beginning of loperamide). Parenteral and/or oral alimentation remain constant during the study. Results show a rapid (24 h) efficacy in 9/14. Although important changes in specific fecal flora counts was noticed for streptococcus D and Proteus as compared to five controls, no bacterial overgrowth appeared or was increased during loperamide treatment.

Child, Preschool↗
PubMed1987

[Importance of the study of the minimal bactericidal time of serum in the choice of optimal treatment of neonatal septicemias].

Rapid eradication of bacteria in bloodstream is critical for the outcome in neonatal bacterial sepsis. Two groups of neonates with E. coli K1 sepsis without purulent meningitis were studied. Group I (n = 14) received cefotaxime IV (100 mg.kg-1 D-1) plus netilmicin (4 mg.kg-1 D-1); group II (n = 8) received amoxicillin/clavulanic acid IV (100/10 mg.kg-1 D-1) plus netilmicin (4 mg.kg-1 D-1). Both groups were identical. For all strains MICs of cefotaxime, amoxicillin/clavulanic acid, netilmicin were less than 0.2, 4 and 1 mg/l respectively. Serum bactericidal activity (SBA) was determined for each patient (peak sample). The SBA was defined as the greatest dilution in which 99,99% of the inoculum was killed. Time-kill curves were performed with 1:16 dilutions of peak serum samples to measure the kinetic of bacterial killing. The minimal bactericidal time of serum (MBTS) was defined as the minimal time required to observe a decrease of more than 4 log CFU/ml of the bacterial inoculum. Samples (10 microliters) were taken at 1 h intervals over a 6 h period and at 24 h for quantitative culture. All patients cured. Median SBA were respectively 1/128 and 1/64 for group I and II. However, mean MBTS for groups I and II were respectively 1.2 h +/- 0.8 and 3.9 h +/- 1.4. Killing was more rapid in group I (p less than 0.01). The MBTS may be a clinically useful adjunctive test when optimal therapy would be expected.

Amoxicillin↗
PubMed1987

[Clinical study and effect of nitroxoline on fecal flora in children].

Twelve children (mean age: 4) are treated in practice office with nitroxoline (200 mg/kg/24 h) during 10 days for urinary tract infection. A study on the effect of nitroxoline against the fecal flora is undertaken in a group of 21 children who receive nitroxoline during 4 days or a long period. Bacteriological and clinical efficacy is checked when urinary concentrations of nitroxoline are greater than 16 mg/l. The results show 8 clinical and bacteriological success one true failure and 3 failure due to a non-compliance to the treatment. No qualitative and quantitative modification of the fecal flora is observed after treatment with nitroxoline.

Adolescent↗
PubMed1987

[Effect of loperamide on fecal flora of children with severe prolonged diarrhea].

Loperamide has recently been proposed in the management of infants with severe protracted diarrhea. The purpose of this study was to determine the effect of loperamide (0.5 mg/kg/d) on fecal flora in 19 cases of severe protracted diarrhea. Criteria analysed were: clinical tolerance (vomiting and abdominal distension) and efficacy (number of stools, transit time and Na/k in stools); complete identification and counts of aerobic and strict anaerobic bacteria in fresh stools before and 4 to 8 days after the beginning of loperamide. Parental and/or oral alimentation remained unchanged during the entire study. Clinical resolution of diarrhea was rapid (less than 24 h) in 9 of 14 patients. In 2 cases ileus was observed and resolved when loperamide was discontinued. Although important changes in specific fecal flora counts was noticed for streptococcus D and proteus as compared to 5 controls, no bacterial overgrowth appeared or was worsened during loperamide treatment.

Child, Preschool↗
PubMed1986

[Value of bactericidal curves in the optimal selection of a beta-lactam-aminoglycoside combination on Pseudomonas aeruginosa. In vitro study of 40 strains of Pseudomonas aeruginosa isolated in pediatric intensive care units].

Antimicrobial sensitivity and time-kill curves were determined for ticarcillin, azlocillin, piperacillin, cefsulodin, ceftazidime, gentamicin, tobramycin and amikacin alone or in combination against 40 strains of Pseudomonas aeruginosa isolated from blood cultures and tracheal aspirates in pediatric intensive care units. The antibiotics were used in concentrations obtainable with the usual therapeutic dosage. No bactericidal effect was observed with each of the beta-lactam antibiotics tested alone. For ticarcillin-sensitive strains the most rapid bacterial inoculum size decrease was observed at 2.5 h with the piperacillin-amikacin combination, and a bactericidal effect was obtained within 4.5 h when amikacin was combined with ticarcillin, azlocillin, piperacillin, ceftazidime or cefsulodin. For ticarcillin-resistant strains a bactericidal effect was obtained within 4.5 h when amikacin was combined with piperacillin, azlocillin, ceftazidime or cefsulodin.

Amikacin↗
PubMed1986

[Optimum choice of antibiotic treatment in neonatal infections due to group B streptococci].

Morbidity and mortality among neonates with group B streptococcal infections remain high. As delays in bacterial killing may be responsible for these poor results, there is a need for studies into killing kinetics. We investigated antimicrobial sensitivity and killing effect time lags for penicillin, ampicillin and mezlocillin, alone and in combination with gentamicin or amikacin, against 20 strains of group B streptococci isolated in cultures of blood and cerebrospinal fluid from neonates. A culture of each strain (10(5) germs/ml) was exposed to the antibiotics individually or in combination. Antibiotics were used in the concentrations achieved clinically. Surviving bacteria were counted after 2 h 30, 4 h 30 and 24 h. incubation. Mean killing curves showed that the time interval until onset of a killing effect was 24 hours with either penicillin or ampicillin alone, against 4 h 30 with penicillin-amikacin or ampicillin-gentamicin. The most rapid killing effect (2 h 30) was observed with mezlocillin alone and ampicillin-amikacin. No antagonism was found between mezlocillin and aminoglycosides. Choice of the best antibiotic treatment for group B streptococcal infections should be based on both the rapidity of the in vitro killing effect and the antibiotic's diffusion into the site of the infection.

Amikacin↗
PubMed1986

[Choice of a rapidly bactericidal beta-lactamin-aminoglycoside combination in the treatment of Pseudomonas aeruginosa infections at a child intensive care unit].

Morbidity and mortality among children with Pseudomonas aeruginosa infection in Pediatric Intensive Care Unit remains high. Delays in bacterial killing may be responsible for the poor outcome. Antimicrobial sensitivity and timed-killing assays were determined for ticarcillin, azlocillin, piperacillin, cefsulodin, ceftazidime, gentamicin, tobramycin and amikacin alone and in combination against 40 strains of Pseudomonas aeruginosa isolated from blood cultures and tracheal aspirate. Antibiotic concentrations used were at clinically achievable level. None bactericidal effect was observed with each beta-lactamin alone. However with the combinations azlocillin or piperacillin or cefsulodin or ceftazidime plus amikacin a bactericidal effect was observed at 4.5 hours.

Aminoglycosides↗
PubMed1986

[Determination of aminoglycosides in the newborn infant. Significance and methods].

Monitoring of serum aminoglycosides is useful in neonates to ensure therapeutic efficacy and avoid toxicity. The choice of a method must take in count several informations: sample size, versatility, sensitivity, specificity, precision, rapidity, equipment requirements and reagent cost. Many methods are now available: Microbiological assay, Radioimmunoassay (RIA) techniques, Radioenzymatic assay (REA), "High Pressure" liquid chromatography (HPLC), Fluorescent immunoassay, Enzyme-Multiplied Immunoassay (EMIT) and Fluorescent polarization Immunoassay (FPIA). Microbiological assay is inexpensive but has major disadvantages: lack of specificity, low precision, requires 24 to 48 hours, large sample size. EMIT and FPIA are rapid, sensitive, highly specific and particularly adapted to the pediatric use but reagent are expensive.

Aminoglycosides↗
PubMed1985

Impact of cefotaxime on the fecal flora in children.

A differential quantitative analysis was used to study the effect of cefotaxime on the fecal flora in 26 hospitalized children ranging from two days to four years of age. Fecal specimens were obtained before, during and after therapy. This study was evaluated in comparison to 41 patients of the same age and from the same environment without antibiotic treatment or signs of infection. The fecal flora of the control group showed qualitative and quantitative stability. Two groups of species were distinguished: a group in which the upper limit was less than or equal to 10(7) bacteria/g of stool (Klebsiella, Enterobacter, other enterobacteria, Staphylococcus, Pseudomonas) and a group with less than or equal to 10(10) bacteria/g of stool (anaerobes, Escherichia coli, Streptococcus D). This stability of the control group of subjects allowed us to interpret the variations of microbial concentrations during and after cefotaxime treatment. In previous studies, we showed in the newborn a substantial risk of septicemia of intestinal origin when overgrowth occurred, especially with Klebsiella. With cefotaxime there was a decrease or a disappearance in 65% of E. coli and a slight decrease of Klebsiella and Enterobacter. This fact was of great interest in the treatment of endogenous secondary septicemia. We observed an appearance of Pseudomonas (nine Pseudomonas aeruginosa, two Pseudomonas putida, one Pseudomonas fluorescens) in 12 cases among the 26 children treated.(ABSTRACT TRUNCATED AT 250 WORDS)

Bacteria↗