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Biomedical subjects

R Finch

Publications and source records attributed to R Finch.

51 records · Page 3Linked to original sources
PubMed1986

Bacterial meningitis. Rational selection and use of antibacterial drugs.

Bacterial meningitis is a continuing challenge. This applies especially to infections in the neonate and the elderly, and to those which are hospital acquired. Factors which maintain the high morbidity and significant mortality from this disease include microbial virulence, a limited host response to infection within the cerebrospinal fluid (CSF), where phagocyte function is often impaired and complement and opsonic antibody activity are deficient, as well as delays in diagnosis and treatment. Added to these adverse factors is the pharmacokinetic hurdle of the 'blood-brain barrier', which limits drug concentrations achievable within the CSF. Inflammatory changes certainly improve the penetration of many agents, especially the penicillins and cephalosporins, but it must be remembered that with resolution of inflammation, achievable concentrations decline. Hence, the necessity for continuing parenteral administration of antibiotics throughout the treatment period. Although penicillin G (benzylpenicillin) remains the drug of choice for both pneumococcal and meningococcal infections, increasing resistance to ampicillin among Haemophilus influenzae has lead to greater reliance on alternative agents. Chloramphenicol is widely used, yet is potentially toxic, so that therapy with cefuroxime and the newer cephalosporins has been increasingly advocated. The advent of these potent, broad spectrum cephalosporins has induced a reappraisal of the treatment of Gram-negative bacillary meningitis, where ampicillin resistance and poor CSF penetration by the aminoglycosides have contributed to an unsatisfactory impact on outcome. Agents such as cefotaxime and ceftazidime have proved effective, although greater controlled experience is required. Finally, the contagious nature of meningococcal and H. influenzae infections justifies offering chemoprophylaxis to selected contacts, with rifampicin (or minocycline for contacts of patients with meningococcal infections).

Aminoglycosides↗
PubMed1986

In vitro assessment of CI-934--a new quinolone derivative.

CI-934 is a new broad-spectrum fluoroquinolone. We have studied its in vitro activity against 203 bacteria and compared it with ciprofloxacin, enoxacin, ampicillin, cefuroxime, cefotaxime, gentamicin, vancomycin and erythromycin. Against Gram-negative pathogens CI-934 showed broad-spectrum activity comparable to enoxacin. Of more interest is its superior activity against Gram-positive bacteria, especially Streptococcus pneumoniae and enterococci. This was further studied by observing its activity in comparison with ampicillin in in vitro kinetic studies. CI-934 was either equally or more rapidly bactericidal than ampicillin at concentrations of 1, 4, and 16 X MIC. On the basis of these findings further in vivo studies appear justified.

Anti-Bacterial Agents↗
PubMed1985

A microbiological study of diabetic foot lesions.

The bacterial nature of infected foot lesions presenting to a diabetic unit during the course of twelve months was studied. Fifty-six swabs were obtained from 25 patients. Swabs were processed within ten minutes of being collected. An average of 3.3 organisms per swab were isolated, Staphylococcus aureus was the most common bacterial species isolated, while anaerobic bacteria comprised 10% of the isolates. Sensitivity testing of the isolates against commonly used antibiotics showed that the antimicrobial regimen that we have previously used empirically on such patients may not always be optimal.

Adult↗
PubMed1980

Studies on the mechanism and characteristics of action of a uricosuric diuretic, indacrinone (MK-196).

1 The renal action of indacrinone (MK-196), a phenoxyacetic acid derivative with diuretic and uricosuric properties, has been studied in fifteen male subjects. 2 Increasing single doses of up to 60 mg of oral indacrinone produced a linear increase in urinary volume and excretion of Na+ and Cl-, whilst the responses of urinary K+, Ca2+, Mg2+ and uric acid excretion, rose to a plateau at the 40 mg dose. 3 Indacrinone evoked a rapid diuretic response which reached a maximum of 2-4 h and was largely complete at 8-12 h after administration. 4 During maximal hydration, indacrinone produced a substantial fall in fractional free water clearance (CH2O), from 8.89% to 5.83% of the filtered load of water, associated with an increase in osmolal clearance, from 1.38% to 5.78% of the filtered load of solute. The reduction in CH2O was of the same order as that produced by a dose of ethacrynic acid with comparable saluretic activity and significantly greater than that produced by an equi-saluretic dose of hydrochlorothiazide. These findings imply an action of indacrinone upon solute transport in the diluting segments of the distal tubule. 5 At the time of maximal indacrinone-induced saluresis, which amounted to an increase from 0.48% to 4.61% of the filtered load of NaCl, fractional urate clearance increased from 5.16% to 12.24% of the filtered load of uric acid. 6 Indacrinone is a long acting diuretic, sharing some properties in common with both loop diuretics and benzothiadiazines. The results are discussed in relation to structure-activity amongst derivatives of phenoxyacetic acid.

Diuresis↗
PubMedDate not supplied

Community acquired pneumonia.

CAP affects all ages but predominantly the elderly. The microbial aetiology is diverse and rarely established at the time of admission. Initial management includes assessment of severity, correction of dehydration and imbalances of gas exchange, and prompt administration of antibiotic. The regimens will vary by risk factor and severity assessment. Mortality remains high, especially in those requiring intensive care. Prevention includes control of underlying disease, smoking and ethanol abuse, and the appropriate use of influenza and pneumococcal vaccines.

Community-Acquired Infections↗