High-dose moxalactam in gram-negative pneumonia.
Explore the source record for details and available documents.
Aged↗
Biomedical subjects
R W Tofte
Publications and source records attributed to R W Tofte.
Rifampin. No longer just for tuberculosis.
Explore the source record for details and available documents.
Adult↗
Susceptibilities of enterococci to twelve antibiotics.
The susceptibilities of 347 urine isolates of enterococci (Streptococcus faecalis, 44%; S. faecalis subsp. zymogenes, 37%; S. faecalis subsp. liquefaciens, 19%) to ampicillin, azlocillin, mezlocillin, piperacillin, vancomycin, gentamicin, erythromycin, rosaramicin, rifampin, rifampin plus trimethoprim (1:4), trimethoprim-sulfamethoxazole (1:20), and chloramphenicol were determined by the agar dilution technique. There were no significant differences in susceptibility to individual agents among the subspecies of S. faecalis. Azlocillin and mezlocillin (MIC for 90% of isolates, 0.78 micrograms/ml) and piperacillin, ampicillin, and vancomycin (MIC for 90% of isolates, 1.56 micrograms/ml) were the most active agents and were significantly more potent than the other reference antibiotics tested.
Anti-Bacterial Agents↗
Effect of decreased renal function on the pharmacokinetics of ceftazidime.
The pharmacokinetics of ceftazidime after a 1-g bolus dose were studied in 11 subjects, with creatinine clearances ranging from 113 to 6 ml/min. Concentrations of ceftazidime in serum were determined by microbiological assay. These data were fitted to a two-compartment open model, and pharmacokinetic parameters were calculated. Correlation of ceftazidime clearance with creatinine clearance was excellent (r = 0.99).
Adult↗
Aeromonas hydrophila wound infection of the hand initially presenting as clostridial myonecrosis.
A traumatic hand laceration in a previously health 17-year-old boy resulted in a rapidly progressive palmar space infection, with gas formation, in the soft tissues caused by Aeromonas hydrophila. Typically associated with aquatic injuries, A. hydrophila was not initially suspected since the injury did not occur near water. Physicians treated trauma-related soft tissue infections, particularly when the initial Gram stain shows many polymorphonuclear leukocytes and gram-negative bacilli, must consider the possibility of an Aeromonas infection even if the injury occurred in a nonaquatic environment. Appropriate therapy, including vigorous wound debridement and an aminoglycoside antibiotic, will be curative in an immunologically normal host.
Adolescent↗
Toxic shock syndrome.
Toxic shock syndrome (TSS) is an exotoxin-mediated illness that occurs primarily in young menstruating women who use tampons. The syndrome ranges from a potentially fatal disease characterized by hypotension and failure in multiple organ systems to a less severe condition commonly misdiagnosed as a nonspecific viral illness or gastroenteritis. Physicians should recognize that an exanthematous, febrile illness that recurs during menstruation or that occurs primarily in the postoperative or postpartum period and in association with staphylococcal infections may be TSS even in the absence of requisite diagnostic criteria. Unless TSS can be excluded with reasonable certainty, appropriate cultures should be obtained, with treatment initiated presumptively. In all menstrual cases, women should be advised to avoid tampon use indefinitely.
Adolescent↗
Clinical use of a one-compartment model for determining netilmicin pharmacokinetic parameters and dosage recommendations.
To determine netilmicin pharmacokinetic parameters and to evaluate the use of a one-compartment pharmacokinetic model, 32 patients receiving netilmicin for suspected gram-negative sepsis were enrolled in our study protocol. Dose and dosage interval for each patient were determined by one-compartment pharmacokinetic analysis of six postinfusion netilmicin serum samples (0.16, 0.33, 0.5, 1, 2, and 3 h) measured by radioimmunoassay. In patients with a normal serum creatinine, mean (+/- SD) half-life and distribution volume were 1.9 +/- 1.1 h and 0.2 +/- 0.8 L/kg, respectively. The average daily dose and mean days of therapy were 5.1 +/- 1.9 mg/kg/day for 7.3 +/- 2.8 days. Serum creatinine changes of greater than 0.5 mg% occurred in 2 of 28 (7%) patients. Substantial variability in half-life and distribution volume occurred in patients. Initial dosages of 5-7 mg/kg/day in divided dosages seem appropriate for adult patients with normal renal function. Monitoring of serum levels and adjustment of dose and dosage interval are necessary to maintain therapeutic antibiotic concentrations. As with other aminoglycosides, the one-compartment pharmacokinetic model proved to be an acceptable method for measuring netilmicin pharmacokinetic parameters and individualizing therapy.
Adolescent↗
Ceftriaxone therapy of serious bacterial infections in adults.
We evaluated the efficacy and safety of ceftriaxone in 50 adults with serious infections, usually giving 1 g every 12 h. Of the 35 patients who could be evaluated for clinical efficacy, 15 had failed on previous therapy, 15 had nosocomial infections, and all but 1 had underlying diseases. One patient had three sites of infection. Favorable responses were seen in 34 of 37 infections, including 11 of 13 respiratory tract infections, all 7 urinary tract infections, all 12 skin and soft tissue infections, 1 of 2 bone and joint infections, a catheter-related septicemia, a liver abscess, and an otitis media and externa. Favorable bacteriological responses were seen for 48 of 58 organisms. This included 6 of 7 Staphylococcus aureus strains, 14 of 16 other aerobic gram-positive cocci, 18 of 20 Enterobacteriaceae, 6 of 9 Pseudomonas aeruginosa, and 1 of 2 anaerobes. Peak plasma ceftriaxone levels on day 1 were 152 micrograms/ml by bioassay and 78 micrograms/ml by high-pressure liquid chromatography. Four of the 31 initial isolates of aerobic gram-negative rods developed resistance to ceftriaxone on disk diffusion testing. Diarrhea occurred in 3 of 50 patients. All three had received a higher than usual dose. Drug administration was stopped twice, once for a thrombocytopenia and once for a thrombocytopenia with leukopenia. Neither problem could be attributed exclusively to ceftriaxone. Other adverse reactions were eosinophilia, abdominal pain, inguinal candidiasis, and nonsuppurative phlebitis. Even among debilitated adults, ceftriaxone was safe and effective in a twice daily regimen.
Adolescent↗
Aminoglycoside dosing in renal transplant patients. Comparison of nomogram and individualized pharmacokinetic methods in patients with shifting renal function.
Serum amikacin concentrations were compared in infected renal transplant recipients that were compared in infected renal transplant recipients that were dosed using a creatinine-based nomogram (group I) or an individual computer-assisted pharmacokinetic dosing method (group II). A total of 30 treatment courses were administered. Mean postinfusion peak levels were 22 microgram/ml in group I and 23.4 microgram/ml in group II. Mean serum trough levels were 8.8 microgram/ml and 5.5 microgram/ml in groups I and II, respectively. Both peak and trough serum levels were significantly more often in the acceptable therapeutic (peak 20-32 microgram/ml) and nontoxic (through less than 10 microgram/ml) ranges in group 11 patients. Seventy-seven per cent of group II and 38% of group I peak levels were in the therapeutic range, while 87% of group II and 70% of group I trough levels were less than 10 microgram/ml. Ototoxicity developed with similar frequency in both groups and occurred significantly more often with a peak level greater than 32 microgram/ml. Declining renal function, usually as a result of allograft rejection, occurred in seven (44%) group I and only three (25%) group II patients but could not be exclusively related to amikacin in any patient. A serum trough level of greater than 10 microgram/ml was associated with an increased risk of declining renal function independent of other risk factors. Failures of aminoglycoside therapy are frequently associated with inadequate serum levels. Conversely, ototoxicity and nephrotoxicity may be related to elevated serum aminoglycoside concentrations. For these reasons, the computer-assisted pharmacokinetic dosing method should be used in septic surgical patients whose renal function is subject to sudden and unexpected changes.
Adolescent↗
Clinical and laboratory manifestations of toxic shock syndrome.
We studied 28 women and two men, with a median age of 20 years, who first had toxic shock syndrome between 1 February 1980 and 15 July 1981. Two of these patients died. All patients had intense myalgia, high fever (greater than or equal to 38.9 degrees C), hypotension or syncope, skin rash and desquamation, and abnormalities in at least three organ systems. Over half had sterile pyuria; immature granulocytic leukocytosis; coagulation abnormalities; hypocalcemia; low serum albumin and total protein concentrations; and elevations of blood urea nitrogen, alanine transaminase, bilirubin, and creatine kinase. Staphylococcus aureus was isolated from cultures from sites of soft-tissue infection in both male patients and from 13 of 19 vaginal and eight of 12 cervical cultures. All isolates produced both pyrogenic exotoxin C and enterotoxin F. All patients with a febrile, exanthematous, multisystem illness, particularly one associated with menstruation or a staphylococcal infection, should be promptly evaluated and empirically treated for toxic shock syndrome.
Adolescent↗
Toxic shock syndrome: management and long-term sequelae.
Little information is available on the optimal management of toxic shock syndrome and on its sequelae. The most appropriate antibiotic treatment, the efficacy of colloid infusions, and the potential role of gamma globulin preparations have not yet been completely ascertained. Coagulase-positive staphylococci associated with toxic shock syndrome had minimal inhibitory concentrations of 0.06 microgram/mL or less to rifampin, 0.25 microgram/mL or less to gentamicin, and 0.50 microgram/mL or less to both nafcillin and clindamycin. In the 36 patients studied abnormal chest roentgenograms were commoner in those who had received albumin than in those who had not. Radioimmunoassay showed antibody titers to staphylococcal enterotoxin F, a marker protein in toxic shock syndrome, of 1:4000 or more for intravenous gamma globulin (12/15 lots) and 1:40 000 or more for intramuscular gamma globulin. Major sequelae of toxic shock syndrome include late-onset rash, compromised renal function, cyanotic extremities, and prolonged neuromuscular abnormalities.
Adolescent↗
Toxic shock syndrome: clinical, laboratory, and pathologic findings in nine fatal cases.
Clinical, laboratory, and pathologic findings in nine of the 12 patients who died from toxic shock syndrome in Minnesota are reported. All patients met the toxic shock syndrome case definition except for desquamation, which occurred in only one patient. Eight were menstruating and at least four were wearing tampons at the time of the acute illness. One patient was using napkins only. Noncardiogenic pulmonary edema was the only clinical development that could be used to predict a fatal outcome. Specific pathologic findings included various degrees of fatty metamorphosis of the liver; pronounced hemophagocytosis by reticuloendothelial macrophages; and a characteristic vaginal lesion consisting of mucosal separation beneath the basal layer with ulceration, severe vasodilatation, inflammation and thrombosis, but with minimal bacterial invasion. This vaginal lesion was noted in two tampon users, but an identical lesion was found in a menstruating patient who used only napkins.
Adult↗
Toxic shock syndrome. Evidence of a broad clinical spectrum.
We evaluated various clinical and laboratory manifestations of toxic shock syndrome (TSS) in 17 menstruating females to define the spectrum of illness. Ten women had definite TSS, while seven who satisfied modified case definition criteria had probable TSS. Patients with definite TSS were younger, and symptoms developed later after onset of menstruation than in those with probable TSS. Overall, 16 (94%) had a rash with subsequent desquamation; 15 (88%), myalgias and orthostatic dizziness; 11 (79%), temperature of 38.9 degrees C or higher; 13 (76%), vomiting; 11 (65%), diarrhea; and 7 (54%), hypotension. All patients survived, and acute respiratory or oliguric renal failure possibly related to the absence of shock did not develop in any of them. None had a recurrent episode of TSS after treatment with an antistaphylococcal antibiotic, discontinuing tampon use, or both. Early recognition and treatment of less severely ill women may obviate potentially serious or fatal recurrences of TSS.
Adolescent↗
Primary cutaneous Nocardia asteroides infection with dissemination.
In a 77 year old previously healthy man with mild adult-onset diabetes mellitus, a primary cutaneous Nocardia asteroides infection developed on the hand following inoculation of a traumatic injury. Initially untreated, the infection became locally invasive and resulted in dissemination to the lungs and normal skin. This represents the first known reported case of a N. asteroides actinomycetoma associated with dissemination.
Aged↗
Antibiotic-associated colitis during moxalactam therapy.
Explore the source record for details and available documents.
Cephalosporins↗
Staphylococcus aureus infection of dialysis shunt: absence of synergy with vancomycin and rifampin.
A 69-year-old man with chronic renal failure maintained on twice weekly hemodialysis had infection of the vascular access graft with bacteremia due to Staphylococcus aureus. Despite serum vancomycin levels that greatly exceeded the mean inhibitory and bactericidal concentrations, he failed to respond and rifampin was added. The bacteremia promptly cleared, but the patient died suddenly eight days later. Autopsy showed an acute arteritis of the graft with intracellular gram-positive organisms; two splenic blood cultures grew S aureus. Although previous investigators have shown that the combination of vancomycin and rifampin may be effective in some cases of S aureus endocarditis this antibiotic combination should not be used routinely unless in vitro synergy is demonstrated.
Aged↗
Moxalactam therapy for a wide spectrum of bacterial infections in adults.
We evaluated the efficacy and toxicity of moxalactam during treatment of 45 documented infections in 36 patients. A majority of patients received 4.5 g of moxalactam per day. There was a good clinical response in 42 of the 45 (94%) infections, including 3 bacteremias, 20 skin and soft tissue infections, 6 gram-negative lower respiratory tract infections, 6 purulent diabetic foot ulcers, 3 wound infections, 3 urinary tract infections, and 4 miscellaneous infections (meningitis, suppurative phlebitis, peritonitis, bursitis). Previously, 11 of these patients had failed to respond to other antibiotics. Our three treatment failures were attributed to abnormal host defense in two patients and to a resistant enterococcal urinary tract infection in another. Moxalactam was tolerated well as produced minimal renal, hepatic, and hematological toxicities. The only serious adverse effect were the development of documented pseudomembranous colitis in one patient and progressive renal dysfunction in another. Acquisition of resistance among noneradicated isolates during therapy was not demonstrated.
Adult↗
Toxic shock syndrome: clinical and laboratory features in 15 patients.
Toxic shock syndrome is a recently recognized illness with serious morbidity and mortality that occurs primarily in healthy menstruating women who use tampons. Thirteen women and two men were evaluated; two of the women died in spite of seemingly appropriate therapy. All patients had a temperature of 38.9 degrees C or greater, hypotension of syncope, a skin rash with subsequent desquamation, mucous membrane inflammation, and laboratory evidence of multiple organ dysfunction. Staphylococcus aureus was isolated from the cervix or vagina in eight women and from soft-tissue infections in both men. Two patients were bacteremic. The significant heterogeneity in the clinical manifestations, laboratory abnormalities, and therapeutic requirements among patients may result in diagnostic confusion and inappropriate therapy. Although toxic shock syndrome appears to be associated with tampon usage and S. aureus, the pathogenesis remains unknown.
Adolescent↗