Secondary spread of H. influenzae.
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Biomedical subjects
Publications and source records attributed to R Wise.
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An isolation unit consisting of 12 ventilated cubicles was investigated over 18 months. Out of 462 patients admitted, 262 (57%) required source and 200 (43%) protective isolation. Admissions of patients with staphylococcal sepsis fell from 16 in the first three months to six in the last three months. Staphylococcus aureus was recovered from 12% of nurses' fingers and often in small numbers from protective clothing and uniforms, but only two patients acquired a strain from a nurse or another patient. Gram-negative bacilli were rarely recovered from hands or protective clothing of nurses, and there was no evidence of spread of infectious diseases. This inexpensive unit, with simple but efficient isolation-nursing techniques, successfully prevented the spread of infection.
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Mezlocillin and azlocillin are broad spectrum penicillins for parenteral administration. In this study it was shown that they were very active against a wide range of pathogenic bacteria. Thirty-five patients were treated with mezlocillin, and 5 patients were treated with azlocillin (in combination with cefoxitin in 3 cases). The serum, bile and CSF levels of the drugs were measured. Both antibiotics would appear to be safe and efficacious in treating serious infections by sensitive pathogens. Infections caused by unknown pathogens could be treated by one of these agents in combination with a broad spectrum beta-lactamase stable cephalosporin or cephamycin.
The pharmacology of cephradine, cephalexin and a new oral cephalosporin, cefaclor, has been compared in six volunteers. Cefaclor was absorbed rapidly and was cleared from the serum more rapidly than the other two agents. This was probably partially due to its instability in serum at body temperature, which was investigated. Against a wide range of common pathogens cefaclor was the more active oral cephalosporin. In particular the activity against Neisseria gonorrhoeae and Haemophilus influenzae was of interest.
1 The influence of probenecid on serum levels and urinary excretion of orally administered cephradine and cefaclor has been investigated. 2 Probenecid caused serum levels of both antibiotics to be increased and also prolonged. Urinary excretion of antibiotic activity was slightly but not significantly decreased by probenecid during the initial 6 h postdosing. It was significantly increased in 6-12 h urine, but only a small percentage of the doses were excreted during that period. 3 The increased serum levels of antibiotic were greater than could be accounted for by reduced elimination rate alone. Possible mechanisms to account for increased circulating levels of antibiotic in the presence of probenecid are discussed in the light of previous observations on probenecid induced changes in tissue distribution of beta-lactam antibiotics.
The pharmacokinetics of the broad-spectrum penicillin Bay k 4999 were studied in six healthy male volunteers. A 2-g dose was given by the intravenous route. The tissue penetration of the antibiotic was studied by both dermabrasion and blister techniques. A total of 26.4% of the drug was recovered in the urine in 24 h, 79% of this being excreted in the first 2 h. The elimination half-life in serum was 1.3 h. The dermabrasion levels of Bay k 4999 were generally similar to those in serum, but after 1 h the blister fluid levels of antibiotic were greater than those in serum. Different drug levels obtained by blister and dermabrasion techniques may be due to the different composition of the two fluids.
An enzyme immunoassay for gentamicin is described. The assay is accurate and specific and needs only simple equipment.
The in vitro activities of LY127935 (LY) were compared with those of other beta-lactam antibiotics. LY was highly active (minimal inhibitory concentration [MIC] range 0.06 to 0.25 micrograms/ml) against the common Enterobacteriaceae (including Providencia stuartiia, Enterobacter, and Serrati marcescens), 8 to 16 times more active than cefoxitin, cefuroxime, or cefazolin, and from one-half to one-eighth as active as cefotaxime (HR756). The activity of LY against Pseudomonas aeruginosa (with MICs of 4 and 64 micrograms/ml for 50 and 90% of test strains, respectively) was essentially similar to that of cefotaxime, but was only one-half as active as CGP 7174/E. LY, cefoxitin, and cefotaxime were essentially equally active against Bacteroides fragilis--each was more active than cefuroxime and cefazolin. Against Staphylococcus aureus, LY (50% MIC and 90% MIC of 4 and 16 micrograms/ml, respectively) was less active than cefotaxime, cefoxitin, or cefuroxime and one-eighth as active as cefazolin. The composition and pH of the culture medium had little effect on the activity of LY, although 7.2 appeared to be the optimum pH.
Serum creatinine and creatinine clearance were measured in 10 healthy volunteers before and after an intravenous injection of 2 g cefoxitin sodium. Results were compared with in vitro work which demonstrated a positive interference by cefoxitin in the Jaffé reaction, the routine laboratory method of creatinine measurement. The serum creatinine estimation should be delayed until at least 2 hours after cefoxitin administration. The creatinine clearance may appear to be falsely high.
The in vitro activity of cefaclor was compared with that of cephalexin and cephradine. This new antibiotic was the most active of the oral agents against Haemophilus influenzae (especially non-beta-lactamase producing strains). It was also significantly more active against N. gonorrhoeae and the Enterobacteriaceae. The instability in agar raises some issues that need further study.
The pharmacokinetics of the oral cephalosporins cefaclor, cephradine, and cephalexin were examined following single 500 mg oral doses to fasted, healthy volunteers. Absorption of the three compounds was rapid following a brief lag period and peak serum levels were obtained in 1-1.5 hours. Serum levels of cefaclor tended to be lower than those of cephradine and cephalexin during the 2-5 hour postdosing period and cefaclor was eliminated more rapidly than other cephalosporins from serum. No difference was observed in the overall bioavailability of the three antibiotics based on comparable FD/V values. Urine levels of the three cephalosporins greatly exceeded the minimum inhibitory concentrations of susceptible organisms during 0-6 hours postdosing, but were considerably reduced during the 6-12 hour collection period. Total urinary recovery of antibiotic activity accounted for almost 90 percent of dosed cephradine and cephalexin compared to 55 percent of dosed cefaclor. Lower serum levels and reduced urinary recovery of intact cefaclor are probably due primarily to its chemical instability. The reduced levels of cefaclor may be compensated for therapeutically by its greater in vitro antibacterial activity.
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