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Biomedical subjects

S J Childs

Publications and source records attributed to S J Childs.

At least 19 recordsLinked to original sources
PubMed1996

Bacteriuria and urinary infections in the elderly.

Aging is associated with a decreased physiological functioning, reflecting the body's progressive inability to maintain homeostasis as age increases. The physiologic dysfunctions experienced in response to the aging process increase the individual's susceptibility to infection. Many elderly subjects are hospitalized for the care and treatment of functional disabilities; thus, an increased exposure to possible uropathogens (many with antimicrobial resistance) often results in infection. Additionally, indwelling catheters and other attending procedures may provide a microenvironment conducive to infection. In catheterized patients, the drainage bag often is infected with polymicrobes, which enhances the transference of antimicrobial genetic information. Postmenopause reflects a decrease in circulating estrogen, and a relational decrease in lactobacilli colonization with a lower vaginal pH. Consequently, vaginal colonization with possible uropathogenic and gastrointestinal bacteria increases, which partially may account for the generally higher incidence of bacteriuria in elderly women as opposed to elderly men. Urinary infections in the elderly more commonly are asymptomatic. Treatment for asymptomatic bacteriuria is not justified and will often present opportunities for the infecting organism to acquire antimicrobial resistance. Only symptomatic bacteriuria presenting adverse conditions in the host should be treated. Antimicrobial selection for the treatment of complicating symptomatic urinary infections in elderly subjects is complicated by the many physiological and environmental conditions associated with older age patients. Unfortunately, data confirming the efficacy and safety of antimicrobial agents for the treatment of symptomatic infections in the elderly presently are insufficient.

Aged↗
PubMed1995

Ultrasound monitoring during laser-assisted transurethral resection of the prostate.

Initial studies utilizing the original visual laser ablation prostatectomy (VLAP) technique of coagulation and a pilot study applying laser energy to prostate cancer led to the realization that these procedures could be monitored effectively in real time by ultrasound. Physical and chemical changes occur in prostate tissue with heating by laser energy, and these changes can be detected, not only as cavitation when the prostate tissue is vaporized, but also as a hyperechoic alteration that presumably is cell death leading to necrosis. Utilizing real-time monitoring helps assure the efficacy of the procedure and predict greater cavitation from slough of dead tissue. Monitoring by ultrasound scanning also allows following of the change of directions of the laser beam in tissue, which could be dangerous to the patient. With ultrasonography, one can make sure that the neurovascular bundle is not compromised and that the energy is not allowed to proceed past the posterior capsule of the prostate into the rectal wall. This is particularly helpful in patients with a high bladder neck but with minimal prostatic tissue posteriorly at the base. Also, the amount of tissue and the length from the verumontanum to the external sphincter can be accurately assessed and correlated with the lesion created at that level to avoid damage to the external sphincter.

Case-Control Studies↗
PubMed1994

Dimethyl sulfone (DMSO2) in the treatment of interstitial cystitis.

DMSO2 is one alternative for treating interstitial cystitis. Research with this compound is very limited, but side effects have been negligible. The drug may hold promise for interstitial cystitis patients, as well as those suffering from painful bladder (urethral) syndrome.

Administration, Topical↗
PubMed1993

Fleroxacin versus norfloxacin for oral treatment of serious urinary tract infections.

Fleroxacin, 400 mg once daily, and norfloxacin, 400 mg twice daily, both administered orally, were compared for the treatment of serious urinary tract infections (UTIs). In total, 301 patients from multiple centers who had serious UTIs were randomized to receive fleroxacin or norfloxacin in a double-blind study. The demographic parameters of the two groups were similar. A total of 190 patients were evaluable for efficacy, 94 in the fleroxacin group and 96 in the norfloxacin group. The reasons for exclusion from the efficacy analysis were not significantly different in the two groups, but more patients receiving fleroxacin were prematurely withdrawn from the study. The majority (134) of the diagnoses were complicated UTI, and the pathogens were primarily Enterobacteriaceae. The clinical responses were cure or improvement in 98% of the fleroxacin group and 92% of the norfloxacin group and failure in 2% of the fleroxacin group and 7% of the norfloxacin group. The bacteriologic results by infection were cure in 98% of the fleroxacin group and 89% of the norfloxacin group (including cure with superinfection in 4% of the fleroxacin group and 5% of the norfloxacin group) and failure in 2% of the fleroxacin group and 11% of the norfloxacin group. Adverse events were more common in the fleroxacin group and were mostly nausea, insomnia, and headache. Fleroxacin, 400 mg once daily, was as effective as norfloxacin, 400 mg twice daily, in eradicating UTIs but was associated with more adverse events.

Administration, Oral↗
PubMed1993

A quantitatively controlled method to study prospectively interstitial cystitis and demonstrate the efficacy of pentosanpolysulfate.

A randomized, prospective, double-blind, placebo-controlled study was conducted at 7 clinical centers on 148 patients. Patients received orally either 100 mg. pentosanpolysulfate (a synthetic polysaccharide) 3 times per day or a placebo. Of the patients on drug therapy 32% showed significant improvement compared to 16% of those on placebo (p = 0.01). This study provides a model to assess this disease quantitatively in a prospective manner using a method whereby the patients globally assess their symptoms as either worse or improved by 0, 25, 50, 75 or 100%. Patients on drug therapy also experienced a significant decrease in pain and urgency (p = 0.04 and 0.01) on analogue scales when compared to placebo and also more drug patients showed an average increase of more than 20 ml. in voided volume than did placebo patients (p = 0.02). All adverse effects were minor, with 7 in the drug group and 10 in the placebo group. The results support the concept that some patients with the interstitial cystitis syndrome may have abnormal bladder surface glycosaminoglycans.

Aged↗
PubMed1992

A multicenter comparison of oral lomefloxacin versus parenteral cefotaxime as prophylactic agents in transurethral surgery.

This report presents the pooled results from two randomized trials of lomefloxacin and cefotaxime used as prophylaxis in patients undergoing transurethral surgical procedures. A total of 499 patients were enrolled at seven centers in the United States. Patients received either 400 mg of lomefloxacin orally 2-6 hours prior to surgery, or 1 g of cefotaxime intravenously or intramuscularly 30-90 minutes preoperatively. Patients undergoing simple cystoscopy or retrograde pyelograms were not eligible for inclusion. Urine cultures were obtained prior to surgery, 24 hours post-surgery, prior to catheter removal, and 3-5 days post operatively. Treatment failure was defined as isolation of greater than or equal to 10(5) colony-forming units (CFU)/mL of pathogenic bacteria from any post-surgical urine culture. Lomefloxacin was successful in preventing post operative infections in 204 of 207 evaluable patients (98.6%); there were three prophylactic failures. Cefotaxime was successful in 196 of 206 (95.1%) evaluable patients; 10 were prophylactic failures. Lomefloxacin concentrations were measured simultaneously in serum and in samples of prostate tissue from 29 patients undergoing transurethral resection of the prostate. Lomefloxacin prostate concentrations were 1.0-22.3 micrograms/g, with a mean of 5.0 micrograms/g. The average tissue:plasma ratio was 2.0. The safety profile of the two study drugs was excellent, and both were well tolerated. Adverse events were reported by 12.7% of the patients treated with lomefloxacin and 13.8% of those treated with cefotaxime. The majority of events were mild and required no treatment.

Administration, Oral↗
PubMed1991

Current concepts in the treatment of urinary tract infections and prostatitis.

Urinary tract infection is a common medical diagnosis. The decision to treat is based on presenting signs and symptoms, bacterial colony counts in urine, and the nature of the infection. Escherichia coli is the single most frequent cause of urinary tract infections, although, depending on the clinical presentation and presence of risk factors, other pathogens may also be implicated. A variety of antimicrobial agents are available for the treatment of urinary tract infections. Fluoroquinolones are useful because these agents have broad-spectrum antimicrobial activity, resistance to these agents is minimal, and they achieve high concentrations in the urinary tract, have long elimination half-lives in urine, and are well tolerated.

4-Quinolones↗
PubMed1991

Treatment of chronic bacterial prostatitis with temafloxacin.

In an open multicenter study [corrected], 112 male patients (mean age 47.1 years) with documented symptomatic chronic bacterial prostatitis were treated with oral temafloxacin 400 mg b.i.d. for 28 days. Urine and prostatic secretions were obtained for culture and susceptibility testing, and clinical signs and symptoms were evaluated at day 14 as well as 5-9 days and 26-30 days post-treatment. The most frequently isolated pretreatment pathogens (n = 97) were 36 strains (38%) of Escherichia coli and 16 strains (17%) of Enterococcus. Clinical success (cure plus improvement) was demonstrated in 74 of 81 (91%) patients at visit 4, 5-9 days post-treatment and at visit 5, 26-30 days post-treatment in 61 of 71 (86%) patients. At visit 4, 94% of patients had eradication of pretreatment pathogens. At visit 5, 92% had continued eradication of their original pathogens. Improvement was observed in the severity of signs and symptoms that existed pretreatment at visit 4 (visit 5): dysuria, 92% (93%); perineal pain, 95% (93%); lower abdominal pain, 93% (100%); lower back pain, 88% (93%); scrotal/penile pain, 91% (83%). Digestive system (6.3%) and nervous system (4.5%) adverse events were observed most frequently. Temafloxacin 400 mg b.i.d. administered orally for 28 days represents a safe and effective treatment for chronic bacterial prostatitis.

Adult↗
PubMed1990

Treatment of recurrent urinary tract infection with norfloxacin versus trimethoprim-sulfamethoxazole.

Norfloxacin, a broad-spectrum antimicrobial analog of nalidixic acid, was evaluated by comparing it to trimethoprim-sulfamethoxazole in 93 office patients with recurrent urinary tract infections. In this prospective randomized study, norfloxacin and trimethoprim-sulfamethoxazole were given on the same dosage schedule with the former drug given as a 400-mg tablet twice daily and the latter drug given as a double strength tablet twice daily. Overall, 50 patients received norfloxacin and 43 patients received trimethoprim-sulfamethoxazole with a cure rate of 96 percent and 79 percent, respectively. Whether a patient had one infection or multiple previous infections, norfloxacin appeared to be superior to trimethoprim-sulfamethoxazole. Only minor side effects were noted in either group, and no patient withdrew from this study as a direct result of these side effects. Minor complaints of nausea, dizziness, and headache were found in the norfloxacin group (24%) and in the trimethoprim-sulfamethoxazole group (16%). Both agents are effective in treating urinary tract infections but norfloxacin is superior to trimethoprim-sulfamethoxazole in patients with either recurrent complicated infections or one previous uncomplicated urinary tract infection.

Adult↗
PubMed1989

A multicenter, double-blind, trimethoprim-sulfamethoxazole controlled study of enoxacin in the treatment of patients with complicated urinary tract infections.

In a double-blind, randomized, controlled trial, 249 patients with complicated urinary tract infections received either 400 mg. enoxacin or 160 mg. trimethoprim plus 800 mg. sulfamethoxazole orally every 12 hours for 14 days. The clinical outcome at the end of treatment revealed that all 89 evaluable patients (100 per cent) in the enoxacin group and 88 of 90 (98 per cent) in the trimethoprim-sulfamethoxazole group had satisfactory clinical responses (cure or improvement). Bacteriological effectiveness was measured cumulatively based on responses during and at the end of treatment, and 7 days later at followup. Satisfactory bacteriological responses (eradication or superinfection at all evaluations throughout the study) were achieved in significantly more (p equals 0.03) patients treated with enoxacin (93 per cent) than in those treated with trimethoprim-sulfamethoxazole (83 per cent). Both study medications were well tolerated. These results indicate that oral enoxacin was more effective clinically and bacteriologically (the latter statistically so) than trimethoprim-sulfamethoxazole when given as empiric therapy in the treatment of complicated urinary tract infections.

Adult↗
PubMed1989

Tissue penetration and clinical efficacy of enoxacin in urinary tract infections.

The fluoroquinolones in general, and particularly enoxacin, show great promise in the treatment of urinary tract infection. Orally administered enoxacin achieves high concentrations in the serum and urine as well as in prostate tissue, kidney and perirenal fat and muscle. These concentrations are generally in excess of the minimum inhibitory concentrations (MIC) for 95% of the common uropathogens, including Escherichia coli, Pseudomonas aeruginosa, Klebsiella spp., Proteus spp., Enterobacter spp., Serratia marcescens and Staphylococcus saprophyticus. In comparative clinical trials, treatment with oral enoxacin has achieved satisfactory clinical results (symptoms improved or absent) in 67 to 96% of patients and satisfactory bacteriological results (less than 10(4) colony count of the original bacteria) in 77 to 98% of patients. Clinical cure or improvement occurred in 94 to 100% of patients in uncontrolled trials, with corresponding satisfactory bacteriological results of 82 to 100%. In a number of studies of patients with difficult-to-treat infections, satisfactory clinical results were achieved in 92 to 100% of patients and satisfactory bacteriological results in 89 to 100% of patients.

Enoxacin↗
PubMed1988

Management of urinary tract infections.

Community-acquired urinary tract infections account for millions of physician visits per year. When urinary tract infections develop in hospitalized patients, they not only increase the duration of hospitalization (and thus its cost) but also have a serious and sometimes devastating impact on the incidence of morbidity and mortality. Treatment depends on the clinical setting, the causative organism, the site of infection, and the patients' host defenses. Diagnosis and subsequent appropriate classification provide important information on which to base therapeutic decisions. Simple first infections, particularly in women, generally respond to treatment with a simple antibiotic drug. Complicated or recurrent infections, in contrast, require other therapeutic strategies.

Adult↗
PubMed1987

Antibiotic genitourinary surgical prophylaxis.

Urologists continue to use antibiotics inappropriately. We should rethink the reasons why certain attitudes exist about powerful drugs for prophylaxis and adjust our prescribing habits for therapy as well. Using catheters and urethral instrumentation sparingly and only when necessary, while employing proper infection control techniques and judicious antibiotic prophylaxis can control the nosocomial infections resulting from genitourinary surgery.

Anti-Bacterial Agents↗
PubMed1986

Upper and lower urinary tract infections: amikacin's role in managing surgical complications.

Approximately one out of every 40 patients admitted to United States hospitals each year acquires a urinary tract infection while hospitalized. Urologic instrumentation is the precipitating cause in 75 to 80 percent of the cases. Such infections are responsible for a mortality rate among these patients that is three times the rate observed for all other hospitalized patients. When associated with gram-negative bacteremia, nosocomial urinary tract infections can progress rapidly to an irreversible state, resulting in death in 10 percent of those patients affected. Survivors are faced with escalating costs of hospital care and drug therapy. Presumptive administration of antibiotics is routinely recommended in selected types of genitourinary surgery, primarily because of the contaminated nature of the procedures, and especially advised when the surgery is likely to be followed by the placement of an indwelling urinary catheter. Quite often, the regimen for presumptive treatment of urinary tract infections includes aminoglycosides, such as amikacin, alone or in combination. The role of amikacin in empiric management of postoperative urinary tract infections is even more obvious. The fact that it has the broadest spectrum of activity compared with other aminoglycosides reduces the chance of therapeutic failure and results in a shorter hospital stay. In that respect, amikacin may effect an overall decrease in total costs of hospitalization.

Amikacin↗