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Silvano Esposito

Publications and source records attributed to Silvano Esposito.

14 recordsLinked to original sources
PubMed2006

Concentration of moxifloxacin in plasma and tonsillar tissue after multiple administration in adult patients.

OBJECTIVES: The antibacterial spectrum of moxifloxacin includes all the major respiratory pathogens, and its pharmacokinetics demonstrate high peak concentrations in plasma as well as at respiratory sites. Nevertheless, tonsillar tissue concentrations have never been investigated. In this study we determined the moxifloxacin concentrations in plasma and tonsillar tissue after the administration of three doses of moxifloxacin 400 mg to adult patients with chronic or recurrent tonsillitis undergoing tonsillectomy. METHODS: This was an uncontrolled, open-label, randomized, parallel group study including 35 patients assigned randomly to five groups of 7 patients each, depending on the time between the last dose of moxifloxacin and plasma and tissue sampling. Moxifloxacin was given orally once daily for 3 days; its concentrations were measured using a validated HPLC assay and fluorescence detection. Each sample was analysed twice and the mean value obtained used for the statistical analysis. Pharmacokinetic data were analysed by presenting descriptive statistics of moxifloxacin concentrations in plasma and tonsillar tissue. RESULTS: C(max) occurred at 3 h in tonsillar tissue (mean 8.96 mg/L) and in plasma (mean 3.20 mg/L), the tissue/plasma concentration ratios (mean values) being constantly >2, ranging between 2.37 (after 2 h) and 2.93 (after 24 h), which indicates a prolonged maintenance of moxifloxacin concentration in tonsillar tissue compared with plasma. Variability among patients was present at 6 h, with the tonsillar tissue/plasma concentration ratio ranging between 0.8 and 3.4. CONCLUSIONS: Moxifloxacin achieves a good penetration in tonsillar tissue, which compares favourably with that reported for other fluoroquinolones. The moxifloxacin concentrations we observed exceed the MICs for the usual respiratory tract pathogens.

Adolescent↗
PubMed2005

Management of severe bacterial infections.

Defining the severity of an infection can play a central role for a correct therapeutic choice, avoiding inadequate antimicrobial treatments. Severe bacterial infections are, in fact, characterized by high morbidity and mortality rates so that the appropriateness of therapy can have a profound clinical impact. Indeed, initial inappropriate empirical therapies, and the further need to modify them, substantially increase the mortality risk. Several strategies have been suggested to improve the clinical outcome of patients affected by severe bacterial infections, such as the use of guidelines, use of antibiotics in combination, de-escalation therapy, cycling therapy and the use of infectious disease specialist consultation. A closer collaboration between the medical staff in the wards and infectious disease specialists can possibly bridge the gap between different strategies and individual needs of the patient, thereby improving the decision-making process.

Anti-Bacterial Agents↗
PubMed2004

[Management of severe bacterial infections and role of the infectious disease specialist: results of an interview-based survey].

Ascertainment of SBIs plays a central role in their management, which can affect the prognosis, hopefully avoiding an inappropriate antibacterial therapy concerning choice, dosing, timing, duration and route of administration of antibiotics. Different aspects of SBI management were evaluated by interviewing doctors practising in ICU, Surgery and Haematology wards. In the period 16 June - 7 July 2003, 150 doctors, equally distributed by specialty and geographical location, experienced in the management of antibiotic therapy, were interviewed in order to acquire the following information: criteria adopted to define SBIs, presumed incidence, most frequent diagnosis, initial approach to antibiotic therapy (empirical or not, route of administration, mono- or combination therapy), ID consultation request. In most cases generic and empirical criteria are used to define SBI, generally associated to the presence of co-morbidities, the highest rates being reported in ICUs (35.1%) and Haematology (34.7%) wards. Pneumonia is the top reported SBI in all the wards, followed by sepsis in ICUs and Haematology, and by intrabdominal infections in Surgery. Antibiotic therapy is often empirical (~90%), often performed i.v. with antibiotics given in combination. Following treatment failure, which occurs on average in 35.5% of cases, ID consultation and microbiological investigation are required. ID consultation is required in 20.2%, 26.1% and 28.1% of cases by haematologists, surgeons and ICU specialists, respectively. SBIs frequently occur in all the wards where the interviews were conducted. Their management is generally empirical and either ID consultation or microbiological investigation is infrequently required especially as an initial approach. The use of appropriate guidelines and ID consultation, as proven in many controlled studies, could be efficacious in reducing the incidence of inappropriate therapies and increasing favourable outcome rates.

Anesthesiology↗
PubMed2003

Comparative activity of garenoxacin and other agents by susceptibility and time-kill testing against Staphylococcus aureus, Streptococcus pyogenes and respiratory pathogens.

OBJECTIVES: Garenoxacin is a novel des-F(6)quinolone that has shown excellent antimicrobial activity against a wide range of clinically important microorganisms. In this study, its activity was examined, in comparison with that of other antimicrobial agents, by susceptibility and time-kill testing against Staphylococcus aureus, Streptococcus pyogenes and respiratory pathogens. METHODS: Overall, 200 bacterial strains were tested. The antimicrobial activity of garenoxacin was compared with that of ciprofloxacin, levofloxacin, moxifloxacin, amoxicillin, co-amoxiclav, cefuroxime, cefotaxime, ceftriaxone, imipenem, erythromycin and clarithromycin. In addition, the bactericidal activity of garenoxacin, moxifloxacin, levofloxacin and ciprofloxacin was evaluated by time-kill analysis against four strains each of staphylococci [two methicillin-susceptible (MSSA) and two methicillin-resistant (MRSA)], pneumococci (two penicillin-susceptible and two penicillin-resistant) and Streptococcus pyogenes (two erythromycin-susceptible and two erythromycin-resistant). Antibiotics were tested at concentrations 1-8 x MIC. RESULTS: MIC90 values of garenoxacin for the MSSA and MRSA strains were 0.03 and 2 mg/L, respectively. Among all the quinolones tested, garenoxacin yielded the lowest MIC values against all pneumococci (MIC90 0.12 mg/L) irrespective of macrolide resistance; the rank order of activity was garenoxacin> moxifloxacin>levofloxacin>ciprofloxacin. Excellent activity was shown also against Haemophilus influenzae (MIC90 or= 3 log10 decrease in viable counts (cfu/mL) within 3 h at 4 x MIC, whereas a moderate, slower killing rate was observed versus streptococci. CONCLUSIONS: This investigational des-F(6)quinolone represents a promising alternative for the treatment of respiratory tract infections.

Anti-Infective Agents↗
PubMed2003

[Multicentre survey of post-surgical infections in Campania (Italy)].

The aim of the study was to evaluate the incidence of post-surgical infections and to assess the way of managing antibiotic surgical prophylaxis. The survey was carried out by means of a questionnaire in order to obtain diverse information such as demographics, length of pre- and post-operative hospitalization, type of surgery, intervention duration, possible antibiotic prophylaxis and onset of post-surgical infections also monitored by post-discharge ambulatory controls. Four General Surgery and five Obstetrics and Gynaecology Departments in Campania (southern Italy) participated in the study, which was carried out in the period December 2001-January 2002. Overall, 410 questionnaires were collected referring to as many patients; antibiotic prophylaxis was performed in 385 (93.9%) patients. Antibiotic prophylaxis was generally managed not according to the general principles suggested by the international guidelines either for timing or for its duration or for the route of administration. Substantial differences were also noted in patient selection and antibiotic choice. Surgical site infections were recorded in 0.6% of patients undergoing clean surgery, in 5.3% of patients undergoing clean-contaminated surgery and in 3.2% of those undergoing contaminated surgery. Distant infections occurred in 1.8% and 6.5% in clean-contaminated and contaminated surgery, respectively. The results of the present study suggest the need of a continuous and accurate monitoring of post-surgical infections and the need to adopt appropriate guidelines to improve the management of surgical prophylaxis.

Adolescent↗
PubMed2002

The decision-making process in antibacterial treatment of pediatric upper respiratory infections: a national prospective office-based observational study.

BACKGROUND: The identification of patient management practices and the sources of medical information is crucial for rationalizing the treatment of respiratory tract infections, whose high incidence, especially in children, makes them one of the maior areas of unnecessary health expenditure. MATERIALS AND METHODS: This national prospective study was designed to investigate the diagnostic and prescribing habits of 100 office-based pediatricians managing upper respiratory tract infections in 1111 pediatric patients (604 males, mean age 6.7962.77 years; 507 females, mean age 6.7362.8 years) sequentially enrolled when an antibiotic treatment was deemed necessary. RESULTS: The most frequently diagnosed diseases were acute tonsillopharyngitis (56.2%) and acute otitis media (18.1%). Penicillins were prescribed in 34.3% of the cases, cephalosporins in 38.1%, and macrolides in 26.1%: oral drugs accounted for 92.2% of the prescriptions. The treatments were administered once or twice daily in 75.8% of the patients, and prescribed for 8 days in more than 80%; 76.7% also received supportive or symptomatic treatment (antipyretics, corticosteroids, cough suppressants and non-steroidal anti-inflammatory drugs). Laboratory or radiologic investigations were rarely requested. The main sources of medical information indicated by the participating pediatricians were pharmaceutical companies (35.6%) and meeting or congress reports (27.3%). CONCLUSIONS: The results indicate that more active education is still needed to improve the decision-making processes of office-based pediatricians.

Acute Disease↗
PubMed2002

Macrolide-resistance genes in clinical isolates of Streptococcus pyogenes.

Macrolide-resistance genes were investigated in 103 macrolide-resistant strains of Streptococcus pyogenes, isolated from children with pharyngotonsillitis. The presence of mef(A), erm(B), and erm(TR) genes was detected by PCR. mef(A) was found in 48 out of 103 (46.6%) strains, whereas erm(B) was detected in 43 isolates (41.7%). All mef(A) strains showed a typical M phenotype (resistance to 14- and 15-membered macrolides, and sensitivity to lincosamides and streptogramin B), whereas erm(B) strains had the MLSB phenotype (resistance to macrolides, lincosamides, and streptogramin B antibiotics). erm(TR) was found in 10 strains, always together with other resistance genes. In seven cases erm(TR) was associated with erm(B), and three cases with mef(A). In two isolates with the M phenotype (1.9%), it was not possible to detect the presence of any of the three macrolide resistance genes tested. Inducible resistance to macrolides was shown for 24 out of the 53 MLSB strains. Analysis of macrorestriction fragment patterns by pulsed-field gel electrophoresis showed that erythromycin-resistant S. pyogenes are polyclonal, however each phenotype, MLSB and M, formed essentially homogeneous groups.

Anti-Bacterial Agents↗
PubMed2002

[Candidal vulvovaginitis: an epidemiological survey among immigrant prostitutes].

OBJECTIVES: Candidal vulvovaginitis is a frequent infectious process in adult women that assumes particular clinical, epidemiological and social importance in prostitutes due to its possible sexual transmission. The aim of the study was to evaluate the frequency of symptomatic or non-symptomatic vulvovaginitis caused by Candida spp and its possible relationship to behavioural risk factors, by a prospective study carried on 153 immigrant prostitutes from various African countries. PATIENTS AND METHODS: All subjects (average age 27 yrs; range 18-50 yrs) coming from sub-Saharan areas (Nigeria, Ghana, Benin, Senegal) and resident in the coastal area northwest of Naples (southern Italy) underwent a microbiological investigation to detect the possible presence of Candida in vaginal, rectal and pharyngeal swabs. Agar Sabouraud with the addition of chloramphenicol was used for cultures and the mycotube system for identification; in vitro sensitivity tests with amphotericin, nystatin, 5-fluorocytosine, econazole, and fluconazole were also performed according to the Kirby Bauer technique. RESULTS: The rate of Candida detection from vaginal swabs was 45% (69/153) with the following distribution by specie: C. albicans 75.4%, C. glabrata 7.2%, C. krusei 2.9%, C. tropicalis 1.4%, Candida spp 13%. The incidence of Candida from pharyngeal and rectal swabs was 18.3% and 26.1%, respectively. The overall resistance of Candida was comprised between 6% for fluconazole and 27% for econazole. No strain was resistant to 5-fluorocytosine, nystatin and amphotericin. CONCLUSIONS: The incidence of Candida in this particular population of immigrates was very high and correlated to many well-identified risk factors.

Adult↗
PubMed2002

[Comparative in vitro bacteriostatic and bactericidal activity of levofloxacin and ciprofloxacin against urinary tract pathogens determined by MIC, MBC, Time-Kill curves and bactericidal index analysis].

The Bactericidal Index is a new way to assess bactericidal activity, representing the total bacterial kill over a drug concentration range. The aim of the study was to compare the in vitro activity of LEV with that of CIP against uropathogens determined by MIC, MBC, time-kill curves and BI analysis. A total of 141 strains [E. coli (EC) n=30; Klebsiella spp n=30; P aeruginosa (PA) n=35; P. mirabilis (PM) n=21; E. cloacae n=25] were preliminarily tested for MIC evaluation. MICs were obtained by 100 l microbroth dilution, followed by whole volume transfer for MBC determination. The time-kill tests were determined with 3 isolates each of EC, PA and PM and the killing monitored over 24h. FQs were added to a final concentration of 0.25, 0.5, 1, 2, 4, 8 and 16xMIC. Aliquots were sub-cultured at intervals. To assess the BI, overnight bacterial cultures were diluted to about 107 CFU/ml and set up containing a range of drug concentrations. MIC values of LEV were slightly higher than CIP; MBC/MIC ratio was in the range 1:1/1:2. LEV showed 99.9% killing after 6h against EC and after 3 h against PA at 1xMIC and after 3h at 2xMIC against PM in contrast with CIP (after 3h at 8xMIC). The BI data showed that FQs became more bactericidal with increasing incubation time and evidenced the enhanced bactericidal potency of LEV. A paradoxical effect was observed for all PA and PM strains, with slower killing at high concentrations of LEV (128 g/ml) at 24h and CIP (4 g/ml) at 3h. CIP was more active in terms of MIC values but LEV exhibited similar or even better bactericidal activity when time-kill curves or BI were compared. Calculation of BI allows the bactericidal activity of drugs, at clinically relevant concentrations, to be readily compared.

Anti-Infective Agents↗
PubMed2002

[Antibiotic prophylaxis in surgery: news and controversies].

Preoperative administration of antibiotics to prevent possible post-surgical infections represents a cornerstone of modern medicine. Although the general principles of surgical prophylaxis have been quite clearly defined during the last few decades, advenaces in surgical techniques, the changes in bacterial ecology in hospital, the spread of bacterial resistance and the substantial increase in the surgical population at risk, suggest that several aspects of surgical prophylaxis should be reviewed and new controlled studies should be carried on. The American guidelines for surgical prophylaxis, worked out recently by the CDC, have not modified their general structure, and have strongly influenced the protocols and the prescriptive behaviour of other countries, including Italy. The following points suggest that these guidelines are probably no longer adeguate for the situation in question: evidence from several sources would extend the advisability of antibiotic prophylaxis to other clean surgeries; the current classification of surgical procedures does not consider the "new" population of risk patients; the duration of prophylaxis and its role in preventing post-surgical infections "at a distance" infections has not been carefully defined; the evolution of bacterial epidemiology and bacterial resistance and the contemporary availability of new antibiotics has moved the fear of a post-antibiotic era In the clinical practice, according to these considerations and whilst awaiting the results of new clinical trials, in some cases and for some at risk patients it would appear justified to use third generation cephalosporins and especially ceftriaxone that, because of its peculiar pharmacokinetcs characteristics, guarantees with a single dose the same efficacy of three doses of other cephalosporins.

Anti-Bacterial Agents↗
PubMed2002

[Outpatient Parenteral Antibiotic Therapy (OPAT): the Italian registry].

In the early eighties, in the US the advantages (reduced costs, no hospitalisation trauma in children, no immobilization syndrome in elderly, reduction of nosocomial and acquired infections by multi-resistant organisms) of OPAT were identified and suitable therapeutic programs were established. Following the US experience, other countries set up their own OPAT programs which vary considerably from country to country because of different ways in which infections are managed in different parts of the world and because of different reimbursement systems. In order to understand the ways of managing OPAT and its results, a National OPAT Registry was set up in 1999 in Italy belonging to a wider International OPAT database, which collects data also from USA, Canada, Spain, Uruguay and Argentina. Up to now 396 patients and as many antibiotic courses have been included in the National Registry by eight different centres. The analysis of data permits to get information about the criteria of patient's selection, treatment (route of administration, site of care, choice of antibiotic, dosage and duration), outcomes and possible side-effects. Italian results offer a quite peculiar picture of OPAT in this country when comparing data with those of other countries. In contrast with other countries where soft tissue infections and osteomyelitis are the most frequent diagnoses for including patients in OPAT programmes, in Italy pneumonia and bronchitis are the top two amenable infections. Ceftriaxone, Teicoplanin and Amikacin are absolutely the top three antibiotics selected for OPAT in Italy which confirm that a single daily dose regimen represents a great advantage in terms of compliance. Finally, a large percentage of antibiotic courses (50%) are carried out by using the i.m. administration route, which is very unusual in other countries. OPAT Registry is still ongoing and it will give us more detailed information in the future about the management of infections in the outpatient setting, but it already permits to define an actual picture of OPAT in our country and/or to compare and correlate data and information from different countries.

Adult↗
PubMed2002

[Outpatient parenteral antibiotic therapy (OPAT) of diabetic foot infections with piperacillin/tazobactam].

Treatment of diabetic foot infections (DFIs) represents an important challenge for surgeons, especially in light of the poor results achieved by traditional therapeutic approaches. In this study, the clinical and bacteriological efficacy of TZP for treatment of DFIs in 38 outpatients was evaluated. All patients (median age 63 yrs) were affected by DFIs to different degrees of severity according to Wagner's classification: degree 0, 7 pts; degree 1, 17 pts; degree 2, 10 pts; degree 3, 4 pts. Degree 0-1 infections underwent a 10-18 day course with TZP given i.m. (2.25 g bid); degree 2-3 infections were initially treated with TZP i.v. (4.5 g bid or tid). Some patients began treatment in hospital and after early discharge continued parenteral therapy at home; others were treated exclusively at home. Some pts, after a 5-7-day course of i.v. therapy switched to i.m. route. The average duration of antibiotic therapy was 28 days. At the end of treatment with TZP, some patients underwent a new treatment with oral coamoxi-clav for 10-15 days. A bacteriological examination was done for all patients: ulcus (degree 1) and deep tissue (degree 2-3) swabs at the first surgical toilette. Clinical controls, medications, surgical toilettes and microbiological cultures were performed according to the degree of severity, extension of the lesion and response to treatment. All cultures were positive for polymicrobial infections (Staphylococcus spp, Enterococcus spp, Enterobacteriaceae, Pseudomonas spp). In 30/38 pts (79%) a complete resolution was observed; in 4 pts (10%) an improvement. DFIs require long term parenteral treatment, with wide spectrum antibiotics including Gram +, Gram - and anaerobes. OPAT represents a valid alternative to hospitalisation when the general conditions of the patient are stable, the infection is not too severe and complications are not present. TZP proved to be a good choice for treatment of diabetic foot infections that, due to its high safety, can be successfully utilized also in OPAT programmes

Adult↗