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Query: UMLS:C0014118 (endocarditis)
 15,629 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Antibiotics can be administered parenterally to outpatients in order to achieve adequate serum levels to treat such infections as endocarditis, osteomyelitis and diabetic foot infections, and to eradicate such difficult-to-treat organisms as methicillin-resistant Staphylococcus aureus, cephalothin-resistant gram-negative bacilli and invasive fungal infections. At Intracare, a free-standing clinic for such therapy, 3,247 outpatients have been treated to date. Besides the type of infection, criteria for patient selection include improvement in the patient's condition, a desire to leave the hospital, an adequate support structure at home, patient compliance and adequate insurance coverage. The most frequently treated infections have been osteomyelitis, followed by infection of skin and skin structure. Ceftriaxone and cefazolin are the two most frequently utilized antibiotics. The program at Intracare is used to examine such issues of quality assurance as patient compliance, therapeutic outcome, adverse events and patient satisfaction in this largely unregulated multibillion dollar industry. It is likely that such infusion centers will evolve into protohospitals, day care centers for present-day medical-surgical patients not occupying intensive care beds.
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PMID:Parenteral antibiotic therapy in outpatients: quality assurance and other issues in a protohospital. 187 82

Parenteral ceftriaxone was administered as a once-daily outpatient treatment to a selected low-risk population of neonates, infants, and children with moderate to severe bacterial infections. No incidences of treatment failure were seen in 200 children with uncomplicated infections responsive to ceftriaxone therapy. The mean period of outpatient treatment in initially hospitalized children with non-CNS infections, excluding endocarditis, was 1-3 days. Ceftriaxone outpatient management was successful in the control of organisms causing meningitis (n = 54), periorbital facial cellulitis (n = 16), sinusitis (n = 10), arthritis (n = 6), endocarditis (n = 4), and other infections.
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PMID:Once-daily ceftriaxone in the outpatient treatment of paediatric infections. 188 51

Heterogeneous diffusion of some antibiotics into fibrin rich infectious processes is one explanation of the difficulty to cure infections such as endocarditis. Ceftriaxone is a beta lactam antibiotic, potentially useful due to a broad spectrum of activity and its long elimination half-life. We investigated by means of autoradiography the diffusion of labelled ceftriaxone into large infected cardiac vegetations obtained in a rabbit model of endocarditis. Ten d after infection 250 microCi 14C ceftriaxone was injected over 30 min. Thirty min after the end of infusion (T30) vegetation/blood radioactivity ratio was 0.58 +/- 0.4 (n = 3). At T200, radioactivity decreased approximatively 3-fold, in blood and in vegetations simultaneously. Autoradiography showed that at T30, ceftriaxone was 20-30 times more concentrated at the periphery of vegetation than in the core. Autoradiography obtained at T200 showed a progressive diffusion toward the core. The diffusion gradient may explain the fact that high local concentrations are necessary to sterilize vegetations. The pattern of diffusion of antibiotics in fibrin is an important pharmacokinetic parameter for predicting in vivo activity.
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PMID:Ceftriaxone diffusion into cardiac fibrin vegetation. Qualitative and quantitative evaluation by autoradiography. 206 51

To determine the influence of in vitro activity, pharmacokinetic properties, and therapeutic regimen on the antibacterial effect in vivo, we compared three cephalosporins, cefotiam, cefmenoxime, and ceftriaxone, in a rabbit model of experimental Escherichia coli endocarditis after 4 days of treatment. The MBCs of cefotiam, cefmenoxime, and ceftriaxone for the E. coli strain were 0.5, 0.125, and 0.06 microgram/ml, respectively. Killing curves at 10 times the MBC were similar for the three cephalosporins. In serum, the elimination half-life of ceftriaxone was twice as much as the elimination half-life of cefotiam or cefmenoxime (2.8 +/- 0.45 versus 1.4 +/- 0.25 or 1.3 +/- 0.4 h, respectively). Ceftriaxone was much more effective than cefotiam. The bacterial titer in the vegetations (log10 CFU per gram of vegetation) was 7.56 +/- 1 with cefotiam and 2.41 +/- 2.6 with ceftriaxone, as their concentrations were 18 and 466 times higher, respectively, than their MBCs. Although ceftriaxone and cefmenoxime exhibited a similar rate of killing and percentage of protein binding, ceftriaxone was more effective than cefmenoxime at the same regimen of 15 mg/kg twice a day (3.08 +/- 1.1 versus 4.82 +/- 3.2 log10 CFU/g of vegetation). When antibiotic was given as a single daily injection of 30 mg/kg, the antibacterial effect persisted for ceftriaxone, but not for cefmenoxime. The longer elimination half-life and the higher local concentration/MBC ratio of ceftriaxone explained these results. The bacterial titer measured 24 h after the fourth injection of 30 mg of ceftriaxone per kg confirmed that this regimen prevented regrowth of bacteria. These results suggest that the local antibiotic level/MBC ratio roughly correlated with the antibacterial effect and could represent an adequate basis to explain the differences observed between the drugs in vivo. They also demonstrate that, provided that the dose is sufficient, a long-acting broad-spectrum cephalosporin may be effective in severe gram-negative infections, even when given at relatively long dosing intervals, in contrast with a rapidly cleared drug with the same intrinsic activity.
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PMID:Comparative efficacy of cefotiam, cefmenoxime, and ceftriaxone in experimental endocarditis and correlation with pharmacokinetics and in vitro efficacy. 330 May 30

In a rabbit model of Escherichia coli endocarditis, we studied the penetration into infected vegetations and the antibacterial effect of ceftriaxone. Ceftriaxone was given at different dosages, alone or with an interfering agent, diclofenac, a nonsteroidal anti-inflammatory drug, to determine the predictive value of the antibiotic levels in serum or infected vegetations on the antibacterial efficacy. Diclofenac increased the serum terminal half-life of ceftriaxone and increased its extravascular diffusion in tissue cage fluid, as well as in infected vegetations, allowing us to obtain various antibiotic concentrations in the infected site. Two hours after the fourth injection, around the time of peak level in serum, we observed a linear relationship between (i) serum and local antibiotic levels in vegetations, (ii) local antibiotic levels in a range of 142 to 600 X MBC and bacterial titer (log10 CFU/g) in vegetations, and (iii) serum antibiotic levels in a range of 800 to 1,400X MBC and bacterial titer in vegetations. In vivo, antibacterial effect was obtained only with high antibiotic levels in vegetations (greater than or equal to 220X MBC). This was confirmed by incubating vegetations sampled from infected animals in rabbit serum containing ceftriaxone (ex vivo experiment). Given once daily at a therapeutic dosage (30 mg/kg) for 4 days, ceftriaxone exhibited good efficacy (log10 CFU/g of vegetation = 2.41 +/- 2.7 versus 7.41 +/- 0.92 in control animals) and prevented regrowth of bacteria until 24 h after the last injection. We concluded that (i) provided the dose is sufficient, a long-acting cephalosporin can prove effective in severe gram-negative infections even when given infrequently, and (ii) serum antibiotic levels around the peak value, reflecting high effective local levels, could predict the therapeutic efficacy and represent a simple test to monitor the clinical course of a severe infectious process.
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PMID:Value of antibiotic levels in serum and cardiac vegetations for predicting antibacterial effect of ceftriaxone in experimental Escherichia coli endocarditis. 332 57

A new, investigational, parenteral form of sparfloxacin was compared with ceftriaxone in the treatment of experimental endocarditis caused by either of three penicillin-susceptible streptococci or one penicillin-resistant streptococcus. Both drugs have prolonged half-lives in serum, allowing single daily administration to humans. Sparfloxacin had relatively low MICs (0.25 to 0.5 mg/liter) for all four organisms and was also greater than or equal to eight times more effective than the other quinolones against 21 additional streptococcal isolates recovered from patients with bacteremia. Ceftriaxone MICs were 0.032 to 0.064 mg/liter for the penicillin-susceptible strains and 2 mg/liter for the resistant isolate. Both antibiotics resulted in moderate bacterial killing in vitro. Rats with catheter-induced aortic vegetations were inoculated with 10(7) CFU of the test organisms. Antibiotic treatment was started 48 h later and lasted either 3 or 5 days. The drugs were injected at doses which mimicked the kinetics in human serum produced by one intravenous injection of 400 mg of sparfloxacin (i.e., the daily dose expected to be given to human adults) and 2 g of ceftriaxone. Both antibiotics significantly decreased the bacterial densities in the vegetations. However, sparfloxacin was slower than ceftriaxone in its ability to eradicate valvular infection caused by penicillin-susceptible bacteria. While this difference was quite marked after 3 days of therapy, it tended to vanish when treatment was prolonged to 5 days. In contrast, sparfloxacin was very effective against the penicillin-resistant isolate, an organism against which ceftriaxone therapy failed in vivo. No sparfloxacin-resistant mutant was selected during therapy. Thus, in the present experimental setting, this new, investigational, parenteral form of sparfloxacin was effective against severe infections caused by both penicillin-susceptible and penicillin-resistant streptococci.
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PMID:Parenteral sparfloxacin compared with ceftriaxone in treatment of experimental endocarditis due to penicillin-susceptible and -resistant streptococci. 769 48

There are a total of 8000 cases of infective endocarditis yearly in the United States. Central nervous system metastatic infections are not uncommon in infective endocarditis. Because ceftriaxone is highly bound to serum proteins, there is concern that the drug is highly bound to serum proteins, there is concern that the drug might not penetrate well in the core of an infected vegetation. To date, there are two published studies on the treatment of nonenterococcal streptococcal endocarditis by ceftriaxone in humans. Ceftriaxone appears to be an attractive alternative antibiotic therapy to conventional regimens in the treatment of streptococcal endocarditis.
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PMID:Ceftriaxone and outpatient treatment of infective endocarditis. 846 57

The efficacy of ceftriaxone or penicillin alone or combined with gentamicin at different dosing intervals was evaluated in experimental endocarditis due to a penicillin-susceptible, ceftriaxone-tolerant strain of Streptococcus sanguis I. The difference between monotherapy with ceftriaxone and procaine penicillin approached statistical significance (P = 0.052). Ceftriaxone combined with gentamicin administered as a single daily dose was less effective than was procaine penicillin combined with gentamicin administered in a single daily dose or in three divided doses.
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PMID:Effect of gentamicin dosing interval on efficacy of penicillin or ceftriaxone treatment of experimental endocarditis due to penicillin-susceptible, ceftriaxone-tolerant viridans group streptococci. 912 65

Efficacy and safety of ceftriaxone (Oframax, Ranbaxy, India) in the treatment of 25 patients with Staphylococcus endocarditis (SE) were studied. The drug was administered intravenously in a dose of 2-4 g a day for 4 weeks and simultaneously gentamicin was used intramuscularly in a dose of 2-3 mg/kg body weight a day every 8 hours for 2 weeks. The treatment was followed by observation of the patients for up to 2 years under the hospital or dyspensary conditions. The disease was due to S. epidermidis (17 patients) or S.aureus (8 patients). The efficacy was controlled in the dynamics. The criteria of the therapy efficacy were disappearance of the disease clinical signs, normalization of the blood count and urinalysis and the pathogen eradication by the results of the control bacteriological blood analysis. The cure without any surgical correction was observed in 68 per cent of the patients and that with the valve replacement was stated in 24 per cent of the patients. The lethal outcome due to bacteriotoxic shock was recorded in 8 per cent of the patients. The SE relapsing was stated in 28 per cent of the patients 3 or more months after the ceftriaxone therapy completion. 10 patients (40 per cent) with evident clinicolaboratory improvement were discharged from the hospital 2 (4 patients) and 3 (6 patients) weeks after the therapy start for the treatment with ceftriaxone as outpatients. In 2 patients nausea as the adverse reaction was observed. Therefore, the complex clinicolaboratory investigation showed that the combined use of ceftriaxone and gentamicin was efficient and safe in the treatment of SE. Ceftriaxone may be considered as a basic drug for the therapy of SE. In some patients with SE the treatment with ceftriaxone may be completed under outpatient conditions.
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PMID:[Ceftriaxone in the treatment of staphylococcal endocarditis]. 964 28

Neisseria elongata subsp. elongata, previously considered nonpathogenic, is a potential agent of human endocarditis. We report the second case of human endocarditis caused by this organism. The patient was successfully treated with Ceftriaxone alone for a total of six weeks.
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PMID:Neisseria elongata subsp. elongata, as a cause of human endocarditis. 1140 72


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