Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0017160 (gastroenteritis)
 11,398 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Many discriminative experimental animal models of infection have been utilized in the evaluation of newer fluoroquinolones. In vivo efficacy of many of the newer agents has been shown in experimental models of meningitis, endocarditis, pneumonia, urinary tract infections, pyelonephritis, osteomyelitis, abscesses of various types, septic arthritis, gastroenteritis, salmonellosis, listeriosis, tuberculosis, syphilis, sinusitis, prostatitis and burn wound sepsis, among others. This review focuses on recent developments in a few selected areas. Although the limitations of animal model studies are well described, these results provide a rationale for the appropriate clinical usage of the newer fluoroquinolones in humans.
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PMID:Evaluation of quinolones in experimental animal models of infections. 186 88

Although animal models of infection are associated with certain limitations in interpretation, properly performed studies provide important information for evaluating the efficacy of new antimicrobial agents in the treatment of human disease. The antibacterial efficacy of the newer quinolones, particularly ciprofloxacin, has undergone extensive evaluation in several animal models. Efficacy has been demonstrated in animal models of pneumonia, endocarditis, meningitis, skin and soft-tissue infections, septic arthritis, burn wound sepsis, empyema, intra-abdominal abscess, osteomyelitis, prostatitis, sinusitis, urinary tract infection, chronic gastroenteritis, granuloma pouch infection, and Pseudomonas septicemia. More recent studies have evaluated the efficacy of ciprofloxacin in animal models of tuberculosis and syphilis, as well as in infections caused by the intracellular pathogens Salmonella typhimurium, Legionella pneumophila, and Listeria monocytogenes.
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PMID:An update on the efficacy of ciprofloxacin in animal models of infection. 258 79

The fluoroquinolones, a new class of potent orally absorbed antimicrobial agents, are reviewed, considering structure, mechanisms of action and resistance, spectrum, variables affecting activity in vitro, pharmacokinetic properties, clinical efficacy, emergence of resistance, and tolerability. The primary bacterial target is the enzyme deoxyribonucleic acid gyrase. Bacterial resistance occurs by chromosomal mutations altering deoxyribonucleic acid gyrase and decreasing drug permeation. The drugs are bactericidal and potent in vitro against members of the family Enterobacteriaceae, Haemophilus spp., and Neisseria spp., have good activity against Pseudomonas aeruginosa and staphylococci, and (with several exceptions) are less potent against streptococci and have fair to poor activity against anaerobic species. Potency in vitro decreases in the presence of low pH, magnesium ions, or urine but is little affected by different media, increased inoculum, or serum. The effects of the drugs in combination with a beta-lactam or aminoglycoside are often additive, occasionally synergistic, and rarely antagonistic. The agents are orally absorbed, require at most twice-daily dosing, and achieve high concentrations in urine, feces, and kidney and good concentrations in lung, bone, prostate, and other tissues. The drugs are efficacious in treatment of a variety of bacterial infections, including uncomplicated and complicated urinary tract infections, bacterial gastroenteritis, and gonorrhea, and show promise for therapy of prostatitis, respiratory tract infections, osteomyelitis, and cutaneous infections, particularly when caused by aerobic gram-negative bacilli. Fluoroquinolones have also proved to be efficacious for prophylaxis against travelers' diarrhea and infection with gram-negative bacilli in neutropenic patients. The drugs are effective in eliminating carriage of Neisseria meningitidis. Patient tolerability appears acceptable, with gastrointestinal or central nervous system toxicities occurring most commonly, but only rarely necessitating discontinuance of therapy. In 17 of 18 prospective, randomized, double-blind comparisons with another agent or placebo, fluoroquinolones were tolerated as well as or better than the comparison regimen. Bacterial resistance has been uncommonly documented but occurs, most notably with P. aeruginosa and Staphylococcus aureus and occasionally other species for which the therapeutic ratio is less favorable. Fluoroquinolones offer an efficacious, well-tolerated, and cost-effective alternative to parenteral therapies of selected infections.
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PMID:Fluoroquinolone antimicrobial agents. 268 58

Norfloxacin is an oral fluoroquinolone antimicrobial agent recently released for the treatment of uncomplicated and complicated urinary tract infections. The drug antagonizes DNA gyrase, an enzyme essential for bacterial DNA replication. Norfloxacin is more potent and broader in spectrum than the earlier developed analogue, nalidixic acid, and is active in vitro against virtually all bacterial pathogens causing urinary tract and gastrointestinal infections, aerobic gram-negative bacilli causing sepsis in neutropenic patients, and Neisseria gonorrhoeae. The drug is administered orally twice daily and achieves high concentrations in urine, stool, renal tissue, and bile. Norfloxacin was at least as effective as currently used agents in treating urinary tract infections, and, in limited studies, bacterial gastroenteritis, gonorrhea, bacterial prostatitis, and prevention of gram-negative bacillary infection in neutropenic patients. Adverse drug effects were mild and included disturbances of the gastrointestinal tract and the central nervous system. Norfloxacin shows promise as an antibacterial agent for genitourinary and gastrointestinal infections.
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PMID:Norfloxacin: a new targeted fluoroquinolone antimicrobial agent. 327 8

Since the introduction of the floroquinolones for clinical use in the late 1980s, they have been used successfully for a large number of clinical situations. As experience accumulates, the indications and optimal use of these agents gradually become more clear. Unfortunately, two of the pathogens for which these agents were most promising--methicillin-resistant S. aureus and P. aeruginosa--have developed resistance. Currently, the quinolones are excellent agents for the treatment of complicated urinary tract infections, including those caused by P. aeruginosa. In addition, they should be considered as initial therapy for the treatment of severe bacterial gastroenteritis. The quinolones should also be considered when attempting to eradicate the chronic stool carriage of S. typhi. These agents also offer significant advantages in the treatment of osteomyelitis and prostatitis caused by gram-negative bacilli that frequently require prolonged antimicrobial therapy. Treatment of STDs, especially gonorrhea, is another clear indication for their use. Ciprofloxacin should be considered as initial therapy in patients with malignant otitis externa and in cystic fibrosis patients with exacerbations secondary to P. aeruginosa in the sputum. The role of the quinolones for soft tissue and respiratory tract infections is less clear and their use probably should be limited to certain situations in which there is a clear advantage over beta-lactams, macrolides, and trimethoprim-sulfamethoxazole. The new quinolones, fleroxacin, perfloxacin, sparfloxacin, and tosufloxacin, which are being developed and tested for clinical use, will offer advantages in once-a-day dosing and better gram-positive antimicrobial activity. Because the inappropriate or heavy use of the fluoroquinoles has resulted in considerable development of resistance, it is imperative that they be used only when there is a distinct advantage over conventional therapy in terms of efficacy, safety, or cost. Otherwise, the rapid development of resistance will jeopardize the potentially bright future for this entire class of compounds.
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PMID:Fluoroquinolones. 749 Apr 40

Quality health care has been defined as the maximization of desired outcomes while minimizing undesirable consequences. Therefore, the optimal antimicrobial agent for a given clinical condition will be one that is the most rapidly effective, produces the least patient discomfort, results in minimal disruption of the patient's or hospital flora, and causes minimal dissatisfaction with the treatment program and its attendant costs. The clinical utility of antimicrobials is generally judged on the basis of in vitro activity, kinetic disposition, resistance trends, safety, and cost. Fluoroquinolones possess characteristics in each of these areas; for example, broad, potent gram-negative spectrum coupled with excellent oral absorption and tissue penetration, and relative safety and reduced cost compared with parenteral therapy. Drawbacks include the emergence of resistance among certain bacteria, particularly staphylococci and Pseudomonas aeruginosa, drug interactions that may compromise efficacy, and greater cost than other potentially useful oral antimicrobial agents. Indications for the agents' use can be categorized as appropriate (gram-negative osteomyelitis, complicated urinary tract infection, prostatitis, certain sexually transmitted diseases, bacterial gastroenteritis), potential (gastrointestinal tract decontamination in granulocytopenic patients, exacerbations of chronic obstructive pulmonary disease, nosocomial pneumonia and bacteremia, eradication of certain bacterial carrier states), or inappropriate (community-acquired pulmonary infections, especially aspiration pneumonitis, serious gram-positive infections, uncomplicated urinary tract infection, surgical prophylaxis except prostatic surgery). Gram-negative osteomyelitis serves as a model to demonstrate the fluoroquinolones as agents for quality health care. Current and future investigations should focus on the cost effectiveness and cost utility of the agents.
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PMID:Therapeutic decisions: assessing clinical fit. 847 33

Over the past decade, the genus Aeromonas has undergone a number of significant changes of practical importance to clinical microbiologists and scientists alike. In parallel with the molecular revolution in microbiology, several new species have been identified on a phylogenetic basis, and the genome of the type species, A. hydrophila ATCC 7966, has been sequenced. In addition to established disease associations, Aeromonas has been shown to be a significant cause of infections associated with natural disasters (hurricanes, tsunamis, and earthquakes) and has been linked to emerging or new illnesses, including near-drowning events, prostatitis, and hemolytic-uremic syndrome. Despite these achievements, issues still remain regarding the role that Aeromonas plays in bacterial gastroenteritis, the extent to which species identification should be attempted in the clinical laboratory, and laboratory reporting of test results from contaminated body sites containing aeromonads. This article provides an extensive review of these topics, in addition to others, such as taxonomic issues, microbial pathogenicity, and antimicrobial resistance markers.
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PMID:The genus Aeromonas: taxonomy, pathogenicity, and infection. 2006 25