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 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Subdural empyema is an intracranial infection that has remained difficult to diagnose and to treat. Seventeen patients with this infection, treated between 1967 and 1974, are analyzed and compared to published series with particular regard to diagnosis using newer procedures and treatment, considering the primary focus of infection. The infection is usually located in the supratentorial spaces, is often bilateral, and results most often from para-nasal sinusitis (single most common cause), otitis, neurosurgical operative infections, and meningitis in infants. Patients suffering from subdural empyema generally present with rapid onset of depressed sensorium, seizures, focal neurological deficits, and signs of increased intracranial pressure, following a period of days to weeks characterized by headache and fever. All 17 of our patients demonstrated localizing neurological signs and 16 manifested either fever or leukocytosis. Diagnostic studies, except for cerebral arteriography, do not reliably corroborate or exclude the diagnosis. Cerebral arteriography established the diagnosis and defined the location and extent of the empyema in all of our cases. The EEG and brain scan produced frequent false-negative and/or non-localizing results in 10 and 8 patients, respectively. The cerebrospinal fluid was abnormal from all 15 patients examined by lumbar puncture, but the findings were similar to those in other infectious and non-infectious central nervous system diseases. Signs of transtentorial herniation developed within eight hours following lumbar puncture in three of seven patients who had exhibited signs of increased intracranial pressure before the procedure was performed. Bacterial cultures were positive in 13 of our cases. A review of our data and that of other studies indicates that the organisms associated with subdural empyema are consistent with those expected from infections of the primary site; e.g. sinusitis, otitis, meningitis, site of prior neurosurgery. A therapeutic approach is suggested which emphasizes specific antibiotic regimens appropriate to the primary site of infection and prompt neurosurgical intervention with evacuation of the subdural spaces bilaterally. In general, combination antimicrobial therapy employing high parenteral doses of penicillin G, a semi-synthetic penicillinase-resistant penicillin and chloramphenicol is recommended.
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PMID:Subdural empyema: analysis of 17 recent cases and review of the literature. 118 92

The use of cefaclor advanced formulation (cefaclor AF) in the treatment of pneumonia caused by susceptible organisms was investigated in a multi-center trial conducted in the United Kingdom and the United States. A total of 266 patients were enrolled in this double-blind, double-dummy, randomized, parallel study; 132 patients were treated with cefaclor AF and 134 patients received the reference drug cefaclor. Inclusion criteria were a diagnosis of lobar pneumonia or bronchopneumonia, with a positive sputum culture and an infiltrate on chest roentgenogram. Patients received either cefaclor AF (750 mg twice daily) or cefaclor (500 mg three times daily) for 10 to 14 days. Forty patients in the cefaclor AF group and 45 in the cefaclor group were evaluable for efficacy, with 37 (92.5%) and 43 (95.6%), respectively, showing a favorable posttherapy clinical response. Proven or presumed pathogen elimination was achieved in 87.5% and 86.7% of cases, respectively. Both study drugs demonstrated high levels of activity against Streptococcus pneumoniae, Haemophilus influenzae (including beta-lactamase-producing strains), and Moraxella catarrhalis (including beta-lactamase-producing strains). There were no statistically significant differences between drugs in efficacy results. One or more side effects were reported by 42.4% of the patients treated with cefaclor AF and by 44.0% of those treated with cefaclor; diarrhea, nausea, headache, and respiratory disorders were the most common adverse events. No drug-related side effects were seen with a frequency or severity that would be unexpected with the use of oral cephalosporins. Cefaclor AF and cefaclor performed equally well with respect to clinical and bacteriologic response rates in the treatment of pneumonia.
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PMID:Cefaclor advanced formulation versus cefaclor in the treatment of pneumonia. 152 91

Loracarbef (LY163892), a member of the class of beta-lactam antibiotics known as carbacephems, is characterized by a high level of chemical stability and a broad spectrum of antibacterial activity that persists in the presence of beta-lactamase. The efficacy and safety of loracarbef, 200 mg (twice daily), and cefaclor, 250 mg (three times daily) (one patient received 178 mg of cefaclor suspension, three times daily), were compared in a randomized, double-blind, multicenter trial conducted in adults with skin and skin-structure infections due predominantly to Staphylococcus aureus. Examination within 72 hours after the completion of therapy indicated a favorable clinical response in 84 (93.3%) of the 90 loracarbef-treated patients evaluable for efficacy and in 79 (95.2%) of the 83 evaluable patients treated with cefaclor. Pathogens were eradicated in 83 (92.2%) of the patients in the loracarbef group and 74 (89.2%) of those in the cefaclor group. Only four adverse events--headache/migraine, diarrhea, abdominal pain, and nausea--occurred in greater than 2% of the total study population. The overall incidence of adverse events in the 201 loracarbef-treated and 192 cefaclor-treated patients evaluated for safety was 19.9% and 24.5%, respectively. Adverse events that required hospitalization or discontinuation of treatment occurred in four patients in the cefaclor group but in none of those treated with loracarbef. There were no statistically significant differences in the clinical or bacteriologic response or the incidence of side effects between the two treatment groups. These findings indicate that loracarbef given twice daily is comparable in safety and efficacy to cefaclor given three times daily in the treatment of adults with skin and skin-structure infections.
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PMID:Loracarbef (LY163892) versus cefaclor in the treatment of bacterial skin and skin-structure infections in an adult population. 162 51

Norfloxacin, a new oral quinolone, was compared with intramuscular spectinomycin for treating culture proved gonorrhoea (caused by penicillinase producing strains of Neisseria gonorrhoeae (PPNG) and non-PPNG strains. A total of 547 infected men and women were randomly allocated to treatment with either single dose norfloxacin (800 mg by mouth) or spectinomycin (2 g intramuscularly). Patient preference for tablets or injections was noted at this visit. Patients returned four to eight days later for assessment of efficacy, safety, and preference. Of the 482 patients who attended follow up, all those treated with norfloxacin (94 infected with PPNG strains, 145 with non-PPNG strains) and all 82 infected with PPNG strains and treated with spectinomycin were cured. Of 161 infected with non-PPNG strains and treated with spectinomycin, 159 (99%) were cured. Side effects (headache, nausea, and sleepiness) occurred in three patients receiving norfloxacin and in 17 (16 pain at injection site, 1 giddiness) receiving spectinomycin. Most patients preferred tablets to injection both on day 1 (313 v 200) and at follow up (373 v 104). This study showed that norfloxacin was a highly effective alternative to spectinomycin, produced fewer side effects, and was the preferred mode of administration.
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PMID:Single dose oral norfloxacin or intramuscular spectinomycin to treat gonorrhoea (PPNG and non-PPNG infections): analysis of efficacy and patient preference. 297 3

The chemistry, mechanism of action, antimicrobial spectrum, pharmacokinetics, clinical efficacy, adverse effects, and dosage and administration of ciprofloxacin and norfloxacin are reviewed, and mechanisms of antimicrobial resistance and drug and laboratory interactions are described. Norfloxacin is the first antimicrobial in the fluoroquinolone class to be marketed in the United States; ciprofloxacin is under investigation in clinical trials. The fluoroquinolones are structurally related to nalidixic acid. The activity and spectrum are enhanced by the addition of 6-fluoro and 7-piperazino substituents. Quinolone antimicrobials appear to inhibit DNA gyrase, an enzyme specific and essential for all bacteria, as their primary mechanism of action. As a result, DNA synthesis is inhibited. Ciprofloxacin and norfloxacin are active against gram-negative enteric bacteria, Pseudomonas aeruginosa, Haemophilus influenzae, and Neisseria gonorrhoeae. Ciprofloxacin has good activity against Staphylcoccus spp., including methicillin-resistant Staph. aureus. Norfloxacin generally is less potent than ciprofloxacin, particularly against Ps. aeruginosa and Staph. aureus. Peak concentrations occur about one to two hours after an oral administration of either drug. Both drugs are widely distributed in body fluids and tissues and are eliminated by renal excretion, metabolism, and biliary excretion. Dosage reductions are required in severe renal dysfunction. Ciprofloxacin and norfloxacin are effective agents for treating urinary-tract infections, including infections caused by Ps. aeruginosa. The recommended dosage of norfloxacin for urinary-tract infections in adults is 400 mg orally every 12 hours; the drug should be given for 7 to 10 days in uncomplicated infections and for 10 to 21 days in complicated ones. The fluoroquinolones may be useful for treating chronic bacterial prostatitis. Ciprofloxacin is potentially useful for treating sexually transmitted diseases. Ciprofloxacin is active against N. gonorrhoeae, including beta-lactamase-producing strains and strains that are resistant to tetracycline, and Chlamydia spp. Use of ciprofloxacin for treating gastrointestinal infections and for selective decontamination of the gastrointestinal tract is promising. In open studies, ciprofloxacin has been effective against a variety of infections caused by susceptible organisms. Resistance to ciprofloxacin has developed during treatment of infections caused by Ps. aeruginosa, Staph. aureus, and Serratia marcescens. The most frequently reported adverse effects of either drug are gastrointestinal complaints, headache, and dizziness.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Ciprofloxacin and norfloxacin, two fluoroquinolone antimicrobials. 331 72

This review covers 2346 norfloxacin treated patients in clinical trials world wide. These studies show that 400 mg of norfloxacin b.i.d. was effective and compared favorably with other standard oral agents in the treatment of urinary tract infections, including complicated and recurrent infections in men. This regimen given b.i.d. or t.i.d. was also effective in the treatment of acute gastroenteritis due to common gastrointestinal pathogens such as enterotoxigenic Escherichia coli, Salmonella spp., Shigella spp., Campylobacter spp. as well as less common organisms. A single 800 mg dose was effective in the treatment of gonorrhoea including patients with extra genito-urinary involvement and penicillinase producing strains of Neisseria gonorrhoeae. Preliminary data from ongoing trials have also shown that norfloxacin is effective in the prophylaxis of traveller's diarrhoea and infections in the granulocytopenic patient. These various regimens of norfloxacin were well tolerated with a low incidence (less than 3%) of drug related adverse experiences. The most common adverse experiences were nausea, headache, dizziness, rash, elevation of liver enzymes and eosinophilia.
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PMID:World-wide clinical experience with norfloxacin: efficacy and safety. 353 57

Over the past 3 years, toxic shock syndrome (TSS) has emerged from virtual obscurity to become a household word. The syndrome, which most commonly occurs in previously healthy women during menses, is characterized by the sudden onset of headache, malaise, high fever, myalgia, diarrhea, syncope, skin rash, and evidence of multisystem involvement with progression to desquamation of skin, nails, and hair. Death has occurred in 5%-10% of cases. Use of highly absorbent tampons and the presence of toxin-producing staphylococcus aureus have been implicated in the pathogenesis of this syndrome. Treatment with beta-lactamase-resistant antibiotics and discontinuation of tampon use are associated with reduction in the risk of recurrence. To date, 42% of cases have occurred in females under the age of 19 years. Accordingly, physicians who care for adolescents should be knowledgeable about the syndrome's myriad manifestations and treatment, as well as the possibility of prevention through education about menstrual practices.
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PMID:Toxic shock syndrome--an adolescent disease. 664 6

Rosoxacin, a beta-lactamase-resistant, pyridyl quinolone derivative with in vitro activity against Neisseria gonorrhoeae, was compared to an oral regimen of ampicillin plus probenecid for the treatment of uncomplicated gonococcal infection. Fifty-seven patients were evaluated for the effectiveness of the two antibiotics. Thirty (97%) of 31 patients receiving rosoxacin were cured of their infection as were 25 (96%) of 26 patients who received the oral regimen of ampicillin plus probenecid. Both drug regimens were associated with a significant number of side effects. Of the ampicillin-treated group, 29% had diarrhea and/or abdominal cramping. Of the rosoxacin-treated patients, 52% had reactions classified as central nervous system effects; these included headaches, dizziness, euphoria, and drowsiness.
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PMID:A comparison of rosoxacin with ampicillin and probenecid in the treatment of uncomplicated gonorrhea. 671 Feb 84

Gemifloxacin is a fluoroquinolone antibacterial agent which has an enhanced affinity for topoisomerase i.v.. It has potent activity against most Gram-positive bacteria, particularly Streptococcus pneumoniae. Gemifloxacin is over 30-fold more active than ciprofloxacin and 4- to 8-fold more active than moxifloxacin against this pathogen. Gemifloxacin has excellent activity against Haemophilus influenzae and Moraxella catarrhalis, and is unaffected by beta-lactamase production. It is generally 2-fold less active than ciprofloxacin against most Enterobacteriaceae. Atypical respiratory pathogens (Legionella, Mycoplasma and Chlamydia spp.) are highly susceptible to gemifloxacin. Preliminary results from phase II trials show that oral gemifloxacin 320 mg/day produced bacteriological responses of 94.7% in patients with acute exacerbations of chronic bronchitis and 95% of patients with uncomplicated urinary tract infections. Adverse events included nausea, abdominal pain, headache and mild rash in patients and healthy volunteers treated with gemifloxacin 320 mg/day. Gemifloxacin has a low potential for mild phototoxicity (comparable to that of ciprofloxacin).
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PMID:Gemifloxacin. 1085 45

The emergence of meningococcal strains with reduced susceptibility to penicillin has been reported in several countries during the past two decades, but not in Taiwan. We report a case of meningococcal meningitis with intermediate resistance to penicillin. A 20-year-old male soldier complained of chills, fever, and headache for 2 days, followed by drowsiness. Physical examination revealed erythema of the pharynx, stiff neck, erythematous maculopapules, and petechiae over the trunk and four limbs including palms and soles. Analysis of the cerebrospinal fluid (CSF) showed a white blood cell count of 9.06 x 10(6)/L, a glucose concentration of 0.165 mmol/L, and a protein concentration of 7.85 g/L. CSF culture yielded Neisseria meningitidis, serogroup B. The minimum inhibitory concentration of penicillin was determined using an E-test (0.125 microgram/mL); there was no beta-lactamase production. He recovered after high-dose penicillin G treatment with six doses of 24 million units per day for 11 days. The emergence of penicillin resistance in N. meningitidis in Taiwan requires surveillance. High-dose penicillin may be successful in treating penicillin-insensitive meningococcal meningitis. Alternative treatment with third-generation cephalosporins should be considered if poor response to penicillin is encountered.
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PMID:Meningitis due to penicillin-resistant Neisseria meningitidis in a 20-year-old man. 1176 Mar 76


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