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Query: UMLS:C0021311 (Infection)
 38,178 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In order to evaluate the role of fungi in patients with cystic fibrosis, we determined serum IgG antibodies against Candida albicans and Aspergillus fumigatus using an indirect ELISA in patients with or without fungi in the sputum and in sera of healthy individuals. For both C. albicans and A. fumigatus the antibody levels were significantly higher in the CF groups than in the control group, regardless of whether these fungi could be isolated during the observation time or not. In contrast to A. fumigatus, we found that in the majority of cases antibody levels increase significantly with the isolation of C. albicans from sputum. Therefore, we conclude that one has to pay more attention to C. albicans in CF patients. One must also particularly reevaluate long-term antibiotic treatment and look for means to prevent fungal recolonization and reinfection.
Infection
PMID:Serologic response to Candida albicans and Aspergillus fumigatus in cystic fibrosis. 331 24

Infections of the respiratory tract are among the most common causes for antibiotic prescribing. Their diagnosis within the community is generally limited to clinical criteria, and microbiological information is frequently lacking. Hospitalised patients with respiratory tract infections are more likely to undergo diagnostic sampling, but difficulties remain in reliably defining a microbial aetiology, thereby providing a confident basis for antibiotic selection. In considering the role of the cephalosporins in the treatment of respiratory tract infections, over 500 published articles have been reviewed. The pharmacokinetic considerations are discussed and the limitations of existing methodology are emphasised. Individual agents are reviewed by site of sepsis and conclusions are drawn from both comparative and non-comparative studies and in relation to currently recommended regimens. Although oral cephalosporins are widely used to treat upper respiratory tract infections, none is considered ideal, especially where Haemophilus influenzae is pathogenic. In the case of lower respiratory tract infections the beta-lactamase stable parenteral cephalosporins have become widely used to treat pneumonia in hospitalised patients, especially where Gram-negative enteric bacilli are of aetiological importance. However, the lack of activity of these drugs against Legionella spp., Mycoplasma pneumoniae and Coxiella burnetii must be emphasised. Another area of increasing use is in the treatment of infective exacerbations in patients suffering from cystic fibrosis of the lungs where Pseudomonas aeruginosa is pathogenic; ceftazidime in particular has proved a useful alternative to earlier antipseudomonal penicillin antibiotics.
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PMID:Treatment of respiratory tract infections with cephalosporin antibiotics. 331 1

In this review we analyzed the pharmacokinetic basis for high dose treatment with antibiotics of patients with cystic fibrosis. Both our results and those from other well designed pharmacokinetic studies do not support the view that low blood levels of antibacterials are a common feature of CF. We were unable to detect a decrease in absorption, nor could we find evidence for enhanced elimination of antibacterials in CF. Both these factors have been considered responsible for reducing the plasma (and tissue) levels of antibiotics. Most recent studies on kidney function are in agreement with these findings, since neither inulin nor creatinine clearance differ between CF-patients and healthy volunteers. In contrast to previous discussion, the volume of distribution (Vdss) was not elevated for any compound. The rational of weight correction of volume terms like Vdss or total clearance has never been clearly demonstrated and should therefore not be used without prior proof of relevance. Since the variability of pharmacokinetic parameters of antibiotics in CF-patients may be considerable, we suggest that a dose increase of 20-30% may be justified, but cannot agree with two to fourfold increases in dosage as previously proposed and applied in many CF-centers. Until more findings become available for non-adult CF-patients, these conclusions are only valid for adult CF-patients.
Infection 1987
PMID:High dose treatment with antibiotics in cystic fibrosis--a reappraisal with special reference to the pharmacokinetics of beta-lactams and new fluoroquinolones in adult CF-patients. 331 14

Lipid A is the toxic component of endotoxin in gram-negative bacteria. Antibodies to lipid A are not usually found in healthy persons (or only at a low titer) without a corresponding history of infection. Even gram-negative septicemia is found to be accompanied by only low titers. A completely different situation is seen in patients with chronic or recurrent infections due to Enterobacteriaceae and other gram-negative bacteria. Here it is notable that the antibody titer varies with the type of disorder (e.g. cystitis and pyelonephritis). A severe wound infection, e.g. due to Pseudomonas aeruginosa, also leads to measurable lipid A antibody titers. Varying antibody titers can be observed in cystic fibrosis, Crohn's disease, and severe surgical infections. One can conclude that a significantly elevated antibody titer develops during an extensive tissue involvement of long duration and indeed is caused by tissue inhibition by endotoxin. Based on clinical experience, it can be assumed that lipid A antibodies present in the body have a protective effect in septic shock.
Infection
PMID:[Lipoid A antibody titer in the human]. 359 12

Lipid A is the toxic component of endotoxin in gram-negative bacteria. Antibodies to lipid A are not usually found in healthy persons (or only at a low titer) without a corresponding history of infection. Even gram-negative septicemia is found to be accompanied by only low titers. A completely different situation is seen in patients with chronic or recurrent infections due to Enterobacteriaceae and other gram-negative bacteria. Here it is notable that the antibody titer varies with the type of disorder (e. g. cystitis and pyelonephritis). A severe would infection, e. g. due to Pseudomonas aeruginosa, also leads to measurable lipid A antibody titers. Varying antibody titers can be observed in cystic fibrosis, Crohn's disease, and severe surgical infections. One can conclude that a significantly elevated antibody titer develops during an extensive tissue involvement of long duration and indeed is caused by tissue inhibition by endotoxin. Based on clinical experience, it can be assumed that lipid A antibodies present in the body have a protective effect in septic shock.
Infection 1987
PMID:[Lipoid A antibody titer in humans]. 361 Mar 31

The treatment of exacerbations of pulmonary infections due to Pseudomonas aeruginosa in patients with cystic fibrosis is unsatisfactory. Serum concentrations and urinary excretion of cephalexin, epicillin, azlocillin, ticarcillin, trimethoprim-sulfa and gentamicin useful in the treatment of these infections were investigated in cystic fibrosis patients suffering from pulmonary infections. The data were compared to those found in non-cystic fibrosis children treated with antibiotics for other reasons. Cephalexin and trimethoprim are absorbed at a slower rate; epicillin, azlocillin, ticarcillin sulfonamides were eliminated at a faster rate by the kidneys which was unique to patients with cystic fibrosis. Gentamicin is also eliminated faster. Further investigations disclosed that a considerable amount of drug is eliminated by tubular secretion in addition to the regular glomerular filtration in patients with cystic fibrosis. Creatinine clearance values were determined in these patients and found to be normal. By doubling the dose of gentamicin and administration as infusion over 90 min, higher serum and tissue concentrations were achieved without being in the toxic range. The clinical relevance of these investigations was determined in 36 patients and 48 episodes of infection with P. aeruginosa. Patients received gentamicin 4 mg/kg BW as i.v. infusion over 90 min q. 8 h and azlocillin or ticarcillin 120-160 mg/kg BW q. 8 h, applied 4 h later. In 14 patients respectively 27 episodes, pseudomonas was eradicated from the sputum for a minimum of three weeks, and in most of them for 12-24 weeks. No side effects were observed from the higher doses of aminoglycosides.
Infection 1987
PMID:Antimicrobial chemotherapy in patients with cystic fibrosis. 369 14

Infections of airways and lung in patients with cystic fibrosis determine quality of life and prognosis. Despite overall improvement of management of infections the underlying causes leading to infection early in life remain an enigma. As a consequence of infection various morphologic alterations arise. The most prominent are development of bronchiectases afflicting more than 70% of patients at age two. The spectrum of bacterial involvement has undergone significant changes. In contrast to earlier reports Pseudomonas aeruginosa at present is the most commonly encountered pathogen. Mucoid forms are typical for cystic fibrosis and are rarely seen in other conditions. Pseudomonas cannot be eradicated once it is established. Antipseudomonas chemotherapy leads to a diminution of bacteria from 10(8)/ml sputum to 10(6) at best. However, clinical results are convincing. Thus regular antispeudomonas treatment has been advocated by one CF-centre. Apart from conventional chemotherapy alternative approaches of treatment such as vaccination or immunoregulation need to be explored in greater detail.
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PMID:[Pulmonary infections in cystic fibrosis: pathogenesis and therapy]. 393 27

The antimicrobial activity of six aminoglycosides against 927 clinical isolates was compared. Gentamicin and netilmicin were most active against Enterobacteriaceae, followed by tobramycin greater than dibekacin greater than amikacin greater than kanamycin. Tobramycin was most active against Pseudomonas aeruginosa, both mucoid and non-mucoid strains, followed by dibekacin greater than gentamicin greater than netilmicin greater than amikacin greater than kanamycin. Piperacillin-aminoglycoside combinations acted (partially) synergistically against 33-40% of the Enterobacteriaceae, 34-58% of non-mucoid strains of P. aeruginosa and 63-84% of the mucoid strains of P. aeruginosa (p less than 0.01). Piperacillin + gentamicin was the most synergistic combination against Enterobacteriaceae and non-mucoid strains of P. aeruginosa (p less than 0.05). The action against Staphylococcus aureus and Streptococcus faecalis was mostly indifferent. Antagonism was not observed. In treating gram-negative infections where tissue concentrations are less important, every aminoglycoside combination may be effective; for Pseudomonas lung infections in cystic fibrosis, piperacillin + gentamicin or tobramycin will remain the drugs of first choice.
Infection
PMID:In vitro comparison of aminoglycoside activities and their synergistic action with piperacillin. 398 52

The proximity of the maxillary sinus floor to the first, second, and third molar teeth predisposes it to contiguous dental disease. Infections of dental origin are usually mixed bacterial growth with anaerobic species predominating; extended-spectrum penicillins or cephalosporins are recommended. The patient with atopic allergy is susceptible to bacterial infection; combined therapy with antimicrobials, corticosteroids, and antihistamines is advised. The large solitary antrochoanal polyp is successfully managed with maxillary sinus surgery alone. Multiple ethmoidal polyps in children suggest cystic fibrosis, and in adults, the asthma triad syndrome. Thorough surgical management of the sinuses combined with antimicrobial and topical corticosteroid therapy is recommended.
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PMID:Dental and allergic aspects of sinusitis and nasal polyposis: a review. 613 2

This study was undertaken to evaluate the efficacy of a fixed combination of amoxicillin and clavulanic acid in 33 patients with chronic or recurrent respiratory tract infections (R.T.I.), mainly bronchitis. In two patients bronchopneumonia was diagnosed, and in one cystic fibrosis. The patients were treated with 750 mg of the drug combination (500 mg amoxicillin/250 mg clavulanic acid) t. i. d. for seven or ten days. Good clinical success was obtained in 17 patients and a clear improvement in another eight. The most frequently isolated micro-organism was Haemophilus influenzae; of the 22 strains isolated, 20 were resistant to 2 mg/l amoxicillin but sensitive to the combination of 2 mg/l amoxicillin and 1 mg/l clavulanic acid. Side-effects were reported in nine patients; two patients discontinued treatment for this reason. Amoxicillin/clavulanic acid is a useful therapeutic addition to the existing forms of treatment for amoxicillin-resistant respiratory tract infections.
Infection 1981
PMID:A combination of amoxicillin and clavulanic acid in the treatment of respiratory tract infections caused by amoxicillin-resistant haemophilus influenzae. 702 35


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