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Query: UMLS:C0023241 (Legionella)
 6,990 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The in vitro activities of temafloxacin, ciprofloxacin, and ofloxacin against gram-negative bacteria are compared. The 90% minimal inhibitory concentrations (MIC90s) of temafloxacin for respiratory pathogens such as Haemophilus influenzae, Moraxella catarrhalis, Neisseria meningitidis, Bordetella pertussis, and Legionella pneumophila are less than or equal to 0.06 micrograms/mL. Temafloxacin is also active against bacterial agents of sexually transmitted diseases, including Neisseria gonorrhoeae (MIC90 less than or equal to 0.015 micrograms/mL) and Chlamydia trachomatis (MIC90 0.25 micrograms/mL). For strains of Enterobacteriaceae, Campylobacter, Vibrio, Aeromonas, and Acinetobacter, temafloxacin is generally inhibitory at less than or equal to 0.5 micrograms/mL. The MIC90 of temafloxacin for Pseudomonas aeruginosa is higher than that of ciprofloxacin, approximately 4 micrograms/mL versus 0.5 micrograms/mL. This activity, combined with its pharmacokinetic characteristics, should make temafloxacin an effective antimicrobial agent against infections caused by gram-negative bacteria.
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PMID:In vitro activity of temafloxacin against gram-negative bacteria: an overview. 166 90

Although the fluoroquinolones share many properties, these agents differ in their ability to kill the same bacterial strain. The bactericidal activity of temafloxacin against a number of pathogens has been compared with that of other fluoroquinolones by determination of minimal bactericidal concentration, time-kill kinetics, and postantibiotic effect. Studies have demonstrated that temafloxacin has equivalent or superior ability to kill when compared with other fluoroquinolones. Temafloxacin, ciprofloxacin, and PD 117558 were more active than other fluoroquinolones against Mycobacterium avium complex, with 90% minimal bactericidal concentrations (MBC90S; 8-16 micrograms/mL) four- to eightfold greater than 90% minimal inhibitory concentrations (MIC90S; 2 micrograms/mL). Against Chlamydia trachomatis the MIC90 and MBC90 of temafloxacin were both 0.25 microgram/mL; ciprofloxacin was less active (MBC90 twice the MIC90), and norfloxacin was least active. Temafloxacin demonstrated more rapid killing kinetics than did ciprofloxacin or ofloxacin at all concentrations tested against Streptococcus pyogenes. Findings were similar against Streptococcus pneumoniae at antibiotic concentrations of 1-2 micrograms/mL. Similar time-kill curves against Escherichia coli were observed for temafloxacin, ciprofloxacin, and difloxacin. Time-kill kinetics of temafloxacin against methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive S. aureus (MSSA) were superior to those of ciprofloxacin and ofloxacin. Postantibiotic effect with temafloxacin against Legionella pneumophila showed a considerable delay in regrowth, and temafloxacin delayed regrowth of MRSA and MSSA to a greater extent than did ciprofloxacin or ofloxacin. By the three methods used in the studies to assess bactericidal activity that are currently published, temafloxacin had equivalent or superior activity to the comparative fluoroquinolones tested. Other organisms remain to be tested and the significance of these findings determined in clinical studies.
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PMID:Evaluation of the bactericidal activity of temafloxacin. 166 93

The new macrolides, notably clarithromycin and azithromycin, are significant advances over previous agents. With an extended antibacterial spectrum, increased activity, improved absorption and excellent tissue and intracellular penetration, they realize therapeutic aims which have been increasingly sought in the 1980s. They are likely to find an extended role in respiratory tract infections, especially in community-acquired pneumonia, where the activity against beta-lactam-resistant bacteria and intracellular pathogens, e.g. Mycoplasma pneumoniae, Legionella spp. and Chlamydia pneumoniae have a significant role to play. Realistic twice or once daily dosing will prove a powerful argument for their use and the major improvement in gastrointestinal tolerance compared with erythromycin is likely to prove a deciding factor in their favour.
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PMID:The future role and importance of macrolides. 168 83

Choosing appropriate antimicrobial therapy for patients with pneumonia requires knowledge of the etiologic agents seen in specific kinds of patients at specific times and places. For community-acquired pneumonia, there is an important difference in the agents seen in the normal and the compromised host. The normal host most often presents with viral, mycoplasmal, or pneumococcal pneumonia. The exact place of Chlamydia pneumoniae is still under study. A normal host who aspirates is at risk of anaerobic pneumonia. Normal hosts with influenza may acquire superinfection with Streptococcus pneumoniae, Haemophilus influenzae, or Staphylococcus aureus. Under specific epidemiologic conditions, community-acquired pneumonia may be due to Legionella species, Yersinia pestis, Francisella tularensis, Coxiella burnetii, Chlamydia psittaci, a mycotic agent, or tuberculosis. Patients with chronic bronchitis and emphysema are predisposed to H. influenzae, Moraxella catarrhalis, and S. pneumoniae infections. HIV-infected patients are likely to have Pneumocystis carinii pneumonia and pneumonia due to cytomegalovirus, S. pneumoniae, and H. influenzae. Patients with diabetes, nursing-home patients, hospitalized patients, immuno-compromised patients, and patients with recent antibiotic therapy are predisposed to pneumonia due to Gram-negative aerobic bacilli of enteric and environmental origin. Initial therapy should be directed at the likely organism or organisms based on hospital susceptibility surveillance. In the normal host with community-acquired pneumonia, the therapy will often be penicillin G or erythromycin. In the patient predisposed to Gram-negative pneumonia, a third-generation cephalosporin with or without an aminoglycoside is the usual choice.
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PMID:Pneumonia. Patient profiles, choice of empiric therapy, and the place of third-generation cephalosporins. 173 Jan 86

A prospective study of community-acquired pneumonia in Hong Kong was carried out between January and December, 1988. Ninety adults (57 male) with a mean age of 57.3 years were admitted to the Prince of Wales Hospital with community-acquired pneumonia. The etiologic diagnosis of pneumonia was made in 37 cases (41 percent). Pneumococcal infection was diagnosed in 11 patients (12 percent). The same number of patients had pulmonary tuberculosis presenting as acute pneumonia. It could not be differentiated from other causes of pneumonia on clinical and radiologic grounds, although pleural effusion and upper lobe involvement were more common in patients with tuberculosis. Chlamydia species were identified in five patients (6 percent) and Mycoplasma pneumoniae was identified in three patients (3 percent). There was no case of Legionnaires' disease. The etiologic agent could not be identified in 59 percent of cases. The low incidence of etiologic diagnosis of community-acquired pneumonia was probably related to the widespread use of antibiotics in private practice. Tuberculosis is an important cause of community-acquired pneumonia in Hong Kong and this diagnosis should be considered in patients who fail to respond to first-line antibiotics.
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PMID:A prospective study of community-acquired pneumonia in Hong Kong. 848 72

The tetracyclines are effective in the treatment of Chlamydia, Mycoplasma pneumoniae, and rickettsial infections and also can be used for gonococcal infections in patients unable to tolerate penicillin. These drugs may cause gastrointestinal irritation, diarrhea, phototoxic dermatitis, and vestibular damage, and fatal reactions due to hepatotoxicity have occurred in pregnant women. Chloramphenicol has a broad spectrum of bacteriostatic activity, but its association with suppression of the bone marrow and aplastic anemia has relegated it to a historical role. Erythromycin is the drug of choice for the treatment of infections caused by M. pneumoniae, Legionella species, group A beta-hemolytic streptococci, and Streptococcus pneumoniae. The frequency of serious adverse effects associated with the use of erythromycin is low; dose-related epigastric distress may occur. Clindamycin is bactericidal to most nonenterococcal gram-positive aerobic bacteria and many anaerobic microorganisms. Although historically it was a frequent cause of antibiotic-associated diarrhea and colitis, clindamycin is considered an excellent alternative to beta-lactam antibiotics for treatment of many staphylococcal infections, and it has therapeutic utility in anaerobic infections and in several protozoan infections in immunosuppressed patients. Metronidazole is efficacious for treating nonpulmonary anaerobic infections, various parasitic infections (trichomoniasis, amebiasis, and giardiasis), nonspecific vaginitis, and Clostridium difficile-mediated colitis. With use of metronidazole, mild side effects such as epigastric discomfort, diarrhea, reversible neutropenia, and allergic-type cutaneous reactions may occur.
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PMID:Tetracyclines, chloramphenicol, erythromycin, clindamycin, and metronidazole. 174 96

To assess the safety and efficacy of a ten-day oral course of ofloxacin (400 mg 12 hourly) as compared with erythromycin (400 mg every 6 hours) for treatment of lower respiratory tract infections, fifty-two adult outpatients with pulmonary infiltrates (pneumonia) or with a cough and purulent sputum (bronchitis) were evaluated. Expectorated sputum specimens were Gram-stained and cultured, and antibody titres to Mycoplasma pneumoniae, Legionella pneumophilia, and in most cases Chlamydia pneumoniae were measured on acute and convalescent serum samples. Patients were evaluated clinically, microbiologically and radiographically three to five days after concluding therapy; the incidence of adverse reactions was monitored throughout the study period. The ofloxacin group (N = 25) was comprised of nineteen patients with pneumonia and six patients with bronchitis. The erythromycin group (N = 27) was comprised of thirteen patients with pneumonia and fourteen patients with bronchitis. All fifty-two patients were either clinically improved or cured after therapy. Microbiological cure was documented in all fourteen cases (27%) in which causative pathogens were identified. Clinical cure was achieved with ofloxacin in 68% of patients with pneumonia and in 83% of patients with bronchitis, while clinical cure with erythromycin was achieved in 46% of patients with pneumonia and 54% of patients with bronchitis. Adverse reactions (mostly mild gastrointestinal or central nervous system symptoms) were reported by eight patients receiving ofloxacin and four patients receiving erythromycin. While the types of adverse effects were similar, ofloxacin showed a trend toward a higher rate of cure than erythromycin. Ofloxacin is a promising new antibiotic for the treatment of acute lower respiratory infections.
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PMID:Treatment of lower respiratory infections in outpatients with ofloxacin compared with erythromycin. 175 88

Macrolide antibiotics have been available and used clinically since 1952. The class of drugs originated from a soil sample obtained from the City of Ilo-Ilo on the Island of Paray in the Philippines. Erythromycin has been the most widely used agent of this class called 'macrolides' because they possess the macrocyclic lactone nucleus. Many esters of erythromycin are well established as agents to treat a variety of respiratory and cutaneous infections, particularly in children. There has been a resurgence of interest in macrolides as a result of the recognition of pathogens such as Legionella, Chlamydia and Campylobacter spp. A number of new 14-membered macrolides have been synthesised in recent years with the goal of overcoming some of the problems of the older erythromycin agents. There has been variable activity of erythromycin against Haemophilus influenzae; there has been gastrointestinal irritation, particularly in adults; and the older agents are administered four times a day. Clarithromycin has increased activity against Legionella, and Branhamella spp., and Pasteurella multocida, and, with its 14-OH metabolite, inhibits Haemophilus spp. It is also more active against chlamydia and against anaerobic species while retaining excellent activity against streptococci including Streptococcus pneumoniae. It has increased plasma peak levels and a sufficiently long half-life for twice daily administration. Furthermore, it is well tolerated. Thus clarithromycin offers potential for use in those areas in which a safe, well tolerated macrolide will be used, namely respiratory, skin structure and selected diarrhoeal and genital infections.
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PMID:The development of macrolides: clarithromycin in perspective. 182 94

Community-acquired pneumonia (CAP) is the sixth most common cause of death in the United States. Despite its frequency and mortality, specific etiologic diagnosis remains a major clinical challenge. The organisms most commonly implicated in CAP are Streptococcus pneumoniae, Mycoplasma pneumoniae, Legionella pneumophila, Haemophilus influenzae, Chlamydia pneumoniae (TWAR), and viruses. Clinical and radiographic criteria have proven to be of little value in determining the etiology of CAP. Laboratory studies, including Gram's stain and culture of sputum, have also been shown to be of severely limited value to the clinician faced with the patient with CAP. Antibiotic therapy must, therefore, generally be empiric. Regimens including erythromycin either as a single agent or coupled with an aminoglycoside or cephalosporin appear to be most efficacious.
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PMID:Community-acquired pneumonia: the clinical dilemma. 186 Dec 71

In view of their antimicrobial activity and pharmacological properties, fluoroquinolones should be suitable for the treatment of lower respiratory tract infections. The overall clinical success rate using enoxacin, ofloxacin, pefloxacin, and ciprofloxacin ranges from 81% to 89%. Despite relatively high MICs of the fluoroquinolones for Streptococcus pneumoniae, the clinical success rate of these drugs in pneumococcal infections is 91%, but the eradication rate of this pathogen is lower (73%). In addition, fluoroquinolones appeared to be as effective as standard antibiotic regimens for treatment of bronchopulmonary infections in most of the comparative trials reported. The new quinolones could be a good alternative for treatment of acute exacerbations of chronic bronchitis, especially if examination of the sputum reveals gram-negative pathogens. In community-acquired pneumonia, drugs other than quinolones seem indicated because of the limited efficacy of the new quinolones in the treatment of severe pneumococcal infections and the poor activity of these drugs against the anaerobic flora causing aspiration pneumonia. In contrast, new quinolones should be very suitable for treatment of nosocomial pulmonary infections due to gram-negative pathogens. Quinolones used with or without erythromycin and rifampin, might be useful in the treatment of Legionnaires' disease. The role of these drugs in treatment of Chlamydia and Rickettsiae infections remains to be defined.
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PMID:Role of quinolones in the treatment of bronchopulmonary infections, particularly pneumococcal and community-acquired pneumonia. 186 91


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