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Query: UMLS:C0027947 (neutropenia)
 17,527 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We report on 17 Australian cases of human infection or colonization with Scedosporium inflatum. The spectrum of clinical manifestations was similar to that in infection caused by Scedosporium apiospermum. The patients were classified into three groups. Four immunocompetent patients who presented with localized infections of a joint, nail bed, eye, or sphenoidal sinus made up the first group. Our first case, in a boy with posttraumatic septic arthritis, responded to surgical drainage with amphotericin B followed by treatment with itraconazole. The other three cases were cured by surgery alone. The second group consisted of five immunocompromised patients who presented with disseminated infections in a variety of sites. Four of these patients did not respond to antifungal therapy and died. The fifth apparently responded to antifungal drugs after correction of his neutropenia. The third group included eight patients with asymptomatic colonization in the external ear (five cases) or respiratory secretions (three cases). The nine isolates of S. inflatum tested by both disk and agar dilution methods were resistant to antifungal drugs. In our first case, which responded clinically to itraconazole, the MIC of this drug for the fungal isolate was 25 micrograms/mL. Thus S. inflatum can cause a broad spectrum of human infections whose severity and prognosis depend largely on the host's immune status.
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PMID:Clinical features of human infection with Scedosporium inflatum. 153 93

The increase in the incidence of infections due to beta-lactam-resistant coagulase-negative staphylococci has resulted in expanded use of vancomycin for such infections. Despite this, coagulase-negative staphylococci have remained susceptible to vancomycin in recent years. This report describes a strain of Staphylococcus haemolyticus with increased resistance to vancomycin (MIC, 8.0 to 16 micrograms/ml). S. haemolyticus was initially isolated from a patient with acute leukemia and neutropenia in surveillance throat and stool cultures. The microdilution vancomycin MICs for these isolates were 1.0 to 2.0 micrograms/ml. Subsequent S. haemolyticus isolates from the bloodstream and tracheal aspirate occurred in the setting of prolonged empirical vancomycin therapy. MICs for these isolates were 8.0 to 16 micrograms/ml. Further vancomycin resistance (MIC, 32 micrograms/ml) could be selected for in vitro in all four isolates. Restriction endonuclease analysis of plasmid DNA indicated that the isolates were very closely related and likely to be of the same strain. We conclude that colonization with a vancomycin-susceptible strain of S. haemolyticus was subsequently linked to a nosocomial bloodstream infection with an apparently identical strain with intermediate levels of vancomycin resistance. Prolonged empirical vancomycin therapy was temporally associated with this episode.
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PMID:Vancomycin resistance in Staphylococcus haemolyticus causing colonization and bloodstream infection. 222 88

To assess the efficacy of ciprofloxacin in neutropenic patients, we conducted a randomized prospective trial comparing the combination of ciprofloxacin and netilmicin against piperacillin plus netilmicin as an empiric treatment of fever in cancer patients with neutropenia. Of 214 evaluable episodes, 115 and 99 were randomly assigned to the ciprofloxacin and the piperacillin arms, respectively. The overall response rates were very similar (59 and 62% for the ciprofloxacin and piperacillin arms, respectively). The response for the gram-positive bacteremias was almost identical (around 40%); this low response was due in part to an outbreak of infection by a multiply resistant strain of Staphylococcus epidermidis (for which the ciprofloxacin MIC was greater than or equal to 128 micrograms/ml) which occurred during the second half of the trial. Among gram-negative bacteremias, 9 of 11 infections (82%) responded to the ciprofloxacin combination compared with 3 of 7 (43%) that responded to the piperacillin combination (P = 0.23). The incidences of persistent, profound neutropenia were comparable in both treatments, but the susceptibility of the gram-negative organism to ciprofloxacin and netilmicin was significantly higher than was susceptibility to the other combination. Ciprofloxacin was well tolerated, and patients were able to convert from intravenous to oral therapy in 64 of 115 episodes.
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PMID:Randomized trial comparing ciprofloxacin plus netilmicin versus piperacillin plus netilmicin for empiric treatment of fever in neutropenic patients. 265 17

Fifteen (15.2%) of 99 Gram-negative bacteria isolated from patients during episodes of fever and neutropenia had minimum inhibitory concentrations ranging from less than 2 to 32 mg/l but were not fully sensitive to piperacillin by disc diffusion testing. These 15 isolates were further examined using a chemostat system, in which susceptible isolates were rapidly killed by piperacillin. Only three of the 15 isolates were susceptible to piperacillin when compared to sensitive control strains using the chemostat system. The results of this study suggest that an increase in the MIC to piperacillin is a less sensitive indicator of resistance to piperacillin amongst Gram-negative isolates than a reduction in the zone of inhibition in disc diffusion testing.
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PMID:Use of a continuous culture system for susceptibility testing of gram-negative bacterial isolates to piperacillin. 280 99

Ceftriaxone, a cephalosporin with an extended half-life and excellent antibacterial activity was used to treat bacterial meningitis, given as a single daily intravenous dose of 100 mg/kg on day one, followed by 80 mg/kg daily. A total of 22 patients were treated, of whom 14 had Haemophilus influenzae type b, five had Streptococcus pneumoniae and three Neisseria meningitidis isolated from their CSF. The CSF of all patients became sterile within 24-48 h. The CSF ceftriaxone concentrations 24 h after dosing were 10 to 100-fold higher than the MIC of the pathogenic bacteria early in therapy, and five to 50-fold higher at the end of therapy. Side effects encountered included mild diarrhoea (32%), thrombocytosis (77%) and neutropenia (9%), but none caused therapy to be stopped. Ceftriaxone is a safe and effective antibiotic for the treatment of bacterial meningitis when administered once daily.
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PMID:Treatment of bacterial meningitis with once daily ceftriaxone therapy. 339 63

Flomoxef (FMOX, 6315-S), a newly synthesized antibiotic which belongs to the oxacephem group, was clinically evaluated for its efficacy and safety in 17 patients with ages ranging from 1 month to 9 year-8-month who had bacterial infections. The results obtained were summarized as follows. 1. A pharmacokinetic study following 20 mg/kg FMOX administration by intravenous bolus injection showed that the half-life of FMOX (beta phase) was 39.8 minutes and the urinary excretion of FMOX in the first 6 hours was 76.5%. 2. FMOX was administered to 3 patients with pneumonia, 8 patients with bronchopneumonia, 2 patients with tonsillitis, 2 patients with pyelonephritis, one patient each with cervical lymphadenitis, and pustulosis associated with severe varicella at daily dosage levels of 61.9 approximately 87.2 mg/kg, divided into 3 or 4 administrations by intravenous bolus injection or by 30 minutes drip infusion. The clinical results of these 17 patients were as follows; excellent: 14 patients, good: 2 patients, poor: 1 patient. The efficacy rate was 94.1%. 3. No clinical adverse reaction was observed in any of the 17 patients. Neutropenia, eosinophilia, a slight elevation of GPT and slight elevations of GOT & GPT were observed in 1, 1, 1, and 2 patients, respectively. No abnormality in coagulation system was observed in any of 10 evaluable patients. 4. MICs of FMOX against 13 strains isolated from patients were as follows. MIC against 2 out of 3 strains of Streptococcus pneumoniae was 0.20 micrograms/ml and that of the remaining 1 strain was 0.39 micrograms/ml.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Clinical studies of flomoxef in the field of pediatrics]. 343 Jul 17

Cefuzonam (L-105, CZON), a new parenteral cephalosporin, was evaluated for its efficacy and safety in 22 children with bacterial infections (Table 1). The results obtained are summarized below. MICs of CZON to 26 strains of isolated organisms are shown in Table 2. MICs to all 14 strains of Haemophilus influenzae and 6 strains of Streptococcus pneumoniae were less than 0.05 microgram/ml. The MIC to 2 strains of Staphylococcus aureus was 0.39 microgram/ml and that to another was 0.78 microgram/ml. Two strains of Escherichia coli showed MICs of less than 0.05 and 0.10 microgram/ml, respectively. The MIC to 1 strain of Enterococcus faecalis was 6.25 micrograms/ml. The CZON was administered in 3 or 4 divided doses at a daily dosage ranging from 58.5 to 85.7 mg/kg by 30-minute drip infusion or intravenous injection to 22 patients (9 cases of pneumonia, 9 cases of tonsillitis, 2 cases of bronchitis, 1 case each of suppurative parotitis and acute pyelonephritis) and the following clinical results were obtained; excellent: 12 cases; good: 7 cases; fair: 3 cases. The overall efficacy rate was 86% (Table 4). Diarrhea was observed in four patients, and was resolved with or without discontinuation of the medication within a week. Anemia was noted in 2 cases. Leucopenia and neutropenia was observed in 1 case. There were a moderate rises in S-GOT and S-GPT activities in 1 patient (Table 4), and they necessitated the cessation of the CZON therapy. The S-GOT and S-GPT activities became normal after the drug treatment was stopped.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Clinical evaluation of cefuzonam in children]. 359 88

Cefoxitin (CFX) was evaluated for its safety and efficacy in children. Fifteen patients were treated with 73-125 mg/kg per day of CFX by intravenous administrations. The diagnosis of the patients were acute pharyngitis (4), pneumonia (2), pertussis and pneumonia (1), urinary tract infection (3); and the remaining 5 patients were esteemed to have nonbacterial infections. All the 10 patients of bacterial infections were cured after the CFX therapy. The pathogens recovered were Streptococcus pyogenes (1), Streptococcus pneumoniae (3), Haemophilus influenzae (2), Escherichia coli (2), enteropathogenic Escherichia coli (1), and Klebsiella pneumoniae (1). All the strains isolated were susceptible to CFX, but the 2 isolates of Haemophilus influenzae had relatively high MIC values (12.5 mcg/ml). Diarrhea (3 cases) and transient neutropenia (1 case) were found to be associated with the CFX therapy. However, no severe adverse reactions were encountered. Half-life of the serum level was short (24.1 minutes) and excretion into the urine was rapid. CSF concentration obtained 30 minutes after an intravenous injection of 50 mg/kg of CFX in 1 case with inflamed meninges was considerably high (8.3 mcg/ml). CFX appears to be a safe and effective antibiotic when used in children with susceptible bacterial infections.
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PMID:[Clinical evaluation of cefoxitin in children (author's transl)]. 728 18

To evaluate the efficacy of a three-drug regimen vs. a two-drug CDDP based combination in the treatment of NSCLC, we conducted a three-arm randomized parallel trial comparing (a) CDDP (120 mg/m2 day 1) + etoposide (100 mg/m2 days 1-3) every 3 weeks (PE--arm A); (b) CDDP (120 mg/m2 every 4 weeks) + mitomycin (8 mg/m2 days 1, 29, 71) + vindesine (3 mg/m2 days 1, 8, 15, 22 every 2 weeks) (MVP--arm B); and (c) CDDP (120 mg/m2 day 1) + mitomycin (6 mg/m2 day 1) + ifosfamide (3 g/m2 day 2) every 3 weeks (MIC--arm C). From May 1989 to April 1992, 393 consecutive previously untreated patients with NSCLC Stage IIIB and IV entered the trial; 373 were evaluable for survival and 360 for response. The response rate was significantly better for both the three-drug regimens compared with PE (Table 3). Logistic regression model showed a significantly better response in patients with a good P.S. and in Stage IIIB. Main toxicity consisted of myelosuppression: neutropenia Grade III-IV was recorded in 14% (arm A), 15% (arm B) and 21% (arm C). Thrombocytopenia Grade III-IV was worst in arm C: 10% vs. 5% (arm A) and 3% (arm B). Nephrotoxicity Grade III-IV was more common in arm C: 3.5%. Toxic deaths were 11 (3%: three in arm A, five in arm B, three in arm C). From our data, the three-drug containing regimens, MVP and MIC, appear more active than the two-drug combination PE in treatment of advanced NSCLC.
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PMID:Superiority of three-drug combination chemotherapy versus cisplatin-etoposide in advanced non-small cell lung cancer: a randomized trial by the Italian Oncology Group for Clinical Research. 755 20

Many factors are considered in designing optimal drug regimens, including dose, route of administration, and the frequency and rate of administration. It is evident that the first parameter to be considered in dosage regimen determinations is the pharmacokinetics of the drug in the treated patient, or more extensively in the corresponding specific population of patients characterized by a similar pathophysiological status, e.g. neutropenics, ICU patients, subjects with renal insufficiency, children, geriatrics... Therefore, over the last two decades, pharmacokinetic principles have widely, and almost exclusively influenced the optimal adaptative control of antibiotics with a small therapeutic index. The large number of available new drugs associated with medical progress, specially in considering the increase of surviving patients with severe diseases or precarious physiopathological status (e.g., neutropenia, AIDS, ICU patients ...) have demonstrated the limits of this approach and pointed out the necessity of the determination of suitable parameters reflecting the in vivo efficacy. Thus, the search for pharmacodynamic parameters that can be accurately related to pharmacokinetic profiles in patients becomes a major tool. The progress in measurement of antibiotics and the additional dimension of the antibiotic's efficacy evaluation based on the analysis of the time course of the antibacterial effects, have provided the basis for the coupled evaluation of pharmacokinetics and pharmacodynamics of antibiotics, which has been largely assessed by in vivo animal models. In an attempt to propose a methodology that can provide information directly applicable to patients to be treated, we have developed a human in vivo/ex vivo model of analysis of the pharmacodynamics of antibiotics. This model has been applied to several drugs and particularly to aminoglycosides. It allows one to have a more rational evaluation of the dose-concentration-effect relations for antibiotics in man. The pharmacodynamics of aminoglycosides is characterized by a strong concentration dependent bactericidal activity and a significant post-antibiotic effect against Gram-negative bacilli. Experimental animal studies confirmed by investigations in man have shown that in vivo efficacy is enhanced by increasing the Cmax and the AUC of these antibiotics regardless of the possible below-MIC value of the C min. Moreover, the in vivo efficacy seems to be the same whether the total dose of aminoglycoside is given as a once a day dosing or as several doses while the toxic risk appears to be attenuated by the first dosage schedule. These data also emphasize the need for the development of models and software for optimal adaptive control including the pharmacodynamic parameters of antibiotics.
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PMID:Optimal adaptive control of pharmacodynamic effects with aminoglycoside antibiotics: a required approach for the future. 792 59


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