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Query: UMLS:C0034186 (pyelonephritis)
 6,144 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The efficacy of the traditionally recommended ampicillin (Amp) plus gentamicin (GM) regimen was compared with that of a trimethoprim-sulfamethoxazole (TMP/SMZ)-plus-GM regimen and the adequacy of 14 days total therapy for acute uncomplicated pyelonephritis (AUPN). Eighty-five women hospitalized for AUPN were randomly assigned to receive either Amp, 1 g intravenously (iv) every 6 h for 3 days, then 500 mg orally four times daily, or TMP/SMZ, 160/800 mg iv every 12 h for 3 days, then 160/800 mg orally twice daily. Initially, all patients also received GM every 8 h iv (mean, 606 doses). Antimicrobial resistance necessitated modifying therapy of 14 (32%) of the Amp recipients but of none of the TMP/SMZ recipients (P less than .001). Both regimens produced a satisfactory bacteriologic and clinical response in all cases. Reinfection occurred in 11% of Amp and in 8% of TMP/SMZ recipients. No patient experienced relapsing infection. The TMP/SMZ regimen was less costly and less likely to require modification due to antimicrobial resistance.
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PMID:Therapy for women hospitalized with acute pyelonephritis: a randomized trial of ampicillin versus trimethoprim-sulfamethoxazole for 14 days. 198 16

To evaluate the natural history of uncomplicated urinary tract infections in women, we observed 51 infection-prone women in a standardized fashion for a median of 9 years. During intervals when patients were not receiving antimicrobial prophylaxis, infections occurred at an average rate of 2.6 per patient-year, but the rate varied widely from patient to patient (range 0.3-7.6 episodes per year). Seventy-three percent of the observed episodes were symptomatic, with an 18:1 ratio of cystitis to pyelonephritis episodes. Infectious episodes were strikingly clustered, and rates of infection decreased in the winter months. Antimicrobial prophylaxis was highly effective in preventing acute cystitis, asymptomatic bacteriuria, and acute pyelonephritis, even when used for as long as 5 years. The proportions of infecting strains resistant in vitro to ampicillin (19%-32%) and nitrofurantoin (5%-18%) were unchanged over the 15-year observation period, while resistance to trimethoprim-sulfamethoxazole increased in the last 5 years of the study.
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PMID:Natural history of recurrent urinary tract infections in women. 196 78

Cefpirome (HR 810) is a new cephalosporin with a 2,3-cyclopentenopyridine group in the 3-position side chain. It was compared with other cephem antibiotics in protective and therapeutic effects on various experimental infections, systemic and local, in mice and rats. HR 810 had more potent protective effect than ceftazidime (CAZ), cefoperazone (CPZ), and cefotaxime (CTX) on systemic infections induced by Escherichia coli Ec-31, Staphylococcus aureus SMITH, and Serratia marcescens Sm-6 in mice. Against systemic infection with Pseudomonas aeruginosa HR 810 was as effective as CAZ. Mice with leukopenia induced by cyclophosphamide were systemically infected with methicillin-resistant S. aureus (MRSA), methicillin-susceptible S. aureus (MSSA), Enterobacter cloacae, Acinetobacter calcoaceticus, and Enterococcus faecalis. HR 810 was superior to cefuzonam (CZON) and cefmetazole against MRSA and MSSA and was much more active than any other antibiotics tested against E. cloacae and A. calcoaceticus. In the activity against E. faecalis, HR 810 was inferior to ampicillin but superior to CZON. In mice with pyelonephritis caused by E. coli Ec-7, the rank order of activities was HR 810 greater than CAZ greater than CTX greater than CPZ. HR 810 was more effective than latamoxef, CAZ, CTX, and CPZ in improving lung infections induced by Streptococcus pneumoniae HL 438 and Klebsiella pneumoniae Kp-51 in mice. HR 810 was superior to CTX and CPZ and comparable to cefazolin in therapeutic effects on intrauterine infections with E. coli Ec-89 and S. aureus SMITH in rats.
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PMID:Therapeutic effects of cefpirome, a new cephalosporin, on various models of infections in mice and rats. 219 11

The purpose of this investigation was to determine the prevalence of antibiotic-resistant uropathogens in 121 pregnant patients hospitalized with acute pyelonephritis. We obtained urine for culture by catheterization and defined a positive culture as greater than 100 colony-forming units per milliliter of urine. We determined bacterial sensitivities with either the Bauer-Kirby disc diffusion test or the Vitek Auto Microbic System. During the 4 years of the study, the prevalence of ampicillin-resistant organisms was 26% (95% confidence interval 18-34%). However, only 4% (95% confidence interval 0-8%) of the uropathogens were resistant to limited-spectrum, first-generation cephalosporins. This observed difference in antibiotic sensitivity was highly significant (P less than .005). Therefore, we conclude that a limited-spectrum cephalosporin is more appropriate than ampicillin for empirical therapy of pyelonephritis in pregnancy.
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PMID:Prevalence of antibiotic-resistant uropathogens in obstetric patients with acute pyelonephritis. 237 Oct 28

A prospective study was carried out in 103/863 obstetric patients with cystitis characterized by urinary urgency and frequency, dysuria, pyuria and suprapubic discomfort in the absence of systemic symptoms such as fever and costovertebral angle tenderness. The association of symptomatic lower urinary tract infection with low-count bacteriuria (10(2)-10(5) UFC/mL of urine) was present in all the patients. The incidence of cystourethritis was about 12%, most of the infections occurred at the first trimester. To learn whether a multiple-dose of nitrofurantoin or ampicillin is safe and effective therapy for acute uncomplicated urinary tract infections, 103 symptomatic pregnant women were randomly grouped to receive oral nitrofurantoin (100 mg t.i.d.) or ampicillin (500 mg t.i.d.) for five days. Seventeen patient were excluded since they did not return for follow-up. Escherichia coli was isolated in 67% of infections. Overall cure varied from 87% to 89%, without any great differences between the regimens. Nine patients had asymptomatic bacteriuria in the course of pregnancy, four developed acute pyelonephritis and one of them had abnormal intravenous pyelogram.
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PMID:[Acute cystourethritis during pregnancy]. 248 4

The analytic hierarchy process (AHP) was used to determine which of seven recommended antibiotic regimens represented optimal initial therapy for a young woman hospitalized for treatment of acute pyelonephritis. The model included the following criteria: maximize cure, minimize adverse effects (broken down into very serious, serious, and limited), minimize antibiotic resistance, and minimize cost (divided into total cost and patient cost). The criteria were weighted according to judgments made by 61 practicing clinicians. Alternatives were compared relative to the criteria using published information on the expected frequencies of urinary pathogens and drug toxicity, local antibiotic sensitivities and antibiotic charges, and expert opinion regarding their propensities for inducing antimicrobial resistance. The analysis identified ampicillin combined with gentamicin as the optimal regimen. This study illustrates several features of the AHP that make it promising for use in medical decision making: its ability to incorporate multiple criteria into a formal decision model, its procedural simplicity, and its similarity to current patient management guidelines. Further studies to establish the role of the AHP in medical decision making are warranted.
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PMID:Medical decision making using the analytic hierarchy process: choice of initial antimicrobial therapy for acute pyelonephritis. 264 20

The therapeutic efficacy of orally administered zidovuldine (3'-azido-3'-deoxythymidine) was determined in animals infected with Escherichia coli and Salmonella dublin. The 50% effective dose (ED50) of zidovudine (9.6 to 11.8 mg/kg of body weight) compared favorably with that of trimethoprim (19.4 to 22.2 mg/kg) in mice with systemic E. coli infection. At 50 mg/kg, both zidovudine and ampicillin reduced the number of bacteria in the kidneys of mice and prevented lethal infection in mice with ascending pyelonephritis caused by E. coli. Zidovudine prevented a lethal S. dublin infection in calves over a wide dose range (8.0 to 31.0 mg/kg per day). Zidovudine levels in plasma of uninfected mice were 28.2 +/- 4.5 and 7.9 +/- 2.2 micrograms/ml at 30 and 60 min, respectively, exceeding the MICs for the bacteria used in the infections. Few zidovudine-resistant strains were observed. The in vivo data raise the possibility that zidovudine may have an antibacterial effect in patients receiving this therapy.
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PMID:In vivo efficacy of zidovudine (3'-azido-3'-deoxythymidine) in experimental gram-negative-bacterial infections. 265 92

Sixty pediatric patients (27 males and 33 females) between the ages of 7 months and 11.7 years (mean age = 4.3 yr) were treated with parenteral sulbactam plus ampicillin (1:2 ratio) for lower respiratory tract infections (29 cases), upper respiratory tract infections (4 cases), urinary tract infections (25 cases) or skin/soft tissue infections (2 cases). The infection was mild in 6 cases, moderate in 44 and severe in 10. The infection was acute in 57 patients, recurrent in 1 (cystitis) and was a flare-up of a chronic infection in 2 (pyelonephritis and cystitis). The children received an average dose of 48 mg/kg/d of sulbactam plus 96 mg/kg/d of ampicillin by the i.m. route (43 cases) or by i.v. drip (17 cases) in 3-4 divided doses. The length of treatment ranged between 3 and 10 d (mean duration = 6 d). At the end of therapy, clinical cure was achieved in 53 patients (88.3%), while 6 (10%) had a marked improvement. Only 1 patient, with a lower respiratory tract infection, did not respond to therapy. All 25 patients with urinary tract infection experienced bacteriological cure at the end of treatment. No side effects were reported. Mild and transient changes in laboratory parameters from baseline values were observed in 10 patients (eosinophilia, elevation of SGOT or SGPT) without clinical consequence. Sulbactam plus ampicillin was effective and safe in the treatment of bacterial infections in children and appears to be useful in the treatment of those infections in which beta-lactamase-producing organisms are involved.
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PMID:Clinical evaluation of sulbactam plus ampicillin in the treatment of general pediatric infections. 266 Aug 70

Pharmacokinetic and clinical studies on sulbactam/ampicillin (SBT/ABPC) were carried out in the field of pediatrics. 1. Absorption and excretion Serum levels and urinary excretion of SBT/ABPC were studied in 4 children with ages 6 to 8 years. The mean serum concentration of SBT at 15 minutes following a single intravenous injection of 30 mg/kg of SBT/ABPC was 27.4 +/- 2.2 micrograms/ml and that of ABPC was 42.8 +/- 3.9 micrograms/ml, and their concentrations declined with mean half-lives of 1.06 +/- 0.15 hours and 0.84 +/- 0.05 hour, respectively, and at 6 hours were 0.3 +/- 0.2 microgram/ml and 0.2 +/- 0.1 microgram/ml on the average, respectively. The urinary recovery rates of SBT and ABPC at 6 hours after the injection were 59.0 +/- 22.4% and 58.4 +/- 25.3% on the average, respectively. 2. Clinical study SBT/ABPC was used for the treatment of a total of 36 pediatric patients with ages ranging 2 months to 11 years and it's clinical effectiveness, bacteriological efficacy and adverse effects were evaluated. Clinical efficacies in 5 patients with acute purulent tonsillitis, 26 with acute pneumonia and 1 with acute pyelonephritis were judged to be excellent in 27 cases and good in 5 cases with an overall efficacy ratio of 100.0%. Clinical efficacies in 6 patients whose infections were caused by beta-lactamase producing strains were judged to be excellent in all cases. Bacteriological efficacies of SBT/ABPC were assessed on 1 strain of Staphylococcus aureus (beta-lactamase producing strain), 2 strains of Streptococcus pneumoniae, 16 strains of Haemophilus influenzae (5 beta-lactamase producing strains and 11 non-beta-lactamase producing strains), 1 non-beta-lactamase strain of Haemophilus parainfluenzae and 2 strains of Escherichia coli (non-beta-lactamase producing strains). All strains except 1 strain of H. influenzae (beta-lactamase producing strain) which decreased in number were eradicated with a bacteriological eradication rate of 95.5%. Only 1 patient complained of diarrhea which was suspected to be related to the drug. No other side effect was reported. Elevations of GOT and GPT were observed in only 1 patient. The above results suggested that SBT/ABPC was a useful drug with preferable safety profile in the treatment for pediatric patients with infectious disease caused by beta-lactamase producing strains as well as those by non-beta-lactamase producing strains.
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PMID:[Studies on sulbactam/ampicillin in the field of pediatrics]. 266 50

Persistent and recurrent infections of the urinary tract are a formidable clinical problem, but several recently developed antibiotics have properties that suggest an increased ability to eradicate such infections. Three of the new-generation antibiotics were compared with established agents by using animal models of urinary tract infection. Of the antibiotics tested, gentamicin and ceftriaxone alone were capable of eradicating infection from acute and chronically infected kidney tissue. Chronic lower urinary tract infection was best managed by using norfloxacin or ceftriaxone. Gentamicin, aztreonam, cotrimoxazole and ampicillin were much less effective. In subacute pyelonephritis, gentamicin, aztreonam, norfloxacin and ceftriaxone successfully eliminated microorganisms from most of the infected kidneys, whereas ampicillin and cotrimoxazole had little effect on bacterial numbers. The data have provided an experimental basis for the selection of antibiotics in the management of persistent urinary tract infection.
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PMID:Antimicrobial agents in the management of urinary tract infection: an experimental evaluation. 268 80


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