Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Aminoglycosides are potent water-soluble antibiotics, with peak concentration-dependent bactericidal activity against many pathogenic aerobic Gram-negative bacilli and Staphylococcus aureus. For systemic therapy, they must be given parenterally (intravenously or intramuscularly). In the body they remain largely extracellular, but penetration into cerebrospinal fluid and other secretions is meagre. They display trough concentration-dependent reversible nephrotoxicity and The commonly irreversible ototoxicity, which may present after treatment ceases. Gentamicin is the usual all-purpose agent of choice, tobramycin is slightly more effective against Pseudomonas aeruginosa infections, amikacin is the least susceptible to degradation by bacterial enzymes and netilmicin is probably the least toxic. Clinical and drug concentration monitoring have a role in therapy. Aminoglycosides exhibit enduring antibacterial activity (especially against Gram-negative bacilli) many hours after tissue concentrations become negligible. Appreciation of this postantibiotic effect is leading to replacement of conventional multiple daily doses by large single daily doses. The latter regimens confer at least equivalent efficacy and less risk of toxicity (particularly renal). However, single daily dosage may be unsuitable for immunocompromised patients and in those with infective endocarditis, where there is insufficient experience. Cotreatment with beta-lactams is commonly used in order to exploit the synergism between these agents, particularly in enterococcal endocarditis and severe Gram-negative sepsis. Liposomal aminoglycosides are promising parenteral formulations. After being taken up by phagocytes they reach the liver, spleen and sites of inflammation; subsequently they are gradually released. To substantiate the applicability of these hitherto experimental formulations, findings from clinical studies are keenly awaited.
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PMID:Parenteral aminoglycoside therapy. Selection, administration and monitoring. 752 30

Gram-negative sepsis contributes significantly to neonatal morbidity and mortality. Gentamicin is an aminoglycoside antibiotic used in the treatment of gram-negative infections. However, developmental differences of the neonate (compared with the older child or adult) influence the drug's disposition in the body. Administration, distribution, elimination, as well as susceptibility to toxicities may be altered in the neonatal period because of these pharmacokinetic differences. A literature review reveals pharmacokinetic differences of the neonate that affect gentamicin dosing. Nursing considerations affected by the developmental differences of the neonate include knowing appropriate dosages and routes of administration, pathophysiological and pharmacological conditions that affect gentamicin disposition, serum monitoring, and evaluation of adverse reactions and toxicities.
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PMID:A review of gentamicin use in neonates. 841 46

The use of gentamicin as a co-therapy for the treatment of sepsis is common practice in neonates and infants. Gentamicin dosing guidelines have been developed over the past 20 years to accommodate a slower renal elimination rate of gentamicin in the neonatal population. Recently, it has become evident that early attainment of serum gentamicin concentrations > or = 5 micrograms/ml results in a greater therapeutic outcome in septic adult patients. As neonatal immunity is immature and aminoglycosides have an extended elimination half-life in the very young population, reassessment of the initial gentamicin dose has become necessary. Using retrospective data, we determined the amount of gentamicin necessary to effectively "load" a group of neonatal/pediatric patients to achieve initial serum concentrations of 6 or 8 micrograms/ml. One hundred sixty-six patients less than 12 months postnatal age were studied. The mean initial dose delivered was 2.41 mg/kg. Younger patients demonstrated larger gentamicin apparent volumes of distribution and slower elimination half-lives than did older patients. Initial serum gentamicin concentrations calculated from steady-state pharmacokinetic parameters were significantly lower than those seen at steady state. In order to achieve initial serum gentamicin concentrations > 6 micrograms/ml an initial dose of 3 mg/kg would be necessary in the group of patients studied. Younger patients (< or = 34 weeks gestational age) would likely require 4 mg/kg as an initial dose.
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PMID:Determination of a gentamicin loading dose in neonates and infants. 845 81

In cranioplasty complexity is proportional to the size of the detect, particularly if greater than 50 cm2. If the patient's own bone flap is not available, allogenic frozen bone graft can be used instead. Between June 1990 and June 1995 twenty cranioplasties with allogenic frozen bone grafts were performed. Age of patients ranged between 23 and 63 years (average 38.4 years). Male/female ratio was 2:1.7. Size of craniectomy ranged between 65 and 150 cm2 (average 83.3 cm2). Follow-up ranged between 10 and 58 months (average 41 months). Donors were tested to rule out transmissible diseases, infections, sepsis and/or cancer. Bone grafts were removed under aseptic conditions, microbiological cultures were taken, wrapped in a gauze soaked with Gentamicin sulphate and Bacitracin, sealed in three sterilised vinyl plastic bags, and stored in a deep freezer for a minimum of 30 days (range 36-93 days, average 67 days), at a temperature of -80 degrees C. Grafts were placed in the defect after a step was carved on its borders to facilitate the contact between host and graft. Vancomycin 1 g. IV/12 hours and Ceftriaxone 1 g. IV/12 hours were administered for five days. Grafts were covered by means of scalp flaps. Only one required a musculocutaneous free flap. None was exposed, extruded or had to be removed. Plain skull X-ray studies showed progressive remodelling of the grafts. Partial resorption was observed in two (2/20, 10%) and loss of thickness in another 3/20 (15%), but with no changes in the contour. Biopsies were taken in 3/20 (15%) cases at a second surgical procedure. Areas of osteoclastic resorptive activity mixed with others of osteoblastic bone apposition, showed replacement with new bone. We conclude that cranial vault frozen allografts are a good alternative to autologous bone when the latter is absent or not present in sufficient amount.
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PMID:Use of frozen cranial vault bone allografts in the repair of extensive cranial bone defects. 926 59

During a 12-month study, 42 adult patients with febrile neutropenia (granulocytes < 1 x 10(9)/l) were treated with once-daily gentamicin (5 mg/kg). Serum gentamicin trough levels were measured 24 hours after the first dose, then twice weekly if < 1 mg/l. Gentamicin was halved if the trough level was 1-2 mg/l and usually stopped if > 2 mg/l. One hundred and sixty samples were assayed: 122 (76%) < 1 mg/l, 27 (17%) l-2 mg/l and 11 (7%) > 2 mg/l. All 1-2 mg/l samples and three of the > 2 mg/l samples (taken at the wrong time) reverted to <1 mg/l with dosage adjustment. The protocol proved simple and effective with a low incidence of gentamicin-associated nephrotoxicity (7%) and no sepsis-related deaths.
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PMID:Audit of once-daily dosing gentamicin therapy in neutropenic fever. 928 64

Bacteria associated with wound infection in Ekpoma, Nigeria, and their antimicrobial susceptibility profile was investigated by standard microbiological methods, using hospital as well as non-hospital patients. Of 40 patients seen, 25 (62.5%) were males, while the rest were females. Those aged 30 years and above accounted for 63% of the patients, and post-operative sepsis was the most frequently encountered wound infection. Of the organisms encountered, Staphylococcus aureus was the most frequently occurring organism (39%), followed by coliform bacilli (24%), which was the most prevalent organism (44%) in post-operative sepsis. Twenty-one percent of the isolates were Pseudomonas aeruginosa. The majority of the bacterial isolates from the infected wounds were susceptible to Gentamicin, as follows: 92% of the Staph. aureus, 100% of Streptococcus faecalis, Escherichia coli and Pseud. aeruginosa, and 75% of the coliform bacilli. It is suggested that gentamicin, in combination with metronidazole, be used not only for empirical treatment of wound infections in Ekpoma locality but also for prophylactic coverage of surgical operations.
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PMID:Microorganisms associated with wound infection in Ekpoma, Nigeria. 1050 64

Gentamicin is frequently used in elderly patients as serious infection, particularly Gram-negative bacilli, remains one of the major health problems experienced by this age group. A number of physiological changes in drug disposition occur with ageing and potentially these can affect gentamicin pharmacokinetics. In particular, there is a measurable decline in renal function, especially after the aged of 65. Any differences in drug distribution with age are apparently not reflected in gentamicin disposition data, as patients of varying ages have similar volumes of distribution. Seriously ill patients with infections frequently require treatment with many different drugs. Of note, the combination of gentamicin and a beta-lactam antibacterial can result in inactivation. However, there appears to be no published data describing detrimental or beneficial pharmacokinetic interactions between gentamicin and drugs used in the elderly. Nonetheless, gentamicin should be used cautiously in order to prevent potential exacerbation of its nephrotoxicity and/or ototoxicity. Such problems may occur as a result of coadministration with, for example, amphotericin, cisplatin, vancomycin, foscarnet, nonsteroidal anti-inflammatory drugs or furosemide (frusemide). The presence of concurrent disease in aged patients (e.g. malignancy, fluid balance disorders and sepsis) may cause problems. In sepsis, for example, the volume of distribution of gentamicin may be increased; however, other pharmacokinetic data are contradictory and inconclusive. Like other aminoglycosides, gentamicin has a narrow therapeutic index and therapeutic drug monitoring has proven to be beneficial, particularly in vulnerable populations such as the elderly. Moreover, there is substantial pharmacokinetic variability in these patients. Recent data support the use of extended interval or once daily doses of gentamicin. It has been suggested that because of a lack of studies for this regimen in the elderly, specific recommendations cannot yet be made. We would argue that some recommendations for its cautious adoption in aged patients could be justified. Suggested procedures for the once daily administration of gentamicin include the use of the 'Hartford' nomogram and the targeted area under the concentration-time curve. The susceptibility of the elderly to aminoglycoside-related nephrotoxicity (and probably ototoxicity) may arise from a decline in renal function and an impaired capacity for cellular repair and regeneration. However, of greater importance is the duration of aminoglycoside therapy and the concomitant use of other nephrotoxic drugs. Further confirmation of the utility and tolerability of the once daily regimen and other possible approaches to gentamicin therapy in the elderly are essential.
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PMID:Pharmacokinetics and therapeutic drug monitoring of gentamicin in the elderly. 1055 48

Eight horses with synovial sepsis induced by trauma were treated by arthroscopic/tenoscopic debridement and lavage followed by the implantation of a gentamicin-impregnated collagen sponge. Seven of them responded favourably and were sound six months after treatment. The other underwent a further surgical procedure and recovered. Gentamicin-impregnated collagen sponges appear to be a safe and useful adjunct in the treatment of septic joints and tendon sheaths, and have the advantage of being bioabsorbable.
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PMID:Treatment of traumatically induced synovial sepsis in horses with gentamicin-impregnated collagen sponges. 1098 61

Gentamicin-impregnated polymethylmethacrylate beads were used to treat infective arthritis in the small tarsal joints of 11 severely lame horses. Under general anaesthesia, between five and 10 beads were placed into a 7 to 8 mm tract drilled across the affected joint and, in all except one horse, they were left in place for 14 days. Two of the horses were euthanased for reasons other than persistent tarsal joint sepsis, but the other nine survived and seven of them returned to their previous level of athletic performance.
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PMID:Treatment of sepsis in the small tarsal joints of 11 horses with gentamicin-impregnated polymethylmethacrylate beads. 1132 53

A study of 256 annual reports from 17 rural tropical hospitals in 4 African countries over a period of 16 years showed an absolute increase in the number of patients admitted with infectious diseases. Admissions were highest for malaria, followed by pneumonia and gastroenteritis. Admissions for immunisable diseases are decreasing in all countries. Fever remains the most important indicator of infectious diseases. Analysis of fever patients in rural tropical hospitals relies on knowledge of the epidemiology of diseases, plus expertise in physical examination. In this study, a detailed analysis of 900 fever patients indicated that 4% showed no infection, 21% of infections could be diagnosed by physical examination, 35% were diagnosed with the help of additional laboratory tests and 40% of patients were diagnosed as FUO (fever of unknown origin). 17% of FUO patients had a short, self limiting fever, but the remaining 23% were severely ill, suggesting bacterial sepsis, as was indicated by earlier studies. Undiagnosed fevers with resulting over-treatment and high resistance are costly and dangerous. These effects stress the need for better and more laboratory facilities, including possibilities for bacterial cultures. At present, patients are generally over-treated with antimalarials and antibiotics, since further diagnostic facilities are not available. Resistance is high for antimalatials ( Malaria) and for Amoxycillin, Cotrimoxazole and Gentamicin (Gram-bacteria from urine and blood).
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PMID:Analysis of infectious diseases in rural tropical areas. 1215 52


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