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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Two new aminoglycoside antibiotics, tobramycin and amikacin, were compared in a randomized study of the treatment of infections in patients with cancer. For the identified infections, the response rate for tobramycin was 60% and for amikacin was 64%. Pneumonia, urinary tract infection, and septicemia were the most frequent infections. Most (78%) of the identified pathogens were gram-negative bacilli; Klebsiella pneumoniae, Escherichia coli, and Pseudomonas aeruginosa were the most frequently isolated organisms. When only infections due to gram-negative bacilli were considered, 67% responded to tobramycin and 69% responded to amikacin. All infections except pneumonias had at least a 50% response rate to either antibiotic. The major form of toxicity of both antibiotics was azotemia and occurred in 22% of cases treated with tobramycin and in 20% treated with amikacin. Tobramycin and amikacin are equally effective in the treatment of gram-negative infections and have similar toxicity.
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PMID:Comparison of amikacin and tobramycin in the treatment of infection in patients with cancer. 40 53

Abscess of the spleen is an uncommon entity that seems even less common as it still represents a diagnostic problem. The most common cause of splenic abscess is metastatic hematogenous seeding of the diseased spleen especially of the infarcted areas or traumatic hematomas. It can result also from the direct spread of infection from surrounding structures. Many patients with splenic abscess have a rapidly progressive generalized sepsis and even the combination of well-timed surgery and antibiotic therapy is not always curative. Local symptoms may be mild and overlooked and there may be only general symptoms of suppuration present. X-rays investigations often yield valuable information about the location of the abscess. By far the most promising technique is splenic scanning with the use of radioisotopes. Our case of splenic abscess following appendicitis has been described. The course and the diagnosis has been established using liver-spleen scanning. The patient was treated with Obracin and Dalacin and the diseased spleen has been removed. After drainage of the left subphrenic abscess the recovery was uneventful.
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PMID:[Spenic abscesses]. 51 22

Tobramycin is an aminoglycoside aminocyclitol antibiotic with pharmacological similarities to gentamycin. Twenty-one of 30 patients with a severe or complicated Gram-negative urinary tract infection were cured by treatment with a 5-day course of tobramycin. No side effects were noted. This drug should prove beneficial for the treatment of severe Gram-negative sepsis, and promises to be particularly valuable for infections due to Pseudomonas aeruginosa. Dosage schedules for administering tobramycin to patients with renal function impairment are presented, together with some observations on its intravenous injection by bolus. A single dose of tobramycin has proved effective for initiating the antibacterial treatment of patients with acute pyelonephritis. The important concept of the differing concentrations of an antibiotic in the urine from kidneys of unequal function is discussed.
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PMID:Tobramycin in the treatment of severe and complicated urinary tract infections. 60 Feb 1

Transfer of high-level gentamycin-tobramycin-sisomycin resistance could be easily demonstrated in strains of P. morganii and P. mirabilis which emerged, in two hospitals, at the end of 1976. First such strains were demonstrated in a patient of a urological ward who died, in September 1976, from generalised sepsis caused by a high-level gentamycin-tobramycin-sisomycin-resistant P. morganii. Since that event, at least nine such strains were isolated in 1976, and the presence of transferable resistant to the antibiotics listed plus other antibacterial substances including carbenicillin and more classical antibiotics could be demonstrated either by a high-frequence direct transfer to suitable recipient strains of Gentamycin or Tobramycin resistance, or by indirect selection, i.e. by analysis of exconjugants selected with kanamycin, streptomycin or carbenicillin. Further numerous strains of P. morganii highly resistant to gentamycin, tobramycin and sisomycin (M.I.C. over 128 mcg/ml) still emerge from wards in the two hospitals monitored and their transferability is under experimental study. It is stressed that, in order to demonstrate a transfer of gentamycin or tobramycin resistance in strains resistant to these substances, it is inevitable to examine properly also exconjugnants showing direct transfer to other, more classical antibiotics. We could not demonstrate, in our strains, any prodromal signs of resistance to netilmycin or amikacin.
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PMID:R plasmids coding for supra-levels of gentamicin, tobramycin and sisomicin resistance in Proteus morganii and P. mirabilis: high-level resistant strains from two hospitals. 73 60

The efficacy of tobramycin in doses of 2.7 to 5.6 mg/kg per day in 29 courses of therapy in 25 hospitalized patients with serious Pseudomonas aeruginosa infections was studied. Eighty-three percent of the P. aeruginosa strains showed zones of inhibition of 16 mm or more around a 10-mug tobramycin disk in the Bauer-Kirby disk method. Tobramycin minimal inhibitory concentration ranged from <0.05 to 1.5 mug/ml (microtiter twofold dilution method); for gentamicin they ranged from 0.05 to 6.2 mug/ml; corresponding geometric means were 0.19 and 0.49 mug/ml. Therapy was given for a median of 10 days (mean 19, range 1 to 83). The clinically satisfactory response rate for the 29 courses of therapy was 52%: critically ill, 44%; seriously ill, 50%; moderately ill, 80%. The response rates for various sites of infection were bone and cartilage, 100%; urinary tract infection, 56%; wound, 50%; respiratory tract, 67%; septicemia, 40%; abscess, 0%; burns, 44%. No adverse reactions were seen. Serum concentration (mug/ml +/- standard deviation) of tobramycin determined by an agar-well plate method, were 4.81 +/- 2.17 (1 h); 3.24 +/- 1.43 (2 h); 2.35 +/- 1.30 (4 h); and 1.40 +/- 1.09 (8 h). Tobramycin appears to be as effacacious as gentamicin in the treatment of serious P. aeruginosa infections and has a theoretical advantage of lower minimal inhibitory concentration for P. aeruginosa. The data suggest that, for life-threatening infections, dosages of tobramycin may need to be increased over those used in this study.
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PMID:Therapy of Pseudomonas aeruginosa infections with tobramycin. 80 2

The susceptibilities of various clinical isolates to tobramycin were studied, and the applicability of these data to clinical situations was evaluated. The bactericidal nature of tobramycin was confirmed by killing curves, and the minimal inhibitory concentrations for 500 common pathogens were used to define its spectrum. Isolates inhibited by less than or equal to 5 mug/ml were considered to be sensitive to tobramycin. The clinical response of some patients was examined in relation to the minimal inhibitory concentration for the infecting organism and the serum and urine levels of tobramycin. The activity of tobramycin was compared with that of gentamicin against Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa. Tobramycin was at least twice as active as gentamicin against P. aeruginosa. The effectiveness of tobramycin against S. aureus and E. coli was compared with that of other commonly used antibiotics, and its clinical role as an alternative to gentamicin in the "best guess" treatment of septicemia was considered. Lincomycin is often added to counter the ineffectiveness of tobramycin against streptococci and anaerobes such as Bacteroides species, but this combination was antagonistic against E. coli when tested in vitro by the checkerboard technique and its graphical display, the isobologram. Tobramycin was essentially similar to gentamicin in laboratory characteristics and clinical application but was more active against P. aeruginosa in general and against gentamicin-resistant strains in particular.
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PMID:Laboratory findings of tobramycin and their relation to clinical response. 82 77

Tobramycin is a new aminoglycoside antibiotic with pharmacological similarities to gentamicin. Eleven of 15 patients with a severe or complicated gram-negative urinary tract infection were cured by treatment with a five day course of tobramycin. No side effects were noted. This drug should prove beneficial for the treatment of severe gram-negative sepsis and promises to be particularly valuable for infections due to Pseudomonas aeruginosa and organisms resistant to gentamicin.
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PMID:Tobramycin in the treatment of severe and complicated urinary tract infections. 82 77

Tobramycin was used in the treatment of 35 severe infections. Its clinical effectiveness was confirmed in broncho-pulmonary infections without septicemia and in septicemia without lung involvement. Poor results were obtained in septicemia where the initial site 9 infection was in the lungs. This antibiotic appeared as a very good antistaphylococcal agent. In vitro superiority over gentamicin against Pseudomonas was not be confirmed clinically. Tobramycin deserves to be administered initially in serious infections because of the possibility that the causative organism might be a gentamicin-resistant, tobramycin susceptible strain. Three such cases were observed in our 35 patients. This susceptibility dissociation in favor of tobramycin was demonstrated in two strains of Klebsiella and one strain of Enterobacter. A dosage regimen in patients with impaired renal function is proposed. It requires confirmation.
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PMID:The use of tombramycin in the management of severe infections. Clinical and pharmacological data. 96 73

Most infections on the surgical ward are due to one or more gram-negative rods, acting either as the sole pathogens or as principal components in a polymicrobial flora. To date, parenteral aminoglycosides have proven to be the most effective antibiotics for control or treatment of such sepsis. Unfortunately, however, serious complications as well as therapeutic failures do occur. During a 40-month period, 405 surgical patients receiving aminoglycosides (Gentamicin, Tobramycin, Sisomicin, or Amikacin) were prospectively studied with respect to: indications for antibiotic; patient population; serum concentrations of antibiotic according to route of administration, dose in mg/kg/day, and renal function; rapidity of antibiotic excretion in the urine; causative bacteria and their sensitivities to each aminoglycoside as determined by both disc and tube dilution methods; severity and frequency of drug complications; and clinical efficacy of each study antibiotic. Results supported the contention of a superior effectiveness from aminoglycosides for established abdominal and unspecified surgical infections, more rapid development of therapeutic blood levels by intravenous administration, need to alter drug dose according to frequent serum creatinine determinations, increased drug toxicity in dehydrated and shocked patients, preventability of complicating Candida sepsis, and the importance of early as well as adequate surgical debridement and drainage.
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PMID:Use of aminoglycosides in surgical infections. 97 53

The choice of antimicrobial therapy for the treatment of bacteremia is often empirical and based on the knowledge of antibiotic susceptibility profiles of the most common bacteria causing such infections. It therefore is crucial to survey the susceptibility of bacteria causing sepsis. This study examines the susceptibility profiles of 941 gram-negative bacteria, isolated from septic patients in 10 Canadian hospitals, to 28 antimicrobial agents. Among the isolates, 30 different species were represented; Escherichia coli dominated, representing 52.5% of isolates. More than 50% of all bacteria were resistant to ampicillin. Only 67% of the E. coli isolates were susceptible to ampicillin, while 30% of all strains were resistant to ticarcillin. Of the cephalosporins, ceftazidime and cefoperazone/sulbactam were the agents to which isolates were the most susceptible (90%). Only 51% of the E. coli strains were susceptible to cephalothin, while 91% were still susceptible to cefazolin. A total of 93% and 98% of the strains were susceptible to aztreonam and imipenem, respectively. Aminoglycosides were highly active against most isolates, in general in the following order: netilmicin greater than tobramycin greater than gentamicin greater than amikacin. Tobramycin was the most active against Pseudomonas aeruginosa. Nearly all isolates were susceptible to the quinolones. Tolerance (MBC/MIC ratio, greater than or equal to 32) was rarely observed. This survey of the susceptibility of gram-negative bacteria causing sepsis provides valuable information for implementing the chemotherapy for gram-negative septicemia and demonstrates that several older and newer agents, alone or in combination, can be used as adequate initial therapy for gram-negative sepsis in Canada.
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PMID:Antibiotic susceptibility profiles of 941 gram-negative bacteria isolated from septicemic patients throughout Canada. The Canadian Study Group. 142 Jun 74


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