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

Amikacin plus penicillin (A+P) was compared to amikacin plus carbenicillin (A+C) in a double-blind study. Therapy with one of these combinations was given, as soon as servere infection was suspected, to 117 patients with proved gram negative infection, none of whom was granulocytopenic. Gram negative bacteremia was documented retrospectively in 52 patients; 25 had received A+P and 27 had been treated with A+C. All the isolated gram negative pathogens were sensitive to amikacin (MIC less than 12 microng/ml). In the A+P group, 55 per cent of the patients responded favorably while in the A+C group 63 per cent did respond; the difference was more striking for bacteremic patients: 52 per cent responded in the A+P group and 70 per cent in the A+C group. This difference, however, was not statistically significant. The outcome of patients whose infection was treated by synergistic combinations against the offending pathogen was better (66 per cent) than that observed in patients who received nonsynergistic combinations (48 per cent) (p less than 0.05). Once again the results were more striking in the bacteremic patients (p less than 0.01). A favorable outcome was associated also with a high (larger than or equal to 1/8) bactericidal activity of the diluted serum of the treated patient against the offending pathogen (p less than 0.05). This study suggests that the optimal therapy in gram negative septicemia might be the administration of synergistic combinations of antibiotics.
 ...
PMID:Significance of antimicrobial synergism for the outcome of gram negative sepsis. 32 79

Case records of 1,098 patients treated with amikacin at 79 research centers in 10 countries in a program of worldwide clinical trials were reviewed. Of the 697 patients eligible for use in evaluation of efficacy of the drug, 81% were cured, as evidenced by clinical remission and eradication of the infecting pathogen. The usual dosage was 7.5 mg/kg administered intramuscularly at 12-hr intervals. This dosage was modified in patients with renal impairment. Amikacin was effective in 90% of 322 patients with genitourinary infections, 85% of 97 patients with septicemia, 70% of 73 patients with infections of skin, soft tissue, or bone (excluding burns), and 69% of 68 patients with infections of the lower respiratory tract. Amikacin was effective in treatment of 88% of 85 infections due to gentamicin-resistant pathogens. The drug was generally well tolerated, and no side effects were reported in 80.6% of the 1,098 patients evaluated. Amikacin shares with other aminoglycosides the risk of ototoxicity and nephtotoxicity; previous exposure to gentamicin was a major factor in the development of such adverse effects. Other adverse reactions were relatively infrequent and in most cases were characterized as mild and transient.
 ...
PMID:A review of results of clinical trials with amikacin. 79 60

Amikacin was administered to 18 patients with gram-negative septicemia. Ten of the patients had blood culture isolates highly resistant to gentamicin; six of these patients had persistent bacteremia while receiving gentamicin alone or in combination with other agents. Fourteen of the 18 patients were cured with amikacin therapy and adjunctive measures. Nine of the 10 patients with gentamicin-resistant pathogens were cured. The occurrence of nephrotoxicity in four patients with elevated amikacin serum levels and serious underlying disease indicates the desirability of monitoring serum amikacin levels. Minor ototoxicity occurred in two patients and was associated with prolonged therapy and high serum amikacin levels. Amikacin is a highly effective agent for treating patients with gram-negative bacteremia; it is the agent of choice in the therapy of patients with suspected or documented gram-negative bacteremia caused by pathogens resistant to gentamicin and susceptible to amikacin.
 ...
PMID:Amikacin therapy for gram-negative septicemia. 86 8

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.
 ...
PMID:Use of aminoglycosides in surgical infections. 97 53

Amikacin was evaluated in patients with malignant diseases during 134 episodes of identified infection, most of which were cases of pneumonia and septicemia. The overall rate of response of the identified infections was 63%. The majority of infections were caused by Escherichia coli, the Klebsiella-Enterobacter-Serratia group, and Pseudomonas aeruginosa. The response rate for infections caused by these organisms was 80%. Five of eight infections caused by organisms resistant to gentamicin responded to therapy with amikacin. Nephrotoxicity was observed in 13% of patients who had normal renal function initially.
 ...
PMID:Amikacin for treatment of infections in patients with malignant diseases. 99 33

Amikacin, a new aminoglycoside antibiotic, was utilized in the treatment of 49 cases of infection which occurred in 39 neutropenic cancer patients. Thirty-four patients (69 per cent) responded to this antibiotic. Pneumonia and septicemia were the most common types of infection treated and the response rates were 65 per cent and 75 per cent, respectively. Gram-negative bacili were responsible for 93 per cent of the identified infections and 74 per cent responded. E. coli, Ps. aeruginosa, and organisms of the Klebsiella-Enterobacter-Serratia group were the most common gram-negative bacilli causing infection. Responses were more frequent among patients who maintained higher serum concentrations of antibiotic, but the differences were not statistically significant. Patients with severe neutropenia (less than 100 neutrophils/mm3) had a response rate of 68 per cent. Toxicity was manifested as azotemia and hearing loss which occurred in 13 per cent and 6 per cent, respectively. However, toxicity was directly related to serum concentration and to the number of treatments with amikacin. This antibiotic is of potential importance because of its efficacy against gram-negative bacilli infections. Best results were obtained when sufficient drug was given as a continuous intravenous infusion to maintain serum concentrations of about 15 mu g/ml.
 ...
PMID:Amikacin therapy of infections in neutropenic patients. 110 49

The effects of hypoxia and azotaemia on the pharmacokinetics of amikacin were evaluated in 20 full-term neonatal critically ill foals which required 24-h supportive care, antibiotics and dextrose-supplemented polyionic fluids given intravenously, nasal insufflation with oxygen and nutritional supplementation. There was no association between sepsis score or survival and pharmacokinetic parameters. Concurrent hypoxia and azotaemia were associated with significantly decreased clearance and increased peak and trough serum concentrations of amikacin; however, peaks or troughs did not exceed toxic values. Derangements in serum peak, trough and clearance values, which were present on admission, persisted over the 6-day duration of this study. Daily monitoring of serum amikacin concentration revealed a tendency to underdose (particularly in foals receiving aggressive fluid therapy), which necessitated increasing the dose/kg body weight (9-12 mg/kg) and increasing the dose interval (10-12 h) in 40% (8/20) of the cases, so that blood concentrations of amikacin could be maintained within the target range of 3-15 micrograms/ml. Amikacin-induced nephrotoxicity was not indicated by conventional laboratory testing, nor was it strongly suspected after examination of post mortem lesions.
 ...
PMID:Effects of hypoxia and azotaemia on the pharmacokinetics of amikacin in neonatal foals. 145 63

We identified and reviewed retrospectively all the cases of infection by Pseudomonas and related genera in patients with AIDS and AIDS-related complex (ARC) who were hospitalized at our Institution over a 36-month period. We recorded 48 episodes of infection in 34 of 355 patients with AIDS, and in two of 73 patients with ARC: 25 pneumonias (9 community-acquired and 16 of nosocomial origin). 20 urinary tract infections, two soft tissue infections and one sepsis. In 14 of 16 patients with nosocomial pneumonia but in only one of nine patients with community-acquired pneumonia did we find coexisting opportunistic lung diseases. The following micro-organisms were isolated: P. aeruginosa in 41 cases, P. fluorescens in three cases, Xanthomonas maltophilia (P. maltophilia) in two cases, P. putida in one case. Comamonas testosteronis (P. testosteronis) and Comamonas acidovorans (P. acidovorans) in one case. Amikacin and ceftazidime, alone or in combination, appear to be the optimal choice of therapy for severe Pseudomonas infections in HIV-infected patients, although in our study six of 47 isolates were resistant in vitro to amikacin, and nine of 31 isolates were resistant to ceftazidime.
 ...
PMID:Pseudomonas infections in patients with AIDS and AIDS-related complex. 158 72

Profoundly granulocytopenic patients in whom fever develops are likely to have gram-negative septicemia, which may rapidly be fatal. These patients require early empiric therapy with a synergistic bactericidal combination of antibiotics that should be chosen on the basis of in vitro studies, animal models, and results of volunteer and clinical trials. From in vitro studies, it is apparent that the degree of synergy between an aminoglycoside and a beta-lactam is determined mainly by the aminoglycoside. Amikacin is the most synergistic of the aminoglycosides. A combination of an aminoglycoside such as amikacin plus a beta-lactam active against Pseudomonas is probably still the best empiric therapy available. The newer compounds and beta-lactam combinations still have to be proven effective in the clinical setting of the persistently and profoundly granulocytopenic patient with fever and bacteremia.
 ...
PMID:Combination therapy and monotherapy in the treatment of severe infection in the immunocompromised host. 372 25

Aminoglycosides have always had a major role in the treatment of gynecologic infections. This therapeutic emphasis has been based upon the bactericidal activity of the aminoglycosides against gram-negative aerobes. This group of organisms is important to the gynecologist because of their frequent isolation from soft tissue, urinary sites, and the bloodstream in women with nosocomial or community-acquired pelvic infections. In the past decade, there has been increasing clinical awareness of the multi-bacterial nature of these soft tissue pelvic infections. A major therapeutic change directed against gram-negative anaerobes has been the substitution of more effective agents like clindamycin or metronidazole for the penicillin arm of the older penicillin-aminoglycoside combination. The majority of intra-abdominal and pelvic infections treated by gynecologists occur in patients who are younger and usually healthier than those with similar infections who are treated by general surgeons. Consequently, in many instances, single drug therapy with a cephalosporin (usually cefoxitin) is adequate, if combined with surgical drainage when indicated. However, there is an increasingly larger group of patients who are significantly older and who may also have pelvic malignancies. In addition, they may be immunocompromised. Infections in this group mandate the use of the most effective antimicrobial agents that will cover the broadest spectrum. When anaerobic bacteria are involved, either clindamycin or metronidazole are acceptable choices; for aerobic gram-negative organisms, an aminoglycoside should be used. Recent studies suggest that amikacin may be the best choice, since it is associated with a low level of bacterial resistance and has been shown to reduce levels of resistance to other aminoglycosides. Amikacin has become the "gold standard" for comparisons with any new cephalosporins or penicillins. New developments will modify the use of aminoglycosides in the future. The expansion of oncology care with immune-system-modifying chemotherapy and radiation will expose patients to the dangers of gram-negative sepsis. Aminoglycosides are a logical part of the initial therapeutic regimen for these septic patients. On the other hand, the majority of gynecologic patients with pelvic infections are young and healthy. Recent studies have demonstrated that as many as 40 percent of these women will be underdosed by standard treatment regimens based upon ideal body weight. This means that patients receiving aminoglycosides will require monitoring of peak and trough levels to insure therapeutic drug levels.(ABSTRACT TRUNCATED AT 400 WORDS)
 ...
PMID:Aminoglycosides in gynecologic infections. 372 31


1 2 3 4 5 Next >>