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Query: UMLS:C0243026 (sepsis)
 52,417 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The chemistry, microbiology, pharmacokinetics, therapeutic use, adverse effects, and dosage of amoxicillin-potassium clavulanate, a beta-lactamase-resistant antibiotic combination, are reviewed. Clavulanic acid is a "suicide" inhibitor of bacterial beta-lactamase enzymes and has been effective in preventing destruction of penicillins by these enzymes. Clavulanic acid alone has weak antibacterial activity against most organisms. After oral administration, clavulanic acid is rapidly absorbed; amoxicillin appears to increase its absorption. Absorption of amoxicillin-clavulanic acid is not affected by food. Amoxicillin-clavulanic acid is effective in treating both acute uncomplicated and complicated urinary-tract infections and exacerbations of chronic bronchitis caused by amoxicillin-resistant organisms in adults. It appears to be comparable in efficacy to cefaclor for treating uncomplicated urinary-tract infections in adults and children, acute bronchitis and bronchopneumonia, and acute sinusitis, otitis media, and skin and soft-tissue infections in children. Other infections for which the combination has been effective include cellulitis and intra-abdominal and pelvic sepsis caused by mixed aerobic/anaerobic organisms. Amoxicillin-clavulanic acid has also successfully cured urethritis in men caused by penicillinase-producing Neisseria gonorrhoeae and is superior to amoxicillin alone for beta-lactamase-positive Haemophilus ducreyi infections (chancroid). Diarrhea or loose stools is the most common side effect seen with amoxicillin-clavulanic acid; nausea, vomiting, and skin rash may also occur. Nausea, vomiting, and diarrhea may be lessened by taking the combination with food.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Amoxicillin-potassium clavulanate, a beta-lactamase-resistant antibiotic combination. 639 83

The penicillinase-resistant penicillins (methicillin, oxacillin, nafcillin) have been the mainstay of antibiotic therapy for S. aureus septicaemia and endocarditis. In experimental rabbit S. aureus endocarditis, these three antibiotics were equally effective. There has been no prospective comparative clinical studies to determine the relative effectiveness of these antibiotics. In experimental rabbit S. aureus endocarditis, cephalothin and cefazolin are less effective than methicillin and nafcillin. The results of therapy with cephalosporins in patients with S. aureus endocarditis are variable. Clindamycin therapy of S. aureus endocarditis has been associated with clinical relapse. Vancomycin has been used to treat S. aureus septicaemia and endocarditis with good results. Fusidic acid has been used in combination with another effective drug in treating S. aureus septicaemia and endocarditis. Although the combination of a cell-wall acting antibiotic with an aminoglycoside has been shown to have an enhanced anti-staphylococcal activity in vitro and in animal studies, there is no evidence that such a combination reduces morbidity or mortality clinically. Rifampin in combination with a cell-wall acting antibiotic is antagonistic against S. aureus in vitro and in experimental endocarditis in rabbits. The use of such a combination has not shown consistent benefits clinically. The clinical importance of tolerance (MBC/MIC greater than or equal to 32) of cell-wall acting antibiotics to S. aureus is not clear. It appears not to be important in animal studies. Cephalosporins appear not to be effective in the treatment of methicillin-resistant S. aureus infections. The treatment of choice of sepsis and endocarditis due to such strains is vancomycin which is effective against all strains of methicillin-resistant S. aureus.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:A general survey of antibiotic treatment of staphylococcal septicaemia and endocarditis. 658 52

During the period 1976-1980 Staphylococcus aureus was found in 265 blood cultures from 13 clinics for adult patients at Lund Hospital. Criteria of septicaemia were fulfilled in 169 patients, 65 had transient bacteremia and 31 cases were not evaluable. Concerning bacteriological data no Staphylococcus phage type dominated and strains resistant to antibiotics other than penicillin were very few. On the average 74% of the strains produced penicillinase with a successive increase during the study period. The incidence of septicaemia was highest in the decade 61-70 years of age. In patients with hospital-acquired septicaemia (n = 99) the main portals of entry for infection were vascular and/or surgical wounds (confirmed by phage typing in 93%). Patients with community-acquired septicaemia (n = 70) often had skin lesions but only a few cultures were taken. Only 4 patients were drug addicts. In 28 patients with no obvious portal of entry 14 nasal cultures were performed. Eight of ten positive cultures showed the same strain in nares as in blood at onset of sepsis. Secondary infectious foci were most frequent (26%) in patients with community-acquired infection. Endocarditis were found in 19 patients, 11 were diagnosed at autopsy. In staphylococcal endocarditis the mortality was 68% compared to 10% in septicaemia without endocarditis. In septic shock, compromised hosts and in connection with chronic diseases the mortality rates were 39%, 26% and 29%, respectively.
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PMID:Staphylococcus aureus septicaemia and endocarditis at the University Hospital in Lund 1976-1980. 658 60

Cefpiramide (CPM) was given to 4 patients with respiratory tract infection (H. influenzae 3 cases, P. aeruginosa 1 case), 1 patient with enteritis (enteropathogenic E. coli) and 1 patient with sepsis (E. cloacae). Bacteriological eradication was observed in 5 cases (83.3%), and clinical effectiveness was 66.7%. Serum concentration of CPM at a dose of 15 mg/kg after intravenous drip-infusion for 30 minutes was 105 micrograms/ml at the end of infusion and 67 micrograms/ml at 1 hour. Bacteriological eradication by the administration of CPM was rapidly occurred in 3 strains of H. influenzae including 1 strain of beta-lactamase producing ABPC-resistant one, and 1 strain of P. aeruginosa in the sputum. One patient aged 2 years and 5 months with pneumonia was cured by the treatment of CPM as an outpatient. No side effects were observed except 1 case of vascular pain. It was concluded that CPM is a useful drug for the treatment of bacterial infections in children.
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PMID:[Clinical evaluation of cefpiramide in 6 cases of infection in children]. 665 37

In a series of 44 patients with lower limb ischaemia requiring amputation for major limb sepsis, the performance of a new antibiotic combination with beta-lactamase-inhibiting properties, amoxycillin plus clavulanic acid (A-CA) (Augmentin; Beecham), was compared with that of penicillin in the prevention of wound infection. The sepsis rate of 12,9% in the group of patients receiving peri-operative A-CA was significantly lower than the 76,9% in the penicillin control group (x2 = 14,48; P less than 0,001). It is concluded that there is a need for peri-operative antibiotic cover in this situation and that A-CA appears to be highly effective. No statistical difference was found as regards development of sepsis in wounds closed primarily or left open while under A-CA cover.
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PMID:Prevention of wound sepsis in amputations by peri-operative antibiotic cover with an amoxycillin-clavulanic acid combination. 684 68

When patients allergic to penicillin develop life-endangering infections that require treatment with beta-lactam antibiotics, they face a fatal infection or the possibility of a fatal allergic reaction. We have approached this situation by using an oral desensitization procedure before full-dose antibiotic therapy. Thirty consecutive patients with histories of allergic reactions to penicillin, positive immediate wheal and flare skin-test reactions to penicillin determinants, and life-threatening infections were studied. Bacterial endocarditis requiring penicillin G therapy led to desensitization of 19 patients, Pseudomonas sepsis of pneumonia requiring treatment led to desensitization of nine subjects, and staphylococcal infections requiring therapy with a penicillinase-resistant penicillin led to desensitization of two patients. Penicillin G or carbenicillin were administered orally, beginning with 100 U or 60 microgram, respectively. At 15-min intervals, progressively doubled doses were given during continuous monitoring for the appearance of allergic reactions. Within 5 hr, full therapeutic doses were administered intravenously. Skin-test reactions disappeared or diminished in all 23 subjects who were retested after desensitization. Full courses of antibiotic therapy and cure of the infections were accomplished in 30 of 30 patients. No deaths, anaphylaxis, or severe acute allergic reactions occurred. Pruritic cutaneous eruptions appeared in nine patients (30%) 6 to 48 hr after the onset of therapy. One patient developed reversible nephritis 3 wk into therapy with penicillin G. The results of this study suggest that oral desensitization is an effective, relatively safe approach to administering beta-lactam antibiotics to penicillin-allergic patients with life-threatening infections.
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PMID:Desensitization of patients allergic to penicillin using orally administered beta-lactam antibiotics. 706 69

In a series of 64 patients requiring amputation for lower limb sepsis, the performance of a new antibiotic combination with beta-lactamase-inhibiting properties, amoxycillin plus clavulanic acid (A-CA) (Augmentin; Beecham) in the prophylaxis of postoperative wound sepsis, was compared with that of a combination of amoxycillin and ampicillin (A-A) (Suprapen; Bencard) and a control group. The sepsis rate following A-CA prophylaxis (12,9%) was significantly less than in the control group (x 2 = 18, 49; P less than 0,001). Although not attaining statistical significance (x 2 = 2, 12),, A-CA compared favourably with A-A (sepsis rate 35.3%) in the prevention of post-amputation wound sepsis. There was no statistically significant difference in the development of sepsis between wounds closed primarily and those left unsatured while under A-CA cover. It is concluded that peri-operative antibiotic cover for amputations in septic lower limb lesions is advisable and that A-CA is a valuable antibiotic in this situation.
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PMID:Peri-operative antibiotic cover in amputations using an amoxycillin-clavulanic acid combination. 708 7

Thirty-two patients with skin infections were treated with Augmentin, a combination of amoxycillin with the beta-lactamase inhibitor clavulanic acid. These infections were primary skin sepsis (7), infected eczema (11), infected trauma (10) and leg ulcers (4). The majority of cases were caused by amoxycillin-resistant Staphylococcus aureus either alone or in combination with Streptococcus pyogenes. Thirty patients (94%) responded to treatment with only one withdrawal (for side effects). Side effects were limited to nausea (9%) diarrhoea (9%) and rash (3%). No patient with diarrhoea showed evidence of Clostridium difficile toxin production in the stools. Augmentin appears to be a safe, useful, effective antibiotic for the treatment of skin infections in general practice and in hospital. It may prove of particular value when mixed infections of penicillin-resistant staphylococci and Streptococcus pyogenes are present.
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PMID:Further experience with augmentin in the treatment of skin infections. 716 11

In basic pharmacological studies, sodium cefoxitin has proved to possess the following features: a broad action spectrum, resistance to bacterial beta-lactamase, activity against anaerobic species, rapid distribution, rapid serum and bile concentration, rapid, elevated excretion in the urine in active form, and low local and general toxicity. Patients in an Emergency Surgery Department often present the following conditions: highly compromised general situation, serious, often polymicrobic sepsis with aerobic and anaerobic flora, prior treatment without result with various cycles of chemo-antibiotic treatment. The theoretical conditions therefore exist to assess the effectiveness of sodium cefoxitin in patients admitted to an emergency surgery department and presenting serious post-surgical or post-traumatic sepsis, or sepsis due to pathology that can be corrected surgically. A study of 14 patients (3 g i.v. or i.m. for 6 days) showed 71% complete cure, 21% definite improvements and one death (treatment commenced 36 hours prior to death). It is therefore maintained that sodium cefoxitin is particularly indicated as first-choice antibiotic in emergency surgery situations.
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PMID:[Cefoxitin in emergency surgery]. 725 45

Serious staphylococcal infections remain a significant clinical problem despite advances in antibacterial therapy. Resistance to penicillin is common and methicillin-resistant staphylococci have become troublesome nosocomial pathogens in many institutions. Penicillinase-resistant penicillins (e.g. flucloxacillin, cloxacillin and oxacillin) are the preferred drugs for all methicillin-susceptible staphylococcal infections, although first generation cephalosporins, beta-lactam/beta-lactamase inhibitor combinations, clindamycin, and occasionally erythromycin and cotrimoxazole (trimethoprim/sulfamethoxazole) are alternatives. Serious infections due to methicillin-resistant staphylococci should be treated with parenteral vancomycin. Teicoplanin, where available, is a suitable alternative. Rifampicin, fusidic acid and some fluoroquinolones may be useful oral alternatives, although resistance develops rapidly if they are used as single agents. Cotrimoxazole and minocycline have also proven useful when strains are susceptible. Staphylococcal toxic shock syndrome often requires aggressive resuscitation and anti-staphylococcal therapy for generally 10 to 14 days. Staphylococcus aureus bacteraemia remains a life-threatening condition which, in all but one-third of cases, is associated with an underlying septic focus such as endocarditis, osteomyelitis or occult abscess. Differentiating between complicated and uncomplicated bacteraemia is critical to define the appropriate treatment regimen. Serious staphylococcal sepsis such as endocarditis and acute osteomyelitis generally requires prolonged (4 to 6 weeks) antibiotic treatment. Coagulase-negative staphylococci are the commonest cause of prosthetic device infection, and generally require prolonged therapy with an agent to which they have proven to be sensitive, e.g. a penicillinase-resistant penicillin or vancomycin. Removal of infected foreign or prosthetic material, and drainage of deep collections remain a critical aspect of all therapy.
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PMID:Optimum treatment of staphylococcal infections. 768 6


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