Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0519030 (Klebsiella)
 21,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

205 paraplegic inpatients with urinary infections were treated with trimethoprim-sulfamethoxazole (TMP-SMZ) bladder instillations (160 mg TMP 800 mg SMZ daily for 2 consecutive weeks). 89.3% out of 84 patients with recent vertebral trauma and no history of previous urinary infection (group A), and 68.6% out of 121 patients with paraplegia since more than 2 years, severe chronic infection and various pathological conditions of the urinary tract (group B) were found to be sterile at the end of the trial. The intravesical concentrations of 3.2 mg/ml TMP and 16 mg/ml SMZ which are reached immediately after instillation are 50--100 times superior to the minimal growth-inhibitory concentrations for most sensitive germs as determined with agar dilution tests. Several strains of Klebsiella and Proteus which had previously proved resistant to oral treatment were eliminated with intravesical TMP-SMZ. The incidence of reinfection, evaluated 1 month after interruption of treatment, was particularly high (62.7%) in patients with known involvement of the upper tract of intravesical obstruction with postmicturition residuals above 75 ml. On the other hand, 28% only among the patients with recent spinal injury and integrity of the upper urinary tract became reinfected after the same interval. The absence of local intolerance could be confirmed in all 21 cystoscopically examined patients between the 6th and 11th day of treatment. Hematuria was never encountered. Systemic side effects were noted in 7.8% Serum concentrations of both drug components are being investigated; results will be published elsewhere.
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PMID:Bladder instillations with trimethoprim-sulfamethoxazole in the treatment of urinary infection. 33 66

The combination of SMZ-TMP has recently been introduced in Congo. This year (1978), it is very used by many Physicians. To help the congolese Physicians working without antibiogram frequently, we have tested 780 strains from August 1977 to August 78. The susceptibility of these strains was: for E. coli 90%, Klebsiella 69,20%, Staphylococcus 93% and for all strains studied Gram + and Gram - the percentage was 75,51. As many authors have showed, the strains of Pseudomonas, Streptococcus faecalis and Providencia are resistant. Our results remain similar to the results obtained by some french and african authors from 1970 to 1975.
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PMID:[The sulfamethoxazole-trimethoprim combination 1st survey into its in vitro activity in brazzaville, Congo Results of 780 bacterial strains isolated at the National Laboratory and the General Hospital in a single year]. 40 Jan 21

Authenic tracheobronchial secretions/exudates (TBSE) were aspirated under direct vision via a sterile catheter passed through a fiberoptic bronchoscope from patients with chronic obstructive pulmonary disease complicated by chronic bronchitis. TBSE, saliva and blood were obtained during long-term administration of trimethoprim-sulfamethoxazole (TMP-SMX) and were assayed for drug content. Before and during treatment TBSE were cultured qualitatively and quantitatively for aerobic and anaerobic bacteria, fungi, mycoplasmas and viruses. Treatment with TMP-SMX was associated with a decrease in the recovery of Hemophilus influenzae, H. parainfluenzae, Klebsiella pneumoniae, Escherichia coli and Proteus mirabilis; however, little effect was observed on the typically nonpathogenic aerobic and anaerobic bacteria of the upper respiratory tract. TMP was found in saliva at concentrations greater than in serum. Both TMP and SMX entered TBSE in absolute and relative concentrations sufficient to take advantage of the potential for synergy against susceptible microorganisms. Patient tolerance of TMP-SMX was generally good and several patients reported a decrease in production of sputum during treatment.
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PMID:Trimethoprim-sulfamethoxazole in chronic bronchitis. 113 33

A multicenter randomized study was conducted to compare the efficacy and safety of ofloxacin with that of trimethoprim/sulfamethoxazole (TMP/SMX) in the treatment of uncomplicated urinary tract infection in adults. Patients were randomized to receive either oral ofloxacin 200 mg daily for three days (102 patients), or oral TMP/SMX 160 mg/800 mg twice daily for seven days (100 patients). The pathogen was eradicated in 73 (97.3%) of the 75 evaluable patients receiving ofloxacin and in 66 (97.1%) of the 68 evaluable patients receiving TMP/SMX. The most frequently isolated pathogens were Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis. More urinary pathogens were susceptible to ofloxacin than to TMP/SMX, although this difference was not statistically significant. The clinical cure rate for patients receiving ofloxacin was 93.3%, with 4% improved and 2.7% failed. For patients receiving TMP/SMX, the clinical cure rate was 86.4%, with 12.1% improved and 1.5% failed. Side effects were reported by 29.7% of the patients receiving ofloxacin and by 40.4% of the patients receiving TMP/SMX. Drug-related adverse experiences, as determined by the investigators, occurred in 5% of the ofloxacin patients and in 15.2% of the TMP/SMX patients, a statistically significant difference. No patients receiving ofloxacin, compared with three patients receiving TMP/SMX, discontinued therapy because of an adverse reaction. These results indicate that short-course ofloxacin is as effective as TMP/SMX in the treatment of uncomplicated urinary tract infection. Ofloxacin therapy is also better tolerated than TMP/SMX.
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PMID:Ofloxacin versus trimethoprim/sulfamethoxazole in the treatment of uncomplicated urinary tract infection. 163 86

The in vitro activity of cefpodoxime, an oral cephalosporin ester, against 792 bacterial isolates representing 36 species was evaluated in comparison to that of ciprofloxacin and trimethoprim/sulfamethoxazole (TMP/SMX). Cefpodoxime inhibited the majority of Streptococcus spp., Haemophilus influenzae and Proteus mirabilis at a concentration of less than or equal to 0.12 microgram/ml. It was also active against Citrobacter diversus, Escherichia coli, Klebsiella spp., Proteus vulgaris, Serratia marcescens and methicillin-susceptible Staphylococcus aureus isolates. Overall, cefpodoxime appeared to be less active than ciprofloxacin and TMP/SMX against many pathogens common in cancer patients.
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PMID:In vitro activity of cefpodoxime against bacterial isolates obtained from patients with cancer. 191 1

The percentage of clinical isolates of several species of Enterobacteriaceae, particularly Escherichia coli and Klebsiella pneumoniae, resistant to trimethoprim (TMPR) has increased gradually at the Brigham and Women's Hospital (Boston) in recent years. Thirty-seven of 42 TMPR isolates from six species of gram-negative bacilli conjugally transferred TMP resistance to K12 E. coli. beta-Lactam resistance cotransferred from 21 of the 37 donors, and sulfamethoxazole (SMZ) resistance cotransferred from five of the 37 donors. Plasmids that encoded TMP resistance either alone or with SMZ resistance had a molecular size of approximately 52.5 kilobases, with identical restriction endonuclease-generated "fingerprints." Plasmids encoding beta-lactam-mediated resistance (beta R) were approximately four kilobases larger and had fragment patterns that were identical for all of the TMPR/beta R plasmids tested and had many restriction endonuclease-generated bands in common with TMPR plasmids. Radiolabeled dihydrofolate reductase (DHFR) probes identified the type II DHFR as the determinant of TMP resistance. In contrast with reports from Europe, TMP resistance in multiple species of Enterobacteriaceae was found to be spread in one hospital by a single, stable conjugative plasmid that has a wide host range and encodes the type II DHFR gene.
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PMID:Trimethoprim resistance in multiple genera of Enterobacteriaceae at a U.S. hospital: spread of the type II dihydrofolate reductase gene by a single plasmid. 298 9

During 59 periods of hospitalisation, 39 patients with either acute myeloid leukemia (22), acute lymphatic leukemia (9), acute undifferentiated leukemia (1), blastic crisis of chronic myeloid leukemia (6) or high-grade malignant non-Hodgkin lymphoma (1) were subjected to aggressive polychemotherapy after selective decontamination of the gut. The patients were given an amphotericin B suspension in a dosage of 1.2 g/day for two days, after which one tablet of trimethoprim/sulphamethoxazole (TMP/SMZ) (160 mg TMP and 800 mg SMZ) t.i.d. was added to prevent endogenous infections by gram-negative aerobic bacteria or moulds and to maintain the "colonisation resistance" endowed by the anaerobes. During 16 of the 59 periods of hospitalisation, no potentially pathogenic aerobic bacteria were isolated. TMP/SMZ-resistant Escherichia coli were the etiological agent of septicemia in two patients, and resistant Klebsiella pneumoniae and Pseudomonas aeruginosa in two other patients. These bacteria were cultured from the patients' fecal samples prior to the development of septicemia. We observed that long-term prophylaxis with TMP/SMZ modified the normal aspect of the fecal biotop culture, not only by suppressing the aerobic gram-negative bacteria, but also by allowing certain clostridia to appear. We differentiated 207 clostridia from the fecal samples of 29 patients and observed a predominance of TMP/SMZ-resistant Clostridium difficile, Clostridium innocuum and Clostridium clostridiiforme. C. difficile was also isolated from the blood culture of a neutropenic patient treated with TMP/SMZ and proved to be very toxic in the Verocell culture.
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PMID:The "clostridial effect" of selective decontamination of the human gut with trimethoprim/sulphamethoxazole in neutropenic patients. 635 9

Antimicrobial susceptibility tests were conducted on bacteria that were isolated from urine specimens collected by antepubic cystocentesis from dogs with urinary tract infections. Antimicrobics to which greater than or equal to 90% of these urinary bacteria were susceptible in vitro included trimethoprim-sulfamethoxazole (TMP-SMZ), nitrofurantoin, cephalexin, nalidixic acid, and gentamicin for isolates of Escherichia coli; ampicillin, TMP-SMZ, cephalexin, nalidixic acid, and gentamicin for isolates of Proteus mirabilis; ampicillin chloramphenicol, TMP-SMZ, nitrofurantoin, cephalexin, kanamycin, and gentamicin for isolates of coagulase-positive staphylococci; cephalexin, nalidixic acid, and gentamicin for isolates of Klebsiella pneumoniae; ampicillin, TMP-SMZ, and gentamicin for isolates of Streptococcus faecalis, Str faecium, and Str zymogenes; ampicillin, chloramphenicol, TMP-SMZ, and gentamicin for isolates of Str viridans; and ampicillin, chloramphenicol, TMP-SMZ, nitrofurantoin, cephalexin, kanamycin, and gentamicin for isolates of Str canis. No antimicrobial agent tested was effective in vitro at the 90% level for isolates of Pseudomonas aeruginosa, but gentamicin was closest, at 89%.
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PMID:In vitro susceptibilities of canine urinary bacteria to selected antimicrobial agents. 641 21

A total of 120 episodes of infection in 113 cancer patients were treated with intravenous trimethoprim-sulfamethoxazole (TMP-SMX) alone (92 episodes) or with TMP-SMX plus continuous infusion tobramycin (28 episodes). The overall response rates were 47% and 75%, respectively. The majority of episodes had failed to respond to prior antibiotics. Pneumonia was the most common infection, and Klebsiella pneumoniae was the most common pathogen. TMP-SMX plus tobramycin cured 86% of episodes of septicemia and 76% of episodes of pneumonia, whereas TMP-SMX alone cured 20% and 42%, respectively. The initial neutrophil count did not appear critical in determining the outcome of infection. It was the change in the neutrophil count during the infection that appeared important. The outcome of infection was less favorable where abnormal renal and/or hepatic functions were documented. The sensitivity of the organism in vitro to TMP-SMX and/or tobramycin correlated well with the in vivo response. Intravenous TMP-SMX was well tolerated with a 4% incidence of reversible toxicity. A 15% incidence of renal toxicity was attributable to tobramycin. Intravenous TMP-SMX appears to be useful antimicrobial regimen for the therapy of infections caused by susceptible organisms in cancer patients.
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PMID:Intravenous trimethoprim-sulfamethoxazole alone or combined with tobramycin for infections in cancer patients. 736 47

The pharmacokinetics of sulfadiazine (SD) combined in a small dose (250 mg) with trimethoprim (TMP, 160 mg) and given twice daily were studied in eight healthy subjects. Both drugs were rapidly absorbed from the gastrointestinal tract and their concentrations in serum as well as in urine could be considered high enough for the treatment of acute urinary tract infections (UTI). In none of the subjects did the concentration of SD in urine exceed the experimental limit established for crystallization of the drug. Serum half-lives of SD and TMP were 10.8 and 11.8 hrs, respectively. In microbiological assay synergistic interaction was found in human urine with both the combination of SD + TMP and SM (sulfamethoxazole) + TMP on all the tested strains of E. coli, Str. faecalis, Str. agalactiae, Klebsiella pneumoniae and Proteus mirabilis. A double-blind clinical trial was carried out with patients having acute UTI, using either the combination SD + TMP (250 mg + 160 mg) or the combination SM + TMP (800 mg + 160 mg) twice daily for one week. The results of the treatment were equally successful in both groups. Treatment failed in only 4 out of 85 cases, although in 12 cases the causative micro-organism was resistant in vitro to the combination of SM + TMP.
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PMID:Pharmacokinetics and clinical experiences of the combination sulfadiazine-trimethoprim in the short-term treatment of acute urinary tract infections. 737 48


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