Inducing capacity and selection of resistant variants of cefpirome (HR 810) in comparison with other beta-lactam compounds

The inducing capacity of cefpirome (HR 810) and the ability of the compound to select for stable derepressed mutants was determined and compared with those of cefodizime (HR 221), cefotaxime, ceftazidime and cefamandol. Variations in both characteristics between and within species was observed. Overall, cefodizime showed the lowest, cefamandol the highest inducing capacity. Antibiotic resistant variants were isolated from all strains tested at a frequency of around 10(-9). A stable increased enzyme production was found in Pseudomonas aeruginosa after exposure to ceftazidime as well as in the resistant mutants from Enterobacter cloacae after selection with cefpirome, ceftazidime, cefotaxime and cefamandol. In the other resistant mutants the resistance was probably due to changes in permeability. All resistant variants remained relatively susceptible to cefpirome.     

Renal and systemic effects of aminoacids administered separately: comparison between L-arginine and non-nitric oxide donor aminoacids.

The present study examined the mechanisms of the renal effect of the NO-donor aminoacid, L-Arg and different non-NO-donor aminoacids, namely L-Asn, L-Ala, L-Gly L-Gln administered separately. In conscious, unrestricted Wistar rats, a bolus of L-Arg produced a short-lasting decrease in mean arterial pressure. No variations in mean arterial pressure were found with either L-Gly, L-Asn, L-Ala or L-Gln. This effect of L-Arg was inhibited by NwNLA, methylene blue and atropine and not affected by meclofenamate. Simultaneously, a dose-response diuretic and natriuretic effect was observed with all the aminoacids. In further experiments with L-Arg and L-Gly, this effect was associated with increased glomerular filtration rate, renal plasma flow, fractional sodium and free water excretion and urinary cyclic guanosine monophosphate. These effects of L-Arg and L-Gly were inhibited by NwNLA. On the contrary, no inhibition by NwNLA was detected on the diuretic, natriuretic and renal hemodynamic effects of L-Gln, and the diuretic and natriuretic effects of L-Asn or L-Ala. Our results show that all the assayed aminoacids were endowed of diuretic and natriuretic capabilities. Such effects were apparently related with a NO-mediated mechanism in the case of L-Arg and L-Gly, but not in the case of L-Gln, L-Asn or L-Ala, therefore suggesting that more than one mechanism is involved in the renal effect of the different aminoacids. Simultaneously, only L-Arg produced a NO-, cyclic guanosine monophosphate-dependent hypotensive effect, which was not shared by the other assayed aminoacids.     

A comparison of the in vitro activities of sulfamethoxazole and sulfadiazine combinations with trimethoprim.

The sensitivity of 125 strains of 13 species or genera of bacteria to sulfamethoxazole (SMZ), sulfadiazine (SDZ), trimethoprim (TMP), SMZ + TMP and SDZ + TMP was determined by means of trays. A comparison of all combinations of the different concentrations used shows that SMZ + TMP is in 1 case and SDZ + TMP in 4 cases more effective against the 13 species or genera tested than the other combinations. SMZ and SDZ were equally effective in synergistic action (as shown by the FIC indices) against the various kinds of bacteria.     

6号和7号头皮针静脉滴注左氧氟沙星时的临床观察及比较

左氧氟沙星在静脉输液时,常会出现局部血管刺激症状,如穿刺局部疼痛,出现局部皮肤发红[1],严重者可引发静脉炎,静脉炎的发生率可高达39%[2].     

Effects of antifungal agent combinations administered simultaneously and sequentially against Aspergillus fumigatus.

The in vitro effects of antifungal agent combinations administered simultaneously and sequentially against 15 strains of Aspergillus fumigatus were tested by the yeast-malt broth method. The synergistic effect of the combination of amphotericin B (AMPH) and miconazole was observed in nine strains (60%). However, the combinations of AMPH and fluconazole, AMPH and ketoconazole, and AMPH and itraconazole administered simultaneously showed antagonistic effects against three (20%), five (34%), and four (26%) strains, respectively. The effects of combinations of azole antifungal agents administered simultaneously were indifferent or antagonistic against A. fumigatus. In experiments measuring the effects of sequentially administered antifungal agents, however, pretreatment with AMPH and then azole antifungal agents exhibited better in vitro efficacy than that found in experiments measuring the effects of simultaneously administered AMPH and azole compounds.     

An isobolographic analysis of the antinociceptive effect of systemically and intrathecally administered combinations of clonidine and opiates

The antinociceptive interaction of opiate analgesics with clonidine was examined with the tail-flick and 55 degrees C hot plate tests. Male Sprague-Dawley rats received fixed ratios of clonidine to fentanyl, meperidine or morphine by i.v. and intrathecal injection. Data are expressed as percentage of maximal possible effect and the dose producing 50 percentage of maximal possible effect for each drug or drug combination is used to index potency. The rank order of potency in both tests after i.v. administration is fentanyl much greater than clonidine greater than meperidine greater than or equal to morphine and after intrathecal administration it is morphine greater than fentanyl much greater than clonidine much greater than meperidine. Isobolographic analysis shows that the effect of clonidine combined with an opiate is additive after i.v. administration; the exception is that morphine and clonidine are synergistic in the hot plate test. The intrathecal combinations of clonidine with morphine or meperidine produces a supra-additive antinociceptive effect in the tail-flick test but not in the hot plate test. Fentanyl does so in both tests. These data confirm a positive interaction between clonidine and opiates in producing antinociception. This interaction may be additive or synergistic, depending on route of administration and the nociceptive test used. The timing of injections and pharmacokinetic factors may also influence the results. Moreover, these results suggest that the interaction between the opiate and alpha-2 adrenergic receptors occurs within the spinal cord.     

Postoperative pain relief with pentazocine and acetaminophen: comparison with other analgesic combinations and placebo

A single-blind, parallel-group study was carried out to evaluate the efficacy and safety of an analgesic combining 650 mg of acetaminophen and 25 mg of pentazocine in 129 patients with moderate postoperative pain. Comparisons were made with a combination containing acetaminophen (300 mg) and codeine (30 mg), a combination containing acetaminophen (650 mg) and propoxyphene napsylate (100 mg), and a placebo. A nurse observer queried patients at regular intervals over a six-hour period concerning the intensity of pain and the degree of pain relief. The scores obtained were used in the calculation of standard measures of analgesic efficacy. Acetaminophen/pentazocine proved to be significantly superior to placebo and equivalent to the other active analgesic combinations. No side effects were reported with acetaminophen/pentazocine, acetaminophen/propoxyphene napsylate, or placebo. One mild side effect was questionably associated with acetaminophen/codeine. This study demonstrates that the combination of acetaminophen and pentazocine is as safe and effective in controlling postoperative pain of moderate severity as other commonly used analgesics.     

Analysis of the capacity of handicapped patients in comparison with non-handicapped patients]

A catalogue of psychological items has been developed that enables any disabled person's job-related abilities as well as the psychological requirements of any job to be assessed. With this newly developed instrument, ability profiles of slow learners and of non-disabled persons have been drawn up. Structural analysis of these data show specific differences in the ability structure of the two groups. The results indicate new ways for well-directed, disability-related promotion in vocational rehabilitation.     

Beta-lactamase stability of cefoxitin in comparison with other beta-lactam compounds

The beta-lactamase stability of cefoxitin, the second-generation cephamycin compound, was compared with that of cefamandole, cefoperazone, cefotaxime, moxalactam, carbenicillin, and piperacillin. Unlike cefamandole, cefoperazone, carbenicillin, and piperacillin, cefoxitin was not hydrolyzed by the common plasmid beta-lactamases, TEM-1, TEM-2, OXA-2, and SHV-1. Cefoxitin and moxalactam were the only agents stable to all chromosomal beta-lactamases, whereas cefamandole, cefoperazone, cefotaxime, carbenicillin, and piperacillin were destroyed by cephalosporinases of Proteus vulgaris and Bacteroides fragilis.     

Comparative capacity of orally administered amoxicillin and parenterally administered penicillin-streptomycin to protect rabbits against experimentally induced streptococcal endocarditis.

A single-intramuscular-dose immunization regimen with a penicillin G-streptomycin combination was compared with three oral-dose amoxicillin regimens for the capacity to prevent Streptococcus sanguis infections of experimentally induced valvular heart lesions in rabbits. Challenge doses of 10(4), 10(6), and 10(8) CFU of a strain of S. sanguis equally susceptible to penicillin and amoxicillin were used in this study. Measured by recovery of test organisms from endocardial lesions, the lowest concentration of these inocula was infective for 60% of the recipients; the two higher-concentration inocula were infective for all recipients. The penicillin G-streptomycin combination provided complete protection against infection with inocula of all sizes. A single-oral-dose amoxicillin regimen (50 mg/kg of body weight) prevented endocarditis when rabbits were challenged with 10(4) CFU, but protection diminished with increasing inoculum concentrations. Similar results were achieved when five oral doses of amoxicillin (8.5 mg/kg of body weight) added at 8-h intervals were included in the single-oral-dose regimen. In contrast, when rabbits received two oral doses of amoxicillin (50 mg/kg of body weight) with a 10-h interval between doses, prophylaxis was fully effective with even the highest inoculum concentration.     

A comparison of the costs of ceftazidime therapy and gentamicin combinations in three UK hospitals.

This study compares the utilization costs of ceftazidime therapy with those of gentamicin in combination with other antibacterial drugs. The results show that the relatively high purchase cost of ceftazidime compared to combinations is more than counterbalanced by the additional materials used for drug administration and serum antibiotic assays, even when other drugs were combined with ceftazidime. The average drug and equipment costs were 230.13 pounds for ceftazidime regimens and 253.94 pounds for gentamicin regimens. It is also shown that ceftazidime therapy is associated with a reduction in personnel time compared to gentamicin regimens. The average times per patient for administration and assay were 1 h 43 min for ceftazidime and 4 h 57 min for gentamicin regimens. We conclude that ceftazidime regimens are cheaper than gentamicin regimens when all drug and equipment costs are quantified. Moreover, the use of ceftazidime will release staff time for other purposes.     

A comparison of diabetes education administered through telemedicine versus in person

OBJECTIVE: To determine whether diabetes education can be provided as effectively through telemedicine technology as through in-person encounters with diabetes nurse and nutrition educators. RESEARCH DESIGN AND METHODS: A total of 56 adults with diabetes were randomized to receive diabetes education in person (control group) or via telemedicine (telemedicine group) and were followed prospectively. The education consisted of three consultative visits with diabetes nurse and nutrition educators. The in-person and telemedicine groups were compared using measures of glycemic control (HbA(1c)) and questionnaires to assess patient satisfaction and psychosocial functioning as related to diabetes. Outcome measures were obtained at baseline, immediately after the completion of diabetes education, and 3 months after the third educational visit. RESULTS: Patient satisfaction was high in the telemedicine group. Problem Areas in Diabetes scale scores improved significantly with diabetes education (adjusted P < 0.05, before vs. immediately after education and 3 months after education), and the attainment of behavior-change goals did not differ between groups. With diabetes education, HbA(1c) improved from 8.6 +/- 1.8% at baseline to 7.8 +/- 1.5% immediately after education and 7.8 +/- 1.8% 3 months after the third educational visit (unadjusted P < 0.001, P = 0.089 adjusted for BMI and age), with similar changes observed in the telemedicine and in-person groups. CONCLUSIONS: Diabetes education via telemedicine and in person was equally effective in improving glycemic control, and both methods were well accepted by patients. Reduced diabetes-related stress was observed in both groups. These data suggest that telemedicine can be successfully used to provide diabetes education to patients.     

A comparison of double beta-lactam combinations with netilmicin/ureidopenicillin regimens in the empirical therapy of febrile neutropenic patients

In a randomized trial ceftazidime plus piperacillin or azlocillin, and netilmicin plus piperacillin or azlocillin were used as initial empirical therapy in 202 febrile neutropenic episodes. Netilmicin plus azlocillin was the most effective combination with a clinical response rate of 81% in clinically and microbiologically documented infections compared with 63% for ceftazidime plus piperacillin. All of the episodes of Gram-negative bacteraemia treated with azlocillin responded compared with 43% of those treated with piperacillin. Gram-positive organisms accounted for 52% of all bacteriologically documented infections and 40% of the febrile episodes were treated with vancomycin for presumptive or documented Gram-positive infection. Patients treated with netilmicin had significantly more nephrotoxicity than those given the double beta-lactam combinations (14.8% vs 3.5%; P less than 0.05). However, this difference was not shown in those patients who did not receive concurrent vancomycin or amphotericin. The double beta-lactam combinations were associated with more hypokalaemia (58.2% vs. 37.7%; P less than 0.05) and more colonization with yeasts (24% vs. 10.4%; P less than 0.05) but there was no evidence that their use was associated with prolongation of neutropenia. These results indicate that ceftazidime plus a ureidopenicillin would be adequate empirical therapy in situations where the concomitant use of nephrotoxic agents precludes the use of aminoglycoside containing combinations.