Monotherapy of nosocomial pneumonia

Nosocomial pneumonia remains a common problem and is the leading cause of death among patients with nosocomial infection. However, the initial empiric therapy of nosocomial pneumonia is directed at the leading organisms common to all patients, and for many patients monotherapy is adequate for at least 48 hours, at which time the microbiological results of appropriate diagnostic procedures should be known and the treatment can be focused. The currently available antimicrobial agents such as third- and fourth-generation cephalosporins, piperacillin plus tazobactam, carbapenems, and some fluoroquinolones are highly active and bactericidal. They should be used in consideration of current pharmacodynamic knowledge, which will lead to convincing clinical results. Combination of antibiotics is necessary only in specific situations or for the amelioration of special pathogens, such as Pseudomonas aeruginosa, Acinetobacter spp., and against mixed aerobic and anaerobic infections.     

Pulmonary schistosomiasis resembling acute pulmonary tuberculosis.

Pulmonary involvement of schistosomiasis is usually characterized by a miliary mottling or diffuse nodular infiltrates. In most cases, pulmonary involvement is associated with an apparent clinical involvement of other organs. This report describes a 35 yr old patient who developed a cavity, a parenchymatous infiltrate and hilar adenopathy in association with pulmonary schistosomiasis. Schistosoma eggs were demonstrated in transbronchial biopsies from the lung. Pulmonary involvement of schistosomiasis is reviewed and atypical features are discussed, which may lead to diagnostic difficulties, particularly compared to tuberculosis.     

Sparfloxacin in the treatment of drug resistant tuberculosis or intolerance of first line therapy.

Patients with multiresistant tuberculosis (TB) and patients with intolerance of first line antituberculosis drugs present a major treatment problem. Sparfloxacin is highly active against mycobacteria, but the use is restricted by side effects and the contribution to antituberculosis therapy is unclear. A prospective study has therefore been performed to analyse the efficacy and tolerability of sparfloxacin in cases of resistant TB or intolerance of first line therapy. Between April 1993 and April 1999, 30 TB patients (28 with pulmonary TB and two with lymph node TB) were treated with combinations of sparfloxacin and at least two other drugs at the Chest Hospital Heckeshorn, Berlin. Sixteen patients were infected by resistant mycobacteria (one single drug resistance (SDR), one polyresistance, and 14 multidrug resistances (MDR); 14 males (age range 23-53 yrs), 2 females (68-74 yrs)). Twelve patients (11 males, one female, 27-80 yrs) had not tolerated first line antituberculosis drugs. Two additional male patients had continuous proof of Mycobacterium tuberculosis in sputum without resistance during therapy The duration of sparfloxacin therapy during hospitalization ranged 2.5-4 months. Twenty-five patients completed therapy and were cured according to this study's definition. Although sparfloxacin was generally well tolerated, five mild phototoxic reactions and six moderate prolongations of the electrocardiographic QT-interval (30-40 ms compared to baseline < or = 450 ms) were registered without clinical symptoms in the patient group. In summary, sparfloxacin proved an effective and safe alternative antituberculosis drug for complicated tuberculosis.     

No early respiratory benefit with CVVHDF in patients with acute renal failure and acute lung injury.

BACKGROUND: There is debate as to whether, in patients with acute lung injury, continuous renal replacement therapy has beneficial effects on pulmonary gas exchange by mechanisms other than fluid removal. Because continuous renal replacement therapy is associated with potential morbidity and mortality, it seems unethical to perform a randomized trial in patients with acute lung injury without renal failure. Therefore, the effects of continuous venovenous haemodiafiltration with zero volume balance on gas exchange were evaluated in patients with acute renal failure and acute lung injury. Because haemofilter conditions should be comparable between patients, we opted for an evaluation of the effects during a 24-h period. Results of this trial can guide future studies in non-renal patients with acute lung injury. METHODS: In all 37 patients with acute renal failure and acute lung injury, treated with continuous venovenous haemodiafiltration with zero fluid balance during a 1 year period, ventilatory and haemodynamic parameters were measured every 8 h during the 24 h preceding therapy and during the first 24 h of therapy. RESULTS: We found a slight, although not statistically significant, increase in the PaO(2)/FIO(2) ratio and the oxygenation index, in the total group of patients, and in the subgroups of patients with acute lung injury of extrapulmonary and pulmonary causes. CONCLUSIONS: During the first 24 h of treatment, continuous venovenous haemodiafiltration with zero volume balance did not result in a significant improvement of the respiratory status in patients with acute renal failure and acute lung injury, nor in the subgroups of patients with acute lung injury with extrapulmonary causes.     

Pharmacokinetic aspects of tuberculosis therapy with a fixed combination of rifampicin, isoniazide and pyrazinamide

The here described investigations show correspondingly that the administration of isoniazid, rifampicin and pyrazinamide in a fixed combination of the administration of the individual substances is bioequivalent under pharmacokinetic aspects. Further investigations on large populations of patients must, however, still confirm whether or not the advantages of the fix combination striven for or theoretically to be expected can be proved in practice.     

Stellenwert der antibiotischen Therapie bei infekti?ser Enteritis

Die Reisediarrh? ist die h?ufigste Form der infekti?sen Diarrh? des Erwachsenen. Abh?ngig von den angestrebten Reisezielen und dem allgemeinen Gesundheitszustand des Reisenden sollten diesem entsprechende Empfehlungen hinsichtlich Prophylaxe und Therapie mit auf den Weg gegeben werden.     

Determination of chromium and cobalt in human serum by neutron activation analysis

Confusion exists about the chromium and cobalt concentrations in the serum of healthy individuals. We determined these elements by neutron activation analysis. The samples were irradiated during 12 days at a flux of approximately 10(14) neutrons.cm-2.s-1. Chromium was selectively separated by distillation after the irradiation. We obtained the following values (mean +/- standard deviation): 0.160 +/- 0.083 mug/liter for chromium, and 0.108 +/- 0.060 mug/liter for cobalt.