Cefotaxime in urinary tract infections

Summary According to available studies the experience with cefotaxime in the treatment of urinary tract infections (UTI) is presented. Because of its broad spectrum antibacterial activity cefotaxime is active against most of the causative organisms, including multiresistant strains (except enterococci). Of 400 isolates cultured from 400 urological inpatients with complicated and/or hospital acquired UTI 90.2% of the gramnegatives and 87.7% of the staphylococci were inhibited by concentrations of 8 mg/l. As with other antibiotics in uncomplicated UTI, high cure rates could be achieved by single dose or short-term treatment. According to six non-comparative and nine comparative studies it could be demonstrated that treatment with cefotaxime achieved favorable results in patients with complicated and hospital acquired UTI even if caused by multiresistant strains. In general, in these studies cefotaxime was superior to gentamicin, cefoxitin, cefazolin and cefuroxime, but as effective as other third generation cephalosporins and aztreonam and as the combination of ampicillin and netilmicin. A good tolerance of cefotaxime was reported in all studies.

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Cefotaxim bei der Behandlung von Harnwegsinfektionen

Zusammenfassung Aufgrund vorliegender Studie wird über die Erfahrung mit Cefotaxim bei der Behandlung von Harnwegsinfektionen (HWI) berichtet. Wegen seines breiten antibakteriellen Spektrums ist Cefotaxim aktiv gegenüber den meisten Erregern (außer Enterokokken) von HWI, multiresistente Stämme eingeschlossen. Von 400 Erregern, angezüchtet aus dem Urin von 400 urologischen Patienten mit komplizierten und/oder im Krankenhaus erworbenen HWI konnte Cefotaxim bis zu einer Konzentration von 8 mg/l 90,2% der gramnegativen Erreger und 87,7% der Staphylokokken hemmen. Wie mit anderen Antibiotika auch, konnten bei unkomplizierten HWI mit der Einmal- bzw. Kurzzeittherapie ausgezeichnete Ergebnisse erzielt werden. In sechs nicht vergleichenden und in neun vergleichenden Studien konnte gezeigt werden, daß bei der Behandlung von Patienten mit komplizierten und nosokomialen HWI auch bei multiresistenten Erregern gute Ergebnisse mit Cefotaxim zu erreichen sind. Im allgemeinen war in diesen Studien Cefotaxim überlegen im Vergleich zu Gentamicin, Cefoxitin und Cefuroxim, aber etwa gleich wirksam wie andere Cephalosporine der dritten Generation, Aztreonam, und die Kombination Ampicillin und Netilmicin. In allen Studien wurde über eine gute Verträglichkeit von Cefotaxim berichtet.

     

Cefuroxime axetil versus ofloxacin for short-term therapy of acute uncomplicated lower urinary tract infections in women

Summary In a multicentre study 163 women with acute lower urinary tract infection were treated orally with either 125 mg cefuroxime axetil or 100 mg ofloxacin twice daily for three days. Both antimicrobial agents were generally well tolerated. Four patients in the group treated with cefuroxime axetil and two in the group treated with ofloxacin experienced adverse events. Clinical cure and improvement were registered in 56 of 66 (84.8%) and 59 of 62 (95.2%) of the evaluable patients treated with cefuroxime axetil and ofloxacin, respectively. Seven to nine days after therapy, bacteriuria (CFU<10³/ml) had been eliminated in 53 of 66 (80.3%) and 57 of 64 (89.1%) of the evaluable patients receiving cefuroxime axetil and ofloxacin, respectively. The results were not statistically significantly different (P>0.1). Pathogens present at baseline were eliminated by up to an MIC of 16 mg/l of cefuroxime axetil, independent of susceptibility to this agent. There was no difference with regard to efficacy and tolerance between patients treated with cefuroxime axetil and those treated with ofloxacin. On the basis of the MICs of six antimicrobial agents (cefuroxime, ofloxacin, cefadroxil, ampicillin, trimethoprim with and without sulfamethoxazole) determined for the pathogens isolated prior to therapy, resistance rates were lowest for cefuroxime (2.2%) and ofloxacin (3.4%).

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Kurzzeittherapie bei akuter, unkomplizierter Harnwegsinfektion bei Frauen. Cefuroximaxetil und Ofloxacin im Vergleich

Zusammenfassung In einer multizentrischen Studie wurden 163 Frauen mit akuten unteren Harnwegsinfektionen mit Cefuroximaxetil in einer Dosis von 125 mg im Vergleich zu Ofloxacin in einer Dosis von 100 mg zweimal täglich über drei Tage behandelt. Beide Antibiotika wurden im allgemeinen gut vertragen. Bei vier Patienten, die mit Cefuroximaxetil behandelt wurden, und bei zwei Patienten, die mit Ofloxacin behandelt wurden, traten Nebenwirkungen auf. Klinische Heilung und Besserung wurde bei 56/66 (84,8%) beziehungsweise 59/62 (95,2%) der Patienten erreicht, die entweder mit Cefuroximaxetil oder Ofloxacin behandelt wurden. Sieben bis neun Tage nach der Therapie fand sich eine Elimination der Bakteriurie bei 53/66 (80,3%) der auswertbaren Patienten, die Cefuroximaxetil erhielten, beziehungsweise bei 57/64 (89,1%) der Patienten, die mit Ofloxacin behandelt wurden. Zwischen den Behandlungsgruppen fanden sich keine statistisch signifikanten Unterschiede (p>0,1). Bis zu einer minimalen Hemmkonzentration (MHK) von 16 mg/l konnten die Erreger unabhängig von der Empfindlichkeit durch Cefuroximaxetil eliminiert werden. Wir fanden keine Unterschiede in der Wirksamkeit und Verträglichkeit der beiden Antibiotikaregime. Entsprechend den MHK-Werten von sechs Antibiotika (Cefuroxim, Ofloxacin, Cefadroxil, Ampicillin, Trimethoprim mit und ohne Sulfamethoxazol), die für die Erreger vor der Therapie bestimmt wurden, fanden sich die niedrigsten Resistenzraten bei Cefuroxim (2,2%) und Ofloxacin (3,4%).

     

Modern approaches to the treatment of breast cancer

Breast cancer is the most common cause of cancer death in women in this country. Until recently, the traditional treatment has been radical surgery with or without radiation therapy for patients with primary breast cancer, and palliative endocrine therapy followed by chemotherapy for patients with advanced disease. These treatments have met with limited effectiveness in terms of eradicating the disease. Studies in the past decade have given cause for optimism for breast cancer patients. Adjuvant systemic therapy after local treatment appears promising for certain subsets of patients with primary breast cancer. The development of estrogen receptor assays has markedly changed our approach to the disease and improved patient care. Estrogen receptor is an important prognostic factor and is useful in planning appropriate therapy for patients with primary breast cancer as well as those with advanced disease. Further research is urgently needed to improve the dismal survival of certain women with this common malignancy.     

Use of the Optomap with lid retraction and its sensitivity and specificity#

Background: Optomap uses the ultra‐wide field scanning laser ophthalmoscopy to provide retinal examination. It permits fundus examination without the use of a mydriatic, which is more comfortable for the patients. This paper determines the sensitivity and specificity of the Optomap for detecting retinal signs under non‐mydriatic conditions. Methods: Fifty‐four eyes identified with retinal/choroidal signs and eight normal eyes were recruited from 31 Hong Kong Chinese subjects. Photo‐documentation of fundal changes was obtained with the Optomap under non‐mydriatic conditions before a dilated fundus examination by a clinician using standard procedures. The eyelid was retracted using a cotton bud when necessary. Dilated fundus examinations were performed by another clinician using binocular indirect ophthalmoscopy and slitlamp biomicroscopy with a fundus lens. The Optomap images were evaluated by four other investigators under masked condition. The International Classification of Disease, Ninth Revision (ICD‐9‐CM) was adopted for recording retinal features. Screening results were compared with those obtained using the dilated fundus examination as the gold standard. Results: The cotton bud method for eyelid retraction showed an improvement in the area of retina that could be visualised. The sensitivity and specificity of the Optomap averaged 76.4 and 71.9 per cent, respectively. Some fundal signs were missed by all observers in the Optomap but not with the biomicroscope. These included white‐without‐pressure, lattice degeneration, paramacular drusen and pigmentary changes at central fundus. Conclusion: Optomap serves as a reliable screening tool for fundus examination especially because it covers a much wider area of the peripheral retina than other digital instruments for fundus photography.     

With medium-chain triglycerides, higher and faster oxygen radical production by stimulated polymorphonuclear leukocytes occurs

BACKGROUND: Parenteral lipid emulsions are suspected of suppressing the immune function. However, study results are contradictory and mainly concern the conventional long-chain triglyceride emulsions. METHODS: Polymorphonuclear leukocytes were preincubated with parenteral lipid emulsions. The influence of the lipid emulsions on the production of oxygen radicals by these stimulated leukocytes was studied by measuring chemiluminescence. Three different parenteral lipid emulsions were tested: long-chain triglycerides, a physical mixture of medium- and long-chain triglycerides, and structured triglycerides. Structured triglycerides consist of triglycerides where the medium- and long-chain fatty acids are attached to the same glycerol molecule. RESULTS: Stimulated polymorphonuclear leukocytes preincubated with the physical mixture of medium- and long-chain triglycerides showed higher levels of oxygen radicals (p < .005) and faster production of oxygen radicals (p < .005) compared with polymorphonuclear leukocytes preincubated with long-chain triglycerides or structured triglycerides. Additional studies indicated that differences in results of various lipid emulsions were not caused by differences in emulsifier. The overall production of oxygen radicals was significantly lower after preincubation with the three lipid emulsions compared with controls without lipid emulsion. CONCLUSIONS: A physical mixture of medium- and long-chain triglycerides induced faster production of oxygen radicals, resulting in higher levels of oxygen radicals, compared with long-chain triglycerides or structured triglycerides. This can be detrimental in cases where oxygen radicals play either a pathogenic role or a beneficial one, such as when rapid phagocytosis and killing of bacteria is needed. The observed lower production of oxygen radicals by polymorphonuclear leukocytes in the presence of parenteral lipid emulsions may result in immunosuppression by these lipids.     

Medium-chain, triglyceride-containing lipid emulsions increase human neutrophil beta2 integrin expression, adhesion, and degranulation

BACKGROUND: To test the hypothesis that lipid emulsions with different triglyceride structures have distinct immunomodulatory properties, we analyzed human neutrophil adhesion and degranulation after lipid incubation. METHODS: Neutrophils, isolated from the blood of 10 healthy volunteers, were incubated in medium or physiologic (2.5 mmol/L) emulsions containing long-chain (LCT), medium-chain (MCT), mixed LCT/MCT, or structured (SL) triglycerides. Expression of adhesion molecules and degranulation markers was evaluated by flow cytometry. Also, functional adhesion was investigated by means of a flow cytometric assay using fluorescent beads coated with the integrin ligand intercellular adhesion molecule (ICAM)-1. RESULTS: Although LCT and SL had no effect, LCT/MCT significantly increased expression of the beta2 integrins lymphocyte-function-associated antigen 1 (+18%), macrophage antigen 1 (+387%), p150,95 (+82%), and (alphaDbeta2 (+230%). Degranulation marker expression for azurophilic (CD63, +210%) and specific granules (CD66b, +370%) also significantly increased, whereas L-selectin (CD62L, -70%) decreased. The effects of LCT/MCT were mimicked by the MCT emulsion. ICAM-1 adhesion (% beads bound) was increased by LCT/MCT (34% +/- 4%), whereas LCT (19% +/-3%) and SL (20% +/- 2%) had no effect compared with medium (17% +/- 3%). CONCLUSIONS: LCT/MCT and MCT, contrary to LCT and SL emulsions, increased neutrophil beta2 integrin expression, adhesion, and degranulation. Apart from other emulsion constituents, triglyceride chain length might therefore be a key feature in the interaction of lipid emulsions and the phagocyte immune system.     

Subjective well-being and quality of life under atypical antipsychotic treatment

The increasing interest in subjective well-being and quality of life of schizophrenic patients represents a conceptual shift in therapeutic outcome criteria. Symptom reduction alone was the most essential outcome parameter for a long time; with the development of atypical antipsychotics more ambitious success criteria, including the patients' perspective, are considered today. While effects on (positive) psychopathology do not differ markedly between typical and atypical antipsychotics, the lack of motor symptoms, the improvement of negative, affective and cognitive symptoms, and particularly the better subjective well-being as well as quality of life are major advantages for the new antipsychotic drugs. Quality of life assessment is a new methodological approach to differentiate therapeutic effects and to give more consideration to the patient's perspective. A number of disease-specific or generic scales have been used to measure quality of life of schizophrenic patients under neuroleptic treatment. There is strong evidence by seven controlled and eight open trials that in comparison to typical neuroleptics, atypicals increase the quality of life significantly, and the difference is of major clinical relevance in many patients. This review describes the development of quality of life research in schizophrenic patients, and summarises the methodological problems and the numerous clinical trials. Furthermore, the benefit of introducing atypical antipsychotics early in the course of illness and their particular benefit in combination with rehabilitative non-pharmacological treatment is discussed.     

Spectrum and antibiotic resistance of uropathogens from hospitalized patients with urinary tract infections: 1994-2000

During the period 1994–2000 all uropathogens cultured from urine of hospitalized urological patients were identified and susceptibility was tested against 11 antibacterials. Duplicated isolates were eliminated. There was no general trend of increased of resistance apart from E. coli to ciprofloxacin (10.4% in 2000). Vancomycin-resistant staphylococci or enterococci was not significant. The lowest overall rates of resistance were found with piperacillin/tazobactam followed by ciprofloxacin and trimethoprim/sulphamethoxazole. Ciprofloxacin was the best oral antibiotic for the empirical treatment of urinary tract infection (UTI) due to Gram-negative rods and ampicillin/sulbactam for the treatment of UTI with Gram-positive cocci.