The clinical laboratory assessment of vancomycin (Edicin) efficacy in treating suppurative wounds of the skin and soft tissues, burn wounds and the infectious complications of burns]

Clinical and bacteriological efficacies of vancomycin (Edicin, LEK) in the treatment of 17 patients with wound infection and 13 patients with thermal affections were studied. The clinical efficacy in the group of the patients with purulent wounds of the soft tissues amounted to 94.1 per cent and that in the patients with thermal affections was 92.3 per cent. The bacteriological effect was recorded in 86.6 per cent of the patients with purulent wounds of the soft tissues and in 69.3 per cent of the patients with burn infections. The drug intolerability was observed in two cases.     

Use of pefloxacin in the treatment of patients with purulent wounds of soft tissues]

Pefloxacin was used in the treatment of 25 patients with wound infection in a dose of 400 mg orally twice a day for 10-12 days. As the monotherapy it was applied to 15 patients. 7 patients with clinical signs of non-clostridial anaerobic infection were treated with pefloxacin in combination with intravenous metronidazole. Pefloxacin was highly efficient in 96 per cent of the cases with extensive posttraumatic purulent wounds with and without bone affection, acute purulent wounds of the soft tissue, purulent wounds of the soft tissues in diabetic patients, trophic or decubitus ulcer. 266 clinical isolates of Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, Proteus mirabilis, Enterobacter spp. and Acinetobacter spp, were tested and 75 to 100 per cent of them was shown to be susceptible to pefloxacin and ciprofloxacin. At the same time the isolates of Pseudomonas aeruginosa and Klebsiella spp. were more susceptible to ciprofloxacin. The pathogen eradication and eradication with superinfection in the cases treated with pefloxacin amounted to 92 per cent. The drug tolerance was good. No clinically significant adverse events were recorded.     

The use of ampicillin/sulbactam (Unasyn) in treating inflammatory urological diseases

Unasyn is a combination of ampicillin, a bactericidal antibiotic, and sulbactam, an inhibitor of beta-lactamases. It was used in treatment of 36 patients with urogenital infections. The combination was administered intravenously and in the main intramuscularly. The treatment course amounted to 7-10 days. The average daily dose was 6 to 9 g. 22 patients with acute nonocclusive pyelonephritis were treated with the combination and its clinical and bacteriological efficacy was stated in 95 per cent of the cases. An excellent clinical effect of the combination was observed in 6 patients with acute epididymitis. A clinical improvement was also observed in the treatment of the patients with acute prostatitis and chronic renal infections. Unasyn proved to be a highly efficient antibacterial combination with regard to gram-positive flora and colon bacilli as representatives of gram-negative organisms. Satisfactory results were also stated in the treatment of infections caused by Proteus spp. Complete elimination of the pathogen was achieved in 57.7 per cent of the cases. No adverse reactions to Unasyn except pain in the site of the injection were recorded.     

Efficacy of meropenem in the treatment of severe complicated urinary tract infections]

The clinical and bacteriological efficacies of meropenem in the treatment of 12 patients with urinary tract infection were studied. In 8 patients the drug was administered intravenously in a dose of 1 g every 8 hours and in 4 patients with the creatinine clearance below 50 ml/min it was administered in a dose of 1 g every 12 hours (the treatment course of 7 to 10 days). Meropenem was used in the monotherapy. Severe complicated urinary tract infections were mainly observed in the patients with long-term urolithiasis, subjected to repeated surgical interventions and isolating as a rule polyresistant strains of Pseudomonas aeruginosa and E.agglomerans as the pyelonephritis pathogens at a titre of 5 x 10(5)-5 x 10(8) microbial cells per 1 ml of the urine susceptible to meropenem in 80 to 96 per cent of the cases. The clinical efficacy of the drug was stated in all the patients while the bacteriological efficacy amounted to 88.9 per cent.     

The results and characteristics of the mupirocin (Bactroban) sanative treatment of intranasal Staphylococcus carriers in a large hospital]

The action of mupirocin as a nasal ointment (Bactroban) was studied on intranasal carriers of the hospital staphylococcal strains. The study included 37 medical workers from different and mainly problem units of the large general hospital. The tolerability of the ointment was good. After the Bactroban use no complications of the patients were recorded. The efficacy of Bacroban by the microbiological criteria in total amounted to 100 per cent. The eradication of methicillin resistant Staphylococcus aureus (MRSA) was observed in 93 per cent of the cases. A decrease of the level of the nasal passages dissemination by MRSA and methicillin resistant coagulase-negative staphylococci (MRSC) up to such low titers as 100 and 90 per cent was stated. No difference in the action of Bactroban on MRSA, MSSA and MRSC was noted. The bacteriological monitoring for 3 to 4 months revealed a change of the staphylococcal strains in 94 per cent of the cases, recolonization by the same staphylococcal strain in 19 per cent, recolonization by some another staphylococcal strains in 33 per cent and no recolonization in 14 per cent. A stable decrease of staphylococcal strains was possible with simultaneous Bactroban sanitation of all the bacterial carriers of the hospital or its isolated unit.     

The clinical and economic efficacies of short courses of azithromycin in acute sinusitis]

A randomized study of a 3-day course of azithromycin therapy (500 mg once daily) vs. a 10-day course of co-amoxiclav therapy (625 mg thrice daily) in patients with acute sinusitis was performed with an account of the GCP criteria. One hundred patients in 2 groups each of 50 persons were enrolled. The estimates of the patient body temperature, headache, pain on palpation in the area of the accessory nasal sinuses, nasal cavity stuffing, nasal discharge nature and the nose mucous membrane appearance were recorded prior to the treatment, in 72 hours and on the 10th-12th and 26th-30th days of the treatment. The microbiological analysis of the punctate from the accessory nasal sinuses was undertaken before the antibiotic therapy and 72 hours after its start. The economic analysis included the cost of the antibiotic therapy course, hospitalization term, medical manipulations and laboratory tests as well as the cost/efficacy index. The frequency of the relapses within 6 months after the cure was estimated in the two groups compared. In 72 hours and on the 10th-12th days after the treatment start the efficacy of azithromycin was significantly higher than that of co-amoxiclav. The cure was stated in 41 (82 per cent) and 26 (52 per cent) patients on the 10th-12th days, in 6 (12 per cent) and 21 (42 per cent) patients the improvement was stated and the fail was stated in 3 (6 per cent) and 2 (4 per cent) patients respectively. The efficacy of the drugs on the 26th-30th days after the treatment start did not differ. The isolates of Staphylococcus aureus and Streptococcus pyogenes were the main pathogens. The bacteriologic eradication was recorded in 29 (90.6 per cent) patients treated with azithromycin and only in 18 (69.2 per cent) patients treated with co-amoxiclav. Adverse reactions and relapses of the disease within 6 months after the cure were more frequent in the patients treated with co-amoxiclav. The cost of the azithromycin therapy was significantly lower. It was shown that the shortened course of the azithromycin therapy provided earlier cure of the patients with acute sinusitis, better tolerance of the drug, less frequent adverse reactions, lower cost as compared to the use of co-amoxiclav and no relapses.     

A trial of the use of mupirocin in the nasal carriage of Staphylococcus aureus in medical personnel]

Many hospital-acquired purulent diseases and wound infections are due to multiresistant hospital strains of Staphylococcus aureus. The role of S. aureus nasal carriage in development of wound infections due to autoinfection is confirmed. Not only inpatients but also hospital staff can be highly colonized with coagulase positive staphylococci. The S. aureus persistence in hospital personnel results in distribution of the microorganisms in the environment. Therefore, detection of S. aureus carriers without signs of the infection among the hospital personnel and eradication of the pathogen make it possible to control outbreaks of S. aureus infection in hospitals. Clinical efficacy of nasal ointment of mupirocin in the treatment of S. aureus carriers among the intensive care personnel of the N. N.Blokhin Cancer Research Center was evaluated. S. aureus nasal carriage was diagnosed in 17 (26 per cent) out of 65 persons. All the isolates were susceptible to oxacillin. 5-7 days after discontinuation of the mupirocin nasal ointment use eradication of S. aureus was stated in 100 per cent of the cases. The effect was still observed in 94 per cent of the cases in 1 month, in 76 per cent of the cases in 5-6 months and in 60 per cent of the cases in 8-9 months. It is believed that mupirocin nasal ointment (Bactroban) is convenient to use, low toxic and highly active in the treatment of persons with S. aureus nasal carriage.     

The efficacy of cefepime (Maxipime) in the treatment of abdominal sepsis in surgical patients]

The efficacy of cefepime in the treatment of 46 patients operated for general peritonitis of various genesis and severity (APACHE II not greater than 35) was studied. Cefepime was used in a dose of 2 g administered every 12 hours as slow intravenous infusions in 0.9 per cent sodium chloride solution in combination with metronidazole administered intravenously in a dose of 7.5 mg/kg body weight. The treatment course was 4 to 15 days. 45 patients were given diflucan for the prophylaxis of fungal superinfection, 3 patients were given aminoglycoside antibiotics (netilmicin or amikacin) and 2 patients were given vancomycin per os. The favourable clinical effect of the cefepime therapy was stated in 38 patients (82.6 per cent) including 4 out of 10 patients with initial APACHE II > 15. 101 isolates of aerobic gram-negative and gram-positive microbes from 38 patients treated with cefepime in combination with metronidazole were tested to estimate the bacteriological efficacy of the therapy and it was shown that only 5.9 per cent of them was resistant. The pathogen eradication was stated in 84.2 per cent of the patients.     

Prolonged antibacterial action of polymer coated suture materials]

The antimicrobial activity of capromed, a surgical polymer-coated sutural material containing dioxidine, quinoxidine or gentamicin was studied in vitro and in vivo. Capromed was shown to be active against the hospital strains of S. aureus, E. coli, Proteus spp., Klebsiella spp. and P. aeruginosa. The antimicrobial activity of ADH and AG threads was preserved for 3 to 4 days after implantation. The DH-2 and G-2 threads preserved their activity for 6 to 7 days. It was concluded that the duration of thread antimicrobial activity depended on the properties of the polymer coating the thread. Capromed was applied to 280 operation wounds in 275 patients. There was no wound suppuration in the group of patients after pure operations (n = 62). In the group of patients after conditionally pure operations (n = 130) suppuration was observed in 2 patients (1.3 per cent). In patients with contaminated wounds (n = 88) suppuration in 5 of them (5.7 per cent) was recorded. The total number of the purulent complications after using capromed in surgical operations amounted to 2.5 per cent. In the control group purulent complications were stated in 8.2 per cent of the cases.     

Use of cefoperazone in clinical practice]

The bacteriological and clinical efficacy and side effects of cefoperazone were studied in 45 patients with severe and moderate purulent inflammatory diseases. The study showed that its bacteriological and clinical efficacy was high in cases with peritonitis, cholecystitis, respiratory and urinary infections, as well as those of the eye and soft tissues. The general clinical efficacy amounted to 95.6 per cent. The number of the side effects was insignificant. This made it possible to recommend the use of cefoperazone in the therapy of many purulent inflammatory diseases, as well as in empirical therapy.     

Spectrum of pathogens in hospital infections in onco-urologic patients and their sensitivity to antibacterial drugs

Retrospective examination of case records and laboratory findings related to 155 patients discharged from the Urological Department of the All-Union Oncology Research Centre, Academy of Medical Sciences of the USSR within a period of 3 months showed that 41.9 per cent of the oncourological patients had infectious processes requiring antibacterial therapy. Among 80 infectious episodes 62 or 77.5 per cent were of intrahospital origin. There was a relationship of the frequency of the infections to localization of the tumor process, a patient's age, the treatment character and some diagnostic and treatment procedures. 70 per cent of the hospital infections were urinary and 15 per cent referred to suppuration of the operative wounds. The predominant causative agents of the complications were Pseudomonas spp., Klebsiella tribe, Proteus spp. and Enterococci with the highest levels of resistance to antibacterial drugs. The drugs of choice for treating the infections in that group of the patients were ofloxacin and cefotaxime. Aminoglycosides, semisynthetic penicillins, cephalosporins and urological antiseptics were used in accordance with antibioticograms. In the treatment of severe gram-negative infections dioxydin was used. Since hospital infections in oncourological patients are usually caused by hospital multiple resistant strains of microorganisms, often present in associations, the adequate antibacterial therapy requires constant bacteriological surveillance providing not only the choice of the most efficient drug but also early correction of the therapy after the pathogen change.     

Sparfloxacin (Sparflo) in the treatment of urological infections]

Sparfloxacin efficacy evaluation for the treatment of urogenital tract infections is presented. The trial was performed on 43 patients with chronic complicated infections of urogenital tract (pyelonephritis, prostatitis). Sparfloxacin (once daily for 7-14 days) was highly effective in the infection management according to clinical and bacteriological results (83.7 per cent and 78.1 per cent subsequently).     

Use of bleomycetin in malignant testicular tumors and the problem of studying bleomycin analogs

The efficacy of the chemotherapy of 16 patients with metastases of malignant tumors of the testicle was studied. The chemotherapy included vinblastine, platidiam and bleomycetin. The latter was used in a dose of 10 mg daily intramuscularly or as long-term intravenous infusions. As a result of the treatment complete and partial regression of the tumors was observed in 5 (31 per cent) and 4 (25 per cent) patients, respectively. Leukopenia was the main side effect. By present the total doses of bleomycetin had amounted to 250 mg for 4 patients and to 300-350 mg for 7 patients. No signs of pulmonary toxicity were observed with the use of these doses. The problem of clinical studies of bleomycin analogs is discussed.     

Comparison of linezolid and vancomycin in nosocomial pneumonia: results of the multicenter double-blind study]

The results of multicenter, randomized, double-blind comparative study of linezolid and vancomycin efficacy, safety and tolerability in the treatment of nosocomial pneumonia are presented. The trial was performed on 69 patients. Clinical efficacy of linezolid was 83 per cent, of vancomycin--79 per cent. Bacteriological effect (pathogen eradication) was 83 per cent for linezolid group and 86 per cent for vancomycin group. During the study good clinical tolerability of linezolid was demonstrated along with lower side effects incidence and shortened recovery period when compared to vancomycin.     

The clinical efficacy of ticarcillin/clavulanate in severe pneumonia]

Efficacy of ticarcillin/clavulanate was studied in the treatment of 11 patients with severe community- and hospital-acquired pneumonia in an open controlled trial. The drug was administered in a dose of 3.1 g every 4 or 6 hours depending on the infection severity. When pneumonia was due to Pseudomonas aeruginosa, amikacin was additionally used. The positive clinical effect of ticarcillin/clavulanate was stated in 73 per cent of the patients. The pathogen eradication was stated in all the patients. However, in 2 cases superinfection due to P.aeruginosa developed. Mild adverse effects were observed in 2 cases. It is concluded that ticarcillin/clavulanate is highly efficient in the treatment of patients with severe or complicated pneumonia. In cases with ventilator-associated pneumonia it is advisable to use ticarcillin/clavulanate in combination with an aminoglycoside.     

Antibacterial prophylaxis of bacteriuria at transrectal multifocal prostatic biopsy]

It was shown that prophylactic use of ciprofloxacin (500 mg per os 30 min prior to and 5 days after transrectal multifocal prostatic biopsy) along with topical treatment with 40 ml 1% povidone-iodine and evacuant enema provided negative bacteriological urine analysis in 24 hours for 94.4 per cent of cases. Positive effect was registered for all patients as no urinary tract infections were demonstrated. Transitory fever over 37.5 degrees C was not registered at 67 (97.2 per cent) patients, for the rest cases no changes of the treatment regime were necessary. The results of the trial proves high bacteriological and clinical efficacy of the therapy regimes and allow to recommend its implementation at transrectal biopsy.     

Experience with using aclarubicin in the treatment of acute leukemia and blast crisis of chronic myeloid leukemia]

The clinical efficacy of aclarubicin, an anthracycline antibiotic, was studied in 48 patients with leukemia. The antibiotic was used in the following combinations with cytarabine: "7 + 7", "5 + 5" and "7 & 3". A complete remission was stated in 14 (42.4 per cent) out of 33 patients with acute nonlymphoid leukemia, 6 (43 per cent) out of the 14 patients having relapses. The combined therapy was effective in 4 out of 5 pre-resistant patients. The "7 + 3" scheme was the most beneficial. The most common adverse reactions were nausea and vomiting.     

Detection of the determinants of tetracycline A, B and C resistance in Shigella and Salmonella using DNA probes

Genetic determinants of tetracycline resistance of classes A, B and C were detected with DNA probes labeled with radioactive phosphorus (32P) in Shigella (44 strains) and Salmonella (50 strains). It was shown that in the Shigella strains the frequency of the Tet A gene amounted to 66 per cent, the frequency of the Tet B gene was equal to 84 per cent, the frequency of their combination was equal to 50 per cent and the frequency of the Tet C gene was nil. In the Salmonella strains the frequency of the Tet A, Tet B and Tet C genes was equal to 0.100 and 20 per cent, respectively, and that of their combination amounted to 20%. Possible use of the DNA probes in epidemiological analysis of outbreaks of Shigella and Salmonella infections is suggested.     

Sulperazone in the treatment of severe infections in patients with cancer]

For the evaluation of rational sulperazone position in oncological hospital and elaboration of its implementation criteria investigation was performed. The trial included 193 patients (88 patients with injuries, 66 with hospital pneumonia, 39 with urinary track infection). From different clinical material of the patients were isolated 136 straines of Gram-negative bacteria. Suseptibile to sulperazone were 67 per cent of P. aeruginosa, 78-86 per cent of P. vulgaris, Klebsiella and E. coli isolates, 66 [symbol: see text] 60 per cent of Enterobacter and Serratia isolates subsequently. Comparative results of treatment with sulperazone as monotherapy and for combination with aminoglycosides (gentamycin or amicacin) in the case of P. aeruginosa infection demonstrated high sulperazone efficacy not lower than imipenem/cilsatatin and cefepime efficacy in the case of hospital infections treatment at critical care units. Low price of the sulperazone treatment when compared to imipenem/cilastatine is emphasized. Another advantage of sulperazone when compared to cefepime is anaerobic infection treatment--cefepime is administered in combination with metronidazole while sulperazone is used in monotherapy.