Ampicillin treatment trial in gonorrhea recurrences]

The results of using ampicillin in treatment of 54 gonorrhea patients (41 males and 13 females) previously treated with other antibiotics without success are presented. Ampicillin was used in a daily dose of 500 mg administered 5 times a day at equal intervals and an 8-hour interval during the night time. The course dose was 6--10 g. Patients with chronic and fresh gonorrhea with insignificantly pronounced symptoms were subjected to immunotherapy before the treatment with ampicillin. Pure gonococcal strains sensitive to ampicillin were isolated from 16 patients before the ampicillin use. Clinical improvement after the treatment with ampicillin in most of the patients was observed by the end of the 1st day and was evident from elimination of the urethral discharges, absence of urination colics and urea clarification. Etiological recovery was recorded in all the gonorrhea patients due to the treatment with ampicillin. All the patients were crossed off the register. The clinical and laboratory investigations showed high efficiency of ampicillin in treatment of gonorrhea relapses. The antibiotic is rapidly absorbed into the blood. Its therapeutic blood levels are maintained during 24 hours. It is well tolerated by the patients.     

Therapy of Anorectal Gonorrhea in Men: Efficacy of Oral Antibiotic Regimens

The results of therapy in 916 men with anorectal gonorrhea treated with orally given antibiotic drugs were reviewed retrospectively. There was a 17.8 percent failure rate for tetracycline (total dose, 10 grams) and a 10.7 percent failure for 3.5 grams of ampicillin plus 1 gram of probenicid. Repeating the ampicillin plus probenicid dose once in 8 to 14 hours reduced the failure rate to 1.6 percent, an efficacy comparable to the regimen of 4.8 million units of aqueous procaine penicillin G given intramuscularly plus 1 gram of probenicid given orally for treatment of anorectal gonorrhea.     

Rifampicin in the therapy of gonorrheal urethritis in men]

The therapeutic efficiency of benemycin (rifampicin of Polish production), a semisynthetic antibiotic was studied in 96 male cases with gonorrhea urethritis. The antibiotic was used in a dose of 300 mg every 6 hours (2.1--3gm for the treatment course depending on the desease severity). Observation of the patients for 1--2 months showed etiological recovery in 91 (94.8 per cent) out of 96 patients. Postgonorrhea inflammatory processes were observed in 8.7 per cent of the cases. For studying late results of the treatmant 62 patients were observed for 3 to 12 months. Gonococci were isolated from none of the patients. No side reactions were found in the patients treated with rifampicin.     

Influence of arginine vasotocin on the estrogen-induced surge of LH and FSH in adult ovariectomized rats

The effects of arginine vasotocin (AVT) on the estrogen-induced surge of LH and FSH were examined in ovariectomized adult rats. Two and one-half weeks after ovariectomy, animals that were treated with a single subcutaneous (s.c.) dose of 5 μg of estradiol benzoate (EB) exhibited a surge of LH and FSH at 1700 and 1900 hours, respectively, two days after the administration of the EB. AVT, antidiuretic hormone (ADH) and oxytocin (OT) were administered s.c. in 1 μg dose every 4 hours beginning at 1500 hours on day 1 after EB treatment and then every 2 hours beginning at 1200 hours on day 2 after EB treatment. AVT completely prevented the LH surge at 1700 hours but was without effect on the FSH surge at 1900 hours on the day 2 after steroid treatment. Neither ADH nor OT had any significant effect on the afternoon surge of these hormones. It is postulated that AVT may interfere with the mechanisms mediating the estrogen-induced afternoon surge of LH in ovariectomized rats.     

The augmentin (amoxicillin/clavulanate) prophylaxis of postoperative infectious complications in patients with acute surgical diseases of the abdominal cavity organs]

Augmentin was used prophylactically in 25 patients with an account of the infectious complication risk according to 4 regimens: ultrashort-term (1.2 g intravenously with initial narcosis), short-term (1.2 g intravenously with initial narcosis followed by intravenous administration in a dose of 600 mg in 8 and 16 hours), middle-term (1.2 g intravenously with initial narcosis followed by intravenous administration in a dose of 600 mg every 8 hours for 2 days) and long-term (1.2 g intravenously with initial narcosis followed by intravenous administration in a dose of 600 mg every 8 hours for 3 days). One complication episode as wound suppuration was recorded. The routine approach to the use of antibiotics in emergency abdominal surgery, when antibiotics are administered every day for several days after the operation, should be revised.     

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.     

Oral amoxicillin in acute uncomplicated gonorrhea

Of 53 patients with acute uncomplicated gonorrhea treated with amoxicillin 2 g and probenecid 1 g orally as a single administration, six failed to return for follow-up examination, 10 developed postgonococcal urethritis and one was a treatment failure. The remainder achieved symptomatic cure in an average of 2.3 days. Adverse drug effects were infrequent, mild and transient. We conclude that this dose of amoxicillin and probenecid is a safe and effective treatment regimen.     

Results of using morphocycline for the treatment of fresh, uncomplicated gonorrhea in men]

A total of 30 males suffering from fresh non-complicated gonorrhea were treated with morphocycline (N-morpholinmethyltetracycline). The diagnosis in all cases was confirmed by bacterioscopic and cultural tests. The drug was administered intravenously in a dose of 0.15 mg 2 times at an interval of 12 hours. Stable recovery was observed in 17 patients. Resistance to the treatment was found in 4 patients and relapses of the disease within 1 to 9 days after the treatment discontinuation were registered in 9 patients. It was concluded that morphocycline in the usual doses was not sufficiently effective.     

氨茶碱联合纳洛酮治疗早产儿原发性呼吸暂停疗效观察

目的 观察氨茶碱联合纳洛酮治疗早产儿原发性呼吸暂停的疗效.方法 60例原发性呼吸暂停早产儿随机分为两组,在常规治疗基础上,两组均应用氨茶碱,首剂5 mg/kg,12 h后给予维持量2.5 mg/kg,每12 h给药1次;治疗组加用纳洛酮10 μg/(kg·h),每8h或12 h给药1次.结果 治疗组总有效率为93.3％,对照组总有效率为70.0％.两组总有效率比较差异有统计学意义(x2=4.01,P＜0.05).结论 氨茶碱与纳洛酮联合应用优于单纯用氨茶碱治疗早产儿原发性呼吸暂停.     

Serial intramuscular injections of 15(S)-15-methyl-prostaglandin F2α in the induction of abortion

Abortion was successfully induced in 62 of 68 patients in the 9th to the 26th week of pregnancy by serial intramuscular administration of 15(S)-15-methyl-prostaglandin F_2α (15-ME-PGF_2α). In 6 patients who failed to abort after 24 hours of prostaglandin administration, a concomitant infusion of oxytocin was initiated; 5 of these patients aborted within 12 hours of the combined therapy. A single patient failed to abort, even with the combined therapy, and underwent surgical evacuation. The mean abortion time in the 67 successful inductions was 14.56 hours. Parous patients aborted somewhat faster, mean 13.98 hours, as compared to nulliparous patients, mean 15.02 hours, but this difference was not statistically significant. In this study initial intramuscular injection of 100 μg 15-ME-PGF_2α was followed in 1 hour by 250 μg and then 250 μg every 2 hours with concomitant oxytocin therapy initiated after 24 hours. The results with this dose schedule were compared to the results obtained in a previous study with a higher dose schedule, an initial dose of 100 μg 15-ME-PGF_2α, followed in 1 hour by 250 μg then 500 μg every 2 hours. There was no significant difference in the mean abortion time and the incidence of side effects between the 2 dose schedules. The mean abortion time for patients with gestational ages of 16 weeks and less was the same with both dose schedules, however patients with gestational ages of 17 weeks and higher aborted somewhat faster with the higher dose schedule. It might therefore be advisable for patients with gestations of 17 weeks and higher to be treated with the higher dose schedule. In earlier gestations patients could be started on the lower schedule, and if abortion had not occurred within 15 hours the dose of 15-ME-PGF_2α could then be increased to 500 μg every 2 hours.     

A method for maintaining normoglycemia during labour and delivery in insulin-dependent diabetic women.

The effectiveness of combining the subcutaneous administration of short- and intermediate-acting insulin with the intravenous infusion of glucose in maintaining normoglycemia during labour and delivery in insulin-dependent diabetic women was tested. Fifty women were given intermediate-acting insulin twice daily in doses that were fractions of their usual dose, based on the projected duration of labour. In addition, they were given regular (i.e., short-acting) insulin every 6 hours, the dose being 1% of their total daily insulin dose for every increase of 10 mg/dl above 100 mg/dl (5.6 mmol/l) in the plasma glucose level 1 hour previously; the levels were measured every 3 hours. All the patients were fasting and received a basal intravenous infusion of 6 g/h of glucose; the rate of infusion was increased by 1 g/h for every decrease of 10 mg/dl in the plasma glucose level below 100 mg/dl. The mean plasma glucose levels (+/- standard deviation) were 90 +/- 46 mg/dl after 3 hours of labour, 92 +/- 35 mg/dl after 6 hours, 97 +/- 49 mg/dl after 9 hours and 107 +/- 65 mg/dl after 12 hours. With only one exception, in a premature infant, the 5-minute Apgar scores were identical to those of the infants of nondiabetic women.     

Vaginally administered 16,16-dimethyl-PGE2 for the induction of midtrimester abortion

Thirty patients in the 13th–20th week of gestation underwent therapeutic abortion utilizing vaginally administered 16,16-dimethyl-PGE₂ (free acid) suppositories. The first 15 patients obtained individual doses in the range of 400–1200 μg given every three hours (mean total dose 4.2 mg). In the following 15 patients a fixed dose schedule was used (800 μg followed by 1000 μg every three hours; mean total dose 5.3 mg). All but one of the 30 patients aborted. The mean induction-abortion interval for all patients was 16.8±6.9 hours (mean ± S.D.) With the fixed dose regime the success rate was 100% and the induction-abortion interval 16.0±5.9 hours. Because gastro-intestinal side effects were minimal, neither anti-emetic nor anti-diarrheic medication was required. A slight elevation of temperature was noted in five patients. The uterine response to the vaginal administration of this compound was characterized by a gradual increase in uterine tonus followed by sustained stimulation. The results are interpreted to suggest that the vaginal administration of 16,16-dimethyl-PGE₂ is a useful alternate method for the induction of second trimester abortion. Moreover, this compound seems to cause fewer gastro-intestinal side effects than other prostaglandins administered by the vaginal route at our department.     

Rocefin (ceftriaxone) in therapy of uncomplicated gonorrhea in males]

One hundred and nineteen males were examined in a unit for anonymous examination and treatment of sexually transmitted infections and the diagnosis of gonorrhea as monoinfection was stated. Rocefin (ceftriaxine) in a single dose of 250 mg intravenously was prescribed. The control examinations were performed in I and 3 weeks with microscopic and cultural methods. The clinical signs ceased by the 1st or 2nd days. The efficacy of the clinical and microbiological cure was 100%. Ceftriaxone proved to be an optimal agent for the treatment of uncomplicated gonorrhea in males.     

Reassessment of systemic administration of prostaglandins for induction of midtrimester abortion

The present investigation was undertaken to evaluate the abortifacient efficacy of vaginal and intramuscular administration of different dose schedules of the 15-methyl analogues of prostaglandin F_2α.1. . Both 15-methyl-PGF_2α and 15-methyl-PGF_2α methyl ester can be absorbed from the vagina in sufficient amounts to induce abortion. The potency of the methyl ester was approximately twice that of the free acid. The most successful treatment schedule consisted of an initial dose of 0.5 mg of the methyl ester followed by 1.0 or 2.0 mg every third hour. On this treatment all patients aborted within 24 hours.2. . Initially 200 μg of 15-methyl-PGF_2α was given. The dose was increased to 400 μg or occasionally to 500 μg depending on the effect and tolerance of the patient and repeated every third hour. The treatment schedule resulted in a 100 per cent abortion rate and the mean induction-abortion interval was 16.1 hours.Both routes were associated with a higher frequency of side effects than that reported for intra-amniotic administration of 15-methyl-PGF_2α. It seems justified to conclude that the intra-amniotic route is preferable after the 14th week when the uterine cavity is easy to puncture but that vaginal or intramuscular injections of the compounds could be an alternative in late first trimester and early second trimester cases.     

Nalidixic Acid (NegGram) in the Treatment of Urinary Infections

In a bacteriologic and clinical assessment of nalidixic acid (NegGram), 95% of Gramnegative urinary pathogens tested in vitro (with the exception of Pseudomonas pyocyanea) were sensitive to therapeutically attainable levels. The antibacterial spectrum of this agent was surpassed only by parenteral kanamycin, which is potentially ototoxic. Of 70 patients treated with 0.5-1.0 g. every six hours for from two weeks to two months, 61 underwent a full course of treatment and could be assessed. In 42 the infection cleared up, in 15 the original organism disappeared and a new resistant organism emerged, and in four the original organisms became resistant. These four were treated with 0.5 g. every six hours, which suggests that the higher dose may be necessary to prevent development of resistance. In only three of 13 patients with nausea did the drug have to be discontinued. Two patients developed drug rashes and one diarrhea. The drug is a valuable addition to the therapeutic agents used for urinary infections.     

Efficacy of pefoxacin (abactal) in the complex treatment of patients with pancreonecrosis]

The efficacy of pefloxacin in the complex treatment of 28 patients with pancreatonecrosis of various etiology was estimated in a prospective trial. The diagnosis of pancreatonecrosis was verified by the data of the disease clinical progress, laboratory findings and instrumental examination. Pefloxacin (Abactal; LEK) was administered intravenously in a dose of 400 mg every 8 hours (1200 mg) in combination with metronidazole in a dose of 1.5-2.0 g a day intravenously. When indicated 3 days after the start of the pefloxacin therapy, the treatment was switched to the oral use of the drug in the same dosage. The positive clinical effect (cure and improvement) at the end of the treatment with pefloxacin was stated in 78 per cent of the patients in spite of the initial severity state of above 15 APACHE II. It was shown that in the treatment of patients with pancreatonecrosis when the severity state was not above 12 APACHE II the antibacterial therapy with pefloxacin in combination with metronidazole was optimal.     

Subchronic and acute preclinic toxicity and some pharmacological effects of the water extract from leaves of Petiveria alliacea (Phytolaccaceae)

We tested the effects of the aqueous extract of Petiveria alliacea leaves on acute and sub-chronic toxicity, hematocrit and blood glucose level and intestinal motility of male albino NGP mice of 20 to 25 g mean weight. Treatments were in all cases doses of 1,000 and 2,000 mg/kg animal weight and a control treatment with 0.5 ml distilled water, using 10 animals per treatment and administered orally every day (5 days per week). Experimental periods were 18 and 70 days for acute and sub chronic toxicity, respectively. No mortality nor any toxicity signs could be observed. A slight but significant increase in the glucose levels during the first three weeks was observed with the 1,000 mg/kg dose but not for the higher 2,000 mg/kg dose. After administering the doses once after a starving period of six hours, no significant differences in intestinal motility could be found.     

Serial intramuscular injections of 15(S)-15-methyl-prostaglandin F2alpha in the induction of abortion.

Abortion was successfully induced in 62 of 68 patients in the 9th to the 26th week of pregnancy be serial intramuscular administration of 15(S)-15-methyl-prostaglandin F2alpha (15-ME-PGF2alpha). In 6 patients who failed to abort after 24 hours of prostaglandin administration, a concomitant infusion of oxytocin was initiated; 5 of these patients aborted within 12 hours of the combined therapy. A single patient failed to abort, even with the combined therapy, and underwent surgical evacuation. The mean abortion time in the 67 successful inductions was 14.56 hours. Parous patients aborted somewhat fasteter, mean 13.98 hours, as compared to nulliparous patients, mean 15.02 hours, but this difference was not statistically significant. In this study initial intramuscular injection of 100 mug 15-ME-PGF2alpha was followed in 1 hour by 250 mug and then 250 mug every 2 hours with concomitant oxytocin therapy initiated after 24 hours. The results with this dose schedule were compared to the results obtained in a previous study with a higher dose schedule, an initial dose of 100 mug 15-ME-PGF2alpha, followed in 1 hour by 250 mug then 500 mug every 2 hours. There was significant difference in the mean abortion time and the incidence of side effects between the 2 dose schedules. The mean abortion time for patients with gestational ages 16 weeks and less was the same with both dose schedules, however patients with gestational ages of 17 weeks and higher aborted somewhat faster with the higher dose schedule. It might therefore be advisable for patients with gestations of 17 weeks and higher to be treated with the higher dose schedule. In earlier gestations patients could be started on the lower schedule, and if abortion had not occurred within 15 hours the dose of 15-ME-PGF2alpha could then be increased to 500 mug every 2 hours.     

A regimen for low-dose aspirin?

The effects of different regimens of 40 mg aspirin on platelet thromboxane A2 synthesis and vascular prostacyclin synthesis were determined in patients who were undergoing elective surgery for removal of varicose veins. Aspirin 40 mg taken at intervals of 48 hours consistently reduced platelet thromboxane A2 synthesis to a level at which it failed to support platelet aggregation and the associated release reaction. This effect lasted for at least 36 hours. In contrast, aspirin 40 mg every 72 hours did not have the same consistent effect. Both dose regimens led to a reduction in vascular prostacyclin synthesis 12 hours after the last dose, but 36 or 72 hours after the last dose prostacyclin synthesis was not reduced; thus the inhibition of prostacyclin synthesis was short lived. If the balance between platelet thromboxane A2 and vascular prostacyclin synthesis is important in thrombosis 40 mg aspirin every 48 hours may have the maximum antithrombotic effect.     

Levothyroxine Pseudomalabsorption and Thyroxine Absorption Testing with Use of High-Dose Levothyroxine: Case Report and Discussion

ObjectiveTo report the case of a 55-year-old woman who had been prescribed a daily dose of 1, 000 μg of levothyroxine for the treatment of hypothyroidism but still had severe biochemical hypothyroidism and to discuss the use of thyroxine absorption testing to diagnose pseudomalabsorption.MethodsThe patient was admitted to the hospital for supervised thyroxine absorption testing. Baseline thyroid function tests were performed. An oral dose of 1, 000 μg of levothyroxine was administered while the patient had an empty stomach, and thyroid function tests were repeated at 2, 4, and 6 hours after administration. She was also given all her prescribed antihypertensive medications, and the blood pressure (which had been persistently high) was measured every 2 hours.ResultsAfter administration of 1, 000 μg of levothyroxine, a rapid improvement in the results of her thyroid function tests was noted. Similarly, a rapid decrease in her blood pressure was observed after supervised administration of her antihypertensive medications. A diagnosis of nonadherence to treatment (pseudomalabsorption of levothyroxine) was made. After reduction of her levothyroxine dosage to 100 μg daily, results of thyroid function tests showed improvement. The doses of her antihypertensive medications were likewise altered.ConclusionWe suggest that patients who are receiving doses of levothyroxine of more than 2 μg/kg of body weight, with persistently increased thyroid-stimulating hormone levels, should undergo testing for malabsorption and pseudomalabsorption of levothyroxine. Thyroxine absorption testing with use of high-dose levothyroxine is useful in diagnosing pseudomalabsorption but needs formal evaluation and validation. (Endocr Pract. 2010;16:1012-1015)