Ways of increasing the effectiveness of chemotherapy of urinary tract infection]

Efficacy of blood UV irradiation (BUVI) followed by its reinfusion to the patient in combination with antibacterial therapy was studied in patients with acute and chronic pyelonephritis and its purulent septic complications. The BUVI was used when the antibacterial drugs failed to be sufficiently efficient and the clinical process of the infection was severe. The kinetics of ferritin, transferrin, alpha 2-macroglobulin, beta 2-microglobulin and haptoglobulin in the blood serum was investigated as a criterion of treatment efficacy. It was shown that the BUVI markedly increased the chemotherapy efficacy. The observed regularities of the changes in the serum antigenic spectrum can be used as a basis for the control of treatment efficacy.     

Clinico-laboratory effectiveness of modern ointments with a polyethylene glycol base in the treatment of purulent wounds]

The 25-year experience with the underbandage treatment of soft tissue purulent wounds of various location and genesis with modern ointments with polyethylene glycol as the basis was analyzed. Levocin, levomecole, dioxycole, 5-percent dioxydinic, 1-percent iodopyronic, 0.5-percent quinifuryl and furagel ointments proved to preserve their high activity against aerobic grampositive and gramnegative flora. 10-percent mafenide acetate ointment had a high selective effect on Pseudomonas aeruginosa. The new ointments nitacid and streptonitole containing nitazole and white streptocide were highly active against both aerobic and anaerobic infections. The use of the ointments with the polyethylene glycol as the basis made it possible to decrease 2 times the period of the patient hospitalization in surgical units and to shorten the terms of the systemic antibacterial therapy. The marked therapeutic effect of such ointments due to their high dehydrating capacity and broad antibacterial spectrum enabled to consider them as the drugs of choice in the local treatment of purulent wounds during the 1st phase of the wound process, trophic and decubic ulcers, infected burns, diabetic and atherosclerotic gangrene, furuncles, carbuncles, mastitis, etc. The ointments in the water soluble vehicle can be as well used with success for the prophylactic treatment of infected wounds after the suture. The multitarget effect of the ointments in the water soluble vehicle and their ability to prevent severe purulent complications permitted to consider them as the 1st order drugs in cases of emergency.     

Efficacy of a combination of dioxidine with beta-lactam antibiotics in the prevention and treatment of purulent-inflammatory complications

Schemes for prevention and treatment of purulent inflammatory complications were developed on the basis of in vitro studies on antimicrobial activity of dioxidine and 7 beta-lactam antibiotics such as mezlocillin, carbenicillin, ampicillin, cefotaxime, cefoxitin, cefuroxime and cephalothin under conditions of aero- and anaerobiosis with an account of the isolated microflora, its sensitivity to antibacterial agents and conditions required for vital activity of obligate anaerobes in humans, i.e. decreased partial oxygen pressure, low oxidation-reduction potentials and high tissue concentrations of carbon dioxide. The use of dioxidine in combination with the antimicrobial drugs enabled one to decrease the number of cases with purulent inflammatory complications after large intestine esophagoplasty to 30.4 per cent against 67.5 per cent in the control group of the patients untreated preventively with the antibacterial drugs. The number of cases with similar complications after gastrectomy amounted to 16.1 per cent against 62 per cent in the control. The use of dioxidine+ in combination with ampicillin and cefotaxime in treatment of purulent necrotic affections of the foot in patients with diabetes mellitus enabled one to increase the number of satisfactory outcomes by 32 per cent, to decrease the number of high amputations by 21.9 per cent and to lower the number of deaths more than 2-fold as compared to the results in the control group of the patients subjected to chemotherapy based on sensitivity of the aerobic microflora alone.     

Pharmacokinetics of gentamicin after its regional endolymphatic and lymphotropic administration to dogs

It was shown that intralymphatic+ inguinal administration of gentamicin provided its high concentrations in central lymph, blood and ++para-aortic lymph nodes and increased the antibiotic levels in the abdominal organs 2.33 to 6.66 times as compared with its intramuscular administration while lymphotropic retroperitoneal administration of gentamicin provided more prolonged maintenance of the antibiotic therapeutic concentrations in lymph of the thoracic lymphatic duct, central blood, ++para-aortic lymph nodes and the abdominal organs in comparison to its intramuscular administration. Intralymphatic+ inguinal administration of drugs providing the highest concentrations in all the organs of the abdominal cavity and the ways of the infection penetration is useful in therapy of severe inflammatory diseases of the abdominal organs inclined to generalization and lymphotropic retroperitoneal administration of drugs is useful in therapy of less severe purulent inflammatory processes in the abdominal cavity.     

Evaluation of the effectiveness of antibacterial therapy

It is recommended to estimate the clinical effect of antibacterial therapy in patients with different purulent inflammatory complications with an account of the data on both the clinical and bacteriological examinations. The full affect consisted in disappearance of the clinical signs and complete bacteriological sanation of the purulent inflammatory foci. The partial effect was shown by a marked decrease in the clinical manifestations without complete bacteriological sanation of the foci. The ill effect was evidenced by clinical picture having no time course and no favourable time course in bacteriological tests. No effect was indicated by deterioration of the clinical picture and no favourable time course in the bacteriological tests.     

Rational chemotherapy of suppurative cholangitis]

A complex bacteriological approach to the problem of purulent cholangitis was applied. Specimens of bile from 140 patients, gallbladder walls from 106 patients, liver tissue from 93 patients and peritoneum tissue from 82 patients were examined. It was microbiologically shown that the infectious process in the patients with purulent cholangitis involved not only the bile and gallbladder walls but also the surrounding tissues of the liver and peritoneum. There was a correlation between the bile microflora and the microflora of the surrounding tissues. The microflora of the bile, gallbladder walls, liver and peritoneum tissues was characterized qualitatively and quantitatively. Sensitivity of 494 clinical isolates to 16 antimicrobial drugs was assayed. To prevent the postoperative complications, schemes for the antibacterial therapy were developed with an account of the aerobic and anaerobic spectra of the microbes disseminating the bile, gallbladder walls, liver and peritoneum.     

Spiral computed tomography in the diagnosis of inflammatory diseases of the vertebral column

A Somatom Plus 4 spiral computed tomograph was used to examine 40 patients with purulent spondylitis and 8 patients with tuberculous spondylitis. Analysis of the primary examination, postoperative status, and follow-up of patients on medical therapy identified the main signs of an inflammatory process from a great variety of the computed tomographic (CT) signs of a lesion. They made it possible not only to reveal the inflammatory nature of a lesion, but also to differentiate purulent and tuberculous spondylitis. The main CT signs that allow a purulent spondylitis to be differentiated from tuberculous one are as follows: the location of involved veterbrae, the number of and the pattern of destruction of trabecular and cortical layers, the extent of and the form of paravertebral tissue lesion.     

Antibiotic therapy of angiogenic sepsis

Introduction to medical practice of new penicillins, cephalosporins and aminoglycosides is one of the chief reserves for increasing efficacy of antibacterial therapy. The main schemes of antibiotic use in treatment of sepsis and individual regimens controlled by laboratory findings are discussed. Optimization of antibiotic therapy schemes is based on pharmacokinetic studies, quantitative assay of antibiotic sensitivity and determination of antibacterial activity of serum and other biosubstrates at definite periods after antibiotic administration. In vitro time course investigation of the bactericidal effect of gentamicin, azlocillin and cefotaxime on pathogens of purulent infections at various sizes of the inoculum provided prediction of the antibiotic therapy efficacy in various purulent septic infections. It is indicated that rational use of antibiotics markedly increases efficacy of sepsis therapy and improves social and economic indices of the treatment.     

Empirical antibiotic therapy of wounds complicated by anaerobic non-clostridial infection

Antibacterial activity of 14 drugs against clinical strains of asporogenic anaerobes causing wound infections in the soft tissues i. e. Bacteroides fragilis and Bacteroides melaninogenicus as well as anaerobic gram-positive++ cocci was assayed with the method of serial dilutions in agar. It was shown that among the investigated species B. fragilis had the most marked resistance since out of the 14 drugs only 8 were sufficiently active against it i.e. carbenicillin, levomycetin, lincomycin, dioxidine, metronidazole, thinidazole, nitrazole and erythromycin. The choice of drugs for treating infections caused by B. melaninogenicus and anaerobic grampositive cocci unlike those caused by B. fragilis offered no difficulty since practically++ all the investigated drugs were highly active against the causative agents. There was observed relationship between the frequency of asporogenic anaerobes and the wound genesis. The characteristic features of the species composition connected with localization of the suppurative foci were indicated. The detected specific antimicrobial profiles of the asporogenic anaerobes causing wound infections and the peculiarity of their participation in development of purulent infections of the soft tissues provided a differential approach to empirical antibacterial therapy prior to the pathogen bacteriological investigation and availability of the antibioticograms.     

Immunoglobulin efficacy for intravenous administration in the therapy of newborn infants with a suppurative infection

The data on the results of clinico-immunological examination of 46 infants having purulent inflammatory infections in the first month of their life and treated with (a) immunoglobulin for intravenous injection, (b) with hyperimmune antistaphylococcal plasma and immunoglobulin for intravenous injection and (c) without the use of specific hyperimmune preparations are presented. The clinico-laboratory data thus obtained (the levels of serum immunoglobulins and the content of T-rosette-forming lymphocytes) are indicative of the expediency of including the intravenous injection of donor immunoglobulin into the complex therapy of newborn infants with severe and moderate forms of purulent inflammatory infections at an early period of the disease irrespective of its etiology.     

Ciprofloxacin in the treatment of infections in oncology patients

Treatment of infectious complications with ciprofloxacin in 65 patients provided good and satisfactory results in 67.7 and 20.0 per cent of the cases, respectively. The drug was efficient in sepsis, urogenital infections, respiratory infections and postoperative purulent complications. Ciprofloxacin showed a broad antibacterial spectrum. 96.3 per cent of the isolates belonging to aerobic organisms causing purulent inflammatory processes, including those with high antibiotic resistance levels, such as Pseudomonas spp., Proteus spp., Klebsiella tribe and Staphylococcus aureus were sensitive to the drug. In its antibacterial spectrum ciprofloxacin was similar to ofloxacin. The advantage of ciprofloxacin is its possible use not only orally but also intravenously. Adverse reactions to ciprofloxacin were observed in 5 (7.7 per cent) out of the 65 patients. In two cases discontinuation of the drug use was required. The use of ciprofloxacin in treatment of infectious complications in oncological patients is promising.     

Effect of gentamycin in combination with prodigiozan on the immunological reactivity of the body

The effect of gentamicin sulphate and its combination will prodigiozan on antibody formation in experiments and the levels of the immunobiologic reactivity of patients with purulent inflammatory processes was studied with a purpose of developing rational schemes of antibiotic therapy of infectious diseases. A decrease in the titers of the antibodies to Aeromonas and the number of antibody-forming cells in the spleen was noted on repeated administration of gentamicin to albino mice in a dose of 20 mg/kg. This was prevented by the use of prodigiozan in a dose of 500 micrograms/kg once every 4 days. The use of gentamicin in patients with purulent inflammatory diseases in doses of 40 or 80 mg twice a day for 7--10 days had no significant effect on the titers of IgA, IgG, IgM, lysozyme blood serum levels, serum bactericidal activity and absorption activity of the peripheral blood neutrophils. Still, it induced a marked suppression of the neutrophil digestive capacity as compared to the initial levels, especially on administration of gentamicin in a dose of 40 mg twice a day. An increase in the level of IgM and no suppression of the neutrophil digestive capacity were noted after completion of the therapy in the patients treated with gentamicin administered in a dose of 40 mg twice a day and prodigiozan administered in a dose of 50 micrograms once every 4 days. It is recommended to use prodigiozan in combinaed therapy with gentamicin for correction of the changes in the specific and nonspecific protective forces of the host.     

Purulent pericarditis,an uncommon entity in modern practice: a case report

We report an 82-year-old female with pneumococcal pneumonia. Antimicrobial therapy was started in an early stage of the disease. On the 10th day of admission she developed peripheral pitting oedema with elevated jugular venous pressure and a drop in blood pressure. Her electrocardiogram showed sinus tachycardia and concave upward ST-segment elevation in almost all leads. A transthoracic two-dimensional echocardiogram revealed a large circumferential pericardial effusion, with diastolic collapse of the right atrium and a mitral inflow pattern that suggested cardiac tamponade. Emergency pericardiocentesis was performed, releasing 600 cc of thick green purulent material, followed by good haemodynamic recovery. The haemodynamic state, pneumonic infiltrate and inflammatory parameters responded gradually to antimicrobial therapy and the patient recovered and was discharged after six weeks. We conclude that even susceptible strains of Streptococcus pneumonia in a patient with no predisposing factors may still cause purulent pericarditis, even in the era of adequate antibiotic therapy.     

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.     

The decline of antibiotic era--new approaches for antibacterial drug discovery

Infectious diseases still remain the main cause of human premature deaths; especially in developing countries. The emergence and spread of pathogenic bacteria resistant to many antibiotics (multidrug-resistant strains) have created the need for the development of novel therapeutic agents. Only two new classes of antibiotics of novel mechanisms of action (linezolid and daptomycin) have been introduced into the market during the last three decades. The recent progress in molecular biology and bacterial genome analysis has had an enormous impact on antibacterial drug research. This review presents new achievements in searching a new bacterial essential genes, a potential targets for antibacterial drugs. Application of metagenomics strategy is also shown. Some recent technologies aimed at development of anti-pathogenic drugs such as inhibitors of quorum sensing process or histidine kinases are also discussed. Extensive research efforts have provided many details concerning structure of bacterial proteins playing an important role in pathogenesis such as adherence proteins or toxins, what allowed searching for antitoxin drugs or drugs interfering with bacterial adhesion. As an example, the review focuses on anthrax therapies under development. Additionally, the article presents the progress in phage therapy; using bacteriophages or their products such as lysins in antibacterial therapy.     

三七皂苷对蛇伤致全身炎症反应综合征的影响

目的探讨三七皂苷对毒蛇咬伤致全身炎症反应综合征的影响。方法将60例毒蛇咬伤病人按随机双盲的原则分为两组,治疗组(A组)30例采用常规治疗加用三七皂苷,对照组(B组)30例采用常规治疗。观察两组病人在治疗过程中心率、血压、血常规、体温等的变化,并进行比较。结果A组病人心率、血压、血常规、体温等在治疗过程中的变化均优于B组。结论三七皂苷对毒蛇咬伤病人的全身炎症反应综合征有拮抗作用,有利于蛇伤病人器官功能不全的预防与治疗。     

Use of the automated system for bacteriological diagnosis of suppurative complications

The use of the microbiological analyzer Cobas-Bact made it possible to markedly widen the possibilities of identifying pathogenic enterobacteria at the account of the species usually not detected with the routine methods. Rapid assay of antibiotic sensitivity with the Cobas-Bact system provided earlier and adequate antibacterial therapy of severe purulent complications.     

Effectiveness of the antibacterial therapy of patients with various forms of dysentery]

The analysis of the efficacy of various methods of antibacterial therapy in 1382 patients with obliterated, light and moderately severe forms of dysentery as compared to the patients subjected only to patholgenic therapy showed that broad spectrum antibiotics lost their role in treatment of such patients. Furazolidon proved to be one of the most active drugs. The authors suppose that treatment of patients with obliterated forms of dysentery with antibacterial drugs is not obligatory and is indicated only in cases with repeated isolation of the causative agent.     

Optimal control of the microflora environment in suppurative foci

The informative capacity of various statistic parameters characterizing the ecology of pathogens of purulent processes was studied. Many-years' results of the routine bacteriological tests of the materials from purulent wounds in patients from surgical, traumatological and burn departments served as the study subjects. The frequency, persistence and contamination capacity of the pathogens were investigated. Data on the changes in the frequency parameter with respect to the main pathogens of wound infections in various contingents of patients were collected. In relation to the observation period and contingent of the patients, various microorganisms were found to be permanent, supplementary and casual. The use of the ecological parameters was shown to provide integrated information on the etiological role of the pathogens in the development of purulent processes. The information characterized the microbial properties which should be considered in planning the use of antibacterial drugs and estimating the efficacy of the epidemiological control.     

Combined antibacterial therapy of infectious complications in oncological patients

Rational antibacterial therapy of infections in oncological patients in relation to the polyetiological nature of the infections and polyresistance of their causative agents contemplates the use of drug combinations. The necessity of long-term antibacterial therapy in many oncological patients also predisposes to it. The choice of drugs for every patient should stem from bacteriological findings: isolation of the pathogen, its identification and assay of its antibiotic sensitivity. When isolation of the causative agent is not possible or could not be done immediately the drug should be chosen according to the general data on the etiological structure of infectious complications in the particular department and particular pathological process as well as antibiotic sensitivity of the bacteria isolated under such conditions.