A clinical cure was achieved in 42 of the 46 patients in the proven group (91 percent) with patients receiving ciprofloxacin and 18 of the 20 in the presumed group (90 percent). This was not statistically significant from the clinical cure rate obtained with ceftazidime— 38 out of 42 in the proven group (90 percent) and 12 out of 14 in the presumed group (85 percent). All 122 of the patients enrolled were adult patients referred to a tertiary care county hospital for treatment of respiratory tract infection considered to be of a severity necessitating hospitalization and parenteral antibiotic therapy. A majority of the patients were elderly who also had significant comorbidities—diabetes, hypertension, ethanol abuse, etc. Continue Reading »
Evaluation of Antibiotic Therapy
A clinical cure was defined as the disappearance of previously documented signs and symptoms of infection. Clinical failure was defined as the continuation of signs and symptoms of infection or worsening of signs and symptoms. Bacteriologic eradication was defined as the elimination of pretreatment pathogens from sputum. Bacteriologic failure was defined as persistence of the original pathogen and/or isolation of a new pathogen on posttreatment sputum cultures. The chi-square test was used in the statistical analysis, and a p value of less than 0.05 was considered statistically significant. further
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Antibiotics were administered in a sequential manner with a computer-generated, randomized code. One group received intravenous ciprofloxacin, 200 mg twice a day, except for five patients who received 300 mg twice a day; and the control group received ceftazidime, 1 to 2 g two to three times a day intravenously. A minimum of five days of therapy was required for evaluation. No patient received other antibiotics concomitantly. Ceftazidime was chosen as the control drug because its in vitro spectrum closely matched that of ciprofloxacin. In addition, it was the most commonly prescribed parenteral antimicrobial agent for the treatment of both community-acquired and hospital-acquired lower respiratory tract infections. Continue Reading »
The recent introduction of potent 4-quinolones represents a major advance in the development of antibiotics, allowing for the first time effective oral therapy of serious infections caused by multiply resistant bacteria. Four fluoroquinolones, as follow, are in various stages of approval and clinical investigation in the United States: norfloxacin, ciprofloxacin, enoxacin, and ofloxacin.
Of the compounds currently available under investigation, ciprofloxacin is among the most attractive in terms of its potency, rapidity of bacterial killing and pharmacokinetics. In vitro studies have shown that ciprofloxacin is active against Gram-positive, Gram-negative, and multi-drug-resistant bacteria, as well as organisms such as Chlamydia, Mycobacteria, and Legionella. We have previously reported on the results of a prospective, double-blind, clinical trial to assess the safety and efficacy of oral ciprofloxacin in comparison with those of ampicillin in the treatment of mild to moderate respiratory tract infections. In this study, we report our results with the comparison of sequential intravenous/oral ciprofloxacin with intravenous ceftazidime in the treatment of hospitalized patients with lower respiratory tract infections.www.cfm-online-shop.com
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An additional promising approach is the use of synergistic combinations of thrombolytic agents with different mechanisms of fibrin specificity.82 The use of rtPA and SC UPA in a significantly reduced dose combination in patients with coronary artery occlusion produced rapid and effective reperfusion, without evidence of systemic fibrinolytic activation or clinically important bleeding.
Since there appears to be little correlation among the degree of hypofibrinogenemia, level of circulating fibrin split products, and the incidence of bleeding, other hemostatic alterations produced by the systemic lytic state must be important. Plasmin can degrade platelet membrane glycoproteins, subendothelial matrix components, and other coagulation and adhesive proteins (von Willebrand factor, thrombospondin, fibronectin). Any of these events can induce independent coagulopathies. read
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Laboratory monitoring during the administration of thrombolytic therapy is intended to document the production of a lytic state. In this regard, the thrombin time and the fibrinogen concentration are the most readily available, the least expensive, and the least labor intensive. Thrombin time prolongations may be exaggerated with concomitant heparinization. The PT and PTT are less sensitive to lytic changes and may be spuriously prolonged by marked hypo-fibrinogenemia (<80 mg/dl) and by plasmin proteolysis of factors VIII and V Measurement of fibrin degradation products is time consuming, and baseline values are often elevated by the underlying thrombotic process. Commercially popular latex agglutination assays measure fibrin fragments D and E but not the earlier-formed split products. Continue Reading »
Originally isolated from human melanoma cell lines, rtPA has recently become the best characterized and most widely administered fibrinolytic agent produced through recombinant DNA technology. rtPA represents the first major advance in thrombolytic therapy since the introduction of streptokinase and urokinase into clinical medicine. Clinical studies with rtPA have revealed a high degree of safety and efficacy. rtPA contains “kringle” structures similar to plasminogen that allows its juxtaposition with plasminogen on the fibrin clot surface with efficient localization of plasmin generation and subsequent fibrinolysis. In practice, pharmacologic doses of rtPA produce systemic lytic effects, but the magnitude of hypofibrinogenemia, o^-antiplasmin consumption, and level of circulating fibrin split products are significantly lower than observed with most of the other thrombolytic agents. Continue Reading »