The new in vitro activity of temocillin (BRL 17421), a new beta-lactamase-stable penicillin, was compared with those of other beta-lactam antibiotics for over 500 clinical bacterial isolates. Temocillin inhibited 94% of the Enterobacteriaceae organisms at concentrations of 0.5 to 8 microgram/ml, regardless of organisms resistance to ampicillin, ticarcillin, cefazolin, or combinations thereof. Most pseudomonas aeruginosa isolates and all staphylococci and streptococci tested were resistant to temocillin.
An in vitro study on the prevalence of resistance to major antibiotics in 1,545 Gram-negative aerobic bacilli isolated from intensive care unit patients was undertaken in 16 community and university hospitals in Belgium. A customized dry microtitre panel carrying 16 antimicrobials over an extended concentration range was used for susceptibility testing. The study revealed a widespread resistance to broad-spectrum penicillins, an alarmingly high incidence of resistance to aminoglycosides and a reduced activity of third generation cephalosporins especially in nosocomial pathogens, and a still relatively high susceptibility to imipenem and ciprofloxacin. Wide variations in percentage of resistance to different antibiotics were observed between hospitals, and these differences were not related to type of hospital or number of beds.
The susceptibility to 8 aminoglycosides of 146 clinical isolates of Serratia marcescens from 4 different hospitals, has been determined. Most isolates were multiply resistant: namely 62% to carbenicillin, 79% to kanamycin, 59% to streptomycin, 56% to gentamicin and sisomicin, and 5% to tobramycin. All strains were susceptible to amikacin and netilmicin. The predominant profile of resistance to aminoglycosides was simultaneous resistance to streptomicin-kanamycin-paromomycin and sisomicin. Transfer experiments confirmed that the resistance to these drugs was plasmid-mediated.
The antibiotic imipenum (thienamycin-formamidine) is partially hydrolyzed during excretion by a renal brush border dehydropeptidase. The co-administration of imipenum with the renal dehydropeptidase inhibitor cilastatin results in an increase of the urinary recovery of the antibiotic, both in animals and humans. To study the pharmacokinetics of imipenem and cilastatin, subjects with normal renal function and patients with different degrees of renal insufficiency received intravenously 250 mg imipenum alone and 250 mg imipenem with 250 mg cilastatin. The mean plasma half-life of imipenem varied from 52 min in subjects with normal renal function to 173 min in subjects with end-stage renal failure studied while off-dialysis. The plasma half-life of imipenem was not affected by the co-administration of cilastatin. The mean plasma half-life of cilastatin varied from 54 min in normals to 798 min in patients with end-stage renal failure. The co-administration of cilastatin resulted in an increase of the urinary concentration and in the urinary recovery of imipenem, the effect being more pronounced in the subjects with normal or only mildly impaired renal function. The plasma clearance of imipenem was decreased when cilastatin was co-administered, possibly due to inhibition of tubular secretion of imipenem. Elimination studies performed during haemodialysis indicated efficient removal of both imipenem and cilastatin during a 4 h session. In view of the important increase in half-life of cilastatin as a function of increasing renal failure, a dosage reduction is proposed in patients with severe renal failure. It is recommended that the maximum dose of imipenem/cilastatin would be limited to either 1000/1000 mg twice daily or 500/500 mg four times daily in patients with a creatinine clearance of less than 15 ml/min. Also, a supplementary dose of imipenem and cilastatin after dialysis is recommended.
Ordinary bone wax was used to stop bleeding from the iliac crest after procurement of autogenous bone graft harvesting. This gave rise to a large, symptomatic retroperitoneal tumor, which had to be removed operatively 19 years later. Microscopically, a bone wax granuloma was diagnosed. As far as the authors know this is the first case reported with such late and severe clinical complications after the use of bone wax.
The in vitro susceptibility of recently isolated respiratory tract pathogens (217 S. pneumoniae, 202 H. influenzae and 178 M. catarrhalis, has been examined against minocycline, doxycycline, amoxycillin, amoxyclavulanate, cefuroxime, clarithromycin and ciprofloxacin. M. catarrhalis was fully susceptible to all antibiotics except amoxycillin (62% susceptible). H. influenzae showed full susceptibility to minocycline, cefuroxime and ciprofloxacin but different percentages of resistance to the other antibiotics. Among S. pneumoniae isolates resistance was observed to all antibiotics tested between 12% to beta-lactams and 22% to doxycycline.
