RESUMEN
The foot is the most common site of infection in the diabetic individual, and one of every four diabetics eventually seeks medical care for a foot problem. This article examines pathologic conditions of the lower extremity from a variety of views, including pathophysiology, classification, microbiology, infections, osteomyelitis, treatment, and prevention strategies.
Asunto(s)
Neuropatías Diabéticas/diagnóstico , Úlcera del Pie/diagnóstico , Osteomielitis/diagnóstico , Infecciones de los Tejidos Blandos/diagnóstico , Amputación Quirúrgica , Antibacterianos/uso terapéutico , Técnicas Bacteriológicas , Dermatomicosis/diagnóstico , Dermatomicosis/microbiología , Dermatomicosis/terapia , Neuropatías Diabéticas/microbiología , Neuropatías Diabéticas/terapia , Úlcera del Pie/microbiología , Úlcera del Pie/terapia , Gangrena Gaseosa/diagnóstico , Gangrena Gaseosa/microbiología , Gangrena Gaseosa/terapia , Humanos , Osteomielitis/microbiología , Osteomielitis/terapia , Pronóstico , Infecciones de los Tejidos Blandos/microbiología , Infecciones de los Tejidos Blandos/terapiaRESUMEN
Teicoplanin is a new glycopeptide antibiotic with activity against Gram-positive bacteria, including methicillin-resistant organisms. Teicoplanin is administered once daily, either intravenously or intramuscularly. Teicoplanin was given once daily, intravenously or intramuscularly, in the treatment of hospitalized or ambulatory patients with Gram-positive bone or joint infections. A total of 90/98 patients were evaluated for efficacy; 41 had acute osteomyelitis, 41 had chronic osteomyelitis, and 8 had septic arthritis. At the end of therapy, 37 acute osteomyelitis patients were cured/improved with a 90% cure rate at 6-month follow-up; 2 relapsed and 1 failed. At the end of therapy 30 chronic osteomyelitis patients were cured/improved with an 88% cure rate at 6-month follow-up; 2 relapsed and 1 failed. 100% of the septic arthritis patients were cured at the end of therapy and at 1-month follow-up. The most common bacterial isolates cultured from bone were S. aureus (39 isolates), S. epidermidis (11 isolates), other coagulase-negative staphylococci (20 isolates), enterococci (6 isolates), and other streptococcal species (20 isolates). The most common bacterial isolates cultured from joint fluid were S. aureus (6 isolates) and S. epidermidis (2 isolates). All patients tolerated the intramuscular or intravenous routes of administration well. Adverse reactions were mild and most cases did not require discontinuation of therapy. The majority of therapy was administered on an outpatient basis. Teicoplanin was safe, effective, convenient and relatively well tolerated in patients with acute or chronic osteomyelitis or septic arthritis.
Asunto(s)
Antibacterianos/uso terapéutico , Artritis Infecciosa/tratamiento farmacológico , Osteomielitis/tratamiento farmacológico , Enfermedad Aguda , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/administración & dosificación , Antibacterianos/efectos adversos , Enfermedad Crónica , Femenino , Estudios de Seguimiento , Glicopéptidos/administración & dosificación , Glicopéptidos/efectos adversos , Glicopéptidos/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Infecciones Estafilocócicas/tratamiento farmacológico , TeicoplaninaRESUMEN
Ciprofloxacin is the first of the new class of antibiotics known as fluoroquinolones to be approved for use in skin, skin structure, and bone and joint infections. It has an extremely broad spectrum and is particularly effective against traditionally resistant gram-negative rods. As an oral agent, it is as effective as parenteral drugs against a variety of organisms and diseases. Its spectrum, pharmacokinetics, and podiatric indications are reviewed.
Asunto(s)
Infecciones Bacterianas/tratamiento farmacológico , Ciprofloxacina/uso terapéutico , Dermatosis del Pie/tratamiento farmacológico , Ciprofloxacina/efectos adversos , Ciprofloxacina/farmacología , HumanosRESUMEN
To compare the effectiveness of cefotetan administered at 2 g once a day with cefoxitin at 1 or 2 g three times a day in the treatment of hospitalized patients with skin and superficial soft tissue infections, 194 patients from eight centers were enrolled in an open, randomized trial. Most of the 104 evaluable patients in the cefotetan group and 50 in the cefoxitin group were young men with community-acquired, moderate or severe cellulitis, or abscesses of the upper and lower extremities caused by Staphylococcus aureus, Streptococcus species, Escherichia coli, Proteus mirabilis, Bacteroides fragilis and other species of bacteroides, peptococcus species, and peptostreptococcus species. The mean duration of treatment was 7.5 days for cefotetan and 7.1 days for cefoxitin. A successful clinical response was achieved in 97 percent of the cefotetan patients and in 94 percent of the cefoxitin patients. Of the 88 and 39 bacteriologically evaluable patients in the cefotetan and cefoxitin groups, respectively, a satisfactory bacteriologic response occurred in 96 percent and 87 percent of the patients. No clinically significant changes in clinical laboratory determinations were noted. The incidence of adverse reactions in the cefotetan group (17 percent) was significantly different from that for the cefoxitin group (6 percent) (p less than 0.05); however, the incidence of treatment-related reactions was not significant and the events were mild. Discontinuation of therapy was necessary only in two patients in whom allergic-type reactions developed. A once-daily regimen of cefotetan was as effective as thrice-daily cefoxitin in this study in the treatment of primarily polymicrobial, moderate, or severe infections of the skin and superficial soft tissue.
Asunto(s)
Absceso/tratamiento farmacológico , Cefoxitina/administración & dosificación , Celulitis (Flemón)/tratamiento farmacológico , Cefamicinas/administración & dosificación , Enfermedades Cutáneas Infecciosas/tratamiento farmacológico , Adulto , Cefotetán , Cefoxitina/uso terapéutico , Cefamicinas/uso terapéutico , Ensayos Clínicos como Asunto , Femenino , Humanos , Masculino , Distribución AleatoriaRESUMEN
In a multicenter trial involving 11 centers, 160 women were enrolled to evaluate the safety and effectiveness of 1 or 2 gm of cefotetan administered every 12 hours in the treatment of obstetric and gynecologic infections. The 133 evaluable patients generally were under 25 years of age, were nonwhite, and had hospital-acquired endometritis or pelvic inflammatory disease caused by both aerobic and anaerobic bacteria. Escherichia coli, Neisseria gonorrhoeae, group D streptococci, Bacteroides sp., and Peptococcus sp. were among the most frequently isolated pathogens. The patients were treated for a mean of 5.6 +/- 1.6 days and received a total dose of 19.27 gm. The signs and symptoms of infection were cleared or improved in 93% of the 133 patients evaluable for clinical response. Of the 116 evaluated bacteriologically, 95% had a satisfactory or presumed satisfactory response; only six patients (5%) were considered to be bacteriologic failures. Differences in the results of several clinical laboratory tests performed before and after treatment were statistically, but not clinically, significant (p less than 0.05). Safety was evaluated in the 158 patients who received cefotetan, and only four (3%) had adverse reactions considered related to the drug. Cefotetan was clearly effective and produced no untoward reactions in these women with obstetric and gynecologic infections caused by both aerobic and anaerobic organisms when administered at 1 or 2 gm every 12 hours.
Asunto(s)
Infecciones Bacterianas/prevención & control , Cefamicinas/uso terapéutico , Enfermedades de los Genitales Femeninos/prevención & control , Complicaciones Posoperatorias/prevención & control , Adulto , Cefotetán , Infección Hospitalaria/prevención & control , Endometritis/prevención & control , Femenino , Humanos , Enfermedad Inflamatoria Pélvica/prevención & controlAsunto(s)
Antiprotozoarios/uso terapéutico , Infecciones por Protozoos/tratamiento farmacológico , Antimaláricos/uso terapéutico , Gluconato de Sodio Antimonio/uso terapéutico , Humanos , Yodoquinol/uso terapéutico , Melarsoprol/uso terapéutico , Metronidazol/uso terapéutico , Nifurtimox/uso terapéutico , Pentamidina/uso terapéutico , Suramina/uso terapéuticoRESUMEN
Aztreonam was used in the initial treatment of infection of the urinary tract (23 cases), respiratory tract (17 cases), skin and soft tissue (12 cases), abdominal cavity (three cases), endocarditis (two cases), septicemia (eight cases), and osteomyelitis (two cases). In 26 of 60 evaluable infectious episodes, aztreonam was used alone. Clinical cure was observed in 35 of 60, improvement in 24 of 60, and failure in one of 60 cases. Ten patients developed subsequent superinfection. Aztreonam was well tolerated, although one case of exfoliative dermatitis and one of pseudomembranous colitis occurred. However, these cases were complicated by proximal administration of other antibiotics.
Asunto(s)
Aztreonam/uso terapéutico , Infecciones Bacterianas/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Aztreonam/toxicidad , Femenino , Bacterias Gramnegativas , Humanos , Masculino , Persona de Mediana Edad , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Sepsis/tratamiento farmacológico , Enfermedades Cutáneas Infecciosas/tratamiento farmacológico , Infecciones Urinarias/tratamiento farmacológicoAsunto(s)
Antibacterianos , Bacterias/efectos de los fármacos , Cefalosporinas , Tienamicinas , Antibacterianos/efectos adversos , Antibacterianos/metabolismo , Antibacterianos/farmacología , Cefalosporinas/efectos adversos , Cefalosporinas/metabolismo , Cefalosporinas/farmacología , Humanos , Cinética , Pruebas de Sensibilidad Microbiana , Tienamicinas/efectos adversos , Tienamicinas/metabolismo , Tienamicinas/farmacologíaAsunto(s)
Complicaciones de la Diabetes , Enfermedades del Pie/etiología , Infecciones/etiología , Diabetes Mellitus/inmunología , Angiopatías Diabéticas/complicaciones , Neuropatías Diabéticas/complicaciones , Enfermedades del Pie/fisiopatología , Humanos , Inmunidad , Infecciones/fisiopatología , Activación de Linfocitos , Riesgo , Úlcera Cutánea/etiología , Úlcera Cutánea/fisiopatologíaAsunto(s)
Infecciones Bacterianas/etiología , Complicaciones de la Diabetes , Enfermedades del Pie/etiología , Angiopatías Diabéticas/complicaciones , Neuropatías Diabéticas/complicaciones , Enfermedades del Pie/microbiología , Humanos , Osteomielitis/etiología , Osteomielitis/microbiología , Úlcera Cutánea/microbiologíaRESUMEN
Pedal puncture wounds are a relatively common injury seen predominantly during the warm weather months and in children. Although most of these injuries heal completely with no sequelae, up to 10% may become infected and produce late complications. Of these, osteomyelitis caused by P. aeruginosa is the most devastating, and it may progress to bone destruction that will require extensive surgical debridement. If instituted early, adequate primary care usually provides the best chance of prevention of these infections.
Asunto(s)
Traumatismos de los Pies , Infecciones por Pseudomonas/terapia , Infección de Heridas/terapia , Heridas Penetrantes/complicaciones , Antibacterianos/uso terapéutico , Humanos , Osteomielitis/diagnóstico , Osteomielitis/tratamiento farmacológico , Osteomielitis/cirugía , Infecciones por Pseudomonas/diagnóstico , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/tratamiento farmacológico , Tétanos/prevención & control , Factores de Tiempo , Infección de Heridas/microbiología , Heridas Penetrantes/microbiologíaRESUMEN
Twenty-six volunteers with various degrees of renal function were given a single 1-g dose of cefotetan intravenously over 30 min. Concentrations of cefotetan and cefotetan tautomer in plasma and urine were determined by high-performance liquid chromatography. The pharmacokinetic parameters for cefotetan were calculated according to a two-compartment open model. The mean plasma cefotetan concentration at the end of the intravenous infusion did not vary with renal function and ranged between 122 and 126 micrograms/ml. The mean terminal half-life was 4.2 h in normal volunteers and 9.9 h in volunteers with moderate renal impairment. There was a significant linear correlation between the systemic clearance of cefotetan and creatinine clearance. The cumulative amount of cefotetan excreted in the urine over 24 h in normal volunteers was approximately 49% of the dose, but this was reduced in volunteers with moderate renal impairment. The mean urinary cefotetan concentrations generally peaked during the 2- to 4-h interval after dosing. Cefotetan tautomer was sporadically detected in the plasma and urine of approximately 50% of the volunteers. The mean plasma cefotetan tautomer concentrations and mean total cumulative urinary recoveries of cefotetan tautomer were only minimal compared with those for cefotetan. The mean percentage of the dose excreted in the urine as cefotetan tautomer was not significantly affected by the degree of renal impairment. Recommendations for the dosing of cefotetan in renal-impaired patients are given.
Asunto(s)
Cefamicinas/metabolismo , Riñón/metabolismo , Adolescente , Adulto , Anciano , Cefotetán , Cefamicinas/administración & dosificación , Cefamicinas/orina , Creatinina/sangre , Femenino , Humanos , Infusiones Parenterales , Pruebas de Función Renal , Cinética , Masculino , Persona de Mediana EdadRESUMEN
The antimicrobial activity of carumonam (formerly RO-17-2301), a monocyclic beta-lactam antibiotic, was compared with those of aztreonam, cefotaxime, cefoperazone, ceftazidime, piperacillin, and gentamicin against 455 bacterial isolates. Carumonam did not possess activity against gram-positive cocci and was generally comparable to aztreonam and ceftazidime for most gram-negative bacilli. However, carumonam was the most active beta-lactam against gentamicin-resistant Pseudomonas aeruginosa strains (90% MIC, 8 micrograms/ml).
Asunto(s)
Antibacterianos/farmacología , Bacterias Gramnegativas/efectos de los fármacos , Bacterias Grampositivas/efectos de los fármacos , Pseudomonas aeruginosa/efectos de los fármacos , Aztreonam/farmacología , Cefoperazona/farmacología , Cefotaxima/farmacología , Ceftazidima/farmacología , Gentamicinas/farmacología , Resistencia a las Penicilinas , Piperacilina/farmacologíaRESUMEN
The in vitro antimicrobial activity of two new aryl-fluoroquinolone antibiotics, A-56619 and A-56620, was compared with those of norfloxacin and several other antibiotics against 448 bacterial isolates. A-56620 was the most active agent tested. The usual 90% MIC of A-56620 was less than or equal to 2 micrograms/ml, except for enterococci, gentamicin-resistant Serratia marcescens, and gentamicin-resistant Pseudomonas aeruginosa, for which the 90% MIC was 4 micrograms/ml. A-56619 and norfloxacin were generally severalfold less active than A-56620. Cross resistance was observed between the quinolone antibiotics and other unrelated antibiotic classes.
Asunto(s)
Antibacterianos/farmacología , Antiinfecciosos , Ciprofloxacina/análogos & derivados , Fluoroquinolonas , Bacterias Gramnegativas/efectos de los fármacos , Norfloxacino/farmacología , Piperazinas/farmacología , Quinolinas/farmacología , Farmacorresistencia Microbiana , Enterobacteriaceae/efectos de los fármacos , Bacterias Grampositivas/efectos de los fármacos , Pruebas de Sensibilidad MicrobianaAsunto(s)
Antibacterianos/uso terapéutico , Meningitis/tratamiento farmacológico , Adolescente , Adulto , Aminoglicósidos/administración & dosificación , Aminoglicósidos/uso terapéutico , Antibacterianos/administración & dosificación , Antiinfecciosos/administración & dosificación , Antiinfecciosos/uso terapéutico , Cefalosporinas/administración & dosificación , Cefalosporinas/uso terapéutico , Niño , Preescolar , Cloranfenicol/administración & dosificación , Cloranfenicol/uso terapéutico , Combinación de Medicamentos/administración & dosificación , Combinación de Medicamentos/uso terapéutico , Fiebre/tratamiento farmacológico , Fiebre/etiología , Humanos , Lactante , Recién Nacido , Meningitis/líquido cefalorraquídeo , Persona de Mediana Edad , Penicilinas/administración & dosificación , Penicilinas/uso terapéutico , Sulfametoxazol/administración & dosificación , Sulfametoxazol/uso terapéutico , Tetraciclina/administración & dosificación , Tetraciclina/uso terapéutico , Trimetoprim/administración & dosificación , Trimetoprim/uso terapéutico , Combinación Trimetoprim y SulfametoxazolAsunto(s)
Diarrea/prevención & control , Viaje , Cólera/prevención & control , Diarrea/tratamiento farmacológico , Hepatitis/prevención & control , Humanos , Inmunización , Malaria/tratamiento farmacológico , Malaria/prevención & control , Sarampión/prevención & control , Rabia/prevención & control , Fiebre Tifoidea/prevención & control , Fiebre Amarilla/prevención & controlAsunto(s)
Infecciones Bacterianas/tratamiento farmacológico , Ácidos Clavulánicos/administración & dosificación , Penicilinas/administración & dosificación , Enfermedades Cutáneas Infecciosas/tratamiento farmacológico , Ticarcilina/administración & dosificación , Adolescente , Adulto , Anciano , Bacterias/aislamiento & purificación , Celulitis (Flemón)/tratamiento farmacológico , Ácido Clavulánico , Ácidos Clavulánicos/efectos adversos , Ensayos Clínicos como Asunto , Combinación de Medicamentos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ticarcilina/efectos adversosRESUMEN
The role of cell-mediated immunity in hamsters during treponemal infection appears to involve the activated macrophage. To date, studies have been hindered by the inability to confirm that macrophages exhibit enhanced treponemicidal activity at the infection site. We show that lipopolysaccharide and thioglycollate-treated animals, when inoculated with Treponema pallidum subsp. pertenue, exhibit enhanced clearance of these organisms compared with controls. Macrophages from these infected groups display an enhanced respiratory burst, as detected by NBT reduction, as well as a marked increase in C3b receptor-mediated ingestion activity. Significant changes in these parameters indicate that alterations in macrophage activation are occurring in the infected compartment. Thus the stimulatory agents apparently modify the host's immune responses to promote subsequent reduction of treponemal infection. In addition, hamster peritoneal macrophages demonstrate enhanced activation behavior as a result of exposure to at least two signals, which may be prerequisite for processing this organism efficiently.